Blood flow in arteries

146

Book reviews

chest physician should find the sections on cardiovascular physiology and disease quite useful. Perhaps the greatest over-al! values could be derived for the physiologically oriented genera! internist and thoracic surgeon. From the cardiological \,iew, a few specilic points bear mention. One might expect to find in this volume more thorough coverage of basic principles of electrocardiography and vectorcartliography. Only a total of 16 pages is devoted to both of these subiects. ‘This seems c!isoroDortiolJ. . ate in comparison to 26 pages on phonorardiography and 14 pages on cinecardionngiography. In a volume such as this, one might expect to find emphasis on pathophysiologic mechanisms, yet csp!anations of such phenomena ;Js pulsus paradosus, pulsus alternans, gallop rhythms, atrscultatory gaps, etc., are inadequate. OnI>- 7 pages arc allotted to a chapter on hypertension, and o\-er half of this deals with therapy. A chapter is devoted to resuscitation, yet little mention is made of closed-chest resuscitative procedures. OJJe chapter deals with peripheral \xscu!ar physiology, but this is incomplete and contains little information on peripheral vascular disease. This reviewer feels that the \xJlume would be much more useful if subjects not adequately rox.ered (e.g., therapy of many disease states) had beeu omitted entirely, and the resulting space had been allotted to an expanded coverage of pnthophysiologic mechanisms. In genera!, each of the chapters presented is supported by key references to the literature. This is a valuable asset aJJd as such helps support this volume as a reference work. =Is a reference work, however, a gross deficiency lies in the index, in which the listings to specific items covered in the text are somewhat inadequate. In summary, regardless of the foregoing criticisms, this is a valuable work. Although occasionally incomplete in depth, it is vast in scope and it serves as a convenient review of this major held of medicine. Some of the contributions are trul) outstanding for the space allotted. In genera!, the volume is clearly written. The paper, printing, and illustrations are of excellent qualit\,.

ccJ!!ected and A systematic approach t,l the roentgcn esnminatiou of the chest is outliJJed. NO attempt is made to describe al! of the diseases oi the chest or a!! of the thoracic- aspects of systemic, diseases since this has been successfully ;~~~onplished in other textbooks. Instead, after r!ca!iJJg \vith the essentials of fluoroscopy and iflustrxtitlg the use of the lxrious projections and spet+J! methods in chest roentgenography, the allthor goes ou to discuss the interpretation of chest s-m! tihns in terJns of the anatomic elements Well ON the films. lie considers separately: the lobes, the segments, the hili, vessels and lymph J&es, the pleura, the extrapleural spare and diaphragm. !Ir gives special attention to the localization of intrathoracic lesions, emphasizing the si!holJcttc sign which he has popularized and the air branchogram. A ntJmber of other special chest s-ra> signs are presented in a later chapter. ‘l‘his book will be of great value for all those interested in the diagnosis of disease within the chest. This includes the radiologist, the specialist in pulmonary tlisenses, the cardiologist, the surgeon, aJJd the general physician. ‘!-he cardiologist will find the following features of special interest: the book oirers a very clear statement concerning many of the pulmonary lesions associated with heart disease; the changes which occur within the lungs along the borders of the heart and the great vessels are we!! illustrated; an extended discussiorl of the appearances of the pulmonary arteries and \-ein5 and the chauges in their appearanc’e iu the course of cartliw and other diseases is presclltctl ; the limits of interpretation concerning appearances of pulmonary arteries ant! Yeins are we!! drawn. The signiticnnce of peculiar shadows, such as the densitv sometimes seen behind the right heart, is explained; it is a reflection of the pleura at a point where the pulmonary \-eins come together. This exceI!ent monograph is peppered with instances of the author’s well-known wit--an added dividend to this fine contribution to the l~nderstanding of intrathoracic diseases.

FLOW rii r~KTIiKIES. By Donald :\. ~McI)ona!d, M.A., D.M. (Oxon.), D.Sc. (Land.), Reader iJr Phvsiologv in the IVniversity of London at the Medical. ?oI!ege of St. Bartholomew’s Hospital, London. England. London. 1960. W. & 1. Mac&\. & Co., ‘Ltde; Baltimore, \~~illinm & \
FUNDAMESTALSOF CHEST ROENTGENOLOGY. By Renjamin Felson, M.D., Professor and Director, Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Director, Departments of Radiology, Cincinnati General, Children’s, Daniel Drake, Dunham, Christian R. Holmes, and Longview Hospitals; Special Consultant, 1 J.S.P.H.S.; and Consultant to the Dayton and Cincinnati Veterans Administration Hospitals. Philadelphia, 1960, \2’. B. Saunders Company, 301 pages, 450 illustrations on 238 figures. Price $10. This work expresses the knowledge and personalit> of an outstanding radiologist who has made important contributions to the roentgenology of the chest. His observations have been published over the years in various journals devoted to r-rays and the chest. In this volume many of them are

This monograph contains a hydrodynamic analysis of pulsatile Row patterns in the circulation, whic,h is \-iewed as a system in a steady-state of oscillation. This contrasts with the conventional stud! of pulsatile pressure changes and the use of the \Vindkesse! analogy of Otto Frank. The latter approach 1s believed by the author to have outgrown its usefulness. The scope and flavor of this book are indicated by the table of contents, which lists chapters dealing with the nature of flow in a liquid, characteristics of b!ood flow in the circulation, disturbances iJl blood flow due to the configura-

Book reviews

tion of the vascular bed, pressure-flow relationship of oscillatory flow, measurement of phasic flow velocity, pulsatile flow pattern in arteries, physical properties of the arterial wall, pulsatile flow in an elastic tube, wave reflection, design of manometers, shape of the pressure pulse wave, and the estimation of cardiac output from pressure recordings. Each topic is treated concisely and critically. The author clearly develops and supports his own points of view. Experimental limitations and difficulties as well as areas of ignorance are clearly pointed out. This book should be most useful to the physiologist who wishes a thorough survey of this particular area. The physiologically oriented clinician may be frightened away by the plethora of mathematical formulae and by the technical nature of much of the discussion. If he gets into this work, he will find that the text is understandable and profitable. He may suspect the author of pleasurably flexing his technical muscles at times, occasionally losing sight of the topic or goal at hand. Although the author regards this approach as the most promising one for the future, there are no revelations for the physician beset by the problems of hypertension or arterial obstruction. The style and format are in tradition expected from the best British publications on physiology. This book can be enthusiastically recommended to the audience for which it is intended-the physiologists of the present and future.

systetn ; unconciousness; and disturbance of water and electrolyte balance as well as pH equilibration. This book gives the best confirmation for the author’s point of view that only through a total synthesis of all information gained from the study of patients is the possibility for rational medical action gained. In this capacity the stud! of Hegglin’s Differentialdiagnose can be readily recommended to the specialist. For instance, for the cardiologist it is most exciting and worth while to read the author’s ideas concerning the numerous relationships of cardiovascular diseases to diseases of other organ systems. Before the preface to the seventh edition, the author has placed the sentence: “The secret of modern internal medicine is based on the conception and coordination of the efforts of its specialists.” This difficult task has been fully realized by Hegglin. The dedication of the seventh edition to K. Jaspers as the mentor for medical unit) should give an impulse to all to remember this goal.

DIE BEHANDLUNG DER SAVID” UND ASDEKEN

INNERER

KRANKHEITEN

In the preface to the first edition, published in 1952, Hegglin points out two items which he hopes will give special value to his book: that the pronouncement of general principles and general lines of orientation may fully compensate for the lack of knowledge in some special details, and that Lhe methods of description may give an easier view for students and practitioners. The further six editions within seven years have shown that this target has been reached in every respect. As far as possible, the grouping of the diseases has been arranged according to pathophysiologic ideas. The details of description are: general aspects; anemias; hemorrhagic diathesis; febrile states; headache: dyspnea; arrhythmias: electrocardiographic changes; cyanosis; thoracic pain; hypertension; hypotension : pulmonary infiltrations; hilar enlargements; enlarged lymph nodes; lymphoma; abdominal pain; diarrhea; obstipa{ion; jaundice; splenomegaly; hematuria; proteinuria; pyuria; cylindruria; edema; pains in arms, legs, and spine; paralysis of the motor

ANGINA PECTORIS MIT MONOA~;IINOXYDASEHE~MERX

“TEK-

(Treatment of Angina Pectoris With “Tersavid” and Other Monoamine Oxidase Inhibitors). Supplement II to Volume 37 of Curdiologia. Bascl, 1960, S. Karger, 288 pages, 51 illustrations. Available in U.S.A. through Albert J. Phiebig, P.O. Box 352, White Plains, N.Y. Price $10.60. The

(Differential Diagnosis of Internal Disease). By Prof. Dr. Robert He&in. Professor fiir innere Medizin. Universitft Zu%h, ‘Zurich, Switzerland; Direkto; der Medizinischen, Universit?its-Poliklinik. Seventh revised edition, Stuttgart, 1960, Georg Thieme, 913 pages. Price: DM 79.50. (In the U.S.A. and Canada, Intercontinental Medical Book Corp., New York.) DIFFERENTIALDIAGNOSE

147

papers read at Lugano, in October, 1959, at a meeting of pharmacologists, toxicologists, and physicians to discuss the treatment of angina pectoris with “Tersavid” and other monoamine oxidase inhibitors are reported in this supplement to Cardiologia. The theoretical aspects of the use of monoamine oxidase inhibitors and the clinical experiences with these agents in angina pectoris are reported. However, most of the experiments reported prefitninary data, and the rfinicaf experiences of most investigators were based on a relatively small series of patients. The point is well made that the clinical use of the so-called monoamine oxidase inhibitors has preceded adequate biochemical and pharmacologic knowledge of the actions of these agents. It is stated that the clinician has had to point the way for the basic investigations of these agents. \\‘hether this is necessarily good remains to be seen. A second point of consideration is the lack of a substantial number of long-term experimental studies. The use of reserpine and now the use of MAO inhibitors has pointed to the need for experiments designed to study the long-term effects of drugs, at least 3 to 6 months. Often the effects seen on the second or third daJ- in the pretreated animal are quite different from the immediate effect. This point should indicate that the pharmacologic basis for the use of these agents will require considerable investigative time. In the section on theoretical aspects an attempt