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THE SURGICAL TREATMENT OF ACUTE MYOCARDIAL ISCHEMIA
development from pure surgical scientist to wideranging biologist, humanist, philosopher, writer, and mystic of later years. Perhaps part of the neglect of Carrel's life stemmed from his controversial ideas of social and political organizations and from its clouded ending when, as a nonpolitical biologic scientist, he became enmeshed in the emotions of torn loyalties in war-time France. Dr. Edwards' desire to place in pe~pectivethis visionary man's work is most sympathetic; and although the book is short, it is more than adequate to kindle interest. Such a unique and far-ranging intellect as Carrel's will surely warrant a future biography in depth. This man had contact with a wide range of cultural and medical leaders and profound thinkers of his time, as illustrated by the foreword written by Carrel's close friend and collaborator, Charles A. Lindbergh. Bhke Cad5 M.D. Boston THE SURGICAL TREATMENT OF ACUTE MYOCARDIAL ISCHEMIA. By LAWRENCE H. COHN.Mount Kisco, NY, Futura Publishing Co., 1973,172 pp, $16.50. Now that operations for coronary artery disease comprise nearly 50 percent of all cardiac operations employing extracorporeal circulation, it is timely to have available to the profession a concise up-to-date monograph on the subject. This need is well filled by Dr. Lawrence H. Cohn's book entitled The Surgical Treatment of Acute Myocardial Ischemia. While this monograph, which confines itself to a discussion of the surgery for acute myocardial ischemia, may not settle the controversy concerning the place of rkvascularization procedures in the treatment of coronary artery disease, it will provide for those interested a basis on which some preliminary judgments can be made. The volume is divided basically into four main chapters. Particularly valuable is the first, which consists of a nicely presented discussion of the pathophysiology of myocardial ischemia. This is followed by a chapter on surgical technique, which is clearly presented and adequately illustrated. Emphasis on the use of hemodilution with lack of dependence on the blood bank is well supported by the author's results. One might question some technical aspects described, particularly the suboptimal flows used and the emphasis on complete dissection of the portion of the left anterior descending coronary to be used for bypass, but these are minor points which have obviously not affected the overall Continued on page 30
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results adversely. I support the author's advocacy of performing direct endarterectomy of the occluded right coronary artery when possible, as opposed to the use of gas endarterectomy, as well as his conservative concepts regarding infarctectomy, a procedure whose initial promise has failed to pay dividends except under special circumstances. The confusion surrounding the many terns used to define "preinfarction angina* is nicely clarified in the next chapter on the surgical management of this condition, and results reported from the Peter Bent Brigham surgical series are commendable. The last chapter on the surgical treatment of acute myocardial infarction rightly emphasizes a wide spectrum of therapeutic modalities, emphasizing the necessity for early operation (within a few hours) when a patient has experienced an acute infarct if myocardial necrosis is to be prevented. The controversial subject of the management of acute myocardial infarction with left ventricular power failure is well covered, though the precise role of surgery in such instances is less convincing than in the other varieties of acute myocardial infarction covered in this chapter. The subject matter covered in the monograph is undergoing constant reevaluation; and, as the author indicates in his preface, this review merely represents a summary of the current state of the art. Changing techniques and concepts will unquestionably alter the surgeon's approach'to the management of acute myocardial ischemia in the years to come. All the same, the basic concepts laid down here will, in most instances, remain a useful foundation on which to base any future changes in therapy. While the monograph can be read profitably by clinicians and cardiologists as well as surgeons, the latter will probably find it of most interest. Each chapter includes a complete and upto-date bibliography of the subject under discussion, and this alone makes the volume a handy one to have in one's library. It is clearly directed towards the specialist, however, and the undergraduate or young postgraduate medical student may find its coverage too restricted for his or her use. F. Heny Ellis, Jr., M.D., Ph.D. Boston TEXTBOOK O F PULMONARY DISEASES (2nd ed). Edited by G m L.. BA-. Boston, Little, Brown and Co., 1974,800-pp, - $50.00.
This textbook, edited by Dr. Baum with the collaboration of 36 eminent authors, is a second edition appearing nine years after the original. The first edition proved to be one of the best textbooks on
pulmonary diseases ever published. The second edition is also superbly written, well organized, and superior because of new subjects that expand the volume to 52 chapters. Predictably, it will become the preferred text for years to come. There has been extensive revision and updating of the chapters on infectious diseases, pulmonary hyperventilation, clinical and laboratoy diagnostic methods, lung tumors, and pleural disease. Chapters on environmental and industrial diseases, genetic and immunologic diseases, and asthma have been completely rewritten. Finally, new chapters have been added that include radioisotopes in diagnosis, use of computers, and even lung transplantation. This book is a textbook in the h e sense of the word. The authorship is unique. Every writer is engaged not only in investigating and relating patterns of pulmonary disease to pathogenesis, malfunction, and therapy, but is expert in organizing facts and passing them on to others. The authors are all teachers, 20 full professors, ten assistant professors, and six chiefs of pulmonary sections in great hospitals. The editor has fully met his objective in creating a textbook "detailed enough and current enough to appeal to the sophisticated specialist and clinical researchers, yet sdciently orderly, clearly organized, and well-indexed to be of use to the beginning student." This m a g n s d n t and authoritative text win be a valuable addition to every large or small medical library and to many a doctor's office. Richard H. Ouerholt, M.D., F.C.C.P. Boston DIFFERENTIAL DIAGNOSIS O F THE ELECTROCARDIOGRAM (2nd ed). By SIDNEYR. ARBE~T,IRAL. RUBM,and HARRY GROSS.Philadelphia, F. A. Davis Co., 1975, 218 pp, 493 illus, $17.50. This book is intended as a reference manual, as the authors state in their foreword. Although there is a brief section in the introduction devoted to basic electrophysiology, the orientation is at a practical level. The text is presented as a series of flow-sheets, commencing with variations in pattern of various components of the eleCtrocardiogram. This aPproach assumes enough basic knowledge of electrocardiography to detect possible deviations from normal as a starting point. The approach seems most successful when dealing with specific in of variContinued on page 33
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results adversely. I support the author's advocacy of performing direct endarterectomy of the occluded right coronary artery when possible, as opposed to the use of gas endarterectomy, as well as his conservative concepts regarding infarctectomy, a procedure whose initial promise has failed to pay dividends except under special circumstances. The confusion surrounding the many terns used to define "preinfarction angina* is nicely clarified in the next chapter on the surgical management of this condition, and results reported from the Peter Bent Brigham surgical series are commendable. The last chapter on the surgical treatment of acute myocardial infarction rightly emphasizes a wide spectrum of therapeutic modalities, emphasizing the necessity for early operation (within a few hours) when a patient has experienced an acute infarct if myocardial necrosis is to be prevented. The controversial subject of the management of acute myocardial infarction with left ventricular power failure is well covered, though the precise role of surgery in such instances is less convincing than in the other varieties of acute myocardial infarction covered in this chapter. The subject matter covered in the monograph is undergoing constant reevaluation; and, as the author indicates in his preface, this review merely represents a summary of the current state of the art. Changing techniques and concepts will unquestionably alter the surgeon's approach'to the management of acute myocardial ischemia in the years to come. All the same, the basic concepts laid down here will, in most instances, remain a useful foundation on which to base any future changes in therapy. While the monograph can be read profitably by clinicians and cardiologists as well as surgeons, the latter will probably find it of most interest. Each chapter includes a complete and upto-date bibliography of the subject under discussion, and this alone makes the volume a handy one to have in one's library. It is clearly directed towards the specialist, however, and the undergraduate or young postgraduate medical student may find its coverage too restricted for his or her use. F. Heny Ellis, Jr., M.D., Ph.D. Boston TEXTBOOK O F PULMONARY DISEASES (2nd ed). Edited by G m L.. BA-. Boston, Little, Brown and Co., 1974,800-pp, - $50.00.
This textbook, edited by Dr. Baum with the collaboration of 36 eminent authors, is a second edition appearing nine years after the original. The first edition proved to be one of the best textbooks on
pulmonary diseases ever published. The second edition is also superbly written, well organized, and superior because of new subjects that expand the volume to 52 chapters. Predictably, it will become the preferred text for years to come. There has been extensive revision and updating of the chapters on infectious diseases, pulmonary hyperventilation, clinical and laboratoy diagnostic methods, lung tumors, and pleural disease. Chapters on environmental and industrial diseases, genetic and immunologic diseases, and asthma have been completely rewritten. Finally, new chapters have been added that include radioisotopes in diagnosis, use of computers, and even lung transplantation. This book is a textbook in the h e sense of the word. The authorship is unique. Every writer is engaged not only in investigating and relating patterns of pulmonary disease to pathogenesis, malfunction, and therapy, but is expert in organizing facts and passing them on to others. The authors are all teachers, 20 full professors, ten assistant professors, and six chiefs of pulmonary sections in great hospitals. The editor has fully met his objective in creating a textbook "detailed enough and current enough to appeal to the sophisticated specialist and clinical researchers, yet sdciently orderly, clearly organized, and well-indexed to be of use to the beginning student." This m a g n s d n t and authoritative text win be a valuable addition to every large or small medical library and to many a doctor's office. Richard H. Ouerholt, M.D., F.C.C.P. Boston DIFFERENTIAL DIAGNOSIS O F THE ELECTROCARDIOGRAM (2nd ed). By SIDNEYR. ARBE~T,IRAL. RUBM,and HARRY GROSS.Philadelphia, F. A. Davis Co., 1975, 218 pp, 493 illus, $17.50. This book is intended as a reference manual, as the authors state in their foreword. Although there is a brief section in the introduction devoted to basic electrophysiology, the orientation is at a practical level. The text is presented as a series of flow-sheets, commencing with variations in pattern of various components of the eleCtrocardiogram. This aPproach assumes enough basic knowledge of electrocardiography to detect possible deviations from normal as a starting point. The approach seems most successful when dealing with specific in of variContinued on page 33