NUCLEAR CARDIOLOGY: CLINICAL APPLICATIONS

The Bookshelf, continued In general, the drug evaluations of the title are limited to statements of effectiveness or non-effectiveness, with little or no attempt to estimate relative efficacy, except for several lists ~ comparative potencies among closely related members of certain chemical classes. The many authors assume, with some a priori justification, that all of their readers will be famiJi~ with ge~eral principles of pharmacology and of pharmacoldnetics. The discussions of individual drugs concentrate on the most predictable desirable and undesirable clinical responses to each agent. That the editors have been able to maintain as much uniformity of content and organization as they have is to their credit and to the user's benefit. Useful features of this new edition include lists of drugs added since the last (1977 ) publication, of drugs still undergoing clinical testing, and of many over-the-counter products most commonly used by patients. Presumably because the index ~s the most used portion of this book, it bas been very convemently bound into the center of the volume. This alone permits the book its rightful role as the best replacement for the PDR. The new edition also boasts new chapters on immunomodulators (the first time I've seen this word), antiviral agents, agents used to treat infertility, and on parenteral and enteral nutrition. The latter contains many tables that will be especially useful. However, as might have been expected, even the best updatings of reference works contain errors of both omission and commission, and each user will find his own favorites. The sections on age and disease as determinants of responses to drugs are a bit too sketchy in the light of newly accumulating important information that would have helped the average clinician prescribe more eftectively. Although readers of Chest will, undoubtedly, not have to consult this volume before administering heparin, they should be aware that there is no good evidence that heparin is metabolized in the liver, nor that 50 percent of the drug is excreted unchanged in the urine. The same section perpetuates the more serious error of assuming that the potent anticoagulant can be administered without taking the patient's body weight into account; I did not find similar errors in other sections pertaining to more familiar drugs. In spite of these highly personal warnings, I can still recommend this book for physicians at all levels of professional development. It will probably be most convenient for potential buyers to employ the order forms in current issues of JAMA.

1. Worth Estes, M.D. BoBfon,MA

CLINICAL STRATEGIES IN ISCHEMIC HEART DISEASE:

NEW CONCEPTS AND CURRENT CONTROVERSIES. By ELIOT CORDAY and H.I.C. SWAN. Baltimore: Williams and WiIldns, 1979, 611 pp, $54.

Strategy (Gk atrategia:

of/ice of a geneml, generalship, piece of

Btrategy • • .) .20: A ooreful plan or method of a cleoer mategem ... b. the art of t:leddng or employing plans or strategems

toward a goal. Weimer's 3,.d New International Dictionary, un-

abridged. Those interpreting the title as promising clinical (Ie bedside) guidance in the sense of a patient-oriented oade mecum will not find it in a number of chapters devoted to bench research and to experimental models, although these may well portend the day of purely instrumental bedside medicine (already partly upon us). Their inclusion stems from this book's apparent origin in what appears to be a symposium (page VIII) that produced its 66 papers by 77 distinguished authors. Unlike many symposia, the contributors have uniformly given their best efforts. Thus, I found no bad chapters, although some could be considered to be rather short. All of the investigative material is well documented by original work and literature references and well expressed by investigators who clearly know their business. Yet problems arise in using the material for one»s own clinical strategy. Treatment, at least, would require a patchwork of material from many chapters to produce an integrated strategy for dealing with patients. Taken individually, the many contributions to this volume may be rated from "good" to "excellent" (mostly excellent). Howard Burchell's chapters on cardiac ischemia in the absence of

coronary disease and typical VI atypical syndromes are pithy expressions of the author's vast experience and acumen. Forrester and Diamond's discussion of hemodynamic subsets in acute infarction superbly summarizes the vital data. One might quibble about including some imprecise neologisms, eg "outflow" for central arterial wave form and "inflow" for atrial wave form. In "Benefits and Limitations of Impedance Reduction for Congestive Heart Failure," Chatterjee and colleagues present a useful condensation of this subject. "Clinical Reappraisal of Treatment of Congestive Heart Failure and Cardiogenic Shock in Acute Myocardial Infarction'" by Mason and his Davis wunderkinder is a minimonograph which fulfllls the strategic promise of the book's title. Excellent as the presentations are from a research and clinical standpoint, some contributors get into conceptual thickets, not to say biases, when dealing with evaluation of treatment results. Thus, Sheldon's "Comparison of Medical and Surgical Management: mect of Longevity" is a curious document. There are good general observations on the benefits of high and low risk interventions in high and low risk subsets of patients with disease and beguiling use of actuarial curves. We are told "in examining the effects of a therapeutic intervention. . ." the control population should be "representative of that commonly seen clinical practice"; "all subjects should receive similar treatment" and "the intervention to be tested . . . applied to a group whose clinical characteristics and basic treatment are similar to the control group." The repeated use of "similar" is unexceptionable, but represents a predictable dodge-bobbing and weaving to avoid recommending randomized controlled trials. Later, there is a long jump to the statement "for reasons mentioned above.we have not considered it feasible . . . to ( perform) randonnzation . . ." though no cogent reasons had been advanced. The author winds up with disclaimers: " ... this is an imperfect analysis, "cognizant of the pitfalls . . .," "the pitfalls of non-randomized comparisons have been emphasized." Not really. In "Controversies--COronary Bypass Surgery vs Medical Management:" Swan and Corday present a thoughtful, well executed essay which, however, is marred by a contrived put-down of the advocates of controlled trials. Yet, the distinguished authors in their editorial role provided the antidote to Sheldon's and their own views in chapter 61 by Edwin Alderman, who concludes, "randomization offers the only certain method by which multiple clinical and laboratory features of coronary diseases can be distributed in equal proportions ..." and "randomization (guarantees) that the patient has a 50-50 chance of having the best possible therapy in the long run • . ." and " • . . to obtain deflnitive iDformation regarding results of coronary surgery, randomized studies mut be carried out" (emphasis mine-D.H.S.). This text: is clearly printed, though with relatively small type size. One suspects this was to compress a vast amount of material into the necessarily large (600-0dd page) result. My copy probably was unique owing to absence of pages and printing errors-double strikes, reversals and transpositions. As a frequenter of publishers' displays at national meetings, I have witnessed colleagues buying books by title or author, sometimes in advance of publication. Such buyers would not be disappointed with this book if they were looking for up-~te, sophisticated information as background material for managang ischemic heart disease. David H. Spodk1c, MD., F.C.CoP.

Worcerier,MA

BOOKS RECEIVED NUCLEAR CARDIOLOGY: CLINICAL APPLICATIONS. By ELIAS H. BoTVINICK AND DAVID M. SHAMBS. Baltimore, WllIiams and WiIldns, 1979, 255 pp, $23. MANAGEMENT OF VENTRICULAR TACHYCARDIA: ROLE OF MEXILTINE. By E. SANDOZ, D. G. JULIAN and J. W. BELL. (Proceedings of a Symposium). Amsterdam and Oxford, Excerpta Medica; New York, Elsevier North-Holland, 1979, 672 pp, price not stated. RESPIRATORY PHARMACOLOGY AND THERAPEUTICS. By

IRwIN21MBNT. Pbiladelphia, Saunders, 1978, 519 pp, $29.50 (US). $33.90 (Canada).