- Email: [email protected]
Coronary Artery Spasm
Mayo Clin Proc, January 1984, Vol 59
logically from a well-organized overview of the field. These criticisms notwithstanding, the book as a whole is highly commendable for its scope and quality of information. Although references to the literature are noticeably lacking in a few chapters, most of the material is well documented and well illustrated. W e readers are indeed fortunate to have seen the completion of this work just before the death of the senior author, Dr. Richard Marshak, a giant in the field of gastrointestinal radiology whose contributions over the years have been always insightful, sometimes controversial, and invariably stimulating. Radiology of the Stomach, Radiology of the Small Intestine, and Radiology of the Colon form a triad of outstanding achievement and a fitting tribute to the memory of Dr. Marshak. Robert L. MacCarty, M.D. Department of Diagnostic Radiology
The Knee: Form, Function, and Ligament Reconstruction, by Werner Müller (translated by T. C. Telger), 314 pp, with illus, $110, New York, SpringerVerlag, 1983 Injuries of the knee ligaments, particularly when they occur in an athlete, continue to pose a difficult therapeutic challenge. In the past, classification of these ligamentous injuries was individual and varied, and this lack of uniformity has led to a great deal of confusion in the treatment of acute and chronic ligamentous injuries. Recent advances, however, have been made in understanding the pathomechanics of these injuries, and a uniform and standardized classification of these injuries has evolved, which has led to improvements in surgical treatment. This book, which is representative of this new body of knowledge, is a superb review of anatomy, kinematics, pathophysiology, and treatment of ligamentous injuries of the knee. The author addresses all aspects of this subject clearly and concisely. The examination and classification of ligamentous injuries and instabilities of the knee are well described, and the material presented will enhance the knowledge of physicians who deal with acute and chronic disabilities of the knee ligaments. The author begins with a brief review of anatomy and then presents a state-of-theart discussion of the kinematics of function of the knee ligaments. This is one of the best chapters, as he reviews a complex subject logically and clearly. The treatment of injuries of the knee ligaments is one of the most controversial areas of orthopedic surgery. The author presents both sides of the controversy fairly. The
BOOK REVIEWS
55
section on surgical approaches and general principles is good. The techniques described for extra-articular capsular repairs and reconstructions are exhaustively complete. One weakness in this book is the lack of a detailed discussion of various techniques of repair, augmentation, and reconstruction of the anterior cruciate ligament. This area of knee ligament surgery has undergone the most radical changes in recent years. Several new concepts and the resultant techniques (which are not discussed in this book) are quite exciting, as they likely will provide improvements over results of previous techniques of reconstruction. Even lacking a state-of-the-art section on techniques of anterior cruciate reconstruction, this book is still up to date and worthwhile and is recommended reading for physicians involved in the diagnosis and treatment of knee injuries. It has a good index and ample references to the current literature. The first half of the book is devoted entirely to anatomy, kinematics, and function of the knee without any mention of injuries or treatment. Although some readers may find this format frustrating, the organization is by the author's design. The point is that anyone looking for easy cookbook-type solutions to this difficult problem will be disappointed with the results. Only through a complete understanding of physiology and function can knee injuries be properly recognized and treated. Although this book is highly technical and useful to even the most knowledgeable knee specialist, it is written simply and with adequate detail to become a reference source for orthopedic surgeons, residents, and anyone involved in the care of athletic knee injuries. Franklin H. Sim, M.D. Department of Orthopedics
Coronary Artery Spasm, edited by Robert A. Chahine, 285 pp, with illus, $34.50, Mount Kisco, New York, Futura Publishing Company, 1983 The understanding of coronary artery disease has developed over many centuries. In this century, we have witnessed the emergence of two important hypotheses regarding the pathophysiologic process that results in the clinical manifestations of coronary disease. One, the fixed-stenosis concept, dominated from about 1930 and is now being reevaluated. The other, the coronary spasm concept, was considered important before 1930 and is now reappearing as an important factor in coronary
56
BOOK REVIEWS
Mayo Clin Proc, January 1984, Vol 59
disease. Both ideas have waxed and waned in apparent importance during the past 70 years. Where the truth lies is still uncertain, and efforts at understanding coronary disease are often hindered by our propensity to support personal theories enthusiastically and to refute our opponents' theories equally enthusiastically without striving to place all of the known data into the proper context. The current literature has provided data to develop several new hypotheses concerning the pathophysiology of coronary disease. These include the hypothesis that coronary spasm contributes to the genesis of the atherosclerotic lesion in the coronary arteries; the hypothesis that unstable angina and rest angina, as well as some proportion of exercise-induced angina, are due to coronary spasm; the hypothesis that coronary spasm initiates the process of coronary occlusion at narrowed sites, which results in myocardial infarction; and the hypothesis that sudden cardiac death in some cases may be due to reperfusion arrhythmias that occur after spasminduced ischemia. An important physiologic concept that accompanies these postulates is the independent regulation of the large proximal (conductance) coronary arteries and the small distal (resistance) coronary arteries and arterioles.
Several chapters address coronary spasm from exposure to industrial nitroglycerin, catheter-induced spasm, and angina with normal coronary vasculature (which, by definition, is not spasm induced). A chapter on current treatment concepts for coronary spasm is followed by a summary and a perspective that raises several important questions on the role of coronary spasm in clinical coronary disease. The work presents one side of the debate concerning fixed versus dynamic coronary lesions. The multiple authors provide timely information that should generate important new concepts about coronary disease for anyone who reads the book. Much has been taught about the fixed-lesion hypothesis in the past; this book provides the other side of the debate, which previously has been presented in only a few works. I strongly recommend this book to anyone involved with care of coronary patients; it will provide an interesting and highly provocative new view of this ancient disease.
This book details one of the two important concepts of the pathophysiology of coronary artery disease. The first chapter provides a brief history of the fixed and dynamic theories of coronary disease. Interestingly, coronary spasm was mentioned as far back as William Harvey. The spasm theory was advocated by Osier (his Lumleian Lecture of 1910 1 should be read by everyone who treats coronary patients) and was refuted 30 years later by Blumgart2 (also to be read for the opposite point of view). From the 1930s until 1959 when Prinzmetal and associates3 published their description of variant angina, the fixed-lesion hypothesis held sway. Current knowledge suggests that both mechanisms are important. The historical chapter leads to a chapter on terminology, followed by a review of physiologic mechanisms involved in coronary spasm. These chapters offer a refreshing respite from the confusion between proximal and distal coronary arteries often found in current writing. Subsequent chapters cover electrocardiography, hemodynamics and angiography in coronary spasm, and the role of spasm in angina, infarction, and sudden death. A chapter on methods for provoking spasm reviews several unconventional and conventional techniques and gives a useful protocol for ergonovine testing in the catheterization laboratory and in the coronary care unit. This chapter contains many angiographic frames that demonstrate the changes in the coronary anatomy induced by ergonovine for both positive and negative responses.
REFERENCES 1. Osier W : The Lumleian Lectures on angina pectoris. Lancet 1:697-702; 839-844; 973-977, 1910 2. Blumgart HL: The question of "spasm" of the coronary arteries (editorial). Am J Med 2:129-130, 1947 3. Prinzmetal M , Kennamer R, Merliss R, Wada T, Bor N: Angina pectoris. I. A variant form of angina pectoris: preliminary report. Am J Med 27:375-388, 1959
Alfred A. Bove, M.D., Ph.D. Division of Cardiovascular Diseases and Internal Medicine
General Thoracic Surgery, 2nd ed, edited by Thomas W. Shields, 1,072 pp, with illus, $118, Philadelphia, Lea & Febiger, 1983 For several years, there has been a need for a current textbook of general thoracic surgery that was philosophically dedicated to this topic alone. Concomitant with the major advances in cardiovascular surgery during the past 2 decades, editors of surgical textbooks have allocated more space to cardiac surgical problems at the expense of the apparently less glamorous problems affecting the remainder of the thorax. Except for their anatomic proximity, cardiovascular and general thoracic surgery are quite separate disciplines; thus, a textbook organized and compiled by general thoracic surgeons is a welcome arrival. These concerns led Dr. Thomas Shields to compile a multiauthored textbook of general thoracic surgery in 1972. That first edition was well received; however, it did have significant defects in content—for example, virtually no discussion of esophageal disease was in-
logically from a well-organized overview of the field. These criticisms notwithstanding, the book as a whole is highly commendable for its scope and quality of information. Although references to the literature are noticeably lacking in a few chapters, most of the material is well documented and well illustrated. W e readers are indeed fortunate to have seen the completion of this work just before the death of the senior author, Dr. Richard Marshak, a giant in the field of gastrointestinal radiology whose contributions over the years have been always insightful, sometimes controversial, and invariably stimulating. Radiology of the Stomach, Radiology of the Small Intestine, and Radiology of the Colon form a triad of outstanding achievement and a fitting tribute to the memory of Dr. Marshak. Robert L. MacCarty, M.D. Department of Diagnostic Radiology
The Knee: Form, Function, and Ligament Reconstruction, by Werner Müller (translated by T. C. Telger), 314 pp, with illus, $110, New York, SpringerVerlag, 1983 Injuries of the knee ligaments, particularly when they occur in an athlete, continue to pose a difficult therapeutic challenge. In the past, classification of these ligamentous injuries was individual and varied, and this lack of uniformity has led to a great deal of confusion in the treatment of acute and chronic ligamentous injuries. Recent advances, however, have been made in understanding the pathomechanics of these injuries, and a uniform and standardized classification of these injuries has evolved, which has led to improvements in surgical treatment. This book, which is representative of this new body of knowledge, is a superb review of anatomy, kinematics, pathophysiology, and treatment of ligamentous injuries of the knee. The author addresses all aspects of this subject clearly and concisely. The examination and classification of ligamentous injuries and instabilities of the knee are well described, and the material presented will enhance the knowledge of physicians who deal with acute and chronic disabilities of the knee ligaments. The author begins with a brief review of anatomy and then presents a state-of-theart discussion of the kinematics of function of the knee ligaments. This is one of the best chapters, as he reviews a complex subject logically and clearly. The treatment of injuries of the knee ligaments is one of the most controversial areas of orthopedic surgery. The author presents both sides of the controversy fairly. The
BOOK REVIEWS
55
section on surgical approaches and general principles is good. The techniques described for extra-articular capsular repairs and reconstructions are exhaustively complete. One weakness in this book is the lack of a detailed discussion of various techniques of repair, augmentation, and reconstruction of the anterior cruciate ligament. This area of knee ligament surgery has undergone the most radical changes in recent years. Several new concepts and the resultant techniques (which are not discussed in this book) are quite exciting, as they likely will provide improvements over results of previous techniques of reconstruction. Even lacking a state-of-the-art section on techniques of anterior cruciate reconstruction, this book is still up to date and worthwhile and is recommended reading for physicians involved in the diagnosis and treatment of knee injuries. It has a good index and ample references to the current literature. The first half of the book is devoted entirely to anatomy, kinematics, and function of the knee without any mention of injuries or treatment. Although some readers may find this format frustrating, the organization is by the author's design. The point is that anyone looking for easy cookbook-type solutions to this difficult problem will be disappointed with the results. Only through a complete understanding of physiology and function can knee injuries be properly recognized and treated. Although this book is highly technical and useful to even the most knowledgeable knee specialist, it is written simply and with adequate detail to become a reference source for orthopedic surgeons, residents, and anyone involved in the care of athletic knee injuries. Franklin H. Sim, M.D. Department of Orthopedics
Coronary Artery Spasm, edited by Robert A. Chahine, 285 pp, with illus, $34.50, Mount Kisco, New York, Futura Publishing Company, 1983 The understanding of coronary artery disease has developed over many centuries. In this century, we have witnessed the emergence of two important hypotheses regarding the pathophysiologic process that results in the clinical manifestations of coronary disease. One, the fixed-stenosis concept, dominated from about 1930 and is now being reevaluated. The other, the coronary spasm concept, was considered important before 1930 and is now reappearing as an important factor in coronary
56
BOOK REVIEWS
Mayo Clin Proc, January 1984, Vol 59
disease. Both ideas have waxed and waned in apparent importance during the past 70 years. Where the truth lies is still uncertain, and efforts at understanding coronary disease are often hindered by our propensity to support personal theories enthusiastically and to refute our opponents' theories equally enthusiastically without striving to place all of the known data into the proper context. The current literature has provided data to develop several new hypotheses concerning the pathophysiology of coronary disease. These include the hypothesis that coronary spasm contributes to the genesis of the atherosclerotic lesion in the coronary arteries; the hypothesis that unstable angina and rest angina, as well as some proportion of exercise-induced angina, are due to coronary spasm; the hypothesis that coronary spasm initiates the process of coronary occlusion at narrowed sites, which results in myocardial infarction; and the hypothesis that sudden cardiac death in some cases may be due to reperfusion arrhythmias that occur after spasminduced ischemia. An important physiologic concept that accompanies these postulates is the independent regulation of the large proximal (conductance) coronary arteries and the small distal (resistance) coronary arteries and arterioles.
Several chapters address coronary spasm from exposure to industrial nitroglycerin, catheter-induced spasm, and angina with normal coronary vasculature (which, by definition, is not spasm induced). A chapter on current treatment concepts for coronary spasm is followed by a summary and a perspective that raises several important questions on the role of coronary spasm in clinical coronary disease. The work presents one side of the debate concerning fixed versus dynamic coronary lesions. The multiple authors provide timely information that should generate important new concepts about coronary disease for anyone who reads the book. Much has been taught about the fixed-lesion hypothesis in the past; this book provides the other side of the debate, which previously has been presented in only a few works. I strongly recommend this book to anyone involved with care of coronary patients; it will provide an interesting and highly provocative new view of this ancient disease.
This book details one of the two important concepts of the pathophysiology of coronary artery disease. The first chapter provides a brief history of the fixed and dynamic theories of coronary disease. Interestingly, coronary spasm was mentioned as far back as William Harvey. The spasm theory was advocated by Osier (his Lumleian Lecture of 1910 1 should be read by everyone who treats coronary patients) and was refuted 30 years later by Blumgart2 (also to be read for the opposite point of view). From the 1930s until 1959 when Prinzmetal and associates3 published their description of variant angina, the fixed-lesion hypothesis held sway. Current knowledge suggests that both mechanisms are important. The historical chapter leads to a chapter on terminology, followed by a review of physiologic mechanisms involved in coronary spasm. These chapters offer a refreshing respite from the confusion between proximal and distal coronary arteries often found in current writing. Subsequent chapters cover electrocardiography, hemodynamics and angiography in coronary spasm, and the role of spasm in angina, infarction, and sudden death. A chapter on methods for provoking spasm reviews several unconventional and conventional techniques and gives a useful protocol for ergonovine testing in the catheterization laboratory and in the coronary care unit. This chapter contains many angiographic frames that demonstrate the changes in the coronary anatomy induced by ergonovine for both positive and negative responses.
REFERENCES 1. Osier W : The Lumleian Lectures on angina pectoris. Lancet 1:697-702; 839-844; 973-977, 1910 2. Blumgart HL: The question of "spasm" of the coronary arteries (editorial). Am J Med 2:129-130, 1947 3. Prinzmetal M , Kennamer R, Merliss R, Wada T, Bor N: Angina pectoris. I. A variant form of angina pectoris: preliminary report. Am J Med 27:375-388, 1959
Alfred A. Bove, M.D., Ph.D. Division of Cardiovascular Diseases and Internal Medicine
General Thoracic Surgery, 2nd ed, edited by Thomas W. Shields, 1,072 pp, with illus, $118, Philadelphia, Lea & Febiger, 1983 For several years, there has been a need for a current textbook of general thoracic surgery that was philosophically dedicated to this topic alone. Concomitant with the major advances in cardiovascular surgery during the past 2 decades, editors of surgical textbooks have allocated more space to cardiac surgical problems at the expense of the apparently less glamorous problems affecting the remainder of the thorax. Except for their anatomic proximity, cardiovascular and general thoracic surgery are quite separate disciplines; thus, a textbook organized and compiled by general thoracic surgeons is a welcome arrival. These concerns led Dr. Thomas Shields to compile a multiauthored textbook of general thoracic surgery in 1972. That first edition was well received; however, it did have significant defects in content—for example, virtually no discussion of esophageal disease was in-