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Respiratory Physiology—the essentials
S8
BRITISH JOURNAL OF ANAESTHESIA BOOK REVIEWS
Recent Advances on Pain: Pathophysiology and Clinical Aspects. Edited by Drs John Bonica, M.D., Paolo Procacci, MJD., and Carlo A. Pagni, MJ3. Published by Charles C Thomas, Springfield, I1L Pp. 373; illustrated. Price £9.88. This book consists of the papers read at a Symposium on Pain held in Florence in 1972 sponsored by the Department of Medicine of the University of Florence and the Lorenzini Foundation of Milan. In spite of the fact that of the twenty-five contributors nineteen are Italian and one Swiss, the others being three Americans and two British, the standard of English is high; a tribute to the Editors. The thirteen chapters follow the now familiar pattern of fundamental, as distinct from practical, symposia on this subject. First comes a chapter on pain receptors by a physiologist (Iggo), then one on the mechanism of neurotransmission by an anatomist (Wall) and one on morphine by pharmacologists (Pepeu and Nistri). These are followed by an account of painful stimuli by a pathologist (Arcangeli) and a physician (Galletti) and of pain threshold measurement by basic scientists (Procacci et al.). The second half of the book consists of chapters on various quasi-clinical matters; headache and cardiac pain (Sicuteri), cancer pain (Houde), nerve blocks (Ciocatto) and surgery (Maspes and Pagni) as treatment, and psychiatric aspects of pain (Benedetti). Finally comes a description of a pain clinic (Bonica) and a chapter on "Operant conditioning for chronic pain" (Bonica and Fordyce). Made and printed in Great Britain by John Sherratt &
The material under these various headings is and up-to-date, with a heavy experimental flavour. Even acupuncture gets an honourable mention. Every author treats his subject fully but concisely, concluding with a valuable reference list. However, this book will be heavy going for the average clinician and he will get little guidance of a practical nature for his daily work. Nevertheless, by thumbing through the pages he is certain to benefit and will pick up all sorts of useful information about pain. To take a few examples, the effect and value of placebos in certain patients is once again confirmed; the possible importance of biological rhythms, circadian and others, on pain threshold is discussed; and the place of "conditioning" the patient in mitring the treatment of pain more effective is clarified. Essentially, however, this is a book for basic scientists and clinical researchers. The clinician must look elsewhere for direct and detailed technical information on the treatment of his individual patients. The illustrations are dear and the production of the book excellent, as expected of Charles C. Thomas. Altogether a recommended addition to any medical library. W. W. Mushin
Respiratory Physiology—the essentials. By J. B. West. Published by Blackwells, Oxford. Price £3.50. In his preface, Dr West explains that the book is primarily written as a core course for medical students and is based on lectures. A set of audiotapes with slides is available to supplement the book. Those who know Dr West will expect a masterpiece of lucidity and will not be disappointed. His concentration on the essentials is maintained from the opening sentence ("The lung is for gas exchange."), to the final page where he gives his choice from the multiplicity of pulmonary function tests which are available. The choice of contents is admirable. He starts with the relationship between structure and function and then develops along familiar lines through ventilation, diffusion and blood flow to the intricacies of ventilationperfusion relationships. As might be expected, Dr West goes into some length on this topic, to which he has made such important contributions. Nevertheless the balance of die book is good, although some might argue that control of breathing receives less than its due. Perhaps it is better this way than the distorted perspective which most of us endured when we were students. The book is paper-backed and relatively expensive for a total of 161 pages of text. However, there can be little doubt that it is a most suitable book for medical students and it may well become their standard text throughout the English-speaking world. It is less easy to say how suitable the book will be for trainee anaesthetists. It should be excellent for those who, for various reasons, missed out on this subject when they were undergraduates, but it should be stressed that the book does not cover the abnormalities of respiration which arise in relation to anaesthesia. There are useful sections on high altitude, space flight, increased pressure, perinatal respiration and exercise but respiratory disease receives scant attention, and the problems of anaesthesia and intensive therapy are hardly mentioned. As its title implies, the book is concerned with physiology rather than pathophysiology. 7. F. Nurm Son Ltd © Macmillan Journals Ltd 1975
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on July 2, 2015
Dye Curves. Edited by D. A. Bloomfkld. Aylesbury: H M + M Medical & Scientific Publishers, 1974. Pp. 450. Price £13.50. Thjs volume is a mine of information for all those concerned with the use of the dye dilution technique for the measurement of cardiac output, valvular insufficiency, pulmonary blood volume, pulmonary extravascular water volume, ventricular volumes, blood volume and effusion volume,' and hepatic-splanchnic blood flow. It is written from a practical viewpoint with a minimum of mathematics but with ample illustrations of dilution curves and a good selection of references. The book is divided into three main sections covering: general and practical considerations; special applications; equipment and materials. Thus there are chapters on practical techniques for measuring cardiac output, injection and sampling, calculation of curve areas, calibration, distortion and correction of dye curves, indocyanine green dye, densitometers, pump systems, and cardiac output computers. For comparison purposes there are chapters -on the tnermodilution method for cardiac output measurement and x-ray videodensitometry. There is also a good account of the use of fibre-optic instrumentation for the measurement of oxygen saturation and cardiac output during cardiac catheterization. Dr Bloomfield has chosen his authors with care, including authorities such as E. H. Wood, L. J. Krovetz, W. Ganz, H. J. C Swan. P. G. Hugenholtz and I. J. Fox. At £13.50 this will be a book for libraries, but as such it will provide a valuable source of reference material. The description of cardiac output determinations by the dye and thermodilution techniques could be read with benefit by primary F.F.A. candidates who often appear to be unsure of the fundamentals of the methods and equipment involved. D. W. Hill
BRITISH JOURNAL OF ANAESTHESIA BOOK REVIEWS
Recent Advances on Pain: Pathophysiology and Clinical Aspects. Edited by Drs John Bonica, M.D., Paolo Procacci, MJD., and Carlo A. Pagni, MJ3. Published by Charles C Thomas, Springfield, I1L Pp. 373; illustrated. Price £9.88. This book consists of the papers read at a Symposium on Pain held in Florence in 1972 sponsored by the Department of Medicine of the University of Florence and the Lorenzini Foundation of Milan. In spite of the fact that of the twenty-five contributors nineteen are Italian and one Swiss, the others being three Americans and two British, the standard of English is high; a tribute to the Editors. The thirteen chapters follow the now familiar pattern of fundamental, as distinct from practical, symposia on this subject. First comes a chapter on pain receptors by a physiologist (Iggo), then one on the mechanism of neurotransmission by an anatomist (Wall) and one on morphine by pharmacologists (Pepeu and Nistri). These are followed by an account of painful stimuli by a pathologist (Arcangeli) and a physician (Galletti) and of pain threshold measurement by basic scientists (Procacci et al.). The second half of the book consists of chapters on various quasi-clinical matters; headache and cardiac pain (Sicuteri), cancer pain (Houde), nerve blocks (Ciocatto) and surgery (Maspes and Pagni) as treatment, and psychiatric aspects of pain (Benedetti). Finally comes a description of a pain clinic (Bonica) and a chapter on "Operant conditioning for chronic pain" (Bonica and Fordyce). Made and printed in Great Britain by John Sherratt &
The material under these various headings is and up-to-date, with a heavy experimental flavour. Even acupuncture gets an honourable mention. Every author treats his subject fully but concisely, concluding with a valuable reference list. However, this book will be heavy going for the average clinician and he will get little guidance of a practical nature for his daily work. Nevertheless, by thumbing through the pages he is certain to benefit and will pick up all sorts of useful information about pain. To take a few examples, the effect and value of placebos in certain patients is once again confirmed; the possible importance of biological rhythms, circadian and others, on pain threshold is discussed; and the place of "conditioning" the patient in mitring the treatment of pain more effective is clarified. Essentially, however, this is a book for basic scientists and clinical researchers. The clinician must look elsewhere for direct and detailed technical information on the treatment of his individual patients. The illustrations are dear and the production of the book excellent, as expected of Charles C. Thomas. Altogether a recommended addition to any medical library. W. W. Mushin
Respiratory Physiology—the essentials. By J. B. West. Published by Blackwells, Oxford. Price £3.50. In his preface, Dr West explains that the book is primarily written as a core course for medical students and is based on lectures. A set of audiotapes with slides is available to supplement the book. Those who know Dr West will expect a masterpiece of lucidity and will not be disappointed. His concentration on the essentials is maintained from the opening sentence ("The lung is for gas exchange."), to the final page where he gives his choice from the multiplicity of pulmonary function tests which are available. The choice of contents is admirable. He starts with the relationship between structure and function and then develops along familiar lines through ventilation, diffusion and blood flow to the intricacies of ventilationperfusion relationships. As might be expected, Dr West goes into some length on this topic, to which he has made such important contributions. Nevertheless the balance of die book is good, although some might argue that control of breathing receives less than its due. Perhaps it is better this way than the distorted perspective which most of us endured when we were students. The book is paper-backed and relatively expensive for a total of 161 pages of text. However, there can be little doubt that it is a most suitable book for medical students and it may well become their standard text throughout the English-speaking world. It is less easy to say how suitable the book will be for trainee anaesthetists. It should be excellent for those who, for various reasons, missed out on this subject when they were undergraduates, but it should be stressed that the book does not cover the abnormalities of respiration which arise in relation to anaesthesia. There are useful sections on high altitude, space flight, increased pressure, perinatal respiration and exercise but respiratory disease receives scant attention, and the problems of anaesthesia and intensive therapy are hardly mentioned. As its title implies, the book is concerned with physiology rather than pathophysiology. 7. F. Nurm Son Ltd © Macmillan Journals Ltd 1975
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on July 2, 2015
Dye Curves. Edited by D. A. Bloomfkld. Aylesbury: H M + M Medical & Scientific Publishers, 1974. Pp. 450. Price £13.50. Thjs volume is a mine of information for all those concerned with the use of the dye dilution technique for the measurement of cardiac output, valvular insufficiency, pulmonary blood volume, pulmonary extravascular water volume, ventricular volumes, blood volume and effusion volume,' and hepatic-splanchnic blood flow. It is written from a practical viewpoint with a minimum of mathematics but with ample illustrations of dilution curves and a good selection of references. The book is divided into three main sections covering: general and practical considerations; special applications; equipment and materials. Thus there are chapters on practical techniques for measuring cardiac output, injection and sampling, calculation of curve areas, calibration, distortion and correction of dye curves, indocyanine green dye, densitometers, pump systems, and cardiac output computers. For comparison purposes there are chapters -on the tnermodilution method for cardiac output measurement and x-ray videodensitometry. There is also a good account of the use of fibre-optic instrumentation for the measurement of oxygen saturation and cardiac output during cardiac catheterization. Dr Bloomfield has chosen his authors with care, including authorities such as E. H. Wood, L. J. Krovetz, W. Ganz, H. J. C Swan. P. G. Hugenholtz and I. J. Fox. At £13.50 this will be a book for libraries, but as such it will provide a valuable source of reference material. The description of cardiac output determinations by the dye and thermodilution techniques could be read with benefit by primary F.F.A. candidates who often appear to be unsure of the fundamentals of the methods and equipment involved. D. W. Hill