- Email: [email protected]
Place des Dosages Enzymatiques en Cardiologie et en Anes-thesie Reanimation
614
anaesthesiologists by the time per week they spend in teaching medical students and then dividing by the number of medical students. The result, 3 minutes per week, should not be equated with the amount of instruction medical students receive in anaesthesiology unless (a) all that instruction is performed by academic anaesthesiologists and (b) all teaching is invariably done on a one teacher/one student basis. Throughout these later pages it is inevitable that the reader will compare situations on either side of the Atlantic. Clearly, there is much to like in the lot of our distant colleagues, but it is at least apparent that they do not have a monopoly of the greener grass. E. A. Cooper
Place des Dosages Enzymatiques en Cardiologie et en Anes-
thesie Reanimation. Edited by G. Levy. Published (in French) by Boehringer Mannheim France SA, Paris, 1975. Pp. 138; illustrated; not indexed. No price available. Anesthesiology and the University. By Nicholas M. Greene. Published by J. B. Lippincott Co. Pp. 164; not This book attempts to show the benefits to a clinician from indexed; not illustrated. Price £7 00. the modern techniques of estimating different enzymes. This is an interesting, if not wholly inspiring, survey of the The author limits himself to Cardiology, Anaesthetics and relationships between the University and practice, teaching Intensive Care; and only four enzymes, glutamic oxaloacetic and research in anaesthesiology. This last word • must transaminase (GOT), glutamic pyruvic transaminase be used, for, although there are clearly interfaces and (GPT), creatine kinase (CK.) and lactate deshydrogenase problems common to Great Britain and the United States, (LDH) are examined, in spite of the fact that there are the book is about America. It is pleasant to see and to about 1200 enzymes actually identified. handle. There are very few typographical errors. The The first part of the book deals mainly with laboratory technique of writing is clear and the text flows well. The techniques, the causes of error and the range of normal author is to be thanked for defining what he means by values. In the second part, there is an analysis of the results various terms which the average British reader might find obtained in some diseases. At this stage the author makes a surprising. Thus the "professional" differs from the distinction between "Cardiology" and "Anaesthetics"specialist" in his "desire to expand and develop new Intensive Care". The chapter on "Myocardial Infarction" knowledge for the sake of knowledge itself". The "University is undoubtedly the most successful: the relations between anesthesiologist" is a clinician practising in a University the clinical state of the patient, the e.c.g. and enzyme setting, but he is not an "academic anesthesiologist". concentrations are stated clearly and supported by many The book begins with a historical survey showing why up-to-date references. The diagrams, sketches and tables anaesthesiology has only recently aspired to academic are very clear. The determination of enzyme concentrations respectability. Presumably it is aimed at the academic non- in pulmonary embolism, aortic aneurysm, cardiac insufanaesthetist and is meant to be a broadbrush picture. ficiency or other heart diseases appears to be less useful. Nevertheless, it seems a pity to introduce errors of detail This probably reflects the lack of specificity of the enzymes. such as the statement that "intravenous anesthesia did not The chapter on the use of the measurement of these four enzymes in Anaesthetics and Intensive Care represents the start until 1935 when Thiopental was first used". The major message of the book is the relationship between most original part of the book; unfortunately, it is only anaesthesiology and the basic sciences and the potential thirteen pages in length. It attempts to summarize the place of the anaesthesiologist in teaching both within and relationship between enzyme concentrations and surgery, without the Medical School. The author particularly strives muscle trauma, malignant hyperthermia, coma, shock and to emphasize the falsity of the supposition that anaes- drugs. The overall conclusion is that anaesthetic agents thesiology is a branch of surgery, although some will think acting alone, do not seem to provoke enzyme release. Factors that he overstates his case in the sentence, "the only thing which are likely to increase the concentrations of these academic anesthesiology had in common with academic enzymes are haemolysis, muscle trauma, hypoxia and hyperthermia. With regard to drugs, when used in the surgery was the source of clinical material". Later parts of the book which discuss the present scene in therapeutic dose range, it seems that the route of administhe States are of less interest on this side of the Atlantic. tration is more important than the actual pharmacological Some interesting ideas are proposed and attempts are made property! to support them with figures. Admittedly these are very Section 3 describes "Enzymatic Profiles" which can be difficult to find or are frequently unobtainable. Even so the used in both the diagnosis and the prognosis of some acute impression gained is that a number of qualitative rather than pathological conditions, especially myocardial infarction. quantitative opinions have been formed, followed by efforts This book is intended mainly for undergraduate students to find supporting statistics. The reviewer doubts if there is or for anaesthetists who need elementary up-to-date much meaning in multiplying the number of academic information on the four enzymes. There are 526 references.
Downloaded from http://bja.oxfordjournals.org/ at Cambridge University on August 31, 2015
value in an intensive care unit. There is over-emphasis on the adult respiratory distress syndrome and too little attention is paid to such topics as antibiotic therapy and cross infection, sterilization of apparatus, the treatment of cardiac arrest, acid-base balance and alkali therapy, and the care of a patient with pneumothorax. The description of paediatric respiratory care, occupying the last five pages of the book, is too brief to be of guidance to a reader seeking help and information about a critically ill child. The over-enthusiastic use of italics throughout the text to emphasize words and sentences irritatingly mars an otherwise well-produced book. The book is an indication of the approach adopted to care of the lungs by medical and paramedical practitioners in one centre in North America. It is a useful source of reference, but its price will rule out its purchase for many individuals. J. B. Owen-Thomas
BRITISH JOURNAL OF ANAESTHESIA
Is this the point where your pipeline plan ends and your pipeline equipment plan starts?
If your piped gas/liquid distrubution system runs according to plan, it makes sense to carry the same plan through to the equipment that uses it At Medishield we don't believe in abandoning the plan at the wall outlet Our policy of total system compatibility takes gas supply through to its logical conclusion from pipework to patient - with a range of purpose designed equipment Each one an integral part of the overall plan. Oxygen flowmeter for highprecision oxygen therapy throughout the hospital. Pipeline suction equipment Controlled high and low suction for routine and emergency cases in ward and theatre.
Injector suction Versatile, portable, quiet venturi suction from oxygen or air outlets. Piped Entonox Safe analgesia instantly available anywhere by plugging in the Entonox demand regulator. More convenient than small cylinder supply and more economical in cylinder rental. The KingBoyle Complete, selfcontained, portable anaesthesia unit that can be wall-mounted and plugged into piped gas supply, releasing valuable floor space.
Medishield Medishield (Harlow) Limited Elizabeth Way, Harlow, Essex CM19 5AB Telephone: Hariow (0279) 29692
Telex: 81497 BJA
Cables: Britoxygen Hartow xxv
Downloaded from http://bja.oxfordjournals.org/ at Cambridge University on August 31, 2015
A good plan is worth following through
5200 PULMOFLATOR •
Digital display of frequency and I/E ratio
•
Integral alarm system
•
Detachable adult and paediatric patient systems
• Flowmeters for O2 and air • Electronic trigger • Peep and negative phase •
Humidicon humidifier fitted
5210 PAEDIATRIC PULMOFLATOR •
Digital display of frequency and I/E ratio
•
Integral alarm system
•
Variable phases
•
Minute volume divider operation
•
Pneumatic control system specially adapted for small volumes
•
Integral respirable air pump
•
Flowmeters for 0 2 and air
•
Electronic trigger
•
Detachable patient system
•
Peep and negative phase
BLEASE MEDICAL EQUIPMENT LIMITED DEANSWAY CHESHAM BUCKS Telephone: Chesham 4422
Telex: 83119 Medical, Chesham
Downloaded from http://bja.oxfordjournals.org/ at Cambridge University on August 31, 2015
• Variable phases
BOOK REVIEWS It is a pity that the section devoted to Anaesthetics and Intensive Care is not more exhaustive—almost no mention is made of the role of the liver in enzyme induction and metabolism. While it is recognized that "enzymology" covers a very wide spectrum of potentially very useful indices of cellular damage, the context of this book is too restricted to give a fair picture of the many applications of enzyme measurement in anaesthesia. The book is well presented, well written (with very little franglais) and can be good value for those who wish to improve their scientific French. Michel Dubois
This is not a book for the average hospital library or the anaesthetist's bookshelf. It does provide a useful guide to the directions in which cerebral metabolism and blood flow research are moving and those areas where real progress has been made. As such, it will be a useful reference for the academic neurophysiological department and the larger medical library. R. Cooper and R. Greenbaum
Childbirth, a Joy—not a Suffering. By Ezzat Abouleish. Published by Dorrance and Company, Philadelphia. Pp. 110; illustrated. Price ?2.95. This book is based upon a series of lectures which the Blood Flow and Metabolism in the Brain. Proceedings of the author—an anaesthetist at the Magee-Womens Hospital, 7th International Symposium on Cerebral Blood Flow Pittsburgh—gives to the preparation-for-childbirth classes and Metabolism. Edited by Harper, Jennett, Miller in his hospital. Undoubtedly the inadequacy of doctor- or and Rowan. Churchill Livingstone. nurse-to-patient communication is the one area in which the This book comprises 150 papers from the symposium, current complaints about obstetric care in the United which have been grouped to form 15 chapters. Each chapter Kingdom may be said to be legitimate. Many of our is accompanied by a summary from its Chairman. Some obstetric anaesthetists do now contribute to courses of summaries are purely presentations of the discussions that ante-natal lectures, but in too many hospitals their duty is, took place, others review the original papers and present a by default, delegated to midwives. Dr Abouleish presents resume of the state of knowledge in the particular area of his lectures in the form of a series of questions and answers. The questions are, on the whole, well chosen, and would study. As may be expected, the papers are too short and frag- provide an excellent framework upon which a newly mented to serve as readable reference sources, and, in many instituted series of talks on pain relief in labour could be built. The answers are, naturally enough, tempered towards cases, the studies have been published elsewhere. The first chapter is concerned with the neurogenic effects American obstetric practice, which still differs in several on cerebral blood flow and the increasing evidence that major particulars from that of the United Kingdom. these effects are important. The innervation of the cerebral However, even with that proviso, I detected in the answers blood vessels is proven, although the sources, extent and an uneasy imbalance between excessive simplicity and over-particularization. For example, a detailed account of function of these nerves have not been determined. the insertion of a lumbar extradural cannula is given in one A chapter headed "Pharmacology and Anaesthesia" deals lecture, yet in a subsequent lecture the author considers it with the cerebral vasodilator effects of carbonic anhydrase necessary to define the word "disposable". inhibitors and demonstrates that autoregulation may be Personally, I would not care to deliver these talks preserved although the carbon dioxide sensitivity factors verbatim to pregnant women, and I would be greatly averse appear to play a part in autoregulation. Many studies reflect the difficulties inherent in designing to encouraging them to read the book. In a number of investigations which have a common starting point, places the innuendos, and on occasion the positive statecommon parameters of stimulation, drug dosage, sites and ments, regarding possible complications is startling. Casual receptors etc. This resulted in dissimilar findings in several references to the dangers of pre-eclampsia, to "patulous cervical os", to the convulsions which might follow the apparently similar studies. The symposium marks the final proof that cerebral blood accidental i.v. injection of a local anaesthetic agent, or to the flow measurements, by the i.a., inhalation and i.v. xenon advisability of routinely performing a repeat Caesarean techniques, yield comparable results, and that non-invasive section, are hardly calculated to instil confidence in the methods are of acceptable accuracy and reliability. The woman who merely reads these lectures. Furthermore, a evolution of multi-channel regional cerebral blood flow fair proportion of our population have little talent for recording has again demonstrated that large regional literacy, and I suspect that a similar percentage is applicable differences in grey matter flow exist and need not be in the U.S.A. I suggest that this book would prove a useful guide for reflected in mean blood flow measurements. Dangerously low local blood flow situations are highlighted by these tutors (provided that they disregard the ill-informed comments about inhalation analgesia), but should be kept sophisticated methods. Raichle and co-workers described the development of out of the hands of most prospective patients. 16 J. Seltoyn Crawford O- and "C-labelled molecules to measure brain permeability characteristics of alcohols and water in studies on the aetiology of cerebral oedema. They also describe A Nurse's Guide to Anaesthetics, Resuscitation and Intensive Care, 5th edition. By W. Norris and D. Campbell. techniques for three-dimensional and non-invasive measurePublished by Churchill-Livingstone, London, 1972. ment of cerebral haemodynamics and metabolism using positron-emitting radio nuclides. The guest speaker, L. The publication of the fifth edition of this book some 8 Sokoloff, presented his experiences in developing the 14C years after its first appearance is a cogent commentary on the deoxyglucose method for the quantitative determination of well-deserved place the book has gained in the essential local cerebral glucose utilization. literature available to nurses.
Downloaded from http://bja.oxfordjournals.org/ at Cambridge University on August 31, 2015
I
615
anaesthesiologists by the time per week they spend in teaching medical students and then dividing by the number of medical students. The result, 3 minutes per week, should not be equated with the amount of instruction medical students receive in anaesthesiology unless (a) all that instruction is performed by academic anaesthesiologists and (b) all teaching is invariably done on a one teacher/one student basis. Throughout these later pages it is inevitable that the reader will compare situations on either side of the Atlantic. Clearly, there is much to like in the lot of our distant colleagues, but it is at least apparent that they do not have a monopoly of the greener grass. E. A. Cooper
Place des Dosages Enzymatiques en Cardiologie et en Anes-
thesie Reanimation. Edited by G. Levy. Published (in French) by Boehringer Mannheim France SA, Paris, 1975. Pp. 138; illustrated; not indexed. No price available. Anesthesiology and the University. By Nicholas M. Greene. Published by J. B. Lippincott Co. Pp. 164; not This book attempts to show the benefits to a clinician from indexed; not illustrated. Price £7 00. the modern techniques of estimating different enzymes. This is an interesting, if not wholly inspiring, survey of the The author limits himself to Cardiology, Anaesthetics and relationships between the University and practice, teaching Intensive Care; and only four enzymes, glutamic oxaloacetic and research in anaesthesiology. This last word • must transaminase (GOT), glutamic pyruvic transaminase be used, for, although there are clearly interfaces and (GPT), creatine kinase (CK.) and lactate deshydrogenase problems common to Great Britain and the United States, (LDH) are examined, in spite of the fact that there are the book is about America. It is pleasant to see and to about 1200 enzymes actually identified. handle. There are very few typographical errors. The The first part of the book deals mainly with laboratory technique of writing is clear and the text flows well. The techniques, the causes of error and the range of normal author is to be thanked for defining what he means by values. In the second part, there is an analysis of the results various terms which the average British reader might find obtained in some diseases. At this stage the author makes a surprising. Thus the "professional" differs from the distinction between "Cardiology" and "Anaesthetics"specialist" in his "desire to expand and develop new Intensive Care". The chapter on "Myocardial Infarction" knowledge for the sake of knowledge itself". The "University is undoubtedly the most successful: the relations between anesthesiologist" is a clinician practising in a University the clinical state of the patient, the e.c.g. and enzyme setting, but he is not an "academic anesthesiologist". concentrations are stated clearly and supported by many The book begins with a historical survey showing why up-to-date references. The diagrams, sketches and tables anaesthesiology has only recently aspired to academic are very clear. The determination of enzyme concentrations respectability. Presumably it is aimed at the academic non- in pulmonary embolism, aortic aneurysm, cardiac insufanaesthetist and is meant to be a broadbrush picture. ficiency or other heart diseases appears to be less useful. Nevertheless, it seems a pity to introduce errors of detail This probably reflects the lack of specificity of the enzymes. such as the statement that "intravenous anesthesia did not The chapter on the use of the measurement of these four enzymes in Anaesthetics and Intensive Care represents the start until 1935 when Thiopental was first used". The major message of the book is the relationship between most original part of the book; unfortunately, it is only anaesthesiology and the basic sciences and the potential thirteen pages in length. It attempts to summarize the place of the anaesthesiologist in teaching both within and relationship between enzyme concentrations and surgery, without the Medical School. The author particularly strives muscle trauma, malignant hyperthermia, coma, shock and to emphasize the falsity of the supposition that anaes- drugs. The overall conclusion is that anaesthetic agents thesiology is a branch of surgery, although some will think acting alone, do not seem to provoke enzyme release. Factors that he overstates his case in the sentence, "the only thing which are likely to increase the concentrations of these academic anesthesiology had in common with academic enzymes are haemolysis, muscle trauma, hypoxia and hyperthermia. With regard to drugs, when used in the surgery was the source of clinical material". Later parts of the book which discuss the present scene in therapeutic dose range, it seems that the route of administhe States are of less interest on this side of the Atlantic. tration is more important than the actual pharmacological Some interesting ideas are proposed and attempts are made property! to support them with figures. Admittedly these are very Section 3 describes "Enzymatic Profiles" which can be difficult to find or are frequently unobtainable. Even so the used in both the diagnosis and the prognosis of some acute impression gained is that a number of qualitative rather than pathological conditions, especially myocardial infarction. quantitative opinions have been formed, followed by efforts This book is intended mainly for undergraduate students to find supporting statistics. The reviewer doubts if there is or for anaesthetists who need elementary up-to-date much meaning in multiplying the number of academic information on the four enzymes. There are 526 references.
Downloaded from http://bja.oxfordjournals.org/ at Cambridge University on August 31, 2015
value in an intensive care unit. There is over-emphasis on the adult respiratory distress syndrome and too little attention is paid to such topics as antibiotic therapy and cross infection, sterilization of apparatus, the treatment of cardiac arrest, acid-base balance and alkali therapy, and the care of a patient with pneumothorax. The description of paediatric respiratory care, occupying the last five pages of the book, is too brief to be of guidance to a reader seeking help and information about a critically ill child. The over-enthusiastic use of italics throughout the text to emphasize words and sentences irritatingly mars an otherwise well-produced book. The book is an indication of the approach adopted to care of the lungs by medical and paramedical practitioners in one centre in North America. It is a useful source of reference, but its price will rule out its purchase for many individuals. J. B. Owen-Thomas
BRITISH JOURNAL OF ANAESTHESIA
Is this the point where your pipeline plan ends and your pipeline equipment plan starts?
If your piped gas/liquid distrubution system runs according to plan, it makes sense to carry the same plan through to the equipment that uses it At Medishield we don't believe in abandoning the plan at the wall outlet Our policy of total system compatibility takes gas supply through to its logical conclusion from pipework to patient - with a range of purpose designed equipment Each one an integral part of the overall plan. Oxygen flowmeter for highprecision oxygen therapy throughout the hospital. Pipeline suction equipment Controlled high and low suction for routine and emergency cases in ward and theatre.
Injector suction Versatile, portable, quiet venturi suction from oxygen or air outlets. Piped Entonox Safe analgesia instantly available anywhere by plugging in the Entonox demand regulator. More convenient than small cylinder supply and more economical in cylinder rental. The KingBoyle Complete, selfcontained, portable anaesthesia unit that can be wall-mounted and plugged into piped gas supply, releasing valuable floor space.
Medishield Medishield (Harlow) Limited Elizabeth Way, Harlow, Essex CM19 5AB Telephone: Hariow (0279) 29692
Telex: 81497 BJA
Cables: Britoxygen Hartow xxv
Downloaded from http://bja.oxfordjournals.org/ at Cambridge University on August 31, 2015
A good plan is worth following through
5200 PULMOFLATOR •
Digital display of frequency and I/E ratio
•
Integral alarm system
•
Detachable adult and paediatric patient systems
• Flowmeters for O2 and air • Electronic trigger • Peep and negative phase •
Humidicon humidifier fitted
5210 PAEDIATRIC PULMOFLATOR •
Digital display of frequency and I/E ratio
•
Integral alarm system
•
Variable phases
•
Minute volume divider operation
•
Pneumatic control system specially adapted for small volumes
•
Integral respirable air pump
•
Flowmeters for 0 2 and air
•
Electronic trigger
•
Detachable patient system
•
Peep and negative phase
BLEASE MEDICAL EQUIPMENT LIMITED DEANSWAY CHESHAM BUCKS Telephone: Chesham 4422
Telex: 83119 Medical, Chesham
Downloaded from http://bja.oxfordjournals.org/ at Cambridge University on August 31, 2015
• Variable phases
BOOK REVIEWS It is a pity that the section devoted to Anaesthetics and Intensive Care is not more exhaustive—almost no mention is made of the role of the liver in enzyme induction and metabolism. While it is recognized that "enzymology" covers a very wide spectrum of potentially very useful indices of cellular damage, the context of this book is too restricted to give a fair picture of the many applications of enzyme measurement in anaesthesia. The book is well presented, well written (with very little franglais) and can be good value for those who wish to improve their scientific French. Michel Dubois
This is not a book for the average hospital library or the anaesthetist's bookshelf. It does provide a useful guide to the directions in which cerebral metabolism and blood flow research are moving and those areas where real progress has been made. As such, it will be a useful reference for the academic neurophysiological department and the larger medical library. R. Cooper and R. Greenbaum
Childbirth, a Joy—not a Suffering. By Ezzat Abouleish. Published by Dorrance and Company, Philadelphia. Pp. 110; illustrated. Price ?2.95. This book is based upon a series of lectures which the Blood Flow and Metabolism in the Brain. Proceedings of the author—an anaesthetist at the Magee-Womens Hospital, 7th International Symposium on Cerebral Blood Flow Pittsburgh—gives to the preparation-for-childbirth classes and Metabolism. Edited by Harper, Jennett, Miller in his hospital. Undoubtedly the inadequacy of doctor- or and Rowan. Churchill Livingstone. nurse-to-patient communication is the one area in which the This book comprises 150 papers from the symposium, current complaints about obstetric care in the United which have been grouped to form 15 chapters. Each chapter Kingdom may be said to be legitimate. Many of our is accompanied by a summary from its Chairman. Some obstetric anaesthetists do now contribute to courses of summaries are purely presentations of the discussions that ante-natal lectures, but in too many hospitals their duty is, took place, others review the original papers and present a by default, delegated to midwives. Dr Abouleish presents resume of the state of knowledge in the particular area of his lectures in the form of a series of questions and answers. The questions are, on the whole, well chosen, and would study. As may be expected, the papers are too short and frag- provide an excellent framework upon which a newly mented to serve as readable reference sources, and, in many instituted series of talks on pain relief in labour could be built. The answers are, naturally enough, tempered towards cases, the studies have been published elsewhere. The first chapter is concerned with the neurogenic effects American obstetric practice, which still differs in several on cerebral blood flow and the increasing evidence that major particulars from that of the United Kingdom. these effects are important. The innervation of the cerebral However, even with that proviso, I detected in the answers blood vessels is proven, although the sources, extent and an uneasy imbalance between excessive simplicity and over-particularization. For example, a detailed account of function of these nerves have not been determined. the insertion of a lumbar extradural cannula is given in one A chapter headed "Pharmacology and Anaesthesia" deals lecture, yet in a subsequent lecture the author considers it with the cerebral vasodilator effects of carbonic anhydrase necessary to define the word "disposable". inhibitors and demonstrates that autoregulation may be Personally, I would not care to deliver these talks preserved although the carbon dioxide sensitivity factors verbatim to pregnant women, and I would be greatly averse appear to play a part in autoregulation. Many studies reflect the difficulties inherent in designing to encouraging them to read the book. In a number of investigations which have a common starting point, places the innuendos, and on occasion the positive statecommon parameters of stimulation, drug dosage, sites and ments, regarding possible complications is startling. Casual receptors etc. This resulted in dissimilar findings in several references to the dangers of pre-eclampsia, to "patulous cervical os", to the convulsions which might follow the apparently similar studies. The symposium marks the final proof that cerebral blood accidental i.v. injection of a local anaesthetic agent, or to the flow measurements, by the i.a., inhalation and i.v. xenon advisability of routinely performing a repeat Caesarean techniques, yield comparable results, and that non-invasive section, are hardly calculated to instil confidence in the methods are of acceptable accuracy and reliability. The woman who merely reads these lectures. Furthermore, a evolution of multi-channel regional cerebral blood flow fair proportion of our population have little talent for recording has again demonstrated that large regional literacy, and I suspect that a similar percentage is applicable differences in grey matter flow exist and need not be in the U.S.A. I suggest that this book would prove a useful guide for reflected in mean blood flow measurements. Dangerously low local blood flow situations are highlighted by these tutors (provided that they disregard the ill-informed comments about inhalation analgesia), but should be kept sophisticated methods. Raichle and co-workers described the development of out of the hands of most prospective patients. 16 J. Seltoyn Crawford O- and "C-labelled molecules to measure brain permeability characteristics of alcohols and water in studies on the aetiology of cerebral oedema. They also describe A Nurse's Guide to Anaesthetics, Resuscitation and Intensive Care, 5th edition. By W. Norris and D. Campbell. techniques for three-dimensional and non-invasive measurePublished by Churchill-Livingstone, London, 1972. ment of cerebral haemodynamics and metabolism using positron-emitting radio nuclides. The guest speaker, L. The publication of the fifth edition of this book some 8 Sokoloff, presented his experiences in developing the 14C years after its first appearance is a cogent commentary on the deoxyglucose method for the quantitative determination of well-deserved place the book has gained in the essential local cerebral glucose utilization. literature available to nurses.
Downloaded from http://bja.oxfordjournals.org/ at Cambridge University on August 31, 2015
I
615