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Digitalis
Book reviews
Digitalis. By Thomas Woodward Smith, M.D., and Edgar Haber, M.D., Boston, 1974, Little, Brown & Company, 110 pages.
This small succinct publication on digitalis is from the Medical Progress Series of the New England Journal of Medicine. It clearly summarizes the present concepts in digitalis administration and further reflects present trends in medicine. For example, on page 49 the authors indicate that digitalis intoxication has been reduced decidedly with the use of computers. This may impress some clinicians, but to this reviewer it is indeed strange that the brains of present day physicians are unable to program the use of digitalis as well as an inanimate computer, especially a clinical problem as simple as the proper digitalization of a patient. Furthermore, even with electronic computers digitalis intoxication is as high as 12 per cent in one series or even 4 per cent in another. The incidence of intoxication should be zero if properly used and intoxication could only then occur if the patient fails to follow proper instructions. Digitalis intoxication has become one of the major clinical problems today and this book fails to teach readers how to avoid it. The first sentence on page 41 under “Digitoxin” is not clear. The authors review the pharmacodynamic action of digitalis, pharmacokinetics, bioavailability, clinical use, hemodynamic effects and other aspects of the drug. They could have included ‘more data on man with critical evaluation of them. For example, in the discussion on serum and plasma concentration (Chapter 20), the authors fail to indicate clearly how a physician is to decide the next dose of a rapidly excreted drug such as digoxin when the blood sample is collected in the early morning and the physician reviews and sees the patient in the late afternoon and when the physician, of course, desires to maintain a fairly constant therapeutic level of the drug in his patient for 24 hours. This book is interesting, and a thoughtful study of the book by an experienced cardiologist will reveal the nature of the pharmacologic and clinical problems which exist today with the use of digitalis and why intoxication with the drug is a major cardiologic disease state today.
Progress in Cardiology. Edited by Paul N. Yu, M.D., and John F. Goodwin, M.D., Philadelphia, 1974, Lea & Febiger, 349 paw.
Volume 3 of Progress in Cardiology edited by Yu and Goodwin reviews the progress made in recent years in epidemiology and prevention of coronary heart disease, selected aspects of electrophysiology and arrhythmia, exercise cardiology, role of the renin-angiotensin system in the etiology of hypertension, drugs affecting the heart, valve placement, prevention of thrombosis, echocardiography and others. Physicians who have been unable to follow the literature closely will find this publication to be especially useful. The respective authors have condensed very well the important publications related to their respective subjects. The field of cardiology is advancing and changing rapidly. Therefore, this publication is welcomed. All physicians who treat heart disease will find this book useful.
820
Blood Flow in Arteries. By Donald A. McDonald, M.A., D.M., D.Sc., Baltimore, 1974, The Williams & Wilkins Company, 498 rww. This book on the fundamental physical principles governing blood flow through the arterial system should interest physiologists and others engaged in research related to the peripheral circulation. Such problems as steady flow of liquid through cylindrical tubes, properties of viscosity of blood, turbulence, pulsatile flow, flowmeters, elastic properties of arterial walls, impedance and wave reflection are among the many aspects of hemodynamic phenomena discussed by McDonald. These complex principles are discussed very well and the many gaps in our knowledge become evident to the reviewer of the book. Clinicians will find this extremely technical unless they are well informed in the principles of hydraulics. This is an important contribution to an important subject of circulation of blood in arteries. Drug Induced Clinical Toxicity, volume I and II. Edited by F. Gilbert McMahon, M.D., Mount Kisco, New York, 1974, Futura Publishing Co., 186 pages. McMahon has edited a series of volumes on the principles and techniques of human research and therapeutics. These first two volumes are extremely important and valuable. The others to follow will include additional information on the subject of drug evaluation and use. These two volumes are of interest to cardiologists in practice and especially to those conducting drug studies related to the heart and circulation. The use of drugs involves all aspects of medical practice. The evaluation and introduction of new dr&s concerns all physicians and their patients. These volumes represent the proceedings of a clinical pharmacology symposium held in New Orleans during March, 1973. The contributors represent outstanding people from medical schools, industry, and the U. S. Government. The subjects included are extensive. The first two volumes readily indicate that the entire series will represent an encyclopedic source of information in one of the important fields of therapeutics and medical practice. Practicing physicians, pharmacologists, pharmaceutical industry, Government, and many others concerned with drug studies will find these two volumes extremely valuable. Carrel, Visionary Surgeon. By W. Sterling Edwards, M.D., and Peter D. Edwards, Springfield, 1974, Bannerstone House, 143 pages. Alexis
This is an interesting and well written brief biography of an important man. Vascular and cardiac surgeons should be especially interested in reading and owning a copy. Carrel performed important pioneering vascular surgery and developed the early and fundamental techniques. Those who knew Carrel personally will find this account to be reliable. Carrel was an interesting man and his personality is evident from this book. The style of presentation is clear and simple so that the reader finds the biography so interesting that he does not want to put the book down before he completes it. Fortunately, Charles Lindbergh, a close good friend of Carrel, was able to write an interesting foreword before his recent death.
June, 1975, Vol. 89, No. 6
Digitalis. By Thomas Woodward Smith, M.D., and Edgar Haber, M.D., Boston, 1974, Little, Brown & Company, 110 pages.
This small succinct publication on digitalis is from the Medical Progress Series of the New England Journal of Medicine. It clearly summarizes the present concepts in digitalis administration and further reflects present trends in medicine. For example, on page 49 the authors indicate that digitalis intoxication has been reduced decidedly with the use of computers. This may impress some clinicians, but to this reviewer it is indeed strange that the brains of present day physicians are unable to program the use of digitalis as well as an inanimate computer, especially a clinical problem as simple as the proper digitalization of a patient. Furthermore, even with electronic computers digitalis intoxication is as high as 12 per cent in one series or even 4 per cent in another. The incidence of intoxication should be zero if properly used and intoxication could only then occur if the patient fails to follow proper instructions. Digitalis intoxication has become one of the major clinical problems today and this book fails to teach readers how to avoid it. The first sentence on page 41 under “Digitoxin” is not clear. The authors review the pharmacodynamic action of digitalis, pharmacokinetics, bioavailability, clinical use, hemodynamic effects and other aspects of the drug. They could have included ‘more data on man with critical evaluation of them. For example, in the discussion on serum and plasma concentration (Chapter 20), the authors fail to indicate clearly how a physician is to decide the next dose of a rapidly excreted drug such as digoxin when the blood sample is collected in the early morning and the physician reviews and sees the patient in the late afternoon and when the physician, of course, desires to maintain a fairly constant therapeutic level of the drug in his patient for 24 hours. This book is interesting, and a thoughtful study of the book by an experienced cardiologist will reveal the nature of the pharmacologic and clinical problems which exist today with the use of digitalis and why intoxication with the drug is a major cardiologic disease state today.
Progress in Cardiology. Edited by Paul N. Yu, M.D., and John F. Goodwin, M.D., Philadelphia, 1974, Lea & Febiger, 349 paw.
Volume 3 of Progress in Cardiology edited by Yu and Goodwin reviews the progress made in recent years in epidemiology and prevention of coronary heart disease, selected aspects of electrophysiology and arrhythmia, exercise cardiology, role of the renin-angiotensin system in the etiology of hypertension, drugs affecting the heart, valve placement, prevention of thrombosis, echocardiography and others. Physicians who have been unable to follow the literature closely will find this publication to be especially useful. The respective authors have condensed very well the important publications related to their respective subjects. The field of cardiology is advancing and changing rapidly. Therefore, this publication is welcomed. All physicians who treat heart disease will find this book useful.
820
Blood Flow in Arteries. By Donald A. McDonald, M.A., D.M., D.Sc., Baltimore, 1974, The Williams & Wilkins Company, 498 rww. This book on the fundamental physical principles governing blood flow through the arterial system should interest physiologists and others engaged in research related to the peripheral circulation. Such problems as steady flow of liquid through cylindrical tubes, properties of viscosity of blood, turbulence, pulsatile flow, flowmeters, elastic properties of arterial walls, impedance and wave reflection are among the many aspects of hemodynamic phenomena discussed by McDonald. These complex principles are discussed very well and the many gaps in our knowledge become evident to the reviewer of the book. Clinicians will find this extremely technical unless they are well informed in the principles of hydraulics. This is an important contribution to an important subject of circulation of blood in arteries. Drug Induced Clinical Toxicity, volume I and II. Edited by F. Gilbert McMahon, M.D., Mount Kisco, New York, 1974, Futura Publishing Co., 186 pages. McMahon has edited a series of volumes on the principles and techniques of human research and therapeutics. These first two volumes are extremely important and valuable. The others to follow will include additional information on the subject of drug evaluation and use. These two volumes are of interest to cardiologists in practice and especially to those conducting drug studies related to the heart and circulation. The use of drugs involves all aspects of medical practice. The evaluation and introduction of new dr&s concerns all physicians and their patients. These volumes represent the proceedings of a clinical pharmacology symposium held in New Orleans during March, 1973. The contributors represent outstanding people from medical schools, industry, and the U. S. Government. The subjects included are extensive. The first two volumes readily indicate that the entire series will represent an encyclopedic source of information in one of the important fields of therapeutics and medical practice. Practicing physicians, pharmacologists, pharmaceutical industry, Government, and many others concerned with drug studies will find these two volumes extremely valuable. Carrel, Visionary Surgeon. By W. Sterling Edwards, M.D., and Peter D. Edwards, Springfield, 1974, Bannerstone House, 143 pages. Alexis
This is an interesting and well written brief biography of an important man. Vascular and cardiac surgeons should be especially interested in reading and owning a copy. Carrel performed important pioneering vascular surgery and developed the early and fundamental techniques. Those who knew Carrel personally will find this account to be reliable. Carrel was an interesting man and his personality is evident from this book. The style of presentation is clear and simple so that the reader finds the biography so interesting that he does not want to put the book down before he completes it. Fortunately, Charles Lindbergh, a close good friend of Carrel, was able to write an interesting foreword before his recent death.
June, 1975, Vol. 89, No. 6