ATLAS OF PATHOLOGIC ANATOMY

THE BOOKSHELF MEDICAL MALPRACTICE LAW (2ud eel) •.By ANGJa.A R0DDEY HOLDER. New York. John Wiley and Sona. Inc.• 1978.562 pp. $25.00. Holder's book is comprebemive in coverage. It may dazzle or diabearten the tyro but DOt the physician with a speci6c medic0legal question. In my opinion, the strongest sectioo is that deaIiJc with negligence. especially in relation to proximate causation. There iI much here to bolster the spirits of the physician who is charged with negligence when only misadventure has in fact occurred. Holder properly upreaes the vast cUerence between emmI of judgment and true negligence. She repeats what the physician in despair often forgets. N. that in diagnosis and treatment,. negligence is not established until the physician can be shown to have deviated &om an accepted standard of care. Even more comforting. Holder says OIl page 141 that -m any malpractice action. there iI a presumption that due care has been used and the plaintiff bean the burden of proving the lack thereof." Holder goes on to say that reprdIea of clinical result, the best defense against a malpractice mit rests In proof that due care and "a reasouahle standard" were applied. 1Ddeed, in chapter 10. we learn that the physician iI DOt required to plOft that he was DOt negligent. The thomy problem of informed coasent apparently is equally veDng to physician and lawyer. It receives careful handling here. Holder emphasizes what Moote8ore HoIpitalln New York found in a deh"berate study. N. that patients with serious ailments forget and fabricate. The varyiDg constituent attitudes toward Informed consent testify to its nebulous and unsettled state before the law (Georgia has abandoned the doctrine of iDformed CODI8Dt 1ft toto).

The choice of words in the closing IeDtence of the last chapter faDs short of the highly seusitive 1aoguage which is a welcome and unusual feature of the work. Neverthelea, any physician with a cloud over hit head will surely pro8t from reading this lucid book. Dtmid P. Boyd, liD.• P.C.C.P. Bo.ttora

RE-ENTRANT ARRIIYTHMIAS: MECHANICS AND TREATMENT. By HENRI E. ltULBERTOS. Baltimore. University Park Press. 1977.372 pp. $39.50. The text edited by Henri E. ltulbertus is the result of a qmposium held in Liege. Belgium. in September 1976. This book is directed toward the serious scholar of arrhythmias. It has. as its spedflc task, to detail the contemporary JmowJedge ClClIDCIerDIng reentry as a mechanism of arrhythmias in man. The text hal a multidisciplinary approach, combining JepOl1I by experts c:oocemed with experimental studies in iJolated cardiac tissue. experimentation in whole animals. in the clinical eJecbophysiologic laboratory. and, 8naJ1y. obIervatioDs obtained with standard surface electrocardiograms. Three major sections deal with the three areas that have engendered the most interest, both clinically and experimentally. with regard to reentry as a mechanism. The first such sed:ioo contains reports dealing with reentry involving the sinoatrial node and atrium. A flDal communication in this sectioD coueIates pathologic anatomy with clinical atrial arrhythmias. Thus. the secon~ major section deals with junctional reentrant arrhythmias. Induding tboee UIOCiated with overt and covert acceaory pathways. The third major section deals with veDtricular arrhythmias. with a major emphasis on mecbaniams of arrhythmias in experimental ischemia and infarction. A 6Dal section eDCOmpasses a variety of diftenmt upectI of treatment of reentrant arrhytbmi~ ·lncluding medical therapy. pacemakers. and surgical therapy. . As is the cue with many recent textbooks which are the diJect reault of a symposium, this book BUffen from a 1aclc of completeness. Neverthe1els. this meetinI brought together many of the world's experts OIl arrhythmias. The quality of the reports in ICulbertus' book emphasiU!S this point clearly. 11Ie book is weD illustrated and has easily readable type. As a whole. this book is highly l8CQI"u!eOded for the serious student of arrhythmias. Moreover. it may be atiJizecl as a bale text for the cardiologist who wants to expand his bowledge of the mechanisms of and therapy for arrhythmias.

studies

William 1.

A-22

)I""".

us».• P.C.CoP. lMAngela

ATLAS OF PATHOLOGIC ANATOMY. By WII.IIEUI DoDll. CDIIILJ) 8cJrol.uNN. and GvNTER ULB (translator. David P. Winstanley). Stuttgart. West Germany (US distributor. PSG Publishing Co.• Ine., Littleton. Mass), 1978, Eng1iIh editIoD (originally 1975).307 PP. 874 color Illus, $89.50. The Atla.t of Pathologic Anatomy is a beautifuI1y produced book with a very high standard of iDustrations. Various disease processes are depicted with both gross and microBCOpic pictures. The text is kept to a minimum and mainly consists of pointing out the salient features of the individual illustrations. Doerr et a1 make good use of wbole-speci.men sections. The book is arranged by organ, with an occasional anomaly such as Figure 65. where a heart with a bicuspid aortic valve. subacute bacterial endocarditis. and a coarctation of the aorta appears under maHormations of vessels. The gross pictures are excellent and clear. but aD have a somewhat orange tint, whereas the color of the photomicrographs is true. Errors and points to disagree with are rare: Figure 218 spells iU with a ;; Figure 283 seems out of focus; the destruction of the neostriatum in Figure 757 is unconviDdng; and Figure 313 is slightly low magni 6cation to see the speciflc feature pointed out. This book is intended for students. interns. and physidanl participating in clinical-pathologic conferences. It will certainly 6nd a place as a reference but at $89.50 is unlikely to be found on many individual bookshelves. E. Teuo H...,.WhgI.. u s». Boaton BIBUOTHECA CARDIOLOGIA: CRITICAL EVALUATION OF CARDIAC REHABIUTATION (No. 36): Proceedings of the Scientific Meeting on Critical Evaluation of Cardiac Rehabilitation, Tel-Aviv. November-December 1975. Edited by J. J. ltBLLERMANN. Basel. Switzerland, S. ltarger AC. 1977. 186 pp. 29 iUus. approximately $27.00 (paperback). This book is the synopsis of an international symposium. The basic theme was an examination of the usefuJness of exercise for enhancing the process of rehabilitation after myocardial inf~ tion. AD authon are in either clinical practice or research In cardiac rehabilitation. and hence the viewpoint is biased; however. many different viewpoints are provided. The interrelationship between health and ezerciIe was presented as the introduction. The report presented an excellent review of the subject and set the stage for the remainder of the symposium, which dealt with patients who have cardiac dUeue. The subject of collateral circulation was discussed extensively in a report which provided an excellent theoretic treatment of the subject. The evidence relating clinical with experimental effects of conditioning was carefully sorted out, and its signi6caDce was

examined.

The formal inpatient rehabilitation institutions in Europe were described, and the results of patient experiences in such facilities were reviewed. The controversies between the benelts and drawbadcs of such inpatient facilities were aired, and a surprisingly good case could be made for inpatient treatme:nt, despite the expense. Financial support of such institutions was only mentioned briefly. since such treatment is covered by health insurance in those countries. The reports indicated enthUliastic acceptance by patients. The psychologic effects of exercise were extensively discuaed, mostly from results of standard tests. The potentially favorable effects of such programs were pointed out in detail. Almost aD participants agreed that the feebng of weD-being which the programs generate is an important benefit. A .preliminary report of studies to determine the elfects of exercise conditioning with low-level and closely mouitored eurcise in the period immediately after infarction was preseuted. The variables relating to outcome will be the rate of return to work. the time for discharge. and the presence of complications. The studies should be ready for analysis in the next few yean. The effects of exercbe OIl the rate of reemployment and health care requirements demonstrate a change in emphasis in recent years in research OIl the elfects of exercise on the process of rehabilitation. The message seemed to be that longevity and reinfarction do not provide useful end-points for study. and other more short-term goals are now being sought. The entire book reviews general principles and provides references to previous work. It is not a book to be used. by the beginner to learn techniques. It does provide a statement of the "state of the art" of exercise rehabilitation. Hence the book is a reference to detenniDe what is accepted about what caD and