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Cerebral infarction: The role of stenosis of the extracranial arteries
Rook reviews
“It is clear that when he came to write the notes, he had been making his experiments and observations on the heart and circulation for a long time. When talking of the systole and diastole of the heart, on folio 77v, he writes, ‘Having observed [the motion of the heart] for whole hours at a time, I was unable to discern [these things] easily by sight or touch, wherefore I propose that you ought to observe and note.’ Certainly he had already come to definite conclusions about the circulation, for on folio 79v he states dogmatically: ‘The heart having been extended and contracted, just as by a kind of force it propels from the right [ventricle] into the lungs, from the left into the aorta; wherefore [occurs] the pulse of the arteries . . .’ Again, on folio 78v, he says, ‘Hence the pulse of the artery [is] not from an innate faculty of the valves as according to Galen 13, but by the heart thrusting forth [as is indicated] by autopsy in the live and dead, by reason [and] by experiment with ligatures.’ His views on the origin of the heart beat are clearly set down on folio 77v: ‘The pulse begins at the auricles and progresses to the point, wherefore as if [there were] two wings WH. Nevertheless the heart beats when separated from the auricles and the auricles awaken the somnolent heart.’ These remarks could only follow prolonged observations on dissections of living animals. Finally, on folio 80” is the conclusive statement, ‘. . . wherefore the beat of the heart produces a perpetual circular motion of the blood’.” * This book is exactly what one would expect of the distinguished translator-editors. It is a scholarly and sensitive presentation of a phase of William Harvey’s work that had remained in undeserved obscurity until now.
PHYSIOLOGICAL AND PATHOLOGICAL AGING. By V. Korenchevsky, M.D.; edited by Geoffrey H. Bourne, D.Sc., D.Phil., F.Z.S., Professor and Chairman of Anatomy, Emory University, Atlanta, Ga. New York, 1961, Hafner Publishing Company, 514 pages. Price $22.50. This monograph was written by Dr. V. Korenchevsky, who was born in Russia in 1880. He organized the Oxford Gerontological Unit in 1945, which he headed until he retired in 1952. He transferred this unit to St. Bartholomew’s Hospital in London, where he now concentrates on the medical literature concerned with aging. This book is a compendium of the author’s own experience and concepts and represents the fruits of his efforts. It is a summary of problems on aging and concerns a review of the literature, without, unfortunately, the author’s evaluation of the literature. It contains a summary of many papers from the Russian literature, an aspect that should be of interest to those who cannot read Russian. Again, however, the author fails to indicate his opinion of the importance or reliability of these reports. The monograph is divided into chapters which are concerned with each of the major systems or physiologic processes, e.g., aging of cells, con-
845
nective tissue, endocrine glands, heart, kidney, nervous system, and others. The chapter entitled “Causes of Aging” is limited to 2 pages, and is almost worthless. There are many interesting aspects of aging that could have beeu included in this chapter, such as data obtained in the fields of biology other than medicine, including genetics. Unfortunately, this book contains a mass of facts which are not presented critically or in an interesting fashion. The monograph is dull but may interest those who have read little on the subject of aging. It repeats a great deal of the material found in other monographs on aging, such as Cowdry’s book. Anyone interested in the aging process should at least glance over this book, but if he is already well informed, he will not find many exciting, stimulating, or new ideas here. It is well recognized that the aging process is poorly understood, but the great need is for concentrated, clear thinking on the subject, using the data already published only as a background.
CEREBRAL INFARCTION: THE ROLE OF STENOSIS OF THE EXTRACRAXIAL ARTERIES (Medical Research Council Special Report No. 300). By Peter 0. Yates and Edward C. Hutchinson, London, 1961, Her Majesty’s Stationery Office, 95 pages (British Information Service, New York, American agent). Price $2.65. Complete postmortem examination of the cerebrovascular tree from the aorta to the brain was done in 100 persons who died with clinically recognized cerebral ischemia in the Manchester Royal Infirmary during the years 1955 and 1956. Thirty-one persons who died from known cerebral hemorrhage during the same period were omitted, as were persons with cerebral infarction not associated with degenerative cerebrovascular disease. Patients with symptoms which were primarily psychiatric or with long histories of remitting illness tended to be excluded since they were not admitted to this hospital. Both carotid and both vertebral vessels were injected with a radiopaque gelatine mixture, and dissection of the vessels was carried out as indicated by radiographs. Cerebral infarction was found in 35 of the 100 subjects. Very few cases were due to local arterial occlusion with complete cessation of blood flow. In only 22 of the 3.5 subjects was there significant stenosis or occlusion of intracranial arteries, but 32 had significant stenosis of the extracranial portions of the cerebral arteries. Thus, in more than one third of the subjects who had cerebral infarction, neither occlusion nor significant stenosis of the intracranial cerebral arteries was found. Systemic factors, such as hypotension and anemia, were emphasized. Case summaries, autopsy findings, and maps of the vascular and cerebral lesions are provided on each patient with cerebral infarction. The authors conclude that cerebral infarction usually results from a combination of systemic disease and stenosis of extracranial arteries, in-
846
Book reviews
tracranial arteries, or both. Disease of the extracranial arteries was more often associated with cerebral infarction than was disease of the intracranial vessels.
HEMODYNAMICS OF AORTIC AND MITRAL VALVE DISEASE. By Alvin J. Gordon, M.D., Associate Attending Physician and Head of the Cardiac Catheterization Team, The Mt. Sinai Hospital, New York; Consultant for Cardiac Clinical Investigation, Beth-El Hospital, Brooklyn, N.Y.; Paul A. Kifschner, M.D., Assistant Attending Surgeon, The Mt. Sinai Hospital, New York; Associate in Surgery, Columbia University; Associate Visiting Surgeon, Chest Service, Bellevue Hospital, New York; Attending Thoracic Surgeon, Veterans Administration Hospital, Bronx, N.Y.; and Howard L. Moscovitz, M.D., Assistant Attending Physician, The Mt. Sinai Hospital, New York. New York, 1961, Grune & Stratton, Inc., 136 pages. Price $5.75. This monograph of personal experience with transbronchial left heart catheterization reviews briefly the technique and interpretation of pressure pulses in rheumatic mitral and aortic disease. Although transseptal techniques have probably replaced most transbronchial approaches to the left heart, the basic data will be unchanged. The great care taken to secure precision in pulse contours is capped by the elegant electronic derivation of mean pressure gradients (a welcome change from the peak gradients frequently used), which permits greater clarity of physiologic interpretation of other events (murmurs, opening snaps, atria1 waves, etc.) However, clinical interpretations of the valve gradients so obtained are limited by the omission of any determination of cardiac output, or of exercise studies. Selection of candidates (now and in the future) for open or closed mitral and aortic operations requires evaluation of the heart both as a flow and a pressure generator, and under conditions of stress.
Am. Ileart J. June, 1962
The chapter on techniques is useful in its detail. Some graphic illustrations of artefacts and poor recording would be helpful. The text is clear and the reproductions are excellent. The book is a useful basic guide to the subjects covered. Angiocardiography is not discussed.
THROMBOSIS AND ANTICOAGULANT THERAPY. Proceedings of a Symposium arranged by Professor P. A. Owren. Professor R. B. Hunter. and Dr. W. Walker and’ held in Queen’s College, -Dundee, Scotland, on Sept. 29 and 30, and Oct. 1, 1960. Edited by W. Walker, Dundee, 1960, D. C. Thomson & Co., Ltd., 106 pages (Williams & Wilkins Company, Baltimore, exclusive U. S. agents). Price $4.25. This is a summary of papers and discussions on thrombosis and anticoagulant therapy presented at Queen’s College, Dundee, Scotland, September 29 through October 1, 1960. The publication was rather slow in appearing, but it still is up to date since little new has developed since then anyway. The symposium was attended by many experts in the field under the sponsorship of the University of St. Andrews. There was nothing especially exciting discussed at the meeting. However, those who do not follow the literature on the subject will find this monograph very useful and interesting. They will find nothing new to support the use of anticoagulants nor any new evidence against their use. This symposium, however, was held before the report of the interesting study from Copenhagen appeared in Lancet (August 12, 1961). The twenty-four papers included in the symposium are well written and well illustrated. The last four pages contain discussions by those present. This is a relatively small but well-written and good symposium on thrombosis and the use of anticoagulants, which should be of interest to clinicians as well as those who are studying the problems of thrombosis and embolism.
Announcement MEDICAL RESEARCH GRANTS: The Life Insurance Medical Research Fund is now receiving applications for awards to be available July 1, 1963, as follows: Until Nov. 1, 1962, for grants to institutions in aid of research on cardiovascular problems, Support is available for physiological, biochemical, and other basic work broadly related to cardjo-
vascular problems as well as for clinical research in this field. Further information and application forms may be obtained from the Scientific Director, Life Insurance Medical Research Fund, 1030 East Lancaster Ave., Rosemont, Pa.
“It is clear that when he came to write the notes, he had been making his experiments and observations on the heart and circulation for a long time. When talking of the systole and diastole of the heart, on folio 77v, he writes, ‘Having observed [the motion of the heart] for whole hours at a time, I was unable to discern [these things] easily by sight or touch, wherefore I propose that you ought to observe and note.’ Certainly he had already come to definite conclusions about the circulation, for on folio 79v he states dogmatically: ‘The heart having been extended and contracted, just as by a kind of force it propels from the right [ventricle] into the lungs, from the left into the aorta; wherefore [occurs] the pulse of the arteries . . .’ Again, on folio 78v, he says, ‘Hence the pulse of the artery [is] not from an innate faculty of the valves as according to Galen 13, but by the heart thrusting forth [as is indicated] by autopsy in the live and dead, by reason [and] by experiment with ligatures.’ His views on the origin of the heart beat are clearly set down on folio 77v: ‘The pulse begins at the auricles and progresses to the point, wherefore as if [there were] two wings WH. Nevertheless the heart beats when separated from the auricles and the auricles awaken the somnolent heart.’ These remarks could only follow prolonged observations on dissections of living animals. Finally, on folio 80” is the conclusive statement, ‘. . . wherefore the beat of the heart produces a perpetual circular motion of the blood’.” * This book is exactly what one would expect of the distinguished translator-editors. It is a scholarly and sensitive presentation of a phase of William Harvey’s work that had remained in undeserved obscurity until now.
PHYSIOLOGICAL AND PATHOLOGICAL AGING. By V. Korenchevsky, M.D.; edited by Geoffrey H. Bourne, D.Sc., D.Phil., F.Z.S., Professor and Chairman of Anatomy, Emory University, Atlanta, Ga. New York, 1961, Hafner Publishing Company, 514 pages. Price $22.50. This monograph was written by Dr. V. Korenchevsky, who was born in Russia in 1880. He organized the Oxford Gerontological Unit in 1945, which he headed until he retired in 1952. He transferred this unit to St. Bartholomew’s Hospital in London, where he now concentrates on the medical literature concerned with aging. This book is a compendium of the author’s own experience and concepts and represents the fruits of his efforts. It is a summary of problems on aging and concerns a review of the literature, without, unfortunately, the author’s evaluation of the literature. It contains a summary of many papers from the Russian literature, an aspect that should be of interest to those who cannot read Russian. Again, however, the author fails to indicate his opinion of the importance or reliability of these reports. The monograph is divided into chapters which are concerned with each of the major systems or physiologic processes, e.g., aging of cells, con-
845
nective tissue, endocrine glands, heart, kidney, nervous system, and others. The chapter entitled “Causes of Aging” is limited to 2 pages, and is almost worthless. There are many interesting aspects of aging that could have beeu included in this chapter, such as data obtained in the fields of biology other than medicine, including genetics. Unfortunately, this book contains a mass of facts which are not presented critically or in an interesting fashion. The monograph is dull but may interest those who have read little on the subject of aging. It repeats a great deal of the material found in other monographs on aging, such as Cowdry’s book. Anyone interested in the aging process should at least glance over this book, but if he is already well informed, he will not find many exciting, stimulating, or new ideas here. It is well recognized that the aging process is poorly understood, but the great need is for concentrated, clear thinking on the subject, using the data already published only as a background.
CEREBRAL INFARCTION: THE ROLE OF STENOSIS OF THE EXTRACRAXIAL ARTERIES (Medical Research Council Special Report No. 300). By Peter 0. Yates and Edward C. Hutchinson, London, 1961, Her Majesty’s Stationery Office, 95 pages (British Information Service, New York, American agent). Price $2.65. Complete postmortem examination of the cerebrovascular tree from the aorta to the brain was done in 100 persons who died with clinically recognized cerebral ischemia in the Manchester Royal Infirmary during the years 1955 and 1956. Thirty-one persons who died from known cerebral hemorrhage during the same period were omitted, as were persons with cerebral infarction not associated with degenerative cerebrovascular disease. Patients with symptoms which were primarily psychiatric or with long histories of remitting illness tended to be excluded since they were not admitted to this hospital. Both carotid and both vertebral vessels were injected with a radiopaque gelatine mixture, and dissection of the vessels was carried out as indicated by radiographs. Cerebral infarction was found in 35 of the 100 subjects. Very few cases were due to local arterial occlusion with complete cessation of blood flow. In only 22 of the 3.5 subjects was there significant stenosis or occlusion of intracranial arteries, but 32 had significant stenosis of the extracranial portions of the cerebral arteries. Thus, in more than one third of the subjects who had cerebral infarction, neither occlusion nor significant stenosis of the intracranial cerebral arteries was found. Systemic factors, such as hypotension and anemia, were emphasized. Case summaries, autopsy findings, and maps of the vascular and cerebral lesions are provided on each patient with cerebral infarction. The authors conclude that cerebral infarction usually results from a combination of systemic disease and stenosis of extracranial arteries, in-
846
Book reviews
tracranial arteries, or both. Disease of the extracranial arteries was more often associated with cerebral infarction than was disease of the intracranial vessels.
HEMODYNAMICS OF AORTIC AND MITRAL VALVE DISEASE. By Alvin J. Gordon, M.D., Associate Attending Physician and Head of the Cardiac Catheterization Team, The Mt. Sinai Hospital, New York; Consultant for Cardiac Clinical Investigation, Beth-El Hospital, Brooklyn, N.Y.; Paul A. Kifschner, M.D., Assistant Attending Surgeon, The Mt. Sinai Hospital, New York; Associate in Surgery, Columbia University; Associate Visiting Surgeon, Chest Service, Bellevue Hospital, New York; Attending Thoracic Surgeon, Veterans Administration Hospital, Bronx, N.Y.; and Howard L. Moscovitz, M.D., Assistant Attending Physician, The Mt. Sinai Hospital, New York. New York, 1961, Grune & Stratton, Inc., 136 pages. Price $5.75. This monograph of personal experience with transbronchial left heart catheterization reviews briefly the technique and interpretation of pressure pulses in rheumatic mitral and aortic disease. Although transseptal techniques have probably replaced most transbronchial approaches to the left heart, the basic data will be unchanged. The great care taken to secure precision in pulse contours is capped by the elegant electronic derivation of mean pressure gradients (a welcome change from the peak gradients frequently used), which permits greater clarity of physiologic interpretation of other events (murmurs, opening snaps, atria1 waves, etc.) However, clinical interpretations of the valve gradients so obtained are limited by the omission of any determination of cardiac output, or of exercise studies. Selection of candidates (now and in the future) for open or closed mitral and aortic operations requires evaluation of the heart both as a flow and a pressure generator, and under conditions of stress.
Am. Ileart J. June, 1962
The chapter on techniques is useful in its detail. Some graphic illustrations of artefacts and poor recording would be helpful. The text is clear and the reproductions are excellent. The book is a useful basic guide to the subjects covered. Angiocardiography is not discussed.
THROMBOSIS AND ANTICOAGULANT THERAPY. Proceedings of a Symposium arranged by Professor P. A. Owren. Professor R. B. Hunter. and Dr. W. Walker and’ held in Queen’s College, -Dundee, Scotland, on Sept. 29 and 30, and Oct. 1, 1960. Edited by W. Walker, Dundee, 1960, D. C. Thomson & Co., Ltd., 106 pages (Williams & Wilkins Company, Baltimore, exclusive U. S. agents). Price $4.25. This is a summary of papers and discussions on thrombosis and anticoagulant therapy presented at Queen’s College, Dundee, Scotland, September 29 through October 1, 1960. The publication was rather slow in appearing, but it still is up to date since little new has developed since then anyway. The symposium was attended by many experts in the field under the sponsorship of the University of St. Andrews. There was nothing especially exciting discussed at the meeting. However, those who do not follow the literature on the subject will find this monograph very useful and interesting. They will find nothing new to support the use of anticoagulants nor any new evidence against their use. This symposium, however, was held before the report of the interesting study from Copenhagen appeared in Lancet (August 12, 1961). The twenty-four papers included in the symposium are well written and well illustrated. The last four pages contain discussions by those present. This is a relatively small but well-written and good symposium on thrombosis and the use of anticoagulants, which should be of interest to clinicians as well as those who are studying the problems of thrombosis and embolism.
Announcement MEDICAL RESEARCH GRANTS: The Life Insurance Medical Research Fund is now receiving applications for awards to be available July 1, 1963, as follows: Until Nov. 1, 1962, for grants to institutions in aid of research on cardiovascular problems, Support is available for physiological, biochemical, and other basic work broadly related to cardjo-
vascular problems as well as for clinical research in this field. Further information and application forms may be obtained from the Scientific Director, Life Insurance Medical Research Fund, 1030 East Lancaster Ave., Rosemont, Pa.