RADIOGRAPHIC ANATOMY OF THE CORONARY ARTERIES: AN ATLAS

THE BOOKSHELF ADVANCES IN CARDIOLOGY: ELECTROCARDIOLOGY II : PHYSIOLOGICAL, PATHOPHYSIOLOGICAL AND DIAGNOSTIC RESEARCH (vol 19): Proceedings of the 2nd International Congress on Electrocardiology (16th International Symposium on Vectorcardiography, Varna, October 1975) . Edited by H. ABEL and Z. PAVLOV. Basel, Switzerland, S. Karger AG, 1977, 318 pp, 119 Illus, approximately $58.25. Both clinical cardiology and investigative cardiology in the United States suffer from a lack of acquaintance with the work of non-English-speaking physicians. The result of a scientific meeting in Bulgaria, this book summarizes in English the work of many European investigators, particularly Eastern Europeans, and a few American and West European contributors. From electrophysiologic theory through clinical application of electrocardiography, the contributions cover a broad range. Because the great majority are two-page or threepage "summary papers," it is impossible to condense even a list of topics . One may cite for particular interest the work of Amirov on cardiac dipole circular movement, of Preda and d' Alche on temperature dependence of cardiac activation, of Antaloczi on computer applications in the interrelationships of cardiac electric measurements, and of McCaughan, Pipberger, and colleagues on the Frank electrocardiogram in normal women. Several investigations indicate support of Burch's well-known contention that the theoretically superior, mathematically "corrected" lead systems do not perform better than simple lead systems. Clin icians will also welcome the very realistic appraisal of the pitfalls of the electrocardiographic diagnosis of strictly posterior infarction by Antonin and Koje. DePadua contributes an excellent critique of limiting the analysis of hemiblocks to a bifascicular left conducting system , providing support for a trifascicular system (anterior septal activation) in explaining normal variants, absence of medial precordial R waves, and presence of exaggerated R waves in leads V I and V 2 in the absence of strict posterior infarction. Those who daily face the problem of "poor r wave progression in the medial precordial leads" can read with profit the series of Berger and Schack, which points to the pluricausality of this phenomenon. While containing much solid material, this book suHers from two more or less serious drawbacks. The great num ber of "summary papers" whet the appetite, but they are frequently too short and too condensed to permit adequate evaluation of the quality of the data. For 288 pages of text, with very few glossy illustrations, the price of the book is astonishing. David H. Spodick, M.D ., D.Sc., F.C.C.P. W orcester, Man THE PHYSIOLOGY OF BREATHING: A TEXTBOOK FOR MEDICAL STUDENTS. By AREND BoUHUYs. New York, Grone and Stratton, Ine., 1977,352 pp, $12.50. Respiratory physiology is one of the most complex fields of human physiology; unfortunately, the number of textbooks aimed at the medical student is exceedingly small Therefore, it is not surprising that respiratory physiology is hard to teach and at least as difficult to understand. This new textbook for medical students by Arend Bou-

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huys is an updated and revised version of the chapters on pulmonary physiology of the book, Breathing: Physiology, Environment and Lung Disease (published in 1974) by the same author. The Physiology of Breathing is, in my opinion, an outstanding addition to the present didactic literature on pulmonary physiology. The 12 chapters of the book are a most readable, accessible, and authoritative presentation of the fundamental aspects of pulmonary physiology. The many illustrations included in the book have been appropriately selected from the best-known and the most informative illustrations of the literature. Each chapter is excellently referenced with review articles and especially with the pertinent original reports. Style, illustrations, and references attest that Bouhuys has sensed the sophistication of the medical student. The book also offers an unusually good introduction to the applied physiology of the lung; for instance, the voluntary acts of breathing (singing, speech, etc) and the influence of the environment on pulmonary disease are considered in two separate chapters. Moreover , the clinical implications of a certain physiologic aspect (clinical measurement of the corresponding function, its pathophysiology, etc) are discussed in every single chapter. Besides the aspects of "classic" pulmonary physiology (ie , the physiology of gas transfer across airways, alveolocapfllary membrane, and red cell membrane), Bouhuys also presents the essentials of the pharmacology and biochemistry of most pulmonary cells, as these aspects relate to the act of breathing. In conclusion, The Physiology of Breathing, by its conception, style, quality, and extent of information, is one of the most important textbooks of pulmonary physiology. It is highly recommended not only for medical students, its specified target, but also for a larger audience, ie, the pulmonary fellow, the physician Interested in refreshing his knowledge of pulmonary physiology, and, of course, the teacher involved in this arduous discipline.

Valentin T . Popa, M.D. , F.C.C.P. Chicago RADIOGRAPHIC ANATOMY OF THE CORONARY ARTERIES: AN ATLAS. By BENIGNO Soro, RICHARD O. RUSSELL, JR., and ROCER E. MORASC. Mount Kisco, NY, Futura Publishing Co., 1976, 305 pp, $35.00. The book by Soto, Russell, and Moraski lives up to the spirit of its subtitle of "atlas," which, according to Webster, is a ''bound collection of maps ." In this case, the maps are those of the human coronary arteries, in health and disease . The book, in spite of its impressive size, is succinct and well organized. Its many large illustrations ably perform the task of guiding the reader from the simple and mnemonically useful "circle-and-loop" diagrams to the intricacies of the diseased vessels and the collateral circulation. Faithful to the scope of the book, details of technique and equipment are reduced to the barest essentials, and even the text preceding the illustrations is brief and concise. "Designed for physicians and students of medicine who do not perform coronary arteriograms,' this volume is not a "how-to" book intended to provide critical insight into the technique of coronary arteriography; however, it will be useful to all "who may review the films of their patients and who recognize the need for a better understanding of this important aspect of anatomy and medicine." I certainly agree that Soto and coauthors have fulfilled this goal.

The lavish use of space and the large illustrations are both a positive and negative feature of this atlas. Their advantage is obvious in terms of easy reading, yet this approach led to a book of considerable bulk and may have increased its cost, perhaps enough to discourage a number of potential readers. Some additional minor points of criticism are the excessive use of the lateral projection (many illustrations labeled "left oblique" are, in fact , lateral), a view that most laboratories utilizing cine techniques do not use routinely. The use of obviously diseased arteries in the chapters dealing with normal anatomy is unsettling (illustrations 4-12, 4-13, 4-18 , 5-2, 5-4, 5-9, 5-10,5-13,5-14, and 6-9) . Occasional statements are incorrect and could be grossly misleading to the beginner, such as the description of the right coronary artery (pages 130 and 131, Fig 7-5B) . which is not normal as the caption indicates, and its collateral circulation is not "well developed." Conspicuously absent is a chapter on left ventriculography, a procedure now universally considered an integral part of the "complete" coronary arteriogram. Despite these minor deficiencies, this atlas constitutes a welcome addition to the library of the well-informed internist and should be regarded as useful, too, for all physicians involved in the care of patients with coronary arterial disease . Goffredo G. Gemini, M.D., F.C.C.P. Syracwe, NY CYSTIC FIBROSIS: PROJECfIONS INTO THE FUTURE: An International Conference Held at the Israel Academy of Sciences and Humanities, Jerusalem, Israel, May 25-27, 1976. Edited by JOHN A. MANGOS and RICHARD C. TALAMO. New York, Stratton Intercontinental Medical Book Corp ., 1976, 370 pp, $19.95. This volume is the proceedings of an international conference of approximately 140 invited participants, which was held at the Israel Academy of Sciences and Humanities in Jerusalem in May 1976. The meeting consisted of both "applied sessions" and "fundamental sessions," and the proceedings reflect both aspects, providing the basic scientist with a clinical perspective and providing the clinician with an overview of the current scientific foundations and areas of controversy. The initial chapters deal with pulmonary, cardiovascular, gastrointestinal and nutritional, pathologic, and psychosocial aspects of cystic fibrosis, although, surprisingly, relatively little is mentioned concerning management of the extremely challenging staphylococcal and Pseudomonas infections. Excellent and detailed chapters are provided concerning the biochemical defect( s) involved in the pathophysiology of the disease while at the same time indicating that the abnormalities discovered thus far are relatively minor. Discussion of the immunologic aspects of cystic fibrosis emphasized that specific immune mechanisms appeared to be reasonably normal in cystic fibrosis and pointed towards a number of relevant areas for research. It was suggested that while there was considerable disagreement about defective mucociliary transport as a fundamental feature of the disease , it seemed evident that, at least quantitatively, the production of mucus was abnormal and that a lowmolecular-weight protein in the serum of patients with cystic fibrosis appeared to be the factor for both the release of mucus and ciliary dyskinesia in vitro, although the relevance of this to the situation in vivo is still unclear. Chapters

dealing with cellular and molecular biology and genetics, as well as physiology and pharmacology, particularly with regard to the definite abnormality noted in polyam ine metabolism, are all excellent and, together with the "projections into the future," should provide current information to anyone interested in this remarkably common genetically determined disease . This volume is well suited to the needs of pediatricians, particularly those having to deal with significant numbers of children with cystic fibrosis, and also to internists, chest physicians, and gastroenterologists who will doubtless encounter adults with the disorder with increasing frequency. For these clinicians and others engaged in the search for the basic defect of cystic fibrosis, the information contained in this volume brings together current knowledge and, out of this, projects future directions for research, which hopefully will lead to an improved understanding and management of this disorder. Michael T. Newhouse, M.D. R amilton, Ontario ATRIOVENTRICULAR CANAL DEFECfS. Edited by ROBERT H. FELDT. Philadelphia, W. B. Saunders Co., 1976, 145 pp, $22.00 (U.S.), $27.00 (Canada). This book consists essentially of a review of the many significant contributions to our knowledge of atrioventricular canal defects by the staff of the Mayo Clinic , to which has been added a valuable chapter by L. H. S. Van Meirop. This latter chapter covers the embryology and pathogenesis which are so basic to our understanding; for example, one must grasp the fact that the basal portion of the interventricular septum is missing to understand the "gooseneck" deformity and the principle of surgical repair. This and other pertinent anatomic points are repeatedly emphasized in chapters dealing with anatomy, cardiac catheterization, echocardiographic findings (I belie ve there is more new unpublished information in this chapter than the others) , angiocardiography, and surgical repair. Pertinent chapters on the conduction system , the electrocardiogram, and clinical features complete the book. Throughout, data are presented from the considerable and excellent experience at Mayo Clinic. This monograph was laid out and started by Dr . Gian Rastelli and was completed by his associates after his untimely death. Rastelli , of course , made a basic contribution in classifying the atrioventricular defects with reference to the deformity of the atrioventricular valve , which contributed significantly to understanding and , hence, to improved surgical results. The contributors can take pride that this memorial is fully worthy. Anthony R. C. Dobell, M.D. Montreal

LUNG CELLS IN DISEASE: Proceedings of a Brook Lodge Conference, Augusta, Michigan, April 21-23, 1976. Edited by AREND BoUHUYs. Amsterdam and New York, Elsevier/ North-Holland Biomedial Press, 1976, 350 pp, $28.95. This book represents the proceedings of a conference held at Brook Lodge, Augusta, Mich, in April 1976. The goal of the conference was to assemble a multidisciplinary group of people who could present and discuss recent data, interpretations, and ideas on studies of pulmonary cells in relation to disease from many different perspectives. The resulting volume attests to the success of the conference in meeting this

goal.

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