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Physical bases of circulatory transport: Regulation and exchange
$cth
the increasing interest in exercise and athletics, the monograph is timely. The book coaxsists of three parts, the first and larger concerned with chronic effects (training) on the resting ECG (Chapters I to III, pp, 7 to 86) the second part with changes during and after an exercise test (Chapters IX’ and V, pp. 87 to 109), and the last (and smallest) with “ tibertmining” and “tiberanstrengung” (Chapter VI, pp. 110 to 114). The concept of excessive work load { tiberiiludung) is quite frequent in the German Iiterature and therefore, substantiation by ECG changes would be of interest. However, the changes described in Chapter VI lack specificity. The sample of 1,250 athletes as listed ln Table 1 and 2,401 athletes as mentioned in the text is substantial. Unfortunately, the results are presented in crude distributiolls, in terms of percentage of subjects in four arbitrary classes for the various ECG items measured. For colli~ariso~l with untrained population, the author used Vaquero’s sample (1947) COL lected in Mexico City. Serious objections can be raised: the differences between the two sarnpies can be due to differences of race, geographical location (Mexico City i5 8,ODO feet in altitude), and to a different sex distrib\ltion as well as to different training condition. As a matter of fact, the differences of some of the ECG items between Vaquero’s Mexican sample and seden” tary Korth American samples are in the same direction as those claimed by the author to be typical for chronic effects of training. In view of the lack af adequate sedentary controls, drawn from the same population, t.he question of training effects on the resting ECG in the author’s material is open to question” On the other hand, the comparison of ECG changes during and after exhaustive (graded) work on the bicycle ergometer in 61 well-trained and 91 “not sufI?ciently” trained athletes is more adequate both in regard to sample selection and statisticai evaluation (means and S,D.) Table 20 (p. 96) gives detailed and interesting information on this series. It is regrettable that a new Iead “K“ was used which is similar to, but not identica1 to, and probabIy less sensitive than, other oblique bipolar chest leads more commonly used in exercise tests. The extensive list of references (pp. 220 to 240) includes about Russian a.nd Eastern European authors, which is of considerable interest. On the other hand, references to recent and important Ameriran investigations are incomplete. The book is profusely illustrated, perhaps overillustrated. In most ECG’s only time marl<111gs are gzven. There is a definite tendency to
overinterpretation of abnorma1ity~ Many of the KG’s shown as typical for an athlete could be found among sedentary population. No attempt was made to obtain statistically discriminatory lralues; perhaps, this may not be possibles because the discrimination is probably poor. It is surprising that the author still adheres to the obsolete unipolar theory of strictly localized ECG patterns, as suggested by- Goidberger ill 1942. The book abounds with strong, but poorly, supported convictions, for instance on p. 45 “All these changes (clockwise rotation)? greater It-V* than R-V3 (quite logical in clockwise rotatiozl), increase of’ R-V5 and S-V, + R-V5 @ms the high functional capacitlr of the heart.” This is hard to reconcile with the incidence of 10 per cent low voltage ECG’s in athletes in the author’s material. In absence of pathological conditions, the low voItage is explained bk- the “better developed skeIeta1 musculature” (p, 68) ‘+The simultaneous depression of S-T and P-Q below the isoelectric line after two minute Stal~d~i~g-ruIlili~~~ in athletes must be considered as sy~npto~ll of inadequa.te general body development (Durchbildung)” (p. 105). (This pattern is qllite common in sinus tachycardia.) HOW ever8 there are also interesting results: In well trained athletes> the T”waT:e increases after maximum exertion, whiIe it decreases in insufficiently trained subjects. Of interest also is the difference of the Q-T interval-heart rate relationship at rest and during exercise (Fig. 5 and 6)The book can be recommended for those who lcnow the subject well enough to separate interesting new information from the body of the text.
F&SES OF CII~~XA~~Y TIW.I~P~~T: I
This
book contains the papers presented at a ~OIIference held at the Colorado Medical Center in September, 1966. The many papers are concerned with attempts to explain the physics of the function of the heart and circulation through the use of models, mathematics, hypotheses, simplification, and a,Tsurnptions as well as available experimental data. The efforts are good and the papers very interesting. The authors present their ideas \:ery well concerning the complex nature of the performance of the cardiovascuIar system. The participants were main&y physiologists, biophysicists, engineers, mathematicians, pathologists, and even anatomists but there were no research cardiologists or clinicians engaged in peripheral vascufar re-
Book reviews
search. Thus, as would be expected, the book should be of interest to investigators engaged in studies of hemodynamic phenomena and of little interest to clinicians except those involved in research who have a good background in physics and the fundamentals of cardiovascular physiology. The discussions are good. By necessity the investigators were forced to deal with simplified models, theories, and assumptions. Nevertheless, their presentations are extremely interesting, and should be of value not only to those actively engaged in such research, but to anyone who wishes to learn more about the physical aspects of the function of the cardiovascular system. Since the authors do not usually work with people or patients with heart disease or, in fact, do not appear to follow the clinical literature as reflected in the discussions and the bibliography, the papers are deficient in pathologic physiology. Nevertheless, those engaged in clinical research should also find this book valuable.
ADVAXES IN GERONTOLOGICAL RESEARCH, vol. 2. Edited by Bernard I,. Strehler, New York and London, 1967, Academic Press, Inc., 431 pages. Price $18.50. Doctor Strehler has brought together in this volume several papers on gerontological research related to the aging process. The contributors are all from the LTnited States of America and therefore represent little from other countries of the world. The subjects discussed are somatic mutations and the aging process, metabolism of ribonucleic acid in young and old rodents, regulation and deterioration of structure of membranes, cell and tissue culture in aging research, general immunology of aging, aging of ground substance in connective tissue, biology and pathogenesis of vascular diseases, and lipid peroxidation. All of these subjects are presented very well and the
433
reader will find the papers most interesting. However, as would be expected, these studies do not yet even approach an answer to the pathogenesis of senescence but rather indicate some differences between old tissue and young or the structure in old and young animals. A good example is the discussion of vascular disease found in old people. The presentation really revriews the literature which has been done repeatedly at many other conferences and in papers on arteriosclerosis. Nevertheless, this is a very important book on an extremely important subject. The reader must realize that the subjects presented are only a few selected topics from authors in the I-nited States of America and therefore do not include the interesting fundamental studies in progress in many other laboratories. This is a good book, however, for those interested in gerontology and in search of an answer to the problem of the aging process.
THE ISNOCEY~ MUR~X. Edited by Cesar -1. Caceres, M.D. and Lowell W. Perry, M.D., Boston, 1967, Little, Brown & Company, 288 pages. Price $13.50. This
book of 300 pages is concerned with one of the most important cardiac problems in clinical medicine. Drs. Caceres and Perry have done a very thorough job in this book. They have called upon 25 (23 physicians) well-qualified people to assist them with the presentation of ideas and facts about innocent murmurs The subject is clearly discussed in chapters devoted to hissound production, auscultation, phonotory, cardiography, delinition, Still’s murmur, cardiorespiratory murmurs, venous hum, late systolic murmur, and other aspects. A large part of the book is in the form of a panel discussion with the contributors expressing their opinions about various aspects of the murmurs. This is a good book which shorrld prove useful to all clinicians and students.
the increasing interest in exercise and athletics, the monograph is timely. The book coaxsists of three parts, the first and larger concerned with chronic effects (training) on the resting ECG (Chapters I to III, pp, 7 to 86) the second part with changes during and after an exercise test (Chapters IX’ and V, pp. 87 to 109), and the last (and smallest) with “ tibertmining” and “tiberanstrengung” (Chapter VI, pp. 110 to 114). The concept of excessive work load { tiberiiludung) is quite frequent in the German Iiterature and therefore, substantiation by ECG changes would be of interest. However, the changes described in Chapter VI lack specificity. The sample of 1,250 athletes as listed ln Table 1 and 2,401 athletes as mentioned in the text is substantial. Unfortunately, the results are presented in crude distributiolls, in terms of percentage of subjects in four arbitrary classes for the various ECG items measured. For colli~ariso~l with untrained population, the author used Vaquero’s sample (1947) COL lected in Mexico City. Serious objections can be raised: the differences between the two sarnpies can be due to differences of race, geographical location (Mexico City i5 8,ODO feet in altitude), and to a different sex distrib\ltion as well as to different training condition. As a matter of fact, the differences of some of the ECG items between Vaquero’s Mexican sample and seden” tary Korth American samples are in the same direction as those claimed by the author to be typical for chronic effects of training. In view of the lack af adequate sedentary controls, drawn from the same population, t.he question of training effects on the resting ECG in the author’s material is open to question” On the other hand, the comparison of ECG changes during and after exhaustive (graded) work on the bicycle ergometer in 61 well-trained and 91 “not sufI?ciently” trained athletes is more adequate both in regard to sample selection and statisticai evaluation (means and S,D.) Table 20 (p. 96) gives detailed and interesting information on this series. It is regrettable that a new Iead “K“ was used which is similar to, but not identica1 to, and probabIy less sensitive than, other oblique bipolar chest leads more commonly used in exercise tests. The extensive list of references (pp. 220 to 240) includes about Russian a.nd Eastern European authors, which is of considerable interest. On the other hand, references to recent and important Ameriran investigations are incomplete. The book is profusely illustrated, perhaps overillustrated. In most ECG’s only time marl<111gs are gzven. There is a definite tendency to
overinterpretation of abnorma1ity~ Many of the KG’s shown as typical for an athlete could be found among sedentary population. No attempt was made to obtain statistically discriminatory lralues; perhaps, this may not be possibles because the discrimination is probably poor. It is surprising that the author still adheres to the obsolete unipolar theory of strictly localized ECG patterns, as suggested by- Goidberger ill 1942. The book abounds with strong, but poorly, supported convictions, for instance on p. 45 “All these changes (clockwise rotation)? greater It-V* than R-V3 (quite logical in clockwise rotatiozl), increase of’ R-V5 and S-V, + R-V5 @ms the high functional capacitlr of the heart.” This is hard to reconcile with the incidence of 10 per cent low voltage ECG’s in athletes in the author’s material. In absence of pathological conditions, the low voItage is explained bk- the “better developed skeIeta1 musculature” (p, 68) ‘+The simultaneous depression of S-T and P-Q below the isoelectric line after two minute Stal~d~i~g-ruIlili~~~ in athletes must be considered as sy~npto~ll of inadequa.te general body development (Durchbildung)” (p. 105). (This pattern is qllite common in sinus tachycardia.) HOW ever8 there are also interesting results: In well trained athletes> the T”waT:e increases after maximum exertion, whiIe it decreases in insufficiently trained subjects. Of interest also is the difference of the Q-T interval-heart rate relationship at rest and during exercise (Fig. 5 and 6)The book can be recommended for those who lcnow the subject well enough to separate interesting new information from the body of the text.
F&SES OF CII~~XA~~Y TIW.I~P~~T: I
This
book contains the papers presented at a ~OIIference held at the Colorado Medical Center in September, 1966. The many papers are concerned with attempts to explain the physics of the function of the heart and circulation through the use of models, mathematics, hypotheses, simplification, and a,Tsurnptions as well as available experimental data. The efforts are good and the papers very interesting. The authors present their ideas \:ery well concerning the complex nature of the performance of the cardiovascuIar system. The participants were main&y physiologists, biophysicists, engineers, mathematicians, pathologists, and even anatomists but there were no research cardiologists or clinicians engaged in peripheral vascufar re-
Book reviews
search. Thus, as would be expected, the book should be of interest to investigators engaged in studies of hemodynamic phenomena and of little interest to clinicians except those involved in research who have a good background in physics and the fundamentals of cardiovascular physiology. The discussions are good. By necessity the investigators were forced to deal with simplified models, theories, and assumptions. Nevertheless, their presentations are extremely interesting, and should be of value not only to those actively engaged in such research, but to anyone who wishes to learn more about the physical aspects of the function of the cardiovascular system. Since the authors do not usually work with people or patients with heart disease or, in fact, do not appear to follow the clinical literature as reflected in the discussions and the bibliography, the papers are deficient in pathologic physiology. Nevertheless, those engaged in clinical research should also find this book valuable.
ADVAXES IN GERONTOLOGICAL RESEARCH, vol. 2. Edited by Bernard I,. Strehler, New York and London, 1967, Academic Press, Inc., 431 pages. Price $18.50. Doctor Strehler has brought together in this volume several papers on gerontological research related to the aging process. The contributors are all from the LTnited States of America and therefore represent little from other countries of the world. The subjects discussed are somatic mutations and the aging process, metabolism of ribonucleic acid in young and old rodents, regulation and deterioration of structure of membranes, cell and tissue culture in aging research, general immunology of aging, aging of ground substance in connective tissue, biology and pathogenesis of vascular diseases, and lipid peroxidation. All of these subjects are presented very well and the
433
reader will find the papers most interesting. However, as would be expected, these studies do not yet even approach an answer to the pathogenesis of senescence but rather indicate some differences between old tissue and young or the structure in old and young animals. A good example is the discussion of vascular disease found in old people. The presentation really revriews the literature which has been done repeatedly at many other conferences and in papers on arteriosclerosis. Nevertheless, this is a very important book on an extremely important subject. The reader must realize that the subjects presented are only a few selected topics from authors in the I-nited States of America and therefore do not include the interesting fundamental studies in progress in many other laboratories. This is a good book, however, for those interested in gerontology and in search of an answer to the problem of the aging process.
THE ISNOCEY~ MUR~X. Edited by Cesar -1. Caceres, M.D. and Lowell W. Perry, M.D., Boston, 1967, Little, Brown & Company, 288 pages. Price $13.50. This
book of 300 pages is concerned with one of the most important cardiac problems in clinical medicine. Drs. Caceres and Perry have done a very thorough job in this book. They have called upon 25 (23 physicians) well-qualified people to assist them with the presentation of ideas and facts about innocent murmurs The subject is clearly discussed in chapters devoted to hissound production, auscultation, phonotory, cardiography, delinition, Still’s murmur, cardiorespiratory murmurs, venous hum, late systolic murmur, and other aspects. A large part of the book is in the form of a panel discussion with the contributors expressing their opinions about various aspects of the murmurs. This is a good book which shorrld prove useful to all clinicians and students.