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Respiration in Health & Disease
Book
has summarized the peer review of the papers that occurred at the meeting. This is followed by a section on assessment and prospects made by the vice-chairman. There is some repetition between these three sections and judging by the peer review section, there seems to have been little controversy apart from in the animal experimentation section. This is the most important review of the health aspects of man-made mineral libres that has as yet appeared. The presentation of the reports falls far short of that achieved by a number of drug company sponsored symposia. There is a great lack of figures with many pages of unrelieved closely typed lines. The short-comings of presentation are a great pity considering the wealth ofmajor international scientific expertise which has gone into the many excellent studies that have been reported at the meeting. P. Sherwood
Burge
of the Respiratory Tract in Children E. L. Kendig and V. Chernick Philadelphia, London, Toronto: W. B. Saunders & Co. 1983. 4th edition. Pp. 968. Price
Disorders
E75.00
The fourth edition of this textbook follows 6 years after the third edition. Its declared object is to provide an answer to almost any question on respiratory diseases in children for all medical practitioners. There are 47 chapters produced by 75 contrtbutors, 63 of whom have a paediatric appomtment. Many of the writers are international authorities in their subject. This is valuable as to read that ‘the diagnosis of cystic fibrosis is a clinical, not a laboratory diagnosis’ (Swachman) is to be authoritatively informed. The language varies, but most sections are comprehensible and useful. I was impressed that, for instance, in the chapter on lungs and sickle cell disease which is apparently written by three authors domiciled in Nigeria and Washington, the text blended effectively and was clear and informative. In areas in which I could claim a particular expertise I generally agreed with the authors’ statements, and in areas of greater ignorance I commonly found new and interesting facts. When I used this book for some current patient problems (measles, pneumonia, desquamative interstitial pneumo-
Reviews
nia) it was relevant, informative and usually helpful. The references at the end of each chapter (average approximately 80) were useful, with 1981 references commonly being included. Not all chapters have summaries or conclusions but where present they were helpful. Unsurprisingly, there are defects. The overall design of the book is neither developmental, anatomic nor functional. In effect this is a selection of monographs, rather than an integrated description of respiratory disease. There were some omissions-there is no section on sinusitis itself but it is described as a complication of other diseases. The index could have compensated for these defects as one does not anticipate that many people will sit down and read this large textbook through. However, the index is only 29 pages long and not very effective. I could not find subjects such as sequestration in the index or in chapter headings, although there is a good description in the text. The x-ray plates are informative and useful but the illustrations are generally disappointing. The diagrams are poor and the black and white pictures of histology are not as useful as a series of coloured plates at the end of the book would have been. The tables, notably those showing the differential diagnosis, are valuable. Despite these criticisms this is the definitive book on paediatric respiratory disease for consulting chest physicians but morejunior staff members may find Phelan et al.‘s (1982) text an easier and cheaper read. All departments professing an interest in paediatric respiratory diseases should have access to Kendig and Chernick’s book. F. Carswell
Respiration
in Health
& Disease.
Third Edition Reuben M. Cherniack and Louis Cherniack Philadelphia and London: W. B. Saunders Company. 1983. 3rd edition. Pp. 458. Price E21 .oo Dr Reuben edition of brother in The book by today’s
Cherniack has brought out the third the textbook that he wrote with his 1961: the second appeared in 1972. is pleasingly produced, fairly priced standards and well written in the
310
Book
relaxed, colloquial style of a good series of lectures. The text is divided into five sections. The first 145 pages deal with respiratory physiology to a good postgraduate standard. This section will be useful for a teacher preparing course material, but there are some parts which date to the early 1970s. The material on respiratory muscle fatigue has been updated, but the discussion of pulmonary gas exchange is limited to the Riley, Fenn and Rahn models of ideal alveolar gas without any discussion of their limitations. Wagner and West’s inert gas method of quantifying ventilation-perfusion mismatching is not mentioned. The section on diffusing capacity deals first, confusingly, with Do2 and then with Dco. The equations for the subdivisions of Dco are misprinted. The equal pressure point of Mead, upstream resistance and airway collapse are described in mathematical rather than intuitive terms, but the effect of the elasticity of the walls of airways on airflow limitation is not discussed. Frequency dependence of compliance is described as the gold standard for the presence of small airway disease, but this concept has proved to be of theoretical value only as it cannot be measured reproducibly. Next follows a section of 30 pages on the manifestations of pulmonary disease which in places anticipates what follows later. The pages on history taking, examination and laboratory assessment are good as far as they go although they have been updated carelessly and very slightly: for example, CT and ultrasound deserve more than six lines in a section which is otherwise quite detailed. The clinical section (95 pages) consists of the sort of background introductory material found in undergraduate textbooks but clinical descriptions of disease are not provided and this part of the book is not likely to be helpful to British students. I was disappointed to find that even pulmonary embolism, a condition in which clinical findings can be predicted from a knowledge of anatomy and physiology, is not discussed in a lucid fashion. A final section on respiratory failure offers useful advice on the principles of artificial ventilation; however, the attempts of the authors to go back to first principles throughout have resulted in a rather incoherent account of the management of chronic respiratory failure. This work contains too much physiological detail for the needs of the average British
Reviews
medical student and too little clinical description. However, those serious students ofrespiratory physiology who like a lucid, discursive prose style will enjoy the first part of this book. G. Laszlo
A Colour Injuries.
Atlas
of
Chest
Trauma
and
Associated
Volume II Augustus Besson and Frederic Saegesser London: Wolfe Medical Publications Limited. 1983. 1st edition. Pp. 384. Price L48 Volume II of this colour atlas on the management of chest trauma provides an excellent and comprehensive collection of clear line drawings and photographic illustrations. Volume I dealt with injuries to the chest wall, lungs and some general considerations such as the management of chest drains. Although of a generally high standard one glaring error remains to the fore. When describing the method of chest drain insertion the authors reiterate the incorrect and dangerous technique of simply making a skin incision and then introducing the trocar and drainage tube by force, rather than dissection down to the pleura. This is a common cause of chest trauma in most hospitals. Apart from this and some other conjectural points such as a discussion on the relative merits of internal fixation versus positive pressure ventilation for the management of flail chest segments the authors give good sound advice based on many years of clinical experience. This second volume devotes a section to each of the major intrathoracic organs. Much of the data is presented as case history with excellent documentation both graphically and in terms of results both successful and unsuccessful. No attempt is made to conceal errors in management and misadventure is used to illustrate the many pitfalls for the unwary clinician. The sections on tracheal and oesophageal injuries are excellent. Although these injuries are not common, if missed they are lethal in the majority of situations. At all times the authors are quick to stress the importance of associated injuries to structures outside the chest: a point of vital importance as injuries severe enough to cause major intrathoracic damage are commonly associated with equally severe injuries to
has summarized the peer review of the papers that occurred at the meeting. This is followed by a section on assessment and prospects made by the vice-chairman. There is some repetition between these three sections and judging by the peer review section, there seems to have been little controversy apart from in the animal experimentation section. This is the most important review of the health aspects of man-made mineral libres that has as yet appeared. The presentation of the reports falls far short of that achieved by a number of drug company sponsored symposia. There is a great lack of figures with many pages of unrelieved closely typed lines. The short-comings of presentation are a great pity considering the wealth ofmajor international scientific expertise which has gone into the many excellent studies that have been reported at the meeting. P. Sherwood
Burge
of the Respiratory Tract in Children E. L. Kendig and V. Chernick Philadelphia, London, Toronto: W. B. Saunders & Co. 1983. 4th edition. Pp. 968. Price
Disorders
E75.00
The fourth edition of this textbook follows 6 years after the third edition. Its declared object is to provide an answer to almost any question on respiratory diseases in children for all medical practitioners. There are 47 chapters produced by 75 contrtbutors, 63 of whom have a paediatric appomtment. Many of the writers are international authorities in their subject. This is valuable as to read that ‘the diagnosis of cystic fibrosis is a clinical, not a laboratory diagnosis’ (Swachman) is to be authoritatively informed. The language varies, but most sections are comprehensible and useful. I was impressed that, for instance, in the chapter on lungs and sickle cell disease which is apparently written by three authors domiciled in Nigeria and Washington, the text blended effectively and was clear and informative. In areas in which I could claim a particular expertise I generally agreed with the authors’ statements, and in areas of greater ignorance I commonly found new and interesting facts. When I used this book for some current patient problems (measles, pneumonia, desquamative interstitial pneumo-
Reviews
nia) it was relevant, informative and usually helpful. The references at the end of each chapter (average approximately 80) were useful, with 1981 references commonly being included. Not all chapters have summaries or conclusions but where present they were helpful. Unsurprisingly, there are defects. The overall design of the book is neither developmental, anatomic nor functional. In effect this is a selection of monographs, rather than an integrated description of respiratory disease. There were some omissions-there is no section on sinusitis itself but it is described as a complication of other diseases. The index could have compensated for these defects as one does not anticipate that many people will sit down and read this large textbook through. However, the index is only 29 pages long and not very effective. I could not find subjects such as sequestration in the index or in chapter headings, although there is a good description in the text. The x-ray plates are informative and useful but the illustrations are generally disappointing. The diagrams are poor and the black and white pictures of histology are not as useful as a series of coloured plates at the end of the book would have been. The tables, notably those showing the differential diagnosis, are valuable. Despite these criticisms this is the definitive book on paediatric respiratory disease for consulting chest physicians but morejunior staff members may find Phelan et al.‘s (1982) text an easier and cheaper read. All departments professing an interest in paediatric respiratory diseases should have access to Kendig and Chernick’s book. F. Carswell
Respiration
in Health
& Disease.
Third Edition Reuben M. Cherniack and Louis Cherniack Philadelphia and London: W. B. Saunders Company. 1983. 3rd edition. Pp. 458. Price E21 .oo Dr Reuben edition of brother in The book by today’s
Cherniack has brought out the third the textbook that he wrote with his 1961: the second appeared in 1972. is pleasingly produced, fairly priced standards and well written in the
310
Book
relaxed, colloquial style of a good series of lectures. The text is divided into five sections. The first 145 pages deal with respiratory physiology to a good postgraduate standard. This section will be useful for a teacher preparing course material, but there are some parts which date to the early 1970s. The material on respiratory muscle fatigue has been updated, but the discussion of pulmonary gas exchange is limited to the Riley, Fenn and Rahn models of ideal alveolar gas without any discussion of their limitations. Wagner and West’s inert gas method of quantifying ventilation-perfusion mismatching is not mentioned. The section on diffusing capacity deals first, confusingly, with Do2 and then with Dco. The equations for the subdivisions of Dco are misprinted. The equal pressure point of Mead, upstream resistance and airway collapse are described in mathematical rather than intuitive terms, but the effect of the elasticity of the walls of airways on airflow limitation is not discussed. Frequency dependence of compliance is described as the gold standard for the presence of small airway disease, but this concept has proved to be of theoretical value only as it cannot be measured reproducibly. Next follows a section of 30 pages on the manifestations of pulmonary disease which in places anticipates what follows later. The pages on history taking, examination and laboratory assessment are good as far as they go although they have been updated carelessly and very slightly: for example, CT and ultrasound deserve more than six lines in a section which is otherwise quite detailed. The clinical section (95 pages) consists of the sort of background introductory material found in undergraduate textbooks but clinical descriptions of disease are not provided and this part of the book is not likely to be helpful to British students. I was disappointed to find that even pulmonary embolism, a condition in which clinical findings can be predicted from a knowledge of anatomy and physiology, is not discussed in a lucid fashion. A final section on respiratory failure offers useful advice on the principles of artificial ventilation; however, the attempts of the authors to go back to first principles throughout have resulted in a rather incoherent account of the management of chronic respiratory failure. This work contains too much physiological detail for the needs of the average British
Reviews
medical student and too little clinical description. However, those serious students ofrespiratory physiology who like a lucid, discursive prose style will enjoy the first part of this book. G. Laszlo
A Colour Injuries.
Atlas
of
Chest
Trauma
and
Associated
Volume II Augustus Besson and Frederic Saegesser London: Wolfe Medical Publications Limited. 1983. 1st edition. Pp. 384. Price L48 Volume II of this colour atlas on the management of chest trauma provides an excellent and comprehensive collection of clear line drawings and photographic illustrations. Volume I dealt with injuries to the chest wall, lungs and some general considerations such as the management of chest drains. Although of a generally high standard one glaring error remains to the fore. When describing the method of chest drain insertion the authors reiterate the incorrect and dangerous technique of simply making a skin incision and then introducing the trocar and drainage tube by force, rather than dissection down to the pleura. This is a common cause of chest trauma in most hospitals. Apart from this and some other conjectural points such as a discussion on the relative merits of internal fixation versus positive pressure ventilation for the management of flail chest segments the authors give good sound advice based on many years of clinical experience. This second volume devotes a section to each of the major intrathoracic organs. Much of the data is presented as case history with excellent documentation both graphically and in terms of results both successful and unsuccessful. No attempt is made to conceal errors in management and misadventure is used to illustrate the many pitfalls for the unwary clinician. The sections on tracheal and oesophageal injuries are excellent. Although these injuries are not common, if missed they are lethal in the majority of situations. At all times the authors are quick to stress the importance of associated injuries to structures outside the chest: a point of vital importance as injuries severe enough to cause major intrathoracic damage are commonly associated with equally severe injuries to