ATLAS OF TOPOGRAPHICAL AND APPLIED HUMAN ANATOMY, VOL. II, THORAX, ABDOMEN AND EXTREMITIES.

THEO-DUR™ Enduring Action Anhydrous Theophylline Sustained Action Tablets Dllcrlll. .: THEa-OUR Sustained Action Tablets contain anhydrous theophylline, with no color additives. Act. ..: The pharmacologic actionS of theophylline are as a bronchodilator, pulmonary vasodilator and smooth muscle relaxant since the drug directly relaxes the smooth muscle of the bronchial airways and pulmonary blood vessels. Theophylline also possesses other actions typical of the xanthine derivatives: coronary vasodilator, diuretic, cardiac stimulant. cerebral stimulant and skeletal muscle stimulant. The actions of theophylline may be mediated throuah inhibition of phosohodiesterase and a resultant increase in intracellular cyclic AMP which could mediate smooth muscle relaxation. 1III1cII...: Symptomatic relief and/or prevention of asthma and reversible bronchospasm associated with chronic bronchitis and emphysema. C. .,.IIIIIcII...: THEa-OUR is contraindicated in individuals who have shown hypersensitivity to any ofits components orxanthine derivatives. .......: Excessive theophylline doses may be associated with toxicity; serum theop~mne levels should be monitored to assure maximum benefit with minimum risk. Incidence of toxicity increases at serum levels greater than 20 mcg/ml. HiOh blood levels of theophylline resultinq from conventional doses are correlated with clinical manifestations of toxicity an: patients with lowered body plasma clearances, patients with liver ~function or chronic obstructive lung disease, and patients who are older than 55 years of . , particularly males. -There are often no early signs of less serious theophylline toxicity such as nausea and restlessness, which may ~ in up to 50% of patients prior to onset of convulsions. Ventricular arrnymmias or seizures may be the first signs of toxicity. Maor patients who have higher theophylline serum levels exhibit a tachycardia. Theophylline products may worsen pre-exlsting arrhythmias. ~ II "-lIe,: safe use in pregnancy has not been established relative to possible adVerse effects on fetal develoornent, but neither have adverse effects on fetal development been established. This is, unfortunately. true for most antt-asthmatic medications. Therefore, use of theophylline in pregnant women should be balanced against the risk of uncontrolled asthma. PrIcIII...: THEa-OUR TABLETS SHOULD NOT BE CHEWED OR CRUSHED. Theophyllines should not be administered concurrently with other xanthine medications. It should be used with caution in patients with severe cardiac disease, severe hypoxemia. hypertension, hvDerthyroidism. acute myocardial injury, cor pulmonale, congestive heart failure,-liver disease and in the elderly. particularly males, and in neonates. Great caution should be used in giving theophylline to patients in ~stive heart failure since these patients show markedly prolonged ~lIine bloOd level curves. Use theophylline cautiouslY in patients with history of peptic ulcer. T~hylline may occasionally act as a local irritant to G.I. tract althoUgh gastrointestinal symptoms are more commonly central and associated with high serum concentrations above 20 meg/mi. AnIrII 1IIIct-.: The most consistent adverse reactions are usually due to overdose and are: Gastrointestinal: Nausea, vomiting, epigastric pain, hematemesis, diarrhea. Central Nervous System: Headaches, irritabilitY, restlessness, insomnia, reflex hyperexcitability, muscle twitching, clonic and tonic generalized convulsions. CardioVascular: PalPitation, tachycardia, extrasystoles, flushing, hypotension, circulatory failure, lifethreatening ventricular arrhythmias. Respiratory: Tachypnea. Renal: Albuminuria, increased excretion of renal tubular cells and red blood cells; potentiation of diuresis. Others: Hyperglycemia and inappropriate ADH syndrome. .... ........: THEO-OUR 100 mg, 200 rng and 300 mg Sustained Action Tablets are available in bottles of100. 1000, and 5000. and in unit dose packages of100 (20x 5's). CIlIa.: FEDERAL LAW PROHIBITS DISPENSING WITHOUT A PRESCRIPTION. Fex full prescribifIIJ informatiOn. S88 package insert. 077t

ZERO-ORDER dc/dt=K™ (Constant rate absorption by GI infusion)

THE BOOKSHELF ATLAS OF TOPOGRAPffiCAL AND APPLIED HUMAN ANATOMY, VOL. II, THORAX, ABDOMEN AND EXTREMITIES. 2nd Revised Edition. Edited by HELMVT FERNBB. Baltimore, Urban and Schwarzenberg, 1980. 418 pp, $98.

This imposing book is from Vienna and rendered into English by Harry Monsen of Chicago. The late Dr. Frank H. Lahey once said that Britishers and Continentals are good surgeons because anatomy is so thoroughly drilled into them in the undergraduate curriculum. The surgical specialist in Europe is after a superlative anatomist. Dr. Lahey added, with perhaps less emphasis, that some of our American surgeons are competent anatomists because they do so much surgery. This reviewer spent five years as an undergraduate student at McGill Medical School as did all his classmates. One and one-half years were given to basic science, and gross anatomy accounted for three hours per day. When the medical curriculum was reduced to the standard North American four years, anatomy was high amcmg the casualities. The teaching of this subject has been the victim of every burgeoning specialty from genetics to legal medicine. At a Trustees meeting at the Countway Ubrary of Medicine at Harvard, the Curator said that he bad found, buried in the cellar, a &rst edition of Gra,l' Anatomy. It bad Otiver Wenden Holmes' book plate in it. The Curator said that he knew of no other text in continuous use at Harvard Medical School for over 100 years. He added that Henry Gray died of smallpox when he was 33, accounting for the fact that it was never revised by its author. The book under review, like others in the past, bids for Grays exalted position. The superb yet restrained color, the ingenuity of combining routine dissection exposures' with multiple colored cross sections make it a superb teaching vehicle. Even the fearsome area of neuro-anatomy as it is appropriate to the cavities and the extremities is lucid and intelligible. The editing of this book is terse but quite complete. Nevertheless, it is an atlas and one suspects that the tyro will use it with Gray by his side. The three areas treated in this Volume II, thorax, abdomen, and extremities are uniformly good. While the price is high, the price of not knowing anatomy in surgery could be infinitely higher. The word applied in the title is proper. Many of the drawings obviously have the surgeon in mind. Furthermore, gross anatomy is related to x-ray appearance in certain areas. This is a most useful device. Human anatomy cannot be made easy. It can be made clear and interesting. This book does this very effectively. It is worth its fairly high mat• Dadd P. Boyd, MD., F.C.CeP.

Bomm.MA

CURRENT CONTROVERSIES IN CARDIOVASCULAR DISEASE. ELLIOT RApAPORT, editor. Philadelphia: W. B. Saunders Co., 1980, 761 pp, $39.50. Reading about controversy awakens our senses and can sharpen our judgment. The editor of this text has asked "each author to present his own experience and viewpoint without attempting to exaggerate the case for the sake of argument." At flrst, this editorial potiey disappointed me. If, for example, I were writing in support of the proposition that bypass surgery prolongs Hfe, I would not neglect, as this text does, the multicenter European randomized prospective study. (This group has followed-up several hundred randomized patients for three to five years and found that triple vessel disease and normal ventricular function is best treated surgically: 93 percent surgical survival vs 84 percent medical, P .001). Further reading of this text, however, reminds us that as physicians we must not only look for research supporting our beliefs. We must constantly inform ourselves as to the Hmita-

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