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Pulmonary Function Indices in Critical Care Patients
Mayo Clin Proc, September 1988, Vol 63
nonneurologists. It has been written so that read ers interested in learning about particular as pects of movement disorders involving the face, head, and neck can choose selected chapters of interest and gain a reasonably good understand ing of that problem. J. Eric Ahlskog, M.D. Department of Neurology
The Liver: Biology and Pathobiology, 2nd ed, edited by Irwin M. Arias, William B. Jakoby, Hans Popper, David Schachter, and David A. Shafritz, 1,377 pp, with illus, $195, New York, Raven Press, 1988 The editors have stated that this book is intended "to provide students of the liver and its diseases the current basis for understanding liver biology and pathobiology." They accomplished this ob jective by inviting a distinguished group of basic scientists and clinical investigators who have contributed to the advancement of hepatology to participate in this endeavor. The result is this magnificent book that belongs in the library of anyone interested in the liver and its diseases. The subjects are organized in seven sections that include a detailed account of the cells that constitute the liver, presented in chapters that provide structural, physiologic, and biochemical insights, as well as a clear description of the extracellular matrix in which these cells function. Despite the diversity of the authors, the material is presented didactically without compromising accuracy, an approach that provides clinical hepatologists with basic aspects of cell function and a state-of-the-art account of this subject. The chap ters are of appropriate length and are accompanied by complete lists of references for further study. A section devoted to the various cellular com ponents of the liver provides the basis for a subsequent special section dedicated to the inter relationship of cell functions. An outstanding contribution in this section is the chapter written by Gumucio and Chianale, which presents an integrated view of liver function and the hetero geneity of liver cells. Sections V and VI deal with the relationship of the liver to other organs and the pathobiologic aspects of liver diseases, respectively. These
BOOK REVIEWS
964
sections include clinically relevant chapters on hepatic encephalopathy, the interaction between the liver and the endocrine system, portal hyper tension, and renal function in liver diseases. The chapter written by the late Hans Popper entitled "Hepatocellular Degeneration and Death" is a masterpiece; the author lucidly presents the pos sible causative mechanisms of hepatocellular death and their interactions and also discusses possible therapeutic options. This chapter is prob ably one of the last scientific contributions from an exceptional scientist and teacher. The book would not be complete without a look to the future. This view is provided in the last section that, according to the editors, should be the inspiration for future chapters in the third edition of the book. The influence of molecular biology and new concepts of immunology are reflected throughout this second edition, and these factors will probably be even more impor tant in years to come. In this second edition, the editors of this book provide an outstanding update on the liver and pertinent aspects of its pathobiology. The intel ligent approach and organization make it a use ful reference source for basic as well as clinical investigators from multiple disciplines who are interested in the liver. This book should also con siderably enhance the understanding of clinical hepatologists who care for patients with liver disease. Jorge Rakela, M.D. Division of Gastroenterology and Internal Medicine
Pulmonary Function Indices in Critical Care Patients, by Josef X. Brunner and Günther Wolff, 171 pp, with illus, $49, New York, SpringerVerlag, 1988 This paperback book is the enhanced and trans lated version of a Ph.D. thesis in which the development and applications of a pulmonary function unit for critically ill, mechanically venti lated patients are described. With this system, data on respiratory mechanics and pulmonary gas exchange are integrated to provide a compre hensive, physiologic assessment of pulmonary function. In chapter 1, general features of an
965 BOOK REVIEWS
ideal monitoring system are discussed, and chap ter 2 examines the physiologic models on which the indices of pulmonary function are based. By necessity, the material in chapter 2 deals with state-of-the-art concepts in pulmonary physiology; unless expert in this area, the critical-care prac titioner will find the information overwhelming. In chapter 3, hardware specifications and the principles of testing instrumentation for data sampling and analysis are presented. In this context, the authors introduce three case reports designed to show that the additional information provided by the pulmonary function unit en hanced the clinician's understanding of rather complex pathophysiologic events. Although these data are most interesting and thought-provoking, they also highlight the serious limitations and potential controversies in their interpretation. As is appropriately stressed in this book, the derived variables are only as good as the models on which they are based. Unfortunately, our incom plete understanding of the derangement of pul monary function in disease stresses the underly ing model assumptions to the utmost. Therefore, the measurement system described in this book must be viewed as an investigative tool for clini cal research that has yet to find a place in clinical practice. This view is supported by the material in chapters 4 through 6, in which results of clinical applications are described. Chapter 4 presents "normal" values of pulmonary function from 28 patients who underwent uncomplicated open heart surgical procedures. In chapter 5, the authors test the hypothesis that there is an opti mal ventilator setting for every patient. This hy pothesis was rejected because ventilator settings had only a minimal and clinically irrelevant effect on gas exchange. Finally, chapter 6 com pares the cardiopulmonary effects of intermittent positive pressure ventilation, intermittent man datory ventilation, and continuous positive air way pressure therapy. The book concludes with nine appendixes that provide more detailed infor mation on the mathematical models, quality con trol studies, and individual patient results. This book is a good starting point for clini cians, biomedical engineers, and experts in data management who have given more than a pass ing thought to monitoring and pulmonary func tion testing in critically ill patients. I agree with the authors that, unless measurement systems like these are tested in academic centers, we will
Mayo Clin Proc, September 1988, Vol 63
not learn whether this information contributes to clinical decision making. At the same time, we must avoid past mistakes and resist introducing new untested technology into routine clinical practice because we are rarely brave enough to part from it, even when we cannot demonstrate a clear benefit to our patients. RolfD. Hubmayr, M.D. Division of Thoracic Diseases and Internal Medicine
BOOKS RECEIVED Practical Blood Transfusion, 4th ed, by Douglas W. Huestis, Joseph R. Bove, and John Case, 424 pp, with illus, $49.50, Boston, Little, Brown and Company, 1988 Tumors of the Upper Respiratory Tract and Ear (Atlas of Tumor Pathology, 2nd Series, Fascicle 25), by Vincent J. Hyams, John G. Batsakis, and Leslie Michaels, 343 pp, with illus, $20, Washington, DC, Armed Forces Institute of Pathology, 1988 Histology (Board Review Series), by Leslie P. Gartner, James L. Hiatt, and Judy M. Strum, 342 pp, with illus, $16.95, Baltimore, Williams & Wilkins, 1988 Transduction Mechanisms of Drug Stimuli (Psychopharmacology, Vol 4), edited by F. C. Colpaert and R. L. Balster, 236 pp, with illus, $89.70, New York, Springer-Verlag, 1988 Rheumatologic Disorders (Advanced Exercises in Diagnostic Radiology, Vol 19), by Lawrence F. Layfer, Jerry Petasnick, and Robert S. Katz, 186 pp, with illus, $29.50, Philadelphia, W. B. Saunders Company, 1988 Breast Cancer: Collaborative Management, edited by Jay K. Harness, Harold A. Oberman, Allen S. Lichter, Dorit D. Adler, and Robert L. Cody, 390 pp, with illus, $69.95, Chelsea, Michigan, Lewis Publishers, 1988 Tumours of the Larynx: Histopathology and Clinical Inferences, by Erhard Meyer-Breiting and Arne Burkhardt, 221 pp, with illus, $160, New York, Springer-Verlag, 1988 The Pharmacologic Approach to the Critically 111 Patient, 2nd ed, edited by Bart Chernow, 975 pp, with illus, $116.50, Baltimore, Williams & Wilkins, 1988 ABO Incompatibility and Transplantation, edited by Aaron D. Bannett, Hans Brynger, Bo Samuelsson, Robert F. McAlack, and Michael Breimer, 246 pp, with illus, $55.75, Philadelphia, Grune & Stratton, 1987 Pediatric Nephrology, 2nd ed, edited by Malcolm A. Holliday, T. Martin Barratt, and Robert L. Vernier, 992 pp, with illus, $112.50, Baltimore, Williams & Wilkins, 1987
nonneurologists. It has been written so that read ers interested in learning about particular as pects of movement disorders involving the face, head, and neck can choose selected chapters of interest and gain a reasonably good understand ing of that problem. J. Eric Ahlskog, M.D. Department of Neurology
The Liver: Biology and Pathobiology, 2nd ed, edited by Irwin M. Arias, William B. Jakoby, Hans Popper, David Schachter, and David A. Shafritz, 1,377 pp, with illus, $195, New York, Raven Press, 1988 The editors have stated that this book is intended "to provide students of the liver and its diseases the current basis for understanding liver biology and pathobiology." They accomplished this ob jective by inviting a distinguished group of basic scientists and clinical investigators who have contributed to the advancement of hepatology to participate in this endeavor. The result is this magnificent book that belongs in the library of anyone interested in the liver and its diseases. The subjects are organized in seven sections that include a detailed account of the cells that constitute the liver, presented in chapters that provide structural, physiologic, and biochemical insights, as well as a clear description of the extracellular matrix in which these cells function. Despite the diversity of the authors, the material is presented didactically without compromising accuracy, an approach that provides clinical hepatologists with basic aspects of cell function and a state-of-the-art account of this subject. The chap ters are of appropriate length and are accompanied by complete lists of references for further study. A section devoted to the various cellular com ponents of the liver provides the basis for a subsequent special section dedicated to the inter relationship of cell functions. An outstanding contribution in this section is the chapter written by Gumucio and Chianale, which presents an integrated view of liver function and the hetero geneity of liver cells. Sections V and VI deal with the relationship of the liver to other organs and the pathobiologic aspects of liver diseases, respectively. These
BOOK REVIEWS
964
sections include clinically relevant chapters on hepatic encephalopathy, the interaction between the liver and the endocrine system, portal hyper tension, and renal function in liver diseases. The chapter written by the late Hans Popper entitled "Hepatocellular Degeneration and Death" is a masterpiece; the author lucidly presents the pos sible causative mechanisms of hepatocellular death and their interactions and also discusses possible therapeutic options. This chapter is prob ably one of the last scientific contributions from an exceptional scientist and teacher. The book would not be complete without a look to the future. This view is provided in the last section that, according to the editors, should be the inspiration for future chapters in the third edition of the book. The influence of molecular biology and new concepts of immunology are reflected throughout this second edition, and these factors will probably be even more impor tant in years to come. In this second edition, the editors of this book provide an outstanding update on the liver and pertinent aspects of its pathobiology. The intel ligent approach and organization make it a use ful reference source for basic as well as clinical investigators from multiple disciplines who are interested in the liver. This book should also con siderably enhance the understanding of clinical hepatologists who care for patients with liver disease. Jorge Rakela, M.D. Division of Gastroenterology and Internal Medicine
Pulmonary Function Indices in Critical Care Patients, by Josef X. Brunner and Günther Wolff, 171 pp, with illus, $49, New York, SpringerVerlag, 1988 This paperback book is the enhanced and trans lated version of a Ph.D. thesis in which the development and applications of a pulmonary function unit for critically ill, mechanically venti lated patients are described. With this system, data on respiratory mechanics and pulmonary gas exchange are integrated to provide a compre hensive, physiologic assessment of pulmonary function. In chapter 1, general features of an
965 BOOK REVIEWS
ideal monitoring system are discussed, and chap ter 2 examines the physiologic models on which the indices of pulmonary function are based. By necessity, the material in chapter 2 deals with state-of-the-art concepts in pulmonary physiology; unless expert in this area, the critical-care prac titioner will find the information overwhelming. In chapter 3, hardware specifications and the principles of testing instrumentation for data sampling and analysis are presented. In this context, the authors introduce three case reports designed to show that the additional information provided by the pulmonary function unit en hanced the clinician's understanding of rather complex pathophysiologic events. Although these data are most interesting and thought-provoking, they also highlight the serious limitations and potential controversies in their interpretation. As is appropriately stressed in this book, the derived variables are only as good as the models on which they are based. Unfortunately, our incom plete understanding of the derangement of pul monary function in disease stresses the underly ing model assumptions to the utmost. Therefore, the measurement system described in this book must be viewed as an investigative tool for clini cal research that has yet to find a place in clinical practice. This view is supported by the material in chapters 4 through 6, in which results of clinical applications are described. Chapter 4 presents "normal" values of pulmonary function from 28 patients who underwent uncomplicated open heart surgical procedures. In chapter 5, the authors test the hypothesis that there is an opti mal ventilator setting for every patient. This hy pothesis was rejected because ventilator settings had only a minimal and clinically irrelevant effect on gas exchange. Finally, chapter 6 com pares the cardiopulmonary effects of intermittent positive pressure ventilation, intermittent man datory ventilation, and continuous positive air way pressure therapy. The book concludes with nine appendixes that provide more detailed infor mation on the mathematical models, quality con trol studies, and individual patient results. This book is a good starting point for clini cians, biomedical engineers, and experts in data management who have given more than a pass ing thought to monitoring and pulmonary func tion testing in critically ill patients. I agree with the authors that, unless measurement systems like these are tested in academic centers, we will
Mayo Clin Proc, September 1988, Vol 63
not learn whether this information contributes to clinical decision making. At the same time, we must avoid past mistakes and resist introducing new untested technology into routine clinical practice because we are rarely brave enough to part from it, even when we cannot demonstrate a clear benefit to our patients. RolfD. Hubmayr, M.D. Division of Thoracic Diseases and Internal Medicine
BOOKS RECEIVED Practical Blood Transfusion, 4th ed, by Douglas W. Huestis, Joseph R. Bove, and John Case, 424 pp, with illus, $49.50, Boston, Little, Brown and Company, 1988 Tumors of the Upper Respiratory Tract and Ear (Atlas of Tumor Pathology, 2nd Series, Fascicle 25), by Vincent J. Hyams, John G. Batsakis, and Leslie Michaels, 343 pp, with illus, $20, Washington, DC, Armed Forces Institute of Pathology, 1988 Histology (Board Review Series), by Leslie P. Gartner, James L. Hiatt, and Judy M. Strum, 342 pp, with illus, $16.95, Baltimore, Williams & Wilkins, 1988 Transduction Mechanisms of Drug Stimuli (Psychopharmacology, Vol 4), edited by F. C. Colpaert and R. L. Balster, 236 pp, with illus, $89.70, New York, Springer-Verlag, 1988 Rheumatologic Disorders (Advanced Exercises in Diagnostic Radiology, Vol 19), by Lawrence F. Layfer, Jerry Petasnick, and Robert S. Katz, 186 pp, with illus, $29.50, Philadelphia, W. B. Saunders Company, 1988 Breast Cancer: Collaborative Management, edited by Jay K. Harness, Harold A. Oberman, Allen S. Lichter, Dorit D. Adler, and Robert L. Cody, 390 pp, with illus, $69.95, Chelsea, Michigan, Lewis Publishers, 1988 Tumours of the Larynx: Histopathology and Clinical Inferences, by Erhard Meyer-Breiting and Arne Burkhardt, 221 pp, with illus, $160, New York, Springer-Verlag, 1988 The Pharmacologic Approach to the Critically 111 Patient, 2nd ed, edited by Bart Chernow, 975 pp, with illus, $116.50, Baltimore, Williams & Wilkins, 1988 ABO Incompatibility and Transplantation, edited by Aaron D. Bannett, Hans Brynger, Bo Samuelsson, Robert F. McAlack, and Michael Breimer, 246 pp, with illus, $55.75, Philadelphia, Grune & Stratton, 1987 Pediatric Nephrology, 2nd ed, edited by Malcolm A. Holliday, T. Martin Barratt, and Robert L. Vernier, 992 pp, with illus, $112.50, Baltimore, Williams & Wilkins, 1987