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886 AMERICAN JOURNAL OF OPHTHALMOLOGY APRIL, 1967
anatomy and physiology of the extraocular muscles as they relate to the diagnosis and treatment of paralytic strabismus.
In the first part of the volume Hamburger discusses the anatomy and physiology of binocular vision and ocular motility and presents, in addition to the classical body of knowledge, the new description of the mechanics of the extraocular muscles as given by Boeder, the anatomic relationships as described by Fink, the histologie structure as investigated by Siebeck and Krüger, and the principles of feed-back control of the ocular movements. The chapter is well and concisely written. One feature which was annoying to this reviewer, which might well be corrected in a future edition, was that the papers of a large number of authors, quoted by name in the text, are not listed in the references. This makes it very difficult for the interested reader to refer to the sources.
The section on the methods of examination, also by Hamburger, is quite brief and by no means complete. However, in a subsequent chapter by Hamburger dealing with the signs and symptoms of paralytic strabismus some of the methods of examination are further discussed, as is the diagnosis of the paralysis of individual muscles and groups of muscles.
Also dealing with the methods of examination is a chapter by Mackensen on the tangent screen devised by Harms. The same author has contributed a brief note on elec-tro-oculography. An excellent survey of electromyography is given in a chapter by Huber.
Klara Weingarten reviews the neuro-oph-thalmologic aspects of the extraocular muscle palsies, in particular their etiology, and includes a survey of the supranuclear paralyses. The surgical treatment is presented by Hollwich and Krebs. The authors emphasize that the goal should be to create parallelism of the visual axes in primary position and to enlarge so -far as possible the field of single binocular vision.
In two separate concluding chapters Adel-
stein and Cuppers discuss ocular torticollis, and the differentiation of true sixth nerve paralyses from an apparent sixth nerve paralysis due to a convergent position of the eyes assumed to block a nystagmus.
The volume does not offer much that is new to the specialist. It is difficult to judge to what extent it might be useful to one who is less well acquainted with the subject. It is, however, of interest to note that the new acquisitions in anatomy and physiology discussed in the first chapter of the book appear, as yet, to have had little effect on the clinical thinking and the handling of patients with paralytic strabismus discussed in subsequent chapters.
Hermann M. Burian
DIE RÖNTGENDIAGNOSTIK DER T R Ä N E N A B L E -
ITENDEN WEGE. By M. Radnót and J. Gall. Budapest, Akademiai Keado, 1966. Cloth-bound, 191 numbered pages, 137 figures, 113 sketches. Price: $11.00.
This very interesting and well-made book, besides presenting useful information, serves to underline one of the dilemmas of medical practice in our time. Modern medicine is indissolubly bound to an increasing number of diagnostic procedures. Blood counts, urinalysis, blood chemistry determinations, microbiologie cultures, electrocardiograms and many other procedures, though occasionally used thoughtlessly, are when properly employed part of the solid foundation on which our uniquely effective practice is based. In purely ophthalmic practice relatively common procedures such as tonography are being augmented by elec-troretinography, electro-oculography, visual-evoked-response determinations, monochromatic ophthalmoscopy, ultrasonography and pupillography. In all of these determinations a common factor is that the aid of a technician is ordinarily employed. The physician, even if he were to possess the skills to perform these procedures, cannot have the time to give effective patient care unless the exe-
VOL. 63, NO. 4 BOOK REVIEWS 887
cution is delegated to others and only interpretation is done by him. This results in inevitable removal of the physician from the scene of the procedure with possible unhappy consequences. Even more separation of execution from purpose arises when the procedure such as clinical chemistry, electro-cardiography or radiography is done by a technician under the supervision of a physician in another department.
It is perfectly evident from the careful description of technique and the 135 well-reproduced plates that the entire basis for the success of lacrimai contrast radiography is the presence of the interested ophthalmologist at the actual examination, the injection of the contrast medium by him, relying on his experience to avoid soft tissue infiltration. Finally, the ophthalmologist sees the results quickly and knows immediately whether the procedure is informative or requires repetition. It is also evident that injection of contrast medium by a radiologist followed at some interval by films made by a technician, followed at a much longer interval by a report to the ophthalmologist is unlikely to yield useful information on the lacrimai system.
This, then, is the dimension of the dilemma. To get a useful result, the interested ophthalmologist must perform the examination—not delegate it to a radiologist, a technician or both. The material presented by the authors make credible their claim that in every case in which surgical manipulation of the lacrimai pathways is contemplated radiographie examination with, or rarely without, contrast medium should be done.
For those interested in details the authors' recommended technique is worth noting. Because fat-soluble compounds tend to ball up and give false contours, and because of their tendency to remain in tissues for extended periods, they are not considered satisfactory as contrast media. The authors use a solution of water-soluble iodinated organic compound Joduron-B ( es Diodrast) whose viscosity has been increased by the
addition of methyl cellulose. All pus must be washed from the lacrimai sac to allow adequate filling. While filling through the lower canaliculus, the upper punctum is partially occluded with a glass rod to allow filling of the upper canaliculus without overflow of contrast medium to the lacus lacrimalis. The chin-nose position is favored for making the picture but other positions are used when appropriate. The Sweet localization technique can also be used to advantage in placing the shadow in relation to the globe. In all cases particular precautions are taken to prevent swallowing and blinking by the patient before the pictures are made.
It would appear that only by paying meticulous attention to details such as these can meaningful results be obtained. The individual physician must solve for himself the problem of how much time he can spend acquiring and practicing a new technique which gives useful results to only the most motivated practitioner.
Albert M. Potts
MODERN PROBLEMS IN OPHTHALMOLOGY (Volume 4) . Edited by E. B. Straff, Lausanne. New York, S. Karger AG, 1966. Clothbound, 308 pages, 104 figures, 26 tables. Price: $20.70.
Volume four of this estimable series concerns the surgery of retinal vascular diseases and the prophylactic treatment of retinal detachment. The papers are those reported before the third meeting of the Jules Gonin Club, held in Amersfoort, Holland, in 1963.
The Jules Gonin Club is composed of members from both hemispheres who are particularly concerned with retinal disease and its treatment. The first meeting was appropriately held in Lausanne in 1959, the second also in Lausanne in 1961, the fourth in Villars-sur Ollon, Switzerland, in 1965, and the fifth in Munich in 1966.
This report opens with a memorial tribute
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