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Respiratory biomechanics—Engineering analysis of structure and function
1. Bfomechanics Vol. 24, No. 6, pp. 495-496, 1991. Printed in Great Britain
0021-9290/91
s3.00 +
.w
Pergamon Press plc
BOOK REVIEWS
PRESSURE SORES-CLINICAL PRACTICE AND SCIENTIFIC APPROACH Dan L. Bader, Macmillan Press, Hampshire, 1990, f&.00, 283 pp., ISBN O-333-46178-9
In this book, the author aims to provide a comprehensive discussion of the problem of pressure sores that can be appreciated by a wide spectrum of readers. In effect, he attempts to create a multi-authored sequel to Bedsore Biomechanics, a publication which has been a bible for practitioners and researchers in the field for many years. In trying to supplant Bedsore Biomechanics, he has taken on a difficult job because that volume (representing the proceedings of a seminar on ‘Tissue Viability and Clinical Applications’) had an air of freshness and scientific validity that are hard to beat. Also, since it was the first comprehensive book in this field, Bedsore Biomechanics always will remain the standard, and a highly significant reference. Thus, while Pressure Sores will not replace its predecessor, it should take its place beside it as an important reference for updated material. Pressure Sores is divided into four parts, ‘Clinical Aspects’ (general background), ‘Experiences in Various Snecific Clinical I%cinlines’. Scientific Asnects’ and ‘Technological Systems for-patient Monitoring< Accordingly, it can be referred to with ease by individuals interested in specific aspects, and the various chapters are complementary rather than repetitive. While the first section is a routine and workmanlike review, the second section is unique because it provides a view of the clinical problem from different standpoints: the orthopaedic patient, the geriatric patient, the severely disabled, the spinal injury patient, and the patient requiring surgical reconstruction. The orthopaedic section is particularly good on identifying stages in treatment during which pressure sores may be initiated, while the reconstructive section is particularly good on wound care. In the other chapters of this section, it would be helpful to
present a more indepth and practical scheme for conservative treatment of pressure sores. There is a great deal of referencing of prevention and treatment methods, but the book lacks a thoughtful comparison of alternative paths of conservative treatment, including detailed discussions of different types of modem dressings and other wound care materials. The scientific section provides a fairly comprehensive and up-to-date review of work in the field and should be of great assistance to researchers developing plans for new studies. Of particular interest is the chapter on visualization of tissue deformation under load in t&o by MRI. Oddly, there is no mention of the several (unproven) attempts to stimulate pressure sore healing by electrical modalities, which have also demonstrated the value of certain electrical techniques in cleaning up infected sores. The section on technological monitoring provides several chapters that give accounts of successful clinical research projects. As such, the information is valuable but fragmented; it would have been useful to have an additional chapter synthesizing information on what is available and recommended in technological monitoring and presenting sample programs, based on currently available equipment, for use by the clinician. In summary, this book has some flaws, but in general, accomplishes its purpose of providing an up-to-date reference volume for those involved in clinical care as well as clinical and basic research on pressure sores.
George Van B. Cochran Helen Hayes Hospital, NY
RESPIRATORY
BIOMECHANICS-ENGINEERING ANALYSIS OF STRUCTURE AND FUNCTION Mary A. Farrell Epstein and James R. Ligas, Springer, New York, 1990, $35.00, 201 pp., ISBN 0-387-97404-O
California. This meeting was unusual in that it succeeded, as no conference had before it, in uniting the biomechanics community at a single meeting, and the success of this book reflects, to a large degree, the success of that meeting. As with any conference proceedings, however, the style and quality of presentation are quite variable. While some readers may find this annoying, I personally did not feel that it detracted significantly from the book’s overall value. In general, the papers contained in this volume either focus on the most recent research contributions of a particular group, or provide a synthesis of existing ideas. I found those of the latter category to be most useful, provided they explained the work in sufficient detail so as not to be. entirely superficial. Some of the contributions, particularly those in the last section (Integrating Mechanics and Transport in Assessing Respiratory Function), were too brief (typically
In its Preface, the authors state the hope that this book ‘will be a source of new viewpoints and encouragement for those engaged in or considering research in respiratory biomechanics’. To a large degree, this volume meets that hope and should prove to be a useful reference for the intended audience. The material contained in this collection has been carefully organized by the editors into sections on (1) Lung Tissue Mechanics; (2) Respiratory Fluid Mechanics and Transport; (3) Pulmonary Circulation; (4) The Use of Mathematics and Advanced Technology to Measure and Evaluate Lung Fluid Exchange and Solute Balance; and (5) Integrating Mechanics and Transport in Assessing Respiratory Function. As a group, these represent most of the important areas of current research. This book is a collection of papers presented at the First World Congress of Biomechanics held recently in La Jolla, 495
496
Book Reviews
one or two pages) to be of much use. Nor did they provide the reader with bibliographies that might have led to publications with a little more ‘meat’. This was especially irksome as the concluding section where a reader would look for some sort of closure, or at least a pathway for further study. This section might have served as a discussion of how the more fundamental research of previous sections was being applied to medicine, but it did not. The coverage of the book is very good considering its length of just over 200 pages. Topics I would have liked to have seen included or expanded upon include chest wall mechanics (totally omitted), micro-structural models of lung parenchyma (mentioned only briefly in the article by LA Fook), and models of solute and solvent transport on a molecular level. There was a notable absence of any papers
on the fluid dynamics of large amplitude flows in the bronchial tree, but this is probably justifiable on the basis that this ground is well-trodden and has been adequately described elsewhere. Despite these few short-comings, however, I found the book to be quite informative and would add it to my own collection. There were many outstanding contributions, in particular those in the section on Respiratory Fluid Mechanics and Transport. This is one of the few texts to which one can look for an up-to-date presentation of respiratory mechanics and is sure to stimulate the inquisitive mind. Roger Kamrn Massachusetts Institute of Technology
0021-9290/91
s3.00 +
.w
Pergamon Press plc
BOOK REVIEWS
PRESSURE SORES-CLINICAL PRACTICE AND SCIENTIFIC APPROACH Dan L. Bader, Macmillan Press, Hampshire, 1990, f&.00, 283 pp., ISBN O-333-46178-9
In this book, the author aims to provide a comprehensive discussion of the problem of pressure sores that can be appreciated by a wide spectrum of readers. In effect, he attempts to create a multi-authored sequel to Bedsore Biomechanics, a publication which has been a bible for practitioners and researchers in the field for many years. In trying to supplant Bedsore Biomechanics, he has taken on a difficult job because that volume (representing the proceedings of a seminar on ‘Tissue Viability and Clinical Applications’) had an air of freshness and scientific validity that are hard to beat. Also, since it was the first comprehensive book in this field, Bedsore Biomechanics always will remain the standard, and a highly significant reference. Thus, while Pressure Sores will not replace its predecessor, it should take its place beside it as an important reference for updated material. Pressure Sores is divided into four parts, ‘Clinical Aspects’ (general background), ‘Experiences in Various Snecific Clinical I%cinlines’. Scientific Asnects’ and ‘Technological Systems for-patient Monitoring< Accordingly, it can be referred to with ease by individuals interested in specific aspects, and the various chapters are complementary rather than repetitive. While the first section is a routine and workmanlike review, the second section is unique because it provides a view of the clinical problem from different standpoints: the orthopaedic patient, the geriatric patient, the severely disabled, the spinal injury patient, and the patient requiring surgical reconstruction. The orthopaedic section is particularly good on identifying stages in treatment during which pressure sores may be initiated, while the reconstructive section is particularly good on wound care. In the other chapters of this section, it would be helpful to
present a more indepth and practical scheme for conservative treatment of pressure sores. There is a great deal of referencing of prevention and treatment methods, but the book lacks a thoughtful comparison of alternative paths of conservative treatment, including detailed discussions of different types of modem dressings and other wound care materials. The scientific section provides a fairly comprehensive and up-to-date review of work in the field and should be of great assistance to researchers developing plans for new studies. Of particular interest is the chapter on visualization of tissue deformation under load in t&o by MRI. Oddly, there is no mention of the several (unproven) attempts to stimulate pressure sore healing by electrical modalities, which have also demonstrated the value of certain electrical techniques in cleaning up infected sores. The section on technological monitoring provides several chapters that give accounts of successful clinical research projects. As such, the information is valuable but fragmented; it would have been useful to have an additional chapter synthesizing information on what is available and recommended in technological monitoring and presenting sample programs, based on currently available equipment, for use by the clinician. In summary, this book has some flaws, but in general, accomplishes its purpose of providing an up-to-date reference volume for those involved in clinical care as well as clinical and basic research on pressure sores.
George Van B. Cochran Helen Hayes Hospital, NY
RESPIRATORY
BIOMECHANICS-ENGINEERING ANALYSIS OF STRUCTURE AND FUNCTION Mary A. Farrell Epstein and James R. Ligas, Springer, New York, 1990, $35.00, 201 pp., ISBN 0-387-97404-O
California. This meeting was unusual in that it succeeded, as no conference had before it, in uniting the biomechanics community at a single meeting, and the success of this book reflects, to a large degree, the success of that meeting. As with any conference proceedings, however, the style and quality of presentation are quite variable. While some readers may find this annoying, I personally did not feel that it detracted significantly from the book’s overall value. In general, the papers contained in this volume either focus on the most recent research contributions of a particular group, or provide a synthesis of existing ideas. I found those of the latter category to be most useful, provided they explained the work in sufficient detail so as not to be. entirely superficial. Some of the contributions, particularly those in the last section (Integrating Mechanics and Transport in Assessing Respiratory Function), were too brief (typically
In its Preface, the authors state the hope that this book ‘will be a source of new viewpoints and encouragement for those engaged in or considering research in respiratory biomechanics’. To a large degree, this volume meets that hope and should prove to be a useful reference for the intended audience. The material contained in this collection has been carefully organized by the editors into sections on (1) Lung Tissue Mechanics; (2) Respiratory Fluid Mechanics and Transport; (3) Pulmonary Circulation; (4) The Use of Mathematics and Advanced Technology to Measure and Evaluate Lung Fluid Exchange and Solute Balance; and (5) Integrating Mechanics and Transport in Assessing Respiratory Function. As a group, these represent most of the important areas of current research. This book is a collection of papers presented at the First World Congress of Biomechanics held recently in La Jolla, 495
496
Book Reviews
one or two pages) to be of much use. Nor did they provide the reader with bibliographies that might have led to publications with a little more ‘meat’. This was especially irksome as the concluding section where a reader would look for some sort of closure, or at least a pathway for further study. This section might have served as a discussion of how the more fundamental research of previous sections was being applied to medicine, but it did not. The coverage of the book is very good considering its length of just over 200 pages. Topics I would have liked to have seen included or expanded upon include chest wall mechanics (totally omitted), micro-structural models of lung parenchyma (mentioned only briefly in the article by LA Fook), and models of solute and solvent transport on a molecular level. There was a notable absence of any papers
on the fluid dynamics of large amplitude flows in the bronchial tree, but this is probably justifiable on the basis that this ground is well-trodden and has been adequately described elsewhere. Despite these few short-comings, however, I found the book to be quite informative and would add it to my own collection. There were many outstanding contributions, in particular those in the section on Respiratory Fluid Mechanics and Transport. This is one of the few texts to which one can look for an up-to-date presentation of respiratory mechanics and is sure to stimulate the inquisitive mind. Roger Kamrn Massachusetts Institute of Technology