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A diagnostic approach to chest diseases: Differential diagnoses based on roentgenograp'ic patterns
Br.J.
Dis.
Chest
(1978)
72,
251
BOOK REVIEWS Lung Sounds Paul
Forgacs
London: Bailliitre Price L4.50
Tindall.
1978.
viii
+ 72.
This is a unique small book. Paul Forgacs uses plain speaking to explain the basic acoustics of the sounds generated within the chest during breathing. The brilliant simplicity of transforming the concepts propounded by Laennec into current scientific thinking, in a way that is also relevant to physicians, makes this book essential for everyone who tries to use a stethoscope. There are very few books indeed that one would expect to be possessed by every doctor, but it is no exaggeration to say that this one not only should be, but almost certainly will be, one of them. The presentation of this book is in the style of its contents. The type setting is large and clear, and the diagrams large, simple and explicit. Good references and an adequate index enhance the value of this splendid book. M. TURNER-WARWICK
A Diagnostic Approach to Chest Diseases: Differential Diagnoses Based on Roentgenograp’ic Patterns Glen
A.
Baltimore: xiv + 608.
Lillington Williams Price $54.00
and
Robert and
W.
Wilkins.
Jamplis 1977.
In this book the aim of the authors is to produce a practical approach to the diagnosis of pulmonary disease. In stating that the patient presents as a collection of symptoms, signs and investigatory findings, they point out that this frequently (though not invariably) means that the chest radiograph is abnormal. They have based their book in the categorisation of abnormal radiographic signs and their subsequent investigation. Whilst they state that the book is not primarily a radiological textbook, they have indicated how investigatory problems may be approached once the radiological signs have been established.
The book is divided int four sections. Firstly, there are three chapters outlining diagnostic techniques. These include the history and physical examination, radiological and radio-isotope studies and finally other diagnostic procedures. The second section is a brief but very clearly defined list of radiographic patterns with illustrative examples. The accompanying text enlarges on the defibition of these paterns. The third and major section considers each of these examples in detail. A differential diagnostic list of the principal causes is presented. A more detailed description is given of these causes and the investigatory techniques which are most likely to prove useful for any particular condition are indicated. The diagnostic techniques themselves are then considered in relation to their likely usefulness. A suggested course of diagnostic management is then outlined. In the fouth section symptoms suchas cough, signs such as haemoptysis and the syndrome of pulmonary infiltration and eosinophilia are considered in the same manner as the radiological appearances detailed in the third section. The quality of the radiographs is excellent and the legends are informative. It would perhaps have helped if there had been more radiographs illustrating the diagnostic differences referred to in the text. Occasionally the subheadings in the text are a little difficult to pick out but these are all minor criticisms. One particularly useful feature is the list of references divided into subsections which appears at the end of each chapter. It is only to be hoped that they do not date too rapidly. The book has been written on the basis that the problem to be solved can be identified and it has been assumed it will usually be related to an abnormal radiograph. The possible causes are indicated. The manner in which these may be identified are oulined and mdghocx by which the diagnosis can be established are suggested. This approach will surely be found invaluable by all clinicians, whether primarily chest specialists or not. It will also appeal to radiologists in that they will have a broader base on which to
Book Reviews
252 place their graph.
interpretation
of the chest radioM. C. PEARSON
Lung Biology in Health and Disease, 2. The Biochemical Basis of Pulmonary Function Ronald
G. Crystal
New York: Marcel Price SF 150
Dekker.
1976. xviii + 534.
This book starts off with a description of the many cell types which go to make up the whole lung which have been identified since the electron microscope was applied to the lung. Although the gross functions of many of these cells are well known, e.g. mucus secretion, phagocytosis, ciliary activity and so on, the activities of others are less well defibed. Indeed, this sort of study had to await the appearance of methods of obtaining concentrated and viable preparations of individual cell types; a chapter of the book is devoted to tracing the development of these methods and to descriptions of those techniques which have been found most suitable. Subsequent chapters deal with the energy requirements of lung tissue, lipid metabolism and protein synthesis in general and with certain aspects of the synthesis of specific secretions of the lung such as surfactant and prostaglandins. The development of collagen and elastin is dealt with in detail and its importance in the fibal structure of the lung and its place in determining the physical properties of the lung as a qhole. A particularly interesting chapter is devoted to at-antitrypsin and its effects on lung development and on the association between deficiency and emphysema. Each contributor has been at pains to point out the possible clinical bearing of the work he describes. The book concludes with a long chapter in which the relationships between the biochemistry of the lung, its true ure and its functions are examined in depth. In the past few decades, we have seen the
emergence of methods which have made it possible to relate the main respiratory functions of the lung to the gross anatomy and histology in quantitative terms. It is now evident that the non-respiratory functions of the lung have also to be taken into account in the genesis of disturbed lung function and that correlations between abnormalities in these and abnormalities of cell structure and function are likely to be fruitful in understanding the mechanisms of disturbed function of the whole lung. The book is well written and (what may be more important) very well edited. The illustrations are uniformly good and apposite without being too numerous. The price in this country is forbiddingly high and may confine the book to established libraries and institutions. Nevertheless, I can see no way of avoiding the necessity for every expert on respiration physiology to read this fascinating book. F. J. PRIME Fundamentals Donald
of Respiratory
Therapy
F. Egan
St Louis: Mosby (London: Henry 1977. x+551. Price E12.60
Kimpton).
The third edition of this will be of great value to the physiotherapist who is working in a chest hospital. Although the first few chapters are mainly concerning academic knowledge, the remaining chapters are of excellent reading and value for clinical work. There have been some very good additions to the third edition, such as a lengthened explanation about positive end-expiratory pressure, and paragraphs explaining fibreoptic bronchoscopy and humidification, to mention only a few examples. I am sure this book will have a place in the physiotherapy departments of chest hospitals. PATRICIA
TOMLIN
Dis.
Chest
(1978)
72,
251
BOOK REVIEWS Lung Sounds Paul
Forgacs
London: Bailliitre Price L4.50
Tindall.
1978.
viii
+ 72.
This is a unique small book. Paul Forgacs uses plain speaking to explain the basic acoustics of the sounds generated within the chest during breathing. The brilliant simplicity of transforming the concepts propounded by Laennec into current scientific thinking, in a way that is also relevant to physicians, makes this book essential for everyone who tries to use a stethoscope. There are very few books indeed that one would expect to be possessed by every doctor, but it is no exaggeration to say that this one not only should be, but almost certainly will be, one of them. The presentation of this book is in the style of its contents. The type setting is large and clear, and the diagrams large, simple and explicit. Good references and an adequate index enhance the value of this splendid book. M. TURNER-WARWICK
A Diagnostic Approach to Chest Diseases: Differential Diagnoses Based on Roentgenograp’ic Patterns Glen
A.
Baltimore: xiv + 608.
Lillington Williams Price $54.00
and
Robert and
W.
Wilkins.
Jamplis 1977.
In this book the aim of the authors is to produce a practical approach to the diagnosis of pulmonary disease. In stating that the patient presents as a collection of symptoms, signs and investigatory findings, they point out that this frequently (though not invariably) means that the chest radiograph is abnormal. They have based their book in the categorisation of abnormal radiographic signs and their subsequent investigation. Whilst they state that the book is not primarily a radiological textbook, they have indicated how investigatory problems may be approached once the radiological signs have been established.
The book is divided int four sections. Firstly, there are three chapters outlining diagnostic techniques. These include the history and physical examination, radiological and radio-isotope studies and finally other diagnostic procedures. The second section is a brief but very clearly defined list of radiographic patterns with illustrative examples. The accompanying text enlarges on the defibition of these paterns. The third and major section considers each of these examples in detail. A differential diagnostic list of the principal causes is presented. A more detailed description is given of these causes and the investigatory techniques which are most likely to prove useful for any particular condition are indicated. The diagnostic techniques themselves are then considered in relation to their likely usefulness. A suggested course of diagnostic management is then outlined. In the fouth section symptoms suchas cough, signs such as haemoptysis and the syndrome of pulmonary infiltration and eosinophilia are considered in the same manner as the radiological appearances detailed in the third section. The quality of the radiographs is excellent and the legends are informative. It would perhaps have helped if there had been more radiographs illustrating the diagnostic differences referred to in the text. Occasionally the subheadings in the text are a little difficult to pick out but these are all minor criticisms. One particularly useful feature is the list of references divided into subsections which appears at the end of each chapter. It is only to be hoped that they do not date too rapidly. The book has been written on the basis that the problem to be solved can be identified and it has been assumed it will usually be related to an abnormal radiograph. The possible causes are indicated. The manner in which these may be identified are oulined and mdghocx by which the diagnosis can be established are suggested. This approach will surely be found invaluable by all clinicians, whether primarily chest specialists or not. It will also appeal to radiologists in that they will have a broader base on which to
Book Reviews
252 place their graph.
interpretation
of the chest radioM. C. PEARSON
Lung Biology in Health and Disease, 2. The Biochemical Basis of Pulmonary Function Ronald
G. Crystal
New York: Marcel Price SF 150
Dekker.
1976. xviii + 534.
This book starts off with a description of the many cell types which go to make up the whole lung which have been identified since the electron microscope was applied to the lung. Although the gross functions of many of these cells are well known, e.g. mucus secretion, phagocytosis, ciliary activity and so on, the activities of others are less well defibed. Indeed, this sort of study had to await the appearance of methods of obtaining concentrated and viable preparations of individual cell types; a chapter of the book is devoted to tracing the development of these methods and to descriptions of those techniques which have been found most suitable. Subsequent chapters deal with the energy requirements of lung tissue, lipid metabolism and protein synthesis in general and with certain aspects of the synthesis of specific secretions of the lung such as surfactant and prostaglandins. The development of collagen and elastin is dealt with in detail and its importance in the fibal structure of the lung and its place in determining the physical properties of the lung as a qhole. A particularly interesting chapter is devoted to at-antitrypsin and its effects on lung development and on the association between deficiency and emphysema. Each contributor has been at pains to point out the possible clinical bearing of the work he describes. The book concludes with a long chapter in which the relationships between the biochemistry of the lung, its true ure and its functions are examined in depth. In the past few decades, we have seen the
emergence of methods which have made it possible to relate the main respiratory functions of the lung to the gross anatomy and histology in quantitative terms. It is now evident that the non-respiratory functions of the lung have also to be taken into account in the genesis of disturbed lung function and that correlations between abnormalities in these and abnormalities of cell structure and function are likely to be fruitful in understanding the mechanisms of disturbed function of the whole lung. The book is well written and (what may be more important) very well edited. The illustrations are uniformly good and apposite without being too numerous. The price in this country is forbiddingly high and may confine the book to established libraries and institutions. Nevertheless, I can see no way of avoiding the necessity for every expert on respiration physiology to read this fascinating book. F. J. PRIME Fundamentals Donald
of Respiratory
Therapy
F. Egan
St Louis: Mosby (London: Henry 1977. x+551. Price E12.60
Kimpton).
The third edition of this will be of great value to the physiotherapist who is working in a chest hospital. Although the first few chapters are mainly concerning academic knowledge, the remaining chapters are of excellent reading and value for clinical work. There have been some very good additions to the third edition, such as a lengthened explanation about positive end-expiratory pressure, and paragraphs explaining fibreoptic bronchoscopy and humidification, to mention only a few examples. I am sure this book will have a place in the physiotherapy departments of chest hospitals. PATRICIA
TOMLIN