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MEDICAL EMERGENCIES: DIAGNOSTIC AND MANAGEMENT PROCEDURES FROM BOSTON CITY HOSPITAL
The Bookshelf (continued) The most important point that the book makes is that asthma in children is quite different from asthma in adults. Most texts do not distinguish between these two entities and treat them as one. The authors are to be commended for writing a book that deals exclusively with asthma in children. Morton P. Galina, M.D. Ν orcross, Ga MEDICAL EMERGENCIES: DIAGNOSTIC AND MANAGE MENT PROCEDURES FROM BOSTON CITY HOSPITAL. Edited by A L A N S. COHEN, RALPH B. FREIDIN, and M A R T I N A.
SAMUELS. Boston, Little, Brown and Co., 1977, 279 pp, $15.00.
Medical Emergencies, edited by Cohen, Freidin, and Samuels, is meant as "both a 'hands on' working reference and a complete refresher course in acute problems in internal medicine." On the whole, the book accomplishes this. I t is a multiauthored work covering such topics as cardiac arrhythmias, acute respiratory failure, and gastrointestinal bleeding. The chapters are brief and well written and have excellent references. There is a strong concentration on the practical basics of diagnosis and treatment, with just enough pathophysiology to allow those basics to fit into a logical framework. Most of the book is filled with "this-is-whatyou-have-to-know" information. Especially good are the chapters on neurologic and psychiatric emergencies. Being a small book, Medical Emergencies tends to be a little superficial and does not qualify as a comprehensive work. There are no case reports, which might focus some of the subtleties of diagnosis and management. The chapter on acute heart failure is slightly dated, and the one on hypertensive crisis fails to confront the problems faced by those who have to treat hypertension as a medical emergency; however, the remaining chapters do provide effective guidance and reflect clinical experience. The book is excellent for those just entering the field of emergency internal medicine. Compton Br oders, Μ.Ό. and Leonard Riggs, Jr., MD, Dallas LOCAL ANESTHETICS (2nd
ed).
By RUDOLPH H . DEJONG.
Springfield, 111, Charles C Thomas, 1977, 338 pp, $32.50.
The new second edition of dejong's book entitled Local Anesthetics has undergone a major revision, including a change in title. Dr. deJong has expanded his discussions of almost all of the topics in the first edition and has included a new chapter entitled "Hemodynamics of Major Conduction Anesthesia." Other physical changes in this edition include increased size of the pages, double-column text on glare-free off-white paper, and large Une drawings that are easy to understand. The table of contents reads Uke an outline and makes locating specific topics extremely easy. The index is complete. The bibUography is large (668 references) and up-to-date (almost two-thirds of the references have been written in the past ten years ). Dr. dejong's literary style is different from any I have ever read in a scientific text. He not only uses colloquial conversational expressions such as "all well and good" and "two neat twists" but also uses words and expressions that seem to come straight from an action-packed novel (eg, on page 253, he says, "The un charged base species is the weary footsoldier trotting from site of injection to the neural battlefield; there it is transformed into the glamorous quantenary amine cation" ). Dr. dejong's vocabulary is indeed impressive, almost to the point of being showy. Parts of his text must be read with a dictionary in hand in order to understand the nuances of what he is saying. He uses words such as "artifice," "arcane," "tyro," and "linchpin," just to mention a few. Having thought myself a dunce because I was not familiar with these words, I felt better when I found that most of my medical colleagues did not understand them either. Nevertheless, I think that deJong is justified in using the words because they help to express his ideas in a truly unique manner. The text is concise and understandable. Dr. deJong uses famiUar ideas and terms to help explain difficult concepts which, if left in their scientific context, would be almost unintelligible to those of us not famiUar with that discipline. This is particularly true in the chapters concerned with the effects of local anesthetics and antiarrhythmic agents on biologic membranes, where de tailed mechanisms are presented in a readable form.
22
Dr. dejong's approach is both pragmatic and, at the same time, theoretic; for example, his chapter on "Absorption, Binding and Disposition" gives the "why's" in the understanding of the pharmacodynamics involved in the treatment of arrhythmias with Udocaine, while his chapter on cardiovascular effects gives the "how to's" in this therapy. Although this book is written by an anesthesiologist, it is not written just for anesthesiologists. Its appeal cuts across specialty Unes so that anyone who uses local anesthetics, for whatever reason, would be interested in what deJong has to say. Most of aU, he has made what might have been a dry subject interesting and appealing. Robert I . Balfour, M.D. Seattle DIE LUNGENTUBERKULOSE I M RÖNTGENBILD. By HERBERT BLA HA. Berlin, Springer-Verlag, 1976, 388 pp, 204 iUus, $159.90 (in German). This monograph discusses the radiologic findings in intrathoracic tuberculosis. The emphasis is on the manifestations of this disease in adults, although there are some examples of pediatric cases, particularly in the discussion of the primary process. While there has been a marked decrease in the incidence of tuberculosis in Europe and North America, this disease still poses a considerable problem for pubUc health in many countries of the "third world," where a large proportion of the population is poverty-stricken, living in crowded and unsanitary conditions. As the chest x-ray film is still the only objective method for diagnosing the extent of disease and its response to therapy, this work is of great value to the physician whose practice is in an area where tuberculosis is endemic. The discussions emphasize the gross morphology of the disease process as manifested in the chest x-ray film, correlated with gross and microscopic pathologic material. The book is profusely illustrated with all of the protean manifestations of this disease, with the quaUty of the reproductions varying considerably. There is abundant statistical material, and there are 50 pages of references. After an introduction stressing the role of radiology and its relationship to other methods in Sie diagnosis of tuberculosis, the various radiologic techniques utilized in the study of the chest as related to tuberculosis are discussed. This is followed by an extensive description of the roentgenologic manifestations (both usual and unusual), their progression and heaUng, and a discussion of the differential diagnosis. Material on the relationship of tuberculosis to other thoracic and systemic illnesses concludes this very thorough work. Herbert F. Gramm, M.D. Boston CONGENITAL MALFORMATIONS OF THE HEART AND GREAT VESSELS: SYNOPSIS OF PATHOLOGY, EMBRYOLOGY AND NATURAL HISTORY. By HANS BANKL. Munich, West Germany, Urban and Schwarzenberg, Inc., 1977, 264 pp, 59 illus, price not stated. This Uttle book is intended to be an introduction to the pathology of congenital heart disease. The volume fulfills this mission to a surprising degree, considering the complexity of the subject, and it provides certain bits of information which generally are not easy to come by, eg, who first described a certain anomaly. Unfortunately, the book also suffers from a number of serious shortcomings which detract from its usefulness. The text is often hard to read and at times is confusing. In large part, this seems to be due to Bankl's unfamiUarity with the EngUsh language, which has resulted in unfortunate choices of words and pecuUar and often also unwieldy structuring of sentences. The manner of organization of the text, rather similar to that of the monograph by Fontana and Edwards, is not really suited for the present book. Descriptions of the cardiac malformations are not arranged in a particular logical order, and one wonders why Bankl has elected to deal with some of the most complex anomalies first. In doing so, terms are used which are not explained until later, an oddity which obviously will present problems to the novice. Certain important lesions are only mentioned in passing or not at all. Discussion of some of the anomalies, simple or complex, appears to be based on literature that is 10 to 20 years old, even though more recent publications (but prior to 1975) are almost always available. In adopting certain views, Bankl is not always
SAMUELS. Boston, Little, Brown and Co., 1977, 279 pp, $15.00.
Medical Emergencies, edited by Cohen, Freidin, and Samuels, is meant as "both a 'hands on' working reference and a complete refresher course in acute problems in internal medicine." On the whole, the book accomplishes this. I t is a multiauthored work covering such topics as cardiac arrhythmias, acute respiratory failure, and gastrointestinal bleeding. The chapters are brief and well written and have excellent references. There is a strong concentration on the practical basics of diagnosis and treatment, with just enough pathophysiology to allow those basics to fit into a logical framework. Most of the book is filled with "this-is-whatyou-have-to-know" information. Especially good are the chapters on neurologic and psychiatric emergencies. Being a small book, Medical Emergencies tends to be a little superficial and does not qualify as a comprehensive work. There are no case reports, which might focus some of the subtleties of diagnosis and management. The chapter on acute heart failure is slightly dated, and the one on hypertensive crisis fails to confront the problems faced by those who have to treat hypertension as a medical emergency; however, the remaining chapters do provide effective guidance and reflect clinical experience. The book is excellent for those just entering the field of emergency internal medicine. Compton Br oders, Μ.Ό. and Leonard Riggs, Jr., MD, Dallas LOCAL ANESTHETICS (2nd
ed).
By RUDOLPH H . DEJONG.
Springfield, 111, Charles C Thomas, 1977, 338 pp, $32.50.
The new second edition of dejong's book entitled Local Anesthetics has undergone a major revision, including a change in title. Dr. deJong has expanded his discussions of almost all of the topics in the first edition and has included a new chapter entitled "Hemodynamics of Major Conduction Anesthesia." Other physical changes in this edition include increased size of the pages, double-column text on glare-free off-white paper, and large Une drawings that are easy to understand. The table of contents reads Uke an outline and makes locating specific topics extremely easy. The index is complete. The bibUography is large (668 references) and up-to-date (almost two-thirds of the references have been written in the past ten years ). Dr. dejong's literary style is different from any I have ever read in a scientific text. He not only uses colloquial conversational expressions such as "all well and good" and "two neat twists" but also uses words and expressions that seem to come straight from an action-packed novel (eg, on page 253, he says, "The un charged base species is the weary footsoldier trotting from site of injection to the neural battlefield; there it is transformed into the glamorous quantenary amine cation" ). Dr. dejong's vocabulary is indeed impressive, almost to the point of being showy. Parts of his text must be read with a dictionary in hand in order to understand the nuances of what he is saying. He uses words such as "artifice," "arcane," "tyro," and "linchpin," just to mention a few. Having thought myself a dunce because I was not familiar with these words, I felt better when I found that most of my medical colleagues did not understand them either. Nevertheless, I think that deJong is justified in using the words because they help to express his ideas in a truly unique manner. The text is concise and understandable. Dr. deJong uses famiUar ideas and terms to help explain difficult concepts which, if left in their scientific context, would be almost unintelligible to those of us not famiUar with that discipline. This is particularly true in the chapters concerned with the effects of local anesthetics and antiarrhythmic agents on biologic membranes, where de tailed mechanisms are presented in a readable form.
22
Dr. dejong's approach is both pragmatic and, at the same time, theoretic; for example, his chapter on "Absorption, Binding and Disposition" gives the "why's" in the understanding of the pharmacodynamics involved in the treatment of arrhythmias with Udocaine, while his chapter on cardiovascular effects gives the "how to's" in this therapy. Although this book is written by an anesthesiologist, it is not written just for anesthesiologists. Its appeal cuts across specialty Unes so that anyone who uses local anesthetics, for whatever reason, would be interested in what deJong has to say. Most of aU, he has made what might have been a dry subject interesting and appealing. Robert I . Balfour, M.D. Seattle DIE LUNGENTUBERKULOSE I M RÖNTGENBILD. By HERBERT BLA HA. Berlin, Springer-Verlag, 1976, 388 pp, 204 iUus, $159.90 (in German). This monograph discusses the radiologic findings in intrathoracic tuberculosis. The emphasis is on the manifestations of this disease in adults, although there are some examples of pediatric cases, particularly in the discussion of the primary process. While there has been a marked decrease in the incidence of tuberculosis in Europe and North America, this disease still poses a considerable problem for pubUc health in many countries of the "third world," where a large proportion of the population is poverty-stricken, living in crowded and unsanitary conditions. As the chest x-ray film is still the only objective method for diagnosing the extent of disease and its response to therapy, this work is of great value to the physician whose practice is in an area where tuberculosis is endemic. The discussions emphasize the gross morphology of the disease process as manifested in the chest x-ray film, correlated with gross and microscopic pathologic material. The book is profusely illustrated with all of the protean manifestations of this disease, with the quaUty of the reproductions varying considerably. There is abundant statistical material, and there are 50 pages of references. After an introduction stressing the role of radiology and its relationship to other methods in Sie diagnosis of tuberculosis, the various radiologic techniques utilized in the study of the chest as related to tuberculosis are discussed. This is followed by an extensive description of the roentgenologic manifestations (both usual and unusual), their progression and heaUng, and a discussion of the differential diagnosis. Material on the relationship of tuberculosis to other thoracic and systemic illnesses concludes this very thorough work. Herbert F. Gramm, M.D. Boston CONGENITAL MALFORMATIONS OF THE HEART AND GREAT VESSELS: SYNOPSIS OF PATHOLOGY, EMBRYOLOGY AND NATURAL HISTORY. By HANS BANKL. Munich, West Germany, Urban and Schwarzenberg, Inc., 1977, 264 pp, 59 illus, price not stated. This Uttle book is intended to be an introduction to the pathology of congenital heart disease. The volume fulfills this mission to a surprising degree, considering the complexity of the subject, and it provides certain bits of information which generally are not easy to come by, eg, who first described a certain anomaly. Unfortunately, the book also suffers from a number of serious shortcomings which detract from its usefulness. The text is often hard to read and at times is confusing. In large part, this seems to be due to Bankl's unfamiUarity with the EngUsh language, which has resulted in unfortunate choices of words and pecuUar and often also unwieldy structuring of sentences. The manner of organization of the text, rather similar to that of the monograph by Fontana and Edwards, is not really suited for the present book. Descriptions of the cardiac malformations are not arranged in a particular logical order, and one wonders why Bankl has elected to deal with some of the most complex anomalies first. In doing so, terms are used which are not explained until later, an oddity which obviously will present problems to the novice. Certain important lesions are only mentioned in passing or not at all. Discussion of some of the anomalies, simple or complex, appears to be based on literature that is 10 to 20 years old, even though more recent publications (but prior to 1975) are almost always available. In adopting certain views, Bankl is not always