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A PRIMER OF VENOUS PRESSURE
The Bookshelf, continued
A PRIMER OF VENOUS PRESSURE. By GEoRGE E. BuRCH. Charles C Thomas, Springfield, Illinois, Second Printing, 1972, 174 pp, $9.50 Can a 22-year-old medical textbook be presented in its original form and serve the profession in any useful form (other than simply for historical interest)? My answer, in this case, is a surprising-yes! In 1950, this book was printed for the first time and now is reprinted with no changes. The reasons that this book remains pertinent are twofold: ( 1) the book was written accurately and well in the first place, ( 2) we have learned relatively little of basic importance about venous pressure in the past two decades. Obviously, a book of this nature will lack certain points of recent interest, particularly about the relationship among cardiac filling pressures, central and peripheral venous pressures; the clinical use of central venous pressure, control and influence of venous tone, and functions of the veins as capacitance vessels. Dr. Burch also makes little attempt to analyze the pressure waves or to relate them to cardiovascular disease. On the positive side, however, this book has numerous assets: a discussion of functional anatomy of the veins is excellent. In this section, the author correlates ~he gross and microscopic anatomy of the veins with their function. One finds such information as the various types and locations of the venous valves, and wall thickness related to pressures and anatomy of specific veins. Further extending this information, another interesting discussion of venous hemodynamics supervenes, in which concepts of Poiseuielle's law, venous pressure, cardiac return and venous How patterns are discussed. In an absolute sense, all venous pressure is positive. From a clinical viewpoint, however, one needs to know specifically that point in the normal venous system where the venous pressure equals atmospheric pressure. At this point, the venous pressure is arbitrarily designated as zero. Mter a brief historic review, the author defines this pointthe "phlebostatic axis." This is defined as the line of function between a transverse ·plane of the body passing through the fourth intercostal space and a sagittal plane halfway between the anterior and posterior surface of the thorax. This point forms the basis upon which all determinations of central and peripheral venous pressure must be calculated from. In other words, one calculates how high above this point a vertical column of fluid is supported (mercury, blood or water). This height is then identified as the "venous pressure." Various clinical causes of
16
increased venous pressure are discussed in some detail, ie, congestive heart failure, cardiac constriction, intra-thoracic pressure changes, venous obstruction, etc. Unfortunately, this discussion is limited on causes for decreased venous pressure, such as shock and hypovolemia stemming partly from the lack of data available at the time about central venous pressure. In summary, therefore, this book is well written, concise, and extremely well illustrated. It stands as a landmark in the accumulation of knowledge of the venous system and it serves as a tribute to the tremendous intellectual capacity of its author-one of the present day giants of American cardiology. Any serious student of hemodynamics and venous physiology could benefit from this book, and it should still serve as an excellent introduction to the beginning student. Morton E. Tavel, M.D. Indianapolis, Ind. THE BIOCHEMICAL AND IMMUNOCHEMICAL BASIS OF BRONCHIAL ASTHMA. By KJELL AAs. Charles C Thomas, Springfield, Illinois, 1972, 238 pp, $11.50 In the short space of 200 pages, the author has compressed a surprising amount of information. This is a review article without much depth in any one area, but there are critical comments on most of the current ideas relating to extrinsic allergic disease. The book is concise, readable and perceptive. Extrinsic allergic disease is clearly described with respect to reaginic antibodies and allergens-the pathogenetic mediators-as well as adrenergic and cholinergic autonomic systems which are responsible for homeostasis. The conceptual framework is very illuminating, an opinion which may be explained in part because it coincides in most respects with the views of this reviewer. Although the mechanisms in intrinsic asthma are not well known, the author presents them with the implication that they have much in common with those of extrinsic asthma. There are some unfortunate errors and omissions, such as describing noradrenalin as a pure beta agonist, a seeming endorsement of the template hypothesis of antibody formation, incomplete basic description of type III hypersensitivity and the formula for resistance and structure of orciprenaline. This book is highly recommended to the general reader who has not kept abreast of the correlations of experimental and clinical studies in IgE mediJacob Pruzansky, Ph.D. ated disease. Chicago, Ill.
A PRIMER OF VENOUS PRESSURE. By GEoRGE E. BuRCH. Charles C Thomas, Springfield, Illinois, Second Printing, 1972, 174 pp, $9.50 Can a 22-year-old medical textbook be presented in its original form and serve the profession in any useful form (other than simply for historical interest)? My answer, in this case, is a surprising-yes! In 1950, this book was printed for the first time and now is reprinted with no changes. The reasons that this book remains pertinent are twofold: ( 1) the book was written accurately and well in the first place, ( 2) we have learned relatively little of basic importance about venous pressure in the past two decades. Obviously, a book of this nature will lack certain points of recent interest, particularly about the relationship among cardiac filling pressures, central and peripheral venous pressures; the clinical use of central venous pressure, control and influence of venous tone, and functions of the veins as capacitance vessels. Dr. Burch also makes little attempt to analyze the pressure waves or to relate them to cardiovascular disease. On the positive side, however, this book has numerous assets: a discussion of functional anatomy of the veins is excellent. In this section, the author correlates ~he gross and microscopic anatomy of the veins with their function. One finds such information as the various types and locations of the venous valves, and wall thickness related to pressures and anatomy of specific veins. Further extending this information, another interesting discussion of venous hemodynamics supervenes, in which concepts of Poiseuielle's law, venous pressure, cardiac return and venous How patterns are discussed. In an absolute sense, all venous pressure is positive. From a clinical viewpoint, however, one needs to know specifically that point in the normal venous system where the venous pressure equals atmospheric pressure. At this point, the venous pressure is arbitrarily designated as zero. Mter a brief historic review, the author defines this pointthe "phlebostatic axis." This is defined as the line of function between a transverse ·plane of the body passing through the fourth intercostal space and a sagittal plane halfway between the anterior and posterior surface of the thorax. This point forms the basis upon which all determinations of central and peripheral venous pressure must be calculated from. In other words, one calculates how high above this point a vertical column of fluid is supported (mercury, blood or water). This height is then identified as the "venous pressure." Various clinical causes of
16
increased venous pressure are discussed in some detail, ie, congestive heart failure, cardiac constriction, intra-thoracic pressure changes, venous obstruction, etc. Unfortunately, this discussion is limited on causes for decreased venous pressure, such as shock and hypovolemia stemming partly from the lack of data available at the time about central venous pressure. In summary, therefore, this book is well written, concise, and extremely well illustrated. It stands as a landmark in the accumulation of knowledge of the venous system and it serves as a tribute to the tremendous intellectual capacity of its author-one of the present day giants of American cardiology. Any serious student of hemodynamics and venous physiology could benefit from this book, and it should still serve as an excellent introduction to the beginning student. Morton E. Tavel, M.D. Indianapolis, Ind. THE BIOCHEMICAL AND IMMUNOCHEMICAL BASIS OF BRONCHIAL ASTHMA. By KJELL AAs. Charles C Thomas, Springfield, Illinois, 1972, 238 pp, $11.50 In the short space of 200 pages, the author has compressed a surprising amount of information. This is a review article without much depth in any one area, but there are critical comments on most of the current ideas relating to extrinsic allergic disease. The book is concise, readable and perceptive. Extrinsic allergic disease is clearly described with respect to reaginic antibodies and allergens-the pathogenetic mediators-as well as adrenergic and cholinergic autonomic systems which are responsible for homeostasis. The conceptual framework is very illuminating, an opinion which may be explained in part because it coincides in most respects with the views of this reviewer. Although the mechanisms in intrinsic asthma are not well known, the author presents them with the implication that they have much in common with those of extrinsic asthma. There are some unfortunate errors and omissions, such as describing noradrenalin as a pure beta agonist, a seeming endorsement of the template hypothesis of antibody formation, incomplete basic description of type III hypersensitivity and the formula for resistance and structure of orciprenaline. This book is highly recommended to the general reader who has not kept abreast of the correlations of experimental and clinical studies in IgE mediJacob Pruzansky, Ph.D. ated disease. Chicago, Ill.