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Radiology of the Chest (2nd ed) (Golden's Diagnostic Radiology Series, No. 3)
REVIEW OF RECENT BOOKS
Anesthesia and the Patient with Heart Disease Edited by Burnell R . Brown, J r . , M.D. Philadelphia, F . A. Davis, 1980 193 p p , $20.00
Reviewed by Laurence H . Coffin, M.D. This compact, concise, and highly readable monograph is the second in a series entitled Contemporary Anesthesia Practice. Dr. Brown and his eleven contributors have set as their goal a comprehensive and practical approach to the preoperative evaluation, intraoperative anesthetic management, and early postoperative care of the patient with diagnosed heart disease undergoing a noncardiac operation. They have achieved their objective with unusual clarity and impact. Each of the ten chapters and its author is introduced in an enticing manner by the editor in a brief paragraph. The initial chapter sets the stage as a model of what a comprehensive and well-documented discussion of the cardiovascular effects of anesthetics and anesthetic adjuvant agents should be. Its sixty-four citations provide a basis for what follows. In the second chapter, a ”nuts and bolts” approach to monitoring should prove of great value to the practicing anesthesiologist whose day-to-day practice may not be in a cardiac operating room. Subsequent chapters on the preoperative evaluation of electrocardiographic conduction defects and the diagnosis and therapy of perioperative arrhythmias are nicely complementary. Specific problems related to the anesthetic management of patients with congenital heart disease are discussed in reference to the particular lesion. The discussion is grouped around lesions with leftto-right and right-to-left shunts, increased or decreased pulmonary blood flow, as well as valvular lesions. There are no prominent omissions, and the editors are to be congratulated for considering the psychological trauma associated with operation. While there is extensive and occasionally repetitive coverage of the prognostic influence of prior myocardial infarction on mortality of patients undergoing elective general thoracic operation, the discussion of the patient requiring emergency operation in the face of a recent infarction is inadequate. As is appropriate, ischemic heart disease is emphasized but the preoperative evaluation of patients with prior coronary artery bypass grafting utilizing stress testing, radionuclide imaging, and angiography needs more elaboration. Specific problems related to patients who have undergone valve operation or who suffer from restrictive or hypertrophic myocardiopathies are not entertained. The discussion of the management of hypotension during anesthesia for a general thoracic operation seems rather vague and rambling for such an impor423
tant topic. As a coda, a brief but important chapter on postoperative care emphasizes the often neglected but labile, dangerous interval between the last skin stitch and arrival in the recovery room. Typographical errors are probably at an irreducible minimum. Those that occur are not particularly disturbing. While this volume is intended for the practicing anesthesiologist, its viewpoint and documentation should stimulate considerable interest on the other side of the ether screen.
Burlington, V T Radiology of the Chest (2nd ed) (Golden’s Diagnostic Radiology Series, No. 3) By Coleman B. Rabin, M.D., and Murray G. Baron, M.D. Baltimore, Williams G. Wilkins, 1980 764 p p , illustrated, $75.00
Reviewed by Paul Friedman, M.D. This substantial book is intended for radiologists and other chest clinicians who depend on roentgen shadows for understanding diseases of the lungs, mediastinum, and chest wall. Abnormalities of the lesser circulation are well covered, although most cardiac lesions are not considered. The book is organized to be read; references are arranged at the end according to chapters, and the text is not disrupted by footnotes. A few authors are mentioned by name, but most of the vast amount of information is delivered without attribution, as in a friendly and understandable lecture. The illustrations are numerous (583), are of excellent quality in general, and are generous in size, though that classic error-the upside-down chest (Figure 256)-is not avoided. Nearly all the roentgenograms were made before the introduction of high kilovoltage technique and the routine use of grids. Therein lies a warning of the major deficiency of this text: it is out-of-date. Drs. Rabin and Baron present a wealth of personal experience and include many clinical and radiological pearls, thereby showing a deep understanding of roentgenograms and the diseases they reveal. Some of the outstanding sections are those on fluoroscopy, which few in modern practice use very much, and tuberculosis, which also illustrates much of the general section of the text as well. But this is not where the emphasis lies today. Sections on allergic disorders of the lungs are meager; there is practically no mention of allergic bronchopulmonary aspergillosis; even asthma gets short shrift, the discussion limited mainly to a description of fluoroscopic findings. The benign lymphoid disorders are not mentioned. Opportunistic infections are not discussed as such.
424 The Annals of Thoracic Surgery Vol 32 No 4 October 1981
In the technical discussion, high kilovoltage radi- those who seek a historical perspective from the perography is the exception rather than the rule, and sonal reflections of two thoughtful clinicians whose many methods are given to get around the technical experience will never be duplicated. problems of old-fashioned chest technique. There are no phototimers or capacitor-discharge portable units Sun Diego, CA in the universe of this book, and image-intensified fluoroscopy is something new. The authors write of a Modem Technics in Surgery: CardiadThoracic time when chest roentgenograms were considered Surgery (Installments I1 and 111) part of the routine physical examination and when all Edited by Lawrence H . Cohn, M . D . contacts of patients with active (”open”) pulmonary M t . Kisko, NY, Futura Publishing Co, 1979 tuberculosis were screened roentgenographically, Illustrated, $32.50 and all sorts of problems were screened fluoroscopically. They use a number of terms that have disap- Reviewed by Harr,y A . Wellons, M . D . peared from contemporary terminology, for example, the terms lung root, the lappet of the anterior part of The addition to the series Modern Technics in Surgery the upper lobe, and the porcupine heart of asbestosis, of these two new sections devoted to cardiac and and a concept that I thought had been quietly thoracic surgery results in a much better coverage of dropped, that of ”senile emphysema.” The discussion the specialty. In the previous installment, fifteen of emphysema is otherwise practical, but does not procedures were covered, and these two installments mention centrilobular or panacinar types, nor does it add another fifteen. In addition, a comprehensive identify any particular kind with alpha,-antitrypsin index for the entire volume, which consists of the deficiency. The authors try to confine the use of the three installments, is provided. The format is identiterm infiltrate to interstitial accumulations of cells in cal to that used in the previous installment; it emthe lung, which does not really accord with the actual phasizes surgical technique, provides a reasonably source of many of the shadows that they and others detailed text, outlines the indications for the parcall ”infiltrates” on a roentgenogram. They give a ticular procedure, and covers preoperative and postconfusing discussion of common apical densities (p operative management. In general, the illustrations 374), which suggests they are clinically unimportant are very well done and easy to follow with the correor limited tuberculous infections and ignores the sponding text. Installment I1 covers nine operative procedures. modern understanding that most patients with these The two congenital heart procedures described are abnormalities have never had tuberculosis. The authors rightly stress the importance of anat- the Senning operations for transposition of the great omy in understanding pulmonary roentgenograms, arteries and patent ductus arteriosus. The five procebut their text mentions none of the advances in dures for acquired heart disease are intraaortic balmediastinal or hilar anatomy of the past twenty loon counterpulsation, repair of ascending aortic disyears (though references are listed in the bibliogra- section, reconstluctive procedures of the mitral valve phy). If you look for a demonstration of which pul- including ring annuloplasty, internal mammary armonary artery is which on a lateral chest roentgeno- tery bypass graft, and tricuspid valve replacement. gram, you won’t find it in this book. The term The descriptions of esophagectomy for midesophazygoesophageal recess is only used, so far as I can ageal cancer and left pneumonectomy complete the find it, in the special appendix on computed tomog- installment. Installment I11 consists of a description of the surraphy, obviously a recently written section. The tracheal wall stripe and the esophageal lines are not gical treatments of atrial septa1 defect, atrial venrecognized; 55-degree oblique hilar tomography is tricular canal, and total anomalous pulmonary mentioned, but illustrated with only two figures, venous drainage. Mitral valve replacement and myoboth of the left side. Detecting subcarinal lymph cardial infarctectomy are described. Dr. William node enlargement on plain roentgenograms of the Bernhard presents the indications for and use of the chest is dismissed as unlikely, as a result of the out- left ventricular assist device, which is being clinically evaluated in Boston. This procedure is, of course, dated techniques available to the authors. There are many other points in which the text fails still undergoing investigation and is not available for to keep up with the times, with our changing un- widespread use. As a whole, this volume makes a noteworthy conderstanding of disease, and with the recognition of new diseases and new complications (it’s now pseu- tribution and will be of interest to residents in domonas, not staphylococcus, that causes severe training as well as to practicing surgeons. Since this problems in cystic fibrosis). There has been so much publication is offered in a looseleaf format, it is progress in chest medicine and radiology in the last hoped that periodic updates of the procedures will be decade that this second edition needed a much more provided, as well as different approaches to the opersubstantial rewriting than it had. It is not useful as a ations by other authorities. reference on general or specific matters or as a guide to current practice. I can recommend this book to Charlottesville, V A
Anesthesia and the Patient with Heart Disease Edited by Burnell R . Brown, J r . , M.D. Philadelphia, F . A. Davis, 1980 193 p p , $20.00
Reviewed by Laurence H . Coffin, M.D. This compact, concise, and highly readable monograph is the second in a series entitled Contemporary Anesthesia Practice. Dr. Brown and his eleven contributors have set as their goal a comprehensive and practical approach to the preoperative evaluation, intraoperative anesthetic management, and early postoperative care of the patient with diagnosed heart disease undergoing a noncardiac operation. They have achieved their objective with unusual clarity and impact. Each of the ten chapters and its author is introduced in an enticing manner by the editor in a brief paragraph. The initial chapter sets the stage as a model of what a comprehensive and well-documented discussion of the cardiovascular effects of anesthetics and anesthetic adjuvant agents should be. Its sixty-four citations provide a basis for what follows. In the second chapter, a ”nuts and bolts” approach to monitoring should prove of great value to the practicing anesthesiologist whose day-to-day practice may not be in a cardiac operating room. Subsequent chapters on the preoperative evaluation of electrocardiographic conduction defects and the diagnosis and therapy of perioperative arrhythmias are nicely complementary. Specific problems related to the anesthetic management of patients with congenital heart disease are discussed in reference to the particular lesion. The discussion is grouped around lesions with leftto-right and right-to-left shunts, increased or decreased pulmonary blood flow, as well as valvular lesions. There are no prominent omissions, and the editors are to be congratulated for considering the psychological trauma associated with operation. While there is extensive and occasionally repetitive coverage of the prognostic influence of prior myocardial infarction on mortality of patients undergoing elective general thoracic operation, the discussion of the patient requiring emergency operation in the face of a recent infarction is inadequate. As is appropriate, ischemic heart disease is emphasized but the preoperative evaluation of patients with prior coronary artery bypass grafting utilizing stress testing, radionuclide imaging, and angiography needs more elaboration. Specific problems related to patients who have undergone valve operation or who suffer from restrictive or hypertrophic myocardiopathies are not entertained. The discussion of the management of hypotension during anesthesia for a general thoracic operation seems rather vague and rambling for such an impor423
tant topic. As a coda, a brief but important chapter on postoperative care emphasizes the often neglected but labile, dangerous interval between the last skin stitch and arrival in the recovery room. Typographical errors are probably at an irreducible minimum. Those that occur are not particularly disturbing. While this volume is intended for the practicing anesthesiologist, its viewpoint and documentation should stimulate considerable interest on the other side of the ether screen.
Burlington, V T Radiology of the Chest (2nd ed) (Golden’s Diagnostic Radiology Series, No. 3) By Coleman B. Rabin, M.D., and Murray G. Baron, M.D. Baltimore, Williams G. Wilkins, 1980 764 p p , illustrated, $75.00
Reviewed by Paul Friedman, M.D. This substantial book is intended for radiologists and other chest clinicians who depend on roentgen shadows for understanding diseases of the lungs, mediastinum, and chest wall. Abnormalities of the lesser circulation are well covered, although most cardiac lesions are not considered. The book is organized to be read; references are arranged at the end according to chapters, and the text is not disrupted by footnotes. A few authors are mentioned by name, but most of the vast amount of information is delivered without attribution, as in a friendly and understandable lecture. The illustrations are numerous (583), are of excellent quality in general, and are generous in size, though that classic error-the upside-down chest (Figure 256)-is not avoided. Nearly all the roentgenograms were made before the introduction of high kilovoltage technique and the routine use of grids. Therein lies a warning of the major deficiency of this text: it is out-of-date. Drs. Rabin and Baron present a wealth of personal experience and include many clinical and radiological pearls, thereby showing a deep understanding of roentgenograms and the diseases they reveal. Some of the outstanding sections are those on fluoroscopy, which few in modern practice use very much, and tuberculosis, which also illustrates much of the general section of the text as well. But this is not where the emphasis lies today. Sections on allergic disorders of the lungs are meager; there is practically no mention of allergic bronchopulmonary aspergillosis; even asthma gets short shrift, the discussion limited mainly to a description of fluoroscopic findings. The benign lymphoid disorders are not mentioned. Opportunistic infections are not discussed as such.
424 The Annals of Thoracic Surgery Vol 32 No 4 October 1981
In the technical discussion, high kilovoltage radi- those who seek a historical perspective from the perography is the exception rather than the rule, and sonal reflections of two thoughtful clinicians whose many methods are given to get around the technical experience will never be duplicated. problems of old-fashioned chest technique. There are no phototimers or capacitor-discharge portable units Sun Diego, CA in the universe of this book, and image-intensified fluoroscopy is something new. The authors write of a Modem Technics in Surgery: CardiadThoracic time when chest roentgenograms were considered Surgery (Installments I1 and 111) part of the routine physical examination and when all Edited by Lawrence H . Cohn, M . D . contacts of patients with active (”open”) pulmonary M t . Kisko, NY, Futura Publishing Co, 1979 tuberculosis were screened roentgenographically, Illustrated, $32.50 and all sorts of problems were screened fluoroscopically. They use a number of terms that have disap- Reviewed by Harr,y A . Wellons, M . D . peared from contemporary terminology, for example, the terms lung root, the lappet of the anterior part of The addition to the series Modern Technics in Surgery the upper lobe, and the porcupine heart of asbestosis, of these two new sections devoted to cardiac and and a concept that I thought had been quietly thoracic surgery results in a much better coverage of dropped, that of ”senile emphysema.” The discussion the specialty. In the previous installment, fifteen of emphysema is otherwise practical, but does not procedures were covered, and these two installments mention centrilobular or panacinar types, nor does it add another fifteen. In addition, a comprehensive identify any particular kind with alpha,-antitrypsin index for the entire volume, which consists of the deficiency. The authors try to confine the use of the three installments, is provided. The format is identiterm infiltrate to interstitial accumulations of cells in cal to that used in the previous installment; it emthe lung, which does not really accord with the actual phasizes surgical technique, provides a reasonably source of many of the shadows that they and others detailed text, outlines the indications for the parcall ”infiltrates” on a roentgenogram. They give a ticular procedure, and covers preoperative and postconfusing discussion of common apical densities (p operative management. In general, the illustrations 374), which suggests they are clinically unimportant are very well done and easy to follow with the correor limited tuberculous infections and ignores the sponding text. Installment I1 covers nine operative procedures. modern understanding that most patients with these The two congenital heart procedures described are abnormalities have never had tuberculosis. The authors rightly stress the importance of anat- the Senning operations for transposition of the great omy in understanding pulmonary roentgenograms, arteries and patent ductus arteriosus. The five procebut their text mentions none of the advances in dures for acquired heart disease are intraaortic balmediastinal or hilar anatomy of the past twenty loon counterpulsation, repair of ascending aortic disyears (though references are listed in the bibliogra- section, reconstluctive procedures of the mitral valve phy). If you look for a demonstration of which pul- including ring annuloplasty, internal mammary armonary artery is which on a lateral chest roentgeno- tery bypass graft, and tricuspid valve replacement. gram, you won’t find it in this book. The term The descriptions of esophagectomy for midesophazygoesophageal recess is only used, so far as I can ageal cancer and left pneumonectomy complete the find it, in the special appendix on computed tomog- installment. Installment I11 consists of a description of the surraphy, obviously a recently written section. The tracheal wall stripe and the esophageal lines are not gical treatments of atrial septa1 defect, atrial venrecognized; 55-degree oblique hilar tomography is tricular canal, and total anomalous pulmonary mentioned, but illustrated with only two figures, venous drainage. Mitral valve replacement and myoboth of the left side. Detecting subcarinal lymph cardial infarctectomy are described. Dr. William node enlargement on plain roentgenograms of the Bernhard presents the indications for and use of the chest is dismissed as unlikely, as a result of the out- left ventricular assist device, which is being clinically evaluated in Boston. This procedure is, of course, dated techniques available to the authors. There are many other points in which the text fails still undergoing investigation and is not available for to keep up with the times, with our changing un- widespread use. As a whole, this volume makes a noteworthy conderstanding of disease, and with the recognition of new diseases and new complications (it’s now pseu- tribution and will be of interest to residents in domonas, not staphylococcus, that causes severe training as well as to practicing surgeons. Since this problems in cystic fibrosis). There has been so much publication is offered in a looseleaf format, it is progress in chest medicine and radiology in the last hoped that periodic updates of the procedures will be decade that this second edition needed a much more provided, as well as different approaches to the opersubstantial rewriting than it had. It is not useful as a ations by other authorities. reference on general or specific matters or as a guide to current practice. I can recommend this book to Charlottesville, V A