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specialty. The update deals with—in addition to prior standard thoracic surgical topics—myocardial preservation, surgical intervention for coronary artery disease and its recurrence and associated survival, surgical treatment of cardiac arrhythmias, cardiac transplantation, and the artificial heart. The text has numerous illustrations that depict pathologic features and surgical techniques. The one weak area of the text may be the less-than-optimal quality of some of the drawings and radiographic reproductions, a frequent finding in multiple-authored works. There is little question about the appeal of this text. Any student, resident, or consultant of the thoracic surgical discipline would benefit from the material in the book. It contains the basics for the student, specific techniques for the resident, and a panorama and depth for the staff consultant. This is, in short, an excellent text for reference and review for anyone interested in thoracic surgical diseases. Thomas A. Orszulak, M.D. Department of Surgery

Medical Emergencies: Diagnostic and Management Procedures From the Boston City Hospital, 2nd ed, edited by Alan S. Cohen, John R. Combes, and Howard K. Koh, 341 pp, with illus, $29.50, Boston, Little, Brown & Company, 1983 During the past few years, the number of new volumes dealing with emergency medicine has increased dramatically as the specialty has become more established. The second edition of Medical Emergencies is a valuable addition to a growing list of reference sources in this field. The book, a multiauthored text from Boston City Hospital, has 21 chapters that cover a broad array of emergency medical problems. The book has been thoroughly updated from the first edition in 1977, and new chapters have been added to expand the scope of the material. As the title implies, the emphasis is on medical emergencies, and no attempt is made to review trauma or surgical subspecialty emergencies. The text is based on an emergency lecture series of the faculty of Boston City Hospital and is oriented toward emergencies in internal medicine. The text is arranged conventionally by major chapter headings, such as drug overdose, neurologic emergencies, and allergic emergencies. Each chapter is further subdivided to address specific conditions, such as subarachnoid hemorrhage and anaphylaxis. A bibliography

is included for each of these topics. Because the book is well indexed, topics can easily be found. Most of the chapters are succi net; a maxi ma I amou nt of information is condensed into the average 20-page chapter. In each chapter, the emphasis is on the practical aspects of diagnosis and management, and a brief discussion of pathophysiology is included when appropriate. Charts and graphs are used frequently, and outlines for treatment are highlighted. Although most of the discussions are useful, some of the chapters deserve special mention as they are particularly well done and have seldom been covered as well in other texts on emergency medicine. The excellent presentations include a well-written and practical discussion on diabetes and other glucose-related emergencies, a section on oncologic emergencies which deals with common complications and treatment of malignant lesions, and a section on psychiatric emergencies with very practical guidelines for managing this often difficult emergency-room situation. In a very succinct and readable form, the authors have incorporated experience and practical management recommendations for diagnosing and treating common emergencies in internal medicine. Because the emphasis throughout is on practical considerations, the text should be available on the shelves of most emergency rooms. Some of the specifics of management at the Boston City Hospital mentioned in this book will differ from procedures at other institutions; however, this factor does not detract from its overall value. The text is modestly priced, and I would recommend it specifically for the physician in training who is entering the arena of the emergency room for the first time, although it will also be a helpful text for the nurse, medical student, and physician involved in emergency medical care. Thomas D. Meloy, M.D. Division of Emergency Medical Services

Congenially Corrected Transposition, by Tom G. Losekoot, Robert H. Anderson, Anton E. Becker, Gordon K. Danielson, and Benigno Soto, 195 pp, with illus, $57, Edinburgh, Churchill Livingstone (distributed by Longman, Inc., New York), 1983 This monograph is a detailed consideration of congenially corrected transposition by five experts: a clinician, two anatomists, a radiologist, and a cardiac surgeon. Only cases with both atrioventricular and ventric-

Aldactone" (spironolactone)

25-ma. 50-ma. and 100-ma tablets WARNING : Spironolactone has been shown t o be a tumorigen in chronic toxicity studies in rats (see Warnmngs) Aldactone should be used only in those conditions described under lndmfmns and Usage Unnecessary use of this drug should be avoided Indications and Usage: Diagnosis and treatment of primary hyperaldosteronism Essential hypertension, edema of congestive heart failure and the nephrotic syndrome. and hypokalemia when other measures are considered inappropriate Cirrhosis of the liver accompanied by edema and/or ascites Contraindications: Anuria, acute renal insufficiency, significant impairment of renal function or hyperkalemia Warnings: Excessive potassium intake rnay cause hyperkalemia Potassium supplements should not be given with Aldactone Do not administer concurrently with other potassium sparing diuretics Spironolactone has been shown t o be a tumorigen in chronic toxicity studies in rats In one study using 25, 7 5 and 250 times the usual daily human dose ( 2 mg/kg) there was a statistically signifi cant dose related increase in benign adenomas of the thyroid and testes In female rats there was a statistically significant increase in malignant mammary tumors at the mid dose only In male rats there was a dose related increase in proliferative changes in the liver At the highest dosage level (500 mg/kg) the range of effects included hepatocytomegaly, hyperplastic nodules and hepato cellular carcinoma. the last was not statistically significant Precautions: Patients should be carefully evaluated for possible disturbances of fluid and electrolyte balance Hyperkalemia may occur in patients with impaired renal function or excessive potas slum intake and can cause cardiac irregularities which may be fatal Reversible hyperchloremic metabolic acidosis may occur in some patients with decompensated hepatic cirrhosis Hyponatremia rnay be caused or aggravated, especially when Aldactone is administered in combination with other diuretics Transient elevation of BUN and/or mild acidosis rnay occur Gynecomastia rnay develop and in rare instances some breast enlargement may persist Aldactone potentiates the effect of other diuretics or antihypertensive agents, particularly ganglionic blocking agents, therefore the dosage of such drugs should be reduced by at least 50 percent when adding Aldactone Vascular responsiveness t o norepinephrine rnay be reduced Spironolactone has been reported t o possibly interfere with digoxin radioimmunoassays Spironolactone may cross the placental barrier Use in pregnant women requires that the anticipated benefit be weighed against possible hazard t o the fetus Breast feeding should be discontinued when Aldactone is being used Adverse Reactions: Gynecomastia is observed not infrequently Gastrointestinal symptoms including cramping and diarrhea. drowsiness. lethargy, headache, maculopapular or erythematous cutaneous eruptions, urticaria mental confusion drug fever, ataxia, inability t o achieve or maintain erection irregular menses or amenorrhea, postmenopausal bleeding, hirsutism and deepening of the voice carcinoma of the breast has been reported but a cause-and effect relationship has not been established Adverse reactions are usually reversible upon discontinuation of the drug Dosage and Administration For primary hyperaldosteronism: 400 m g daily for three t o four weeks (long test), or for four days (short test) For preparation for surgery or for long term maintenance therapy, 100 to 400 m g daily For edema in adults: Initial daily dosage is 100 m g but rnay range from 25 t o 200 m g daily If after five days an adequate diuretic response has not occurred, a second diuretic which acts more proximally in the renal tubule rnay be added The dosage of Aldactone should remain unchanged when other diuretic therapy is added For edema in children: Initial daily dosage should provide approximately 1 5 m g per pound of body weight (3 3 mg/kg) For essential hypertension: Initial adult daily dosage of 50 t o 100 mg. alone or with diuretics which act more proximally in the renal tubule, or with other antihypertensive agents Continue treat ment for at least two weeks since maximal response rnay not occur before this time Adjust subsequent dosage according t o patient response For hypokalemia: 25 to 100 m g daily

Address medical inquiries to: G. D. Searle & Co. Medical Communications Department Box 5110, Chicago, IL 60680

41051

uloarterial discordance are included; "first cousin" disorders with atrioventricular discordance and a variety of other ventriculoarterial connections are discussed only in terms of differential diagnosis. The book is organized into five parts. The first section deals with historical background, nomenclature, and incidence. The second part is much more extensive and concerns the basic malformation itself; discussions are presented on morphology, physiology, clinical features, and diagnostic methods. There are separate chapters on electrocardiography, chest radiography, echocardiography, cardiac catheterization, and angiocardiography. The third section considers anomalies that commonly complicate corrected transposition; separate chapters review ventricular septa1 defects, pulmonic stenosis, left atrioventricular valve abnormalities, and the conduction system. The last two sections address differential diagnosis and surgical therapy, respectively. The audience for this book is somewhat difficult to determine. Like most multiauthored works, it is uneven, both in depth of treatment and in quality of exposition. The chapter on nomenclature and definitions is remarkably clear and includes a thorough discussion of sequential chamber localization and morphologic features of the four cardiac chambers. The chapters on morphology and angiocardiography are very detailed and superbly written. Although they may be technically difficult for the reader who does not have extensive experience with this anomaly, they will be quite useful as reference material. The illustrations are well chosen and of very high quality. The chapter on chest radiography is likewise good. The clinical chaptersthose dealing with diagnosis, clinical presentation, and natural history-are somewhat less detailed but cover the important points. In my opinion, the chief problem with these chapters is the diction. Ventricles cannot "propagate" blood; they can only "propel" it. "Signs" and "symptoms" are not synonyms; yet they are used interchangeably in this portion of the text. In addition, several typographic errors are evident in these chapters. The chapter on echocardiography is especially well done. The juxtaposition of echocardiograms and illustrations of morphologic cross sections is very effective, and the text is well organized and logical. The figures in the chapter on electrocardiography and vectorcardiography are adequate and illustrate the electrocardiographic spectrum of corrected transposition quite well. Some of the mechanisms advanced for these patterns are suspect, and, again, the diction is occasionally imprecise. The discussion of the associated anomalies in Chapters 15 through 19 is quite good. The portions of these chapters devoted to morphology and angiography are gen-

Mayo Clin Proc, April 1984, Vol 59

erally better presented than those dealing with the clinical aspects of the anomalies. The consideration of the conduction system is especially good and is clinically pertinent. The illustrations of the morphologic features and the angiography of associated anomalies are very effective. The surgical chapter is concise and includes data from what must be one of the largest surgical series in the world. Overall, this book is an important addition to the literature and should prove to be useful to the clinician w h o is interested in c o m p l e x congenital cardiac anomalies. James R. Zuberbuhler, M.D. Director, Pediatric Cardiology Children's Hospital of Pittsburgh

Infectious Diseases: A Modern Treatise of Infectious Processes, 3rd ed, edited by Paul D. Hoeprich, 1,464 pp, with illus, $75, Philadelphia, Harper & Row, Publishers, 1983 " O f all the diseases to which man is heir, those known in etiology, possible of cure, capable of prevention are, for the most part, caused by infectious agents." This quotation explains the need for readily available expert information about infectious diseases. Hoeprich and 122 contributors to this text succeed in providing such information in 170 chapters in an excellent manner, with only a few exceptions. As a result, this book is one of two or three major texts of choice in infectious diseases which is highly recommended to practicing physicians of almost any specialty and to those in general practice. It is a must for all medical libraries, particularly those associated with hospitals and physicians' offices. The book is organized primarily according to organ system rather than by organism, an arrangement that is more difficult for the authors but of considerable benefit to the practicing physician. Eight new chapters in this edition include "Immunopathology of Infectious Diseases," "Legionnaires' Disease," and "Non-A, Non-B Hepatitis." New subjects in this edition include Campylobacter diarrhea, toxic shock syndrome, Clostridium difficile pseudomembranous colitis, Lyme disease, hepatitis vaccine, and new rabies vaccine. Certain shortcomings are unavoidably inherent in any text as a result of the information explosion. Antiviral, antibacterial, antifungal, and antiparasitic advances are too rapid for any text to be completely current; thus, the

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practicing physician must have another source of expert, up-to-date advice readily available. In textbooks, information on "new diseases" such as Lyme disease, Campylobacter diarrhea, and acquired immunodeficiency syndrome (AIDS) is likely to be (and is in this text) insufficient or absent. The chapters on necrotizing pneumonias, legionnaires' disease and related infections, pneumocystosis, viral hepatitis, varicella-zoster infections, and infections after burns are particularly well done. More than 90% of the chapters and subjects are presented in an excellent manner, but several are disappointing, including the discussion of infections in various defects in host resistance, extrapulmonary tuberculosis, fever of undetermined origin, aspergillosis, gas gangrene, and periodic fever syndromes. Particularly disappointing is the 3-page chapter entitled "Infections Following Surgical Operations." The number of references cited in many of the chapters is insufficient for a reference text. Most of the illustrations and the tables are of good quality, and the typeface and format have a professional appearance. This book is a bargain. Robert E. Van Scoy, M.D. Division of Infectious Diseases and Internal Medicine

Critical Care Respiratory Therapy: A Laboratory and Clinical Manual, by Elian J. Nelson, Elizabeth A. Morton, and Patricia M. Hunter, 394 pp, with illus, $18.95, Boston, Little, Brown & Company, 1983 This is a critical care procedure manual intended for use by respiratory therapists who have been newly assigned to the intensive care unit. Patient management problems are approached logically through a sequence that begins with a case presentation and is followed by a description of the step-by-step process in the particular problem that has been identified by the authors as appropriate for the therapist's mastery. The approach is cookbook-like, and very little effort is expended on theory. This procedure is satisfactory for the more manipulative and mechanical problems reviewed but is cumbersome for problems that involve shunt determination and weaning. The photographs and drawings are clear and helpful, but some awkwardness is apparent in using the standard physiologic symbols and relationships. This situation is exacerbated by inadequate redacting, which has allowed obvious printing errors to persist (for example, Pa0 2 =