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Textbook of Radiology (2nd ed)
REVIEW OF RECENT BOOKS
Heart Disease Edited b y Earl N . Silber, M . D . , and Louis N . Katz, M . D . N e w York, Macmillan, 1975 1,430 pp, illus, $39.95 Reviewed b y Oglesby Paul, M . D . This large volume (over 7 pounds and 1,430 pages) is another of the comprehensive texts on heart disease now available. The first authoritative volume on cardiology was that of Dr. Paul Dudley White, published in 1931, and it was followed by less comprehensive but valuable texts, each with its own personality, by Sir Thomas Lewis (1933) and Dr. Samuel A. Levine (1936). The era of these single-author efforts has largely gone by, though the extremely useful volume by Dr. Charles A. Friedberg was such an undertaking. The chief authors of this new book are Dr. Earl N. Silber and the late, distinguished Dr. Louis N. Katz of Michael Reese Hospital in Chicago, and they have enlisted the services of only a small number of colleagues. Not having multiple authors, the book has been able to retain some of the advantages of the monograph in both style and content. The book is well printed with very legible type and contains a moderate number of generally excellent illustrations and a valuable, large bibliography (for example, 370 references on the pathogenesis of systemic hypertension). Approximately 100 pages are devoted to a discussion of physiology, and a similar amount of space is allocated to pathophysiology. Examination of the patient occupies 60 pages, and there is a major portion (150 pages) on diagnostic techniques. The style of writing is lucid, for which Dr. Silber must receive principal credit. This should be a useful text although it does not supplant others currently on the market. The sections on physiology, pathophysiology, and electrocardiography are particular strengths, the last being truly admirable, as one might expect from this medical center. I was pleased to see that in 1975 acute rheumatic fever still receives a fine review. Hypertension is also handled in a most impressive fashion, as are most of the clinical chapters. It is unfortunate that matters of great interest today-such as the gross anatomy and distribution of secondary and tertiary coronary artery branches, echocardiography, and especially coronary angiography-receive less than an appropriate amount of space. The problems of anxiety (neurocirculatory asthenia-effort syndrome) are mentioned in only one paragraph, though their importance in clinical practice certainly justifies far more consideration. I failed to find mention of the association of myocardial infarction with the use of oral contraceptives. These and other reservations are distinctly minor, however, because the enormous labor invested in this work is well repaid. Heart Disease is an excellent book. 366
It should be a fine, authoritative resource for students and practitioners, including surgeons, and i t does great credit to its authors. I t is an especially happy legacy from Louis Katz, one of the giants in the field.
Chicago, I L Textbook of Radiology (2nd ed) Edited b y David Sutton, M . D . ChurchilllLivingston, Edinburgh, London, and N e w York, 1975 2300 p p , illustrated, $79.50 Reviewed b y Hiram T . Langston, M . D . This is the second edition of what apparently has been a popular text on the subject of radiology in England and probably Europe. It is a large volume containing more than 1300 pages, which tends to tax the durability of the binding. The paper is of good quality, the descriptive text is very legible, and the illustrations are clearly reproduced. Dr. Sutton was assisted by Ronald G. Grainger, M.D., in his editorial duties. They have called upon sixteen other authors from Britain and one from Canada to help them. The first edition (1969)was brought out in the hope of supplying a comprehensive single volume on the subject of radiology that would bridge the gap between a short compendium suitable for beginning radiologists or senior medical students on the one hand and exhaustive multiple-volume works on the other. The general format in the chapters of interest to thoracic surgeons is to move from a description of techniques in radiological examination to standards of normal in the various fields. Disease processes are then grouped according to convenient anatomical regions such as lung, mediastinum, pulmonary circulation, cardiac chambers, and pericardium; finally disease entities with similar or comparable characteristics are discussed. Obviously, this arrangement cannot be carried to ultimate completeness because such rigidity is not necessarily compatible with the various disease processes, nor will it embrace the overlaps among them. One should assume that the index would compensate for this by directing the reader to the areas of full treatment in a given subject. This is disappointing. As an example of such miscarriage, in the index ”Diaphragm, hernia” offers references to pages 303 and 427 of the text, wherein rather cursory treatment of the subject is tucked under the heading “Local Bulge of the Diaphragm” on page 303 and a paragraph titled ”Diaphragmatic Hernia,” hidden among Mediastinal Lesions on page 427. This latter paragraph deals primarily with extrusions through the foramen of Morgagni. Actually, a more comprehensive discussion is provided on page 302 in an adjacent paragraph headed ”Rupture of Diaphragm.”
367
Review of Recent Books
If one reads further in the index a bold heading of "Diaphragmatic Hernia" recommends seeking information under "Hernia." "Hernia, diaphragmatic" calls attention to two sections. One paragraph headed "Diaphragmatic Hernia," this time on page 432 in the chapter on problems of the mediastinum, treats the subject rather superficially. The other reference is to pages 708 to 710, where the topic is presented more fully, including a working classification. Interestingly enough, these pages are in the chapter that deals with the esophagus and precedes the discussion on hiatus hernia, which is listed separately. The descriptive clinical material that should bind the illustrations into a cohesive mass of information is at times deceptive, the flow of words leading to impressions rather than to facts that are directly quotable. The disparity between the authors' views and my own is great on some points. Examples follow. Even though tuberculosis seems to play a prominent role in the various manifestations of chest diseases in Britain, it is not depicted in a very modern setting even for 1969. "One of the most characteristic features of chronic pulmonary tuberculosis is that evidence of healing may be present in one part of the lung, while a spread is occurring elsewhere." Prior to chemotherapy this did occur on occasion, but this concept is incongruous with modern management. Calcific disease in the chest is depicted as pathognomonic for tuberculosis, but the reference is repeatedly made that fungal disease competes with this as an etiological factor in American experience. A startling example of this concept appears in the form of a full page of roentgenograms depicting superior vena caval obstruction due to tuberculous fibrosing mediastinitis. No further proof or discussion of etiology is offered. Constrictive pericarditis is a "late result of tuberculous or suppurative pericarditisrarely due to rheumatic fever." At times there appears to be undue emphasis on the esoteric and unusual. Aroentgenogram depicting "an infiltrating pericardial fibrosarcoma" appears with the discussion of pericardial cysts, seemingly out of context. In a similar vein an illustration is offered of osteoblastic metastases to ribs from a bronchial carcinoid adenoma. A strange paradox also seems to pervade the area of studies utilizing contrast materials. The chapters on the cardiovascular system are replete with good illustrations of all sorts of heart and blood vessel studies using contrast material, and sections on arteriography, phlebography, and lymphangiography are offered, yet the oldest contrast study in chest diseasenamely, bronchography-is downgraded severely. "Bronchography is reasonably safe . . . uncomfortable . . . should never be performed unless there are definite clinical indications." And, "Bronchography is a rather uncomfortable technique for the patient and should only be employed with strict clini-
cal indications." The clinical indications are not described. In sharp contrast, selective injection of the bronchial arterial supply to various lung tumors is highlighted. Very disconcerting examples of "thought dropping'' or comments made en pnssant are found i n two sections which discuss epiphrenic diverticula. On page 696 I find: "Aetiologically they are probably varieties of intestinal duplication," and on page 713: "Such diverticula may represent minor forms of intestinal duplication." Such a concept negates totally the precepts of management currently subscribed to and in fact belies the cognomen of pulsion for these diverticula. Curiously enough, Zenker's diverticula are discussed in a manner consistent with current views even though the role of cricopharyngeal dysfunction in this entity is not acknowledged. In the case of midesophageal diverticula, traction by "tuberculous" mediastinal glands is offered as a usual cause, although they may "represent developmental defects" also. Likewise, concerning the site of origin for bronchogenic carcinomas, I find that they "originate in a major bronchus" and "many bronchial carcinomas arise in the major branches in the hilar region." Such references suggest that the main bronchi are the common sites of origin rather than more peripheral locat ions. The section on the postoperative chest contains a poor selection of illustrations: wire sutures (not staples) presenting long ends are offered as the hallmark of a pulmonary resection. There are three examples of plombage thoracoplasty, which is a bit excessive in the current era. The only illustration for a pneumonecto'my shows contralateral spill through a bronchopleural fistula. This is certainly poor advertisement for their surgical colleagues. On the other side of the ledger, however, several sections in this book provide excellent diagnostic checklists, often in tabular form. Vascular rings, anomalies of the aortic arch, centers of skeletal ossification, and characteristics of the various contrast media as well as their fields of usefulness are among these. Chapter 21 offers some twenty pages'of suggested entities to be included in differential diagnoses. These include solitary pulmonary nodules, disseminated pulmonary opacities, honeycomb lung, unilateral hyperlucency of the chest, calcifications of the chest, and rib notchings. Chapter 20, "The Chest in Children," is a welcome feature. The discussion of trauma is brief, as is that on irradiation changes. As a means for review in the field of radiology this book is very well suited and, in fact, is probably popular. As an atlas against which to compare puzzling roentgenograms it will be helpful, but its usefulness might well be enhanced by improved indexing that would assure the user a full listing of the pages
368
The Annals of Thoracic Surgery Vol 21 No 4 April 1976
wherein the desired discussion appears. Likewise, the bibliographic references are sometimes cramped or skimpy and therefore do not always offer avenues for broader reading. Within the area studied, the principal defect in the clinical text, and sometimes the illustrative material as well, lies in its reflection of partisan.views and concepts or the highlighting of rare and esoteric occurrences, providing a distorted view of incidence and frequency. This material is therefore not always safe for direct quotation. It is worthy of comment that this book represents a massive effort aimed at bridging the broad field of radiology for those who aspire to become acquainted with it. The authors are to be complimented on the massiveness of this attempt. It is lamentable that they did not provide better organization to the material and that they allowed some imprecisions to appear in the development of supportive discussions.
Chicago, I L
Treatment of Cardiac Emergencies By Emanuel Goldberger, M . D . Mosby, S t . Louis, 2974 355 p p , illustrated, $15.50 Reviewed by Will C. Sealy, M.D Dr. Goldberger has written an excellent manual on the treatment of cardiac emergencies. In the first section, the clinical syndromes that are either present in or develop into cardiac emergencies are clearly described. The illustrative electrocardiograms used throughout the text are of good quality. The management of cardiac emergencies is given in a lucid and understandable way. The second portion is an excellent review of the use of cardiac pacemakers, defibrillators, and monitoring devices. The last section describes the drugs commonly used for cardiac and vascular problems. Reaction, indication, and dosages are clearly spelled out. At the end of each drug description, a table gives the route and dosage of the drug. In addition to rhythm disturbances, the treatment of acute hypertensive states-including the hypertension associated with dissecting aortic aneurysms-is amply described; the treatment of aortic dissections was written by Dr. Myron Wheat. This book is of such length and in such a form that it can serve not only as a source of knowledge about cardiac emergencies but as a ready reference to have available in all acute care units and emergency rooms. I t is highly recommended to thoracic and cardiac surgeons as a practical manual for everyday use.
Durham, NC
Heart Disease Edited b y Earl N . Silber, M . D . , and Louis N . Katz, M . D . N e w York, Macmillan, 1975 1,430 pp, illus, $39.95 Reviewed b y Oglesby Paul, M . D . This large volume (over 7 pounds and 1,430 pages) is another of the comprehensive texts on heart disease now available. The first authoritative volume on cardiology was that of Dr. Paul Dudley White, published in 1931, and it was followed by less comprehensive but valuable texts, each with its own personality, by Sir Thomas Lewis (1933) and Dr. Samuel A. Levine (1936). The era of these single-author efforts has largely gone by, though the extremely useful volume by Dr. Charles A. Friedberg was such an undertaking. The chief authors of this new book are Dr. Earl N. Silber and the late, distinguished Dr. Louis N. Katz of Michael Reese Hospital in Chicago, and they have enlisted the services of only a small number of colleagues. Not having multiple authors, the book has been able to retain some of the advantages of the monograph in both style and content. The book is well printed with very legible type and contains a moderate number of generally excellent illustrations and a valuable, large bibliography (for example, 370 references on the pathogenesis of systemic hypertension). Approximately 100 pages are devoted to a discussion of physiology, and a similar amount of space is allocated to pathophysiology. Examination of the patient occupies 60 pages, and there is a major portion (150 pages) on diagnostic techniques. The style of writing is lucid, for which Dr. Silber must receive principal credit. This should be a useful text although it does not supplant others currently on the market. The sections on physiology, pathophysiology, and electrocardiography are particular strengths, the last being truly admirable, as one might expect from this medical center. I was pleased to see that in 1975 acute rheumatic fever still receives a fine review. Hypertension is also handled in a most impressive fashion, as are most of the clinical chapters. It is unfortunate that matters of great interest today-such as the gross anatomy and distribution of secondary and tertiary coronary artery branches, echocardiography, and especially coronary angiography-receive less than an appropriate amount of space. The problems of anxiety (neurocirculatory asthenia-effort syndrome) are mentioned in only one paragraph, though their importance in clinical practice certainly justifies far more consideration. I failed to find mention of the association of myocardial infarction with the use of oral contraceptives. These and other reservations are distinctly minor, however, because the enormous labor invested in this work is well repaid. Heart Disease is an excellent book. 366
It should be a fine, authoritative resource for students and practitioners, including surgeons, and i t does great credit to its authors. I t is an especially happy legacy from Louis Katz, one of the giants in the field.
Chicago, I L Textbook of Radiology (2nd ed) Edited b y David Sutton, M . D . ChurchilllLivingston, Edinburgh, London, and N e w York, 1975 2300 p p , illustrated, $79.50 Reviewed b y Hiram T . Langston, M . D . This is the second edition of what apparently has been a popular text on the subject of radiology in England and probably Europe. It is a large volume containing more than 1300 pages, which tends to tax the durability of the binding. The paper is of good quality, the descriptive text is very legible, and the illustrations are clearly reproduced. Dr. Sutton was assisted by Ronald G. Grainger, M.D., in his editorial duties. They have called upon sixteen other authors from Britain and one from Canada to help them. The first edition (1969)was brought out in the hope of supplying a comprehensive single volume on the subject of radiology that would bridge the gap between a short compendium suitable for beginning radiologists or senior medical students on the one hand and exhaustive multiple-volume works on the other. The general format in the chapters of interest to thoracic surgeons is to move from a description of techniques in radiological examination to standards of normal in the various fields. Disease processes are then grouped according to convenient anatomical regions such as lung, mediastinum, pulmonary circulation, cardiac chambers, and pericardium; finally disease entities with similar or comparable characteristics are discussed. Obviously, this arrangement cannot be carried to ultimate completeness because such rigidity is not necessarily compatible with the various disease processes, nor will it embrace the overlaps among them. One should assume that the index would compensate for this by directing the reader to the areas of full treatment in a given subject. This is disappointing. As an example of such miscarriage, in the index ”Diaphragm, hernia” offers references to pages 303 and 427 of the text, wherein rather cursory treatment of the subject is tucked under the heading “Local Bulge of the Diaphragm” on page 303 and a paragraph titled ”Diaphragmatic Hernia,” hidden among Mediastinal Lesions on page 427. This latter paragraph deals primarily with extrusions through the foramen of Morgagni. Actually, a more comprehensive discussion is provided on page 302 in an adjacent paragraph headed ”Rupture of Diaphragm.”
367
Review of Recent Books
If one reads further in the index a bold heading of "Diaphragmatic Hernia" recommends seeking information under "Hernia." "Hernia, diaphragmatic" calls attention to two sections. One paragraph headed "Diaphragmatic Hernia," this time on page 432 in the chapter on problems of the mediastinum, treats the subject rather superficially. The other reference is to pages 708 to 710, where the topic is presented more fully, including a working classification. Interestingly enough, these pages are in the chapter that deals with the esophagus and precedes the discussion on hiatus hernia, which is listed separately. The descriptive clinical material that should bind the illustrations into a cohesive mass of information is at times deceptive, the flow of words leading to impressions rather than to facts that are directly quotable. The disparity between the authors' views and my own is great on some points. Examples follow. Even though tuberculosis seems to play a prominent role in the various manifestations of chest diseases in Britain, it is not depicted in a very modern setting even for 1969. "One of the most characteristic features of chronic pulmonary tuberculosis is that evidence of healing may be present in one part of the lung, while a spread is occurring elsewhere." Prior to chemotherapy this did occur on occasion, but this concept is incongruous with modern management. Calcific disease in the chest is depicted as pathognomonic for tuberculosis, but the reference is repeatedly made that fungal disease competes with this as an etiological factor in American experience. A startling example of this concept appears in the form of a full page of roentgenograms depicting superior vena caval obstruction due to tuberculous fibrosing mediastinitis. No further proof or discussion of etiology is offered. Constrictive pericarditis is a "late result of tuberculous or suppurative pericarditisrarely due to rheumatic fever." At times there appears to be undue emphasis on the esoteric and unusual. Aroentgenogram depicting "an infiltrating pericardial fibrosarcoma" appears with the discussion of pericardial cysts, seemingly out of context. In a similar vein an illustration is offered of osteoblastic metastases to ribs from a bronchial carcinoid adenoma. A strange paradox also seems to pervade the area of studies utilizing contrast materials. The chapters on the cardiovascular system are replete with good illustrations of all sorts of heart and blood vessel studies using contrast material, and sections on arteriography, phlebography, and lymphangiography are offered, yet the oldest contrast study in chest diseasenamely, bronchography-is downgraded severely. "Bronchography is reasonably safe . . . uncomfortable . . . should never be performed unless there are definite clinical indications." And, "Bronchography is a rather uncomfortable technique for the patient and should only be employed with strict clini-
cal indications." The clinical indications are not described. In sharp contrast, selective injection of the bronchial arterial supply to various lung tumors is highlighted. Very disconcerting examples of "thought dropping'' or comments made en pnssant are found i n two sections which discuss epiphrenic diverticula. On page 696 I find: "Aetiologically they are probably varieties of intestinal duplication," and on page 713: "Such diverticula may represent minor forms of intestinal duplication." Such a concept negates totally the precepts of management currently subscribed to and in fact belies the cognomen of pulsion for these diverticula. Curiously enough, Zenker's diverticula are discussed in a manner consistent with current views even though the role of cricopharyngeal dysfunction in this entity is not acknowledged. In the case of midesophageal diverticula, traction by "tuberculous" mediastinal glands is offered as a usual cause, although they may "represent developmental defects" also. Likewise, concerning the site of origin for bronchogenic carcinomas, I find that they "originate in a major bronchus" and "many bronchial carcinomas arise in the major branches in the hilar region." Such references suggest that the main bronchi are the common sites of origin rather than more peripheral locat ions. The section on the postoperative chest contains a poor selection of illustrations: wire sutures (not staples) presenting long ends are offered as the hallmark of a pulmonary resection. There are three examples of plombage thoracoplasty, which is a bit excessive in the current era. The only illustration for a pneumonecto'my shows contralateral spill through a bronchopleural fistula. This is certainly poor advertisement for their surgical colleagues. On the other side of the ledger, however, several sections in this book provide excellent diagnostic checklists, often in tabular form. Vascular rings, anomalies of the aortic arch, centers of skeletal ossification, and characteristics of the various contrast media as well as their fields of usefulness are among these. Chapter 21 offers some twenty pages'of suggested entities to be included in differential diagnoses. These include solitary pulmonary nodules, disseminated pulmonary opacities, honeycomb lung, unilateral hyperlucency of the chest, calcifications of the chest, and rib notchings. Chapter 20, "The Chest in Children," is a welcome feature. The discussion of trauma is brief, as is that on irradiation changes. As a means for review in the field of radiology this book is very well suited and, in fact, is probably popular. As an atlas against which to compare puzzling roentgenograms it will be helpful, but its usefulness might well be enhanced by improved indexing that would assure the user a full listing of the pages
368
The Annals of Thoracic Surgery Vol 21 No 4 April 1976
wherein the desired discussion appears. Likewise, the bibliographic references are sometimes cramped or skimpy and therefore do not always offer avenues for broader reading. Within the area studied, the principal defect in the clinical text, and sometimes the illustrative material as well, lies in its reflection of partisan.views and concepts or the highlighting of rare and esoteric occurrences, providing a distorted view of incidence and frequency. This material is therefore not always safe for direct quotation. It is worthy of comment that this book represents a massive effort aimed at bridging the broad field of radiology for those who aspire to become acquainted with it. The authors are to be complimented on the massiveness of this attempt. It is lamentable that they did not provide better organization to the material and that they allowed some imprecisions to appear in the development of supportive discussions.
Chicago, I L
Treatment of Cardiac Emergencies By Emanuel Goldberger, M . D . Mosby, S t . Louis, 2974 355 p p , illustrated, $15.50 Reviewed by Will C. Sealy, M.D Dr. Goldberger has written an excellent manual on the treatment of cardiac emergencies. In the first section, the clinical syndromes that are either present in or develop into cardiac emergencies are clearly described. The illustrative electrocardiograms used throughout the text are of good quality. The management of cardiac emergencies is given in a lucid and understandable way. The second portion is an excellent review of the use of cardiac pacemakers, defibrillators, and monitoring devices. The last section describes the drugs commonly used for cardiac and vascular problems. Reaction, indication, and dosages are clearly spelled out. At the end of each drug description, a table gives the route and dosage of the drug. In addition to rhythm disturbances, the treatment of acute hypertensive states-including the hypertension associated with dissecting aortic aneurysms-is amply described; the treatment of aortic dissections was written by Dr. Myron Wheat. This book is of such length and in such a form that it can serve not only as a source of knowledge about cardiac emergencies but as a ready reference to have available in all acute care units and emergency rooms. I t is highly recommended to thoracic and cardiac surgeons as a practical manual for everyday use.
Durham, NC