The Bookshelf (continued) volume is noteworthy. There is much of value from the many contributors. Among the more outstanding features is a clear, brief exposition of the ultrastructure and cellular composition of the lung. Relatively new observations are discussed and slcillfully interdigitated with modem techniques and functional correlates. This fine example is, unfortunately, not standard in all presentations that follow, and there is a notable absence of ultrastructural information in many contributions. This reviewer is distressed by the lack of editorial organization and integration of the contributions and by the academic unevenness of the individual sections. Drug-induced pulmonary disease seems out of place as chapter 2, as does the adult respiratory distress syndrome as chapter 3. The excellent and current discussion of the cell biology of mucus secretion is placed as chapter 7, and the beautifully illustrated "Basis of Pulmonary Edema, with Emphasis on Ultrastructure" by G. G . Pietra is chapter 12. These chapters clearly belong among the earlier ones. It is unfortunate that the term, "adult respiratory distress syndrome," is used, since many clinicians and physiologists (and "adult respiratory distress syndrome" is, after all, a purely clinical description) now are ready to abandon that term. While Pratt discusses the morphology admirably and forc;efully supports the role of high oxygen tension in its progression, the events which initiate the pulmonary lesions are inadequately discussed. The chapter on diffuse infiltrative pulmonary disease by Carrington and Gaensler emphasizes the continued need for clinical pathologic correlation, but it omits mention of new aids to specific diagnosis, such as immunopathologic examination and electron microscopy (if only to indicate their limited utility). Chapter 5 on hypersensitivity pneumonitis attempts to integrate basic and clinical science but is too brief and superficial in both areas. On the other hand, the chapter on pneumoconioses is too encyclopedic in its approach. It is mainly a treatise on new analytic techniques and an appeal for their application. This chapter is more than is required for this volume and is done at the expense of a more detailed discussion of other topics vital to occupational pulmonary disease. The concluding chapter fails on two counts. The smorgasboard of topics included in this chapter is, at times, repetitive; and the unexplainable jump from topic to topic is distracting r.nd superficial. The photographs in the section on surgical pathology are not up to the standards in these volumes; however, there is no other single authoritative update of pulmonary pathology available in the organized medical literature. This book is a valuable colle~ tion of current information on pulmonary pathology for the internist, as well as the pathologist. ]flf'ome Kleinerman, M.D.
SLEEP APNEA SYNDROMES (Kroc Foundation Series, vol 11). Edited by CHRISTIAN GuiLLEMINAULT and WILLIAM C. DEMENT. New York, Alan R. Liss, Inc., 1978, 372 pp, $34.00. The editors of this book are the well-known directors of the Sleep Disorders Clinic of Stanford University School of Medicine. Dement is, in a way, the Julius Comroe of sleep physiology. The editors made a superb selection for the authors as a comprehensive multidisciplinary approach to the problem. The different chapters are grouped under seven headings. The first part covers the symptoms of sleep-induced apnea, and it opens with the long experience of the Stanford Clinic, including 150 patients. The following chapter shows that habitual and heavy snoring is not just annoying but has important effects on alveolar ventilation and the circulation of the blood. The third chapter reveals that about one-third of the individuals who complain of excessive sleepiness in the daytime have obstruction of the upper airway during sleep; this is enough to suggest that everyone who sleeps too much during the day should have his sleep examined. In the second part of the book, Phillipson and Sullivan, using unanesthetized dogs, showed, among other things, that during the rapid-eye-movement phase of sleep, the brain may be too busy to concentrate on breathing. Orem, using a similar preparation in cats, presents an extensive analysis of patterns of breathing during sleep and wakefulness, in addition to measurements of the function of the upper airway. Henderson-Smart and Read demon-
strated that newborns have a depression of intercostal and abdominal muscular activity in active sleep. The third part of the volume is on respiration, the central nervous system, and the heart in sleep-induced ap~ea, including topics such as sleep and breathing at high altitudes and the electroencephalogram before and after apnea, as well as hemodynamics and cardiac arrhythmias in sleep-induced apnea. The fourth part of the book covers the mechanisms of obstruction of the upper airway during sleep; it has a detailed discussion on the role of the tongue and pharyngeal muscles in keeping the upper airway patent during sleep. The fifth part of the book deals with specific syndromes related to sleep-induced apnea, such as micrognathia, cervical chordotomy, myotonic dystrophy, poliomyelitis, and the Shy-Drager syndrome. The sixth part of this volume is a study showing mirror fluctuations of the levels of glucose, growth hormone, and cortisol during sleep in patients with obstructive sleep-induced apnea. The final part of the book covers the management of central hypoventilation by diaphragmatic pacing and tracheostomy in obstructive sleep-induced apnea. Hill, Simmons, and Guilleminault present a protocol for postoperative care. This is an excellent book which should be of interest to internists, pediatricians, cardiologists, neurologists, psychiatrists, and respirologists. Noe Zamel, M.D., F.C.C.P.
PRINCIPLES OF CHEST X-RAY DIAGNOSIS (4th ed). By GEoRGE SIMON. Woburn, Mass, Butterworths, USA, 1978, 296 pp, $39.95. The fourth edition of the late Dr. George Simon's book maintains the format, method of presentation, and unique style which characterized the previous editions. The book has been updated modestly with added illustrations, new tables, and revision of some of the previous material, which was made necessary by advancing knowledge in the field of diagnostic radiology of the chest. Like the previous editions, this book can in no way be regarded as a complete treatise on all aspects of thoracic radiology. What it does present is clinical, pathologic, and radiologic correlations based on roentgenographic appearance, rather than on diseases. Since that is the way that radiologists approach interpretation of x-ray films, the book has extraordinary value for students, residents interested in the chest, and those who wish to understand more about the correlation of the radiographic image with disease processes. As with the previous editions, this book was not intended to be, nor does it serve the function of a reference volume. Bibliographic data are incomplete. Considerable philosophy is included. Some might disagree with the emphasis that Simon places on measurements, and· the section on definitions is also subject to some controversy. Nevertheless, this book is a valuable contribution to the literature and represents part of the legacy of a fine radiologist and a superb teacher.
Richard H. Greenspan, M.D., F.C.C.P. New Haven, Conn FONOMECANOCARDIOGRAFIA CLINICA (2nd ed). By BERNARDO L. FISHLEDER. Mexico City, La Prensa Medica Mexicana, 1978, 1,098 pp, price not stated (text in Spanish). This is an exhaustive treatise on the application of phonocardiography and graphic recording of precordial movements and peripheral arterial and venous pulses to the diagnosis and physiopathologic understanding of cardiovascular disease. Each chapter is well organized. A systematic appl'Oach using these diagnostic techniques is employed to describe the physiopathologic disturbances of the disease under consideration. A multitude of graphs is included to clarify the text. This is usually preceded by a brief introduction, with an anatomic description and classification where appropriate. The bibliography is enormous. References taken from the world literature are up-to-date and are listed at the end of each chapter. In the second edition, special attention has been given to the chapters on precordial movements, cronocardiography, mitral insufficiency, and aortic stenosis. I believe that this is a useful reference text for anyone interested in the application of noninvasive diagnostic techniques to cardiovascular disease. John BeU-Thomwn, M.D.