112
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The style is clear and easy to read. The editors insert personal comments throughout the chapters in a conversational style, which are sometimes replied to by the author, which provides entertaining discussion of some of the more contentious areas. This editorial device adds to the colour of the book, but emphasises one of its weaknesses, which is the often anecdotal nature of the basis for the advice given. The editors do not deal with the serious problems which underlie their premise that athletes at risk can be identified, in particular the logistics and practicalities of screening athletes, the costeffectiveness and the lack of evidence that massive screening programmes would alter the low incidence of tragic events. Thus, for the physician involved in the assessment of athletes, this book provides interesting and valuable information, but the wider questions of who should be assessed, how and by whom, remain uncertain. Department of Medical Cardiology, Royal Infirmary Glasgow G31 2ER, UK
Dr. A.C. Rankin Senior Lecturer
SSDI 0167-5273(93)01899-Z
Coronary Thrombolysis
in Perspective
B.E. Sobell, D. Collen (Editors) Marcel Dekker, New York, NY, 1993; 320 pp.; U&%99.75;ISBN O-8247-9154- 1 This is a compact book of just over 300 pages and is part of the series Fundamental and Clinical Cardiology of which this is Number 16. This suggests that the editorsin-chief have a good track record. Unfortunately, it is a rather unattractive book with a dull blue and gold cover, but this should not put readers off. It is divided into 15 chapters each of which is written by an expert in the field. Whilst the text is easy to read there is, unfortunately, a paucity of diagrams. Some of the chapters are more authoritative than others and whilst thrombolysis being a subject that continues to be in vogue is still moving rapidly it has reached, to some degree, a plateau and, therefore, much of what is in the book will already be known. This book does not, however, seem dated. Indeed, some of the preliminary reports of the GUSTO Study are included. Who, then, is this book suitable for? It is a useful reference for those wishing to place an aspect of their own research into context. 1 would like to have seen more questions raised by the various experts to stimulate people into further research. My only other criticism is that each of these chapters sits individually juxtaposed against the next and the former. It
/Inr.
J. Curcliol. 43 ( 1994) 111-113
would be nice to have had, on reading the book, a feeling of continuity and applicability to patient management. The objectives in developing the monograph are clearly set out by Sobell and Collen and I think this monograph goes many ways towards achieving its aims - not an easy thing to do when there are so many chapter editors. At $99.75 I think it is a valuable addition to our reference list, outlining the current state of development of thrombolysis. It may, however, be the last of its type for some time. Department of Cardiology Glenfield General Hospital Leicester. UK
A.H. Gershlick*
SSDI 0167-5273(93)01919-O
Atlas of Intravascular Ultrasound
J.M. Hodgson, H.M. Sheehan (Editors) Raven Press, New York, NY, 1993; 351 pp.; US$145.00; ISBN O-7817-0013-2 Having developed a recent interest in intravascular ultrasound and with the department considering buying an intravascular ultrasound machine I was caught by this title and reviewed the book with anticipation. This book is a hard-back, large, glossy papered book comprising 320 pages plus. There are approximately 30 contributors indicating the extent to which intravascular ultrasound is currently being evaluated. There are 16 chapters comprising predominantly B mode with photographs, all of which are very clear but could have benefited from adjacent line diagrams. These chapters consist of clinical examples of different presentations of atheroma and post-angioplasty. It is unclear to what extent the pictures are representative of the type of lesion they are purporting to show. This goes to the core of the problem with intravascular ultrasound in that when we scan and it appears to show soft atheroma in the absence of histology from the same lesion the interpretation becomes, to some degree, speculative. However, this is much more an argument about the value or otherwise of intravascular ultrasound rather than the value of the book, although it does suggest that some of the dogmatic statements really need to be kept in perspective. The only really disappointing chapter was Chapter 16 on 3-dimensional imaging which has now progressed much further than is indicated in this book. The second half of the book consists of diagnostic cases and the value of these cases is to indicate where intravascular ultrasound may be helpful. In this context
Book revietvsilnt.
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43 (1994)
clinical implications are drawn. I think, personally, there is still a case for collecting information and subjecting it to clinical trials rather than what is outlined in this book. In some of the cases the operators have actually acted on the basis of data emanating from a very new technology. On the positive side this book is well presented and the layout is excellent. The photographs are clear and the writing is to the point. It covers all aspects of intervention including stent implantation. To what extent the book will be used is less clear. It may be of value to those just starting, like ourselves, and having read it a number of times it has given me a clearer idea of what to expect in terms of image and what the images mean. Clearly this is not the same as looking at the dynamic pictures. If there were another edition to the book then I would recommend that at the back all the images were collected together, perhaps in a smaller size so that there is a portfolio or atlas of imaging which would help accustom the eye to what it is likely to see. There are very few books that address this new topic and I would certainly recommend a glance at it for anyone starting intravascular ultrasound. Department of Cardiology Glenfield General Hospital Leicester, UK
A.H. Gershlick*
SSDf 0167-5273(93)01933-O
Heart Failure: Basic Science and Clinical Aspects J.K. Gwathmey, G.M. Briggs, P.D. Allen Marcel Dekker, New York, NY, 1993; 736 pp.; US$195.00;
ISBN O-8247-87772-2
The title of the final chapter alone ‘Heart Failure: Is the Pathology due to Calcium Overload or to Mismatch in Energy Supply and Demand?’ is sufftciently weird to raise the suspicion that the editors have little grasp of the clinical problem, or indeed broader basic aspects of heart failure. In the story about the Emperor’s Clothes, the emperor is naked but the populace is in fear of saying so lest they be thought stupid. Likewise many cardiologists fail to see the relevance of much basic research to clinical practice, though they perceive this as too heretical to vocalise and politely attribute the poor productivity, in terms of new solutions to clinical problems, to the low yield of long-term research. The majority of basic scientists have a very poor grasp of clinical medi*Associate Editor of the
Inrernutional
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111-113
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tine. This book exposes the weakness of the clinical knowledge of the majority of basic scientists rather than helping to bridge the gap. This book, with some notable exceptions, does not have a breadth of vision of the clinical problem of heart failure; the sections trying to justify the relevance of the basic research are either absent, weak or poorly clinically researched. However. the blame for the weakness of the link between clinical and basic science lies as much at the door of the clinician as the basic scientist, a large dose of mutual education is required. The book covers the role of calcium in excitationcontraction coupling extensively. Although calcium undoubtedly plays a fundamental role in a wide variety of intra-cellular processes, clinically, modification of calcium handling has been more a disappointment than a success in heart failure. The chapters on adrenergic neuro-transmission are one of the strongest aspects of the book; the mutual relevance of basic and clinical observations are better integrated here than elsewhere. Despite the singular lack of success of inotropic agents most of the book is devoted to this concept. The renin angiotensin system and ACE inhibitors, the outstanding area of success in heart failure in the last decade. are relegated to a mere 60 pages (less than 10”A1). Important areas such as the recently described polymorphisms in the various components of the renin angiotensin system and the characterisation of angiotensin 11receptors and their signal transduction pathways are not mentioned or only poorly described. Likewise endothelial function is covered in about 20 pages. However, the most discouraging feature is the almost entirely cardio-centric view of heart failure. Many of the most interesting pathophysiological aspects of heart failure and virtually all the successful therapies other than surgery, are mediated through extra-cardiac organs. Even digoxin. the one agent in clinical use that might still conventionally be considered inotropic, is now perceived to be a neuroendocrine modulator, a vasodilator and a diuretic. In conclusion this book serves to till some gaps in the knowledge of people who have already worked extensively in this area, but the book lacks proper perspective making it a poor primer for the clinician or basic scientist in this field. British Cardiac Society
Fitzroy Square. London, UK
SSDI
0167-5273(93)01940-Y
Dr J. Cleland