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Thrombolytic Therapy
Mayo Clin Proc, September 1988, Vol 63
BOOK REVIEWS
961
ment, such as uncemented hip replacement, un- geon. Chapters in this section discuss techniques cemented revision of hip replacement, and the of cardiomyoplasty and cardiac transplantation. Overall, the book is easy to read and provides new-generation components intended for use with a vast resource of clinical experience and data cement. related to cardiac valve replacement. The editors have put together a remarkably useful, concise Brian F. Kavanagh, M.D. Department of Orthopedics text that presents clinically relevant material based on many years of experience and followup of patients with cardiac valvular prostheses. Heart Valve Replacement & Future Trends The text is not an atlas of cardiac surgical proce in Cardiac Surgery, edited by Gregorio dures but does contain pertinent illustrations in Räbago and Denton A. Cooley, 515 pp, with the appropriate chapters. One shortcoming of the illus, $65, Mount Kisco, New York, Futura Pub book is that the section on noninvasive evalua tion of prosthetic heart valves spends little time lishing Company, 1987 discussing Doppler echocardiography and transThis handy book is a compilation of the experi esophageal echocardiography, which can be ex ences and practices of world-renowned experts in tremely useful in the assessment of patients with the field of cardiac valve surgery. The clinical valvular problems. In addition, as mentioned aspects of both simple and complicated cardiac previously, the material on cardiomyoplasty and valve operations are discussed and backed up heart transplantation is totally unrelated to the with considerable data. The book covers a broad main topic of the book. spectrum of valvular problems. As the title em This book provides a vast resource of clinically phasizes, the text is concerned only with the relevant material that will be enjoyed by resi pertinent aspects of cardiac valve replacement dents in cardiac surgery, fellows, practicing sur and does not cover methods of valve repair. geons, and cardiologists alike. In fact, anyone The book is divided into seven sections. Part with an interest in heart valve replacement and I deals with historical aspects, statistical analy the associated complications will enjoy this book ses, and definitions pertinent to cardiac valve immensely. replacement. Part II addresses technical aspects of cardiac valve replacement in general. In part Ben M. Westbrook, M.D. III, the long-term experiences with the porcine Division of Thoracic and bioprosthesis, the aortic homograft, and the most Cardiovascular Surgery commonly used mechanical prosthetic valves are discussed in detail. In addition, a chapter on valve replacement in the pediatric age group is Thrombolytic Therapy, edited by Anthony J. included. A final chapter dealing with the com Comerota, 306 pp, with illus, $49.50, Philadel parative aspects of mechanical and bioprosthetic phia, Grune & Stratton, 1988 valves completes the section. Part IV details thromboembolic complications and anticoagu An economically priced book entitled Thrombolant regimens in patients with various heart lytic Therapy can hardly fail to attract attention valve prostheses in different anatomic locations. these days. This mode of therapy has become of Part V discusses the clinical, noninvasive, and prime importance in the management of acute invasive investigation of heart valve prostheses. myocardial infarction, as well as having clinical Part VI contains several chapters on reoperative application in a broad spectrum of disorders in valve procedures. The first chapter deals with cluding deep venous thrombosis, central retinal general considerations of reoperations and with vein thrombosis, peripheral arterial occlusion, and specific technical problems that may be encoun pulmonary embolism. A plethora of new agents, tered. The remaining chapters deal with reasons applications, strategies, and trials has made for valve failure and expected results with re- keeping pace a challenge, even for subspecialists. The concept behind this book is an excellent operation. The final section is totally unrelated to the main subject of the book but is, neverthe one—that is, presenting all the thrombolytic less, of interest to the practicing cardiac sur agents and the strategies for their use in a single
Mayo Clin Proc, September 1988, Vol 63
text. Thus, the principles common to their use are available for cardiologists, neurologists, ophthal mologists, vascular specialists, and radiologists. Certain issues (for example, those related to bleed ing and allergy) are indeed common to all uses of these agents. This broad coverage is especially valuable because thrombolytic therapy has de veloped considerably since the medical school training of most of today's practitioners. These same attractive advantages, however, also contribute to significant limitations in this book. The evolution of thrombolytic therapy has been so rapid that new material quickly becomes outdated. That problem is exaggerated in this volume—for example, the chapter on myocardial infarction has only two references more recent than 1983, and the chapter dealing with the future of thrombolytic therapy has just a handful of references as recent as 1986. The one chapter most immune to these con cerns is the introductory chapter by Dr. Sol Sherry, which provides a historical overview of thrombolytic therapy. Dr. Sherry worked with Dr. W. S. Tillett at Bellevue Hospital, where the clinical use of streptokinase and other thrombo lytic agents was pioneered. This chapter is fas cinating. In addition to chapters devoted to periph eral and arterial occlusion, the book includes contributions on thromboembolic disorders of the eye and thrombolytic therapy in acute stroke, as well as general discussions of some of the new agents and their associated complications. Because a book on thrombolytic therapy must rely on angiographic documentation, outstand ing radiologic illustrations are imperative. Al though most of the illustrations in this book are satisfactory, in some chapters they are clearly inadequate. In addition, some illustrations are not well labeled, and some graphic details are obscure. The effort to provide a broad overview will leave some subspecialists unsatisfied with the coverage of their field. As a cardiologist, for example, I was disappointed to find just one chapter on the man agement of acute myocardial infarction with thrombolytic therapy, especially when so many key issues have been debated recently at national meetings and in journals. These issues include the appropriateness of associated procedures such as angioplasty, the ability to perform sur gical procedures in patients who have recently had thrombolytic therapy, the occurrence of rethrombosis, the possible potentiation of these
BOOK REVIEWS
962
agents with antiplatelet regimens, possible clin ical synergism of various therapies, and the re sults of the now numerous clinical trials with genetically engineered agents such as tissue plasminogen activator and single-chain urokinasetype plasminogen activator. Finally, any multiauthored, multi-institutional volume has the potential for some redundancy. In this book, the editor might have deleted some of the repetitive discussion on the fibrinolytic system and potential complications that seem to crop up in almost every chapter. All in all, I wish I could recommend this book with more enthu siasm. Perhaps, however, we will have to wait until the dust settles from the recent storm of innovation before a definitive, comprehensive text on thrombolytic therapy can be written. Ronald E. Vlietstra, M.B.,Ch.B. Division of Cardiovascular Diseases and Internal Medicine
Color Doppler in Clinical Cardiology, by Wal ter J. Duncan, 163 pp, with illus, $95, Phila delphia, W. B. Saunders Company, 1988 The development of color flow technology has added a new dimension to the echocardiographic examination. In color-encoded format, blood flow is superimposed on real-time tomographic images of the heart. Dr. Duncan's book reviews Doppler color flow technology and features examples of clinical cases in which Doppler color flow exami nation proved diagnostically valuable. The book is divided into five chapters. The first chapter concisely describes the background of Doppler technology, principles of Doppler exami nations, and color flow patterns. This chapter emphasizes practical equations and principles of clinical practice rather than in-depth discussions of physics or theory. The second chapter outlines a step-by-step approach to complete echocardio graphic examination with use of Doppler color flow techniques. In the remaining three chapters, case studies of pediatric and adult cardiac patients and intra operative procedures are presented with accom panying color flow images that illustrate specific abnormalities in flow patterns. This format al lows easy and interesting reading and reinforces the clinical usefulness and practical applications
BOOK REVIEWS
961
ment, such as uncemented hip replacement, un- geon. Chapters in this section discuss techniques cemented revision of hip replacement, and the of cardiomyoplasty and cardiac transplantation. Overall, the book is easy to read and provides new-generation components intended for use with a vast resource of clinical experience and data cement. related to cardiac valve replacement. The editors have put together a remarkably useful, concise Brian F. Kavanagh, M.D. Department of Orthopedics text that presents clinically relevant material based on many years of experience and followup of patients with cardiac valvular prostheses. Heart Valve Replacement & Future Trends The text is not an atlas of cardiac surgical proce in Cardiac Surgery, edited by Gregorio dures but does contain pertinent illustrations in Räbago and Denton A. Cooley, 515 pp, with the appropriate chapters. One shortcoming of the illus, $65, Mount Kisco, New York, Futura Pub book is that the section on noninvasive evalua tion of prosthetic heart valves spends little time lishing Company, 1987 discussing Doppler echocardiography and transThis handy book is a compilation of the experi esophageal echocardiography, which can be ex ences and practices of world-renowned experts in tremely useful in the assessment of patients with the field of cardiac valve surgery. The clinical valvular problems. In addition, as mentioned aspects of both simple and complicated cardiac previously, the material on cardiomyoplasty and valve operations are discussed and backed up heart transplantation is totally unrelated to the with considerable data. The book covers a broad main topic of the book. spectrum of valvular problems. As the title em This book provides a vast resource of clinically phasizes, the text is concerned only with the relevant material that will be enjoyed by resi pertinent aspects of cardiac valve replacement dents in cardiac surgery, fellows, practicing sur and does not cover methods of valve repair. geons, and cardiologists alike. In fact, anyone The book is divided into seven sections. Part with an interest in heart valve replacement and I deals with historical aspects, statistical analy the associated complications will enjoy this book ses, and definitions pertinent to cardiac valve immensely. replacement. Part II addresses technical aspects of cardiac valve replacement in general. In part Ben M. Westbrook, M.D. III, the long-term experiences with the porcine Division of Thoracic and bioprosthesis, the aortic homograft, and the most Cardiovascular Surgery commonly used mechanical prosthetic valves are discussed in detail. In addition, a chapter on valve replacement in the pediatric age group is Thrombolytic Therapy, edited by Anthony J. included. A final chapter dealing with the com Comerota, 306 pp, with illus, $49.50, Philadel parative aspects of mechanical and bioprosthetic phia, Grune & Stratton, 1988 valves completes the section. Part IV details thromboembolic complications and anticoagu An economically priced book entitled Thrombolant regimens in patients with various heart lytic Therapy can hardly fail to attract attention valve prostheses in different anatomic locations. these days. This mode of therapy has become of Part V discusses the clinical, noninvasive, and prime importance in the management of acute invasive investigation of heart valve prostheses. myocardial infarction, as well as having clinical Part VI contains several chapters on reoperative application in a broad spectrum of disorders in valve procedures. The first chapter deals with cluding deep venous thrombosis, central retinal general considerations of reoperations and with vein thrombosis, peripheral arterial occlusion, and specific technical problems that may be encoun pulmonary embolism. A plethora of new agents, tered. The remaining chapters deal with reasons applications, strategies, and trials has made for valve failure and expected results with re- keeping pace a challenge, even for subspecialists. The concept behind this book is an excellent operation. The final section is totally unrelated to the main subject of the book but is, neverthe one—that is, presenting all the thrombolytic less, of interest to the practicing cardiac sur agents and the strategies for their use in a single
Mayo Clin Proc, September 1988, Vol 63
text. Thus, the principles common to their use are available for cardiologists, neurologists, ophthal mologists, vascular specialists, and radiologists. Certain issues (for example, those related to bleed ing and allergy) are indeed common to all uses of these agents. This broad coverage is especially valuable because thrombolytic therapy has de veloped considerably since the medical school training of most of today's practitioners. These same attractive advantages, however, also contribute to significant limitations in this book. The evolution of thrombolytic therapy has been so rapid that new material quickly becomes outdated. That problem is exaggerated in this volume—for example, the chapter on myocardial infarction has only two references more recent than 1983, and the chapter dealing with the future of thrombolytic therapy has just a handful of references as recent as 1986. The one chapter most immune to these con cerns is the introductory chapter by Dr. Sol Sherry, which provides a historical overview of thrombolytic therapy. Dr. Sherry worked with Dr. W. S. Tillett at Bellevue Hospital, where the clinical use of streptokinase and other thrombo lytic agents was pioneered. This chapter is fas cinating. In addition to chapters devoted to periph eral and arterial occlusion, the book includes contributions on thromboembolic disorders of the eye and thrombolytic therapy in acute stroke, as well as general discussions of some of the new agents and their associated complications. Because a book on thrombolytic therapy must rely on angiographic documentation, outstand ing radiologic illustrations are imperative. Al though most of the illustrations in this book are satisfactory, in some chapters they are clearly inadequate. In addition, some illustrations are not well labeled, and some graphic details are obscure. The effort to provide a broad overview will leave some subspecialists unsatisfied with the coverage of their field. As a cardiologist, for example, I was disappointed to find just one chapter on the man agement of acute myocardial infarction with thrombolytic therapy, especially when so many key issues have been debated recently at national meetings and in journals. These issues include the appropriateness of associated procedures such as angioplasty, the ability to perform sur gical procedures in patients who have recently had thrombolytic therapy, the occurrence of rethrombosis, the possible potentiation of these
BOOK REVIEWS
962
agents with antiplatelet regimens, possible clin ical synergism of various therapies, and the re sults of the now numerous clinical trials with genetically engineered agents such as tissue plasminogen activator and single-chain urokinasetype plasminogen activator. Finally, any multiauthored, multi-institutional volume has the potential for some redundancy. In this book, the editor might have deleted some of the repetitive discussion on the fibrinolytic system and potential complications that seem to crop up in almost every chapter. All in all, I wish I could recommend this book with more enthu siasm. Perhaps, however, we will have to wait until the dust settles from the recent storm of innovation before a definitive, comprehensive text on thrombolytic therapy can be written. Ronald E. Vlietstra, M.B.,Ch.B. Division of Cardiovascular Diseases and Internal Medicine
Color Doppler in Clinical Cardiology, by Wal ter J. Duncan, 163 pp, with illus, $95, Phila delphia, W. B. Saunders Company, 1988 The development of color flow technology has added a new dimension to the echocardiographic examination. In color-encoded format, blood flow is superimposed on real-time tomographic images of the heart. Dr. Duncan's book reviews Doppler color flow technology and features examples of clinical cases in which Doppler color flow exami nation proved diagnostically valuable. The book is divided into five chapters. The first chapter concisely describes the background of Doppler technology, principles of Doppler exami nations, and color flow patterns. This chapter emphasizes practical equations and principles of clinical practice rather than in-depth discussions of physics or theory. The second chapter outlines a step-by-step approach to complete echocardio graphic examination with use of Doppler color flow techniques. In the remaining three chapters, case studies of pediatric and adult cardiac patients and intra operative procedures are presented with accom panying color flow images that illustrate specific abnormalities in flow patterns. This format al lows easy and interesting reading and reinforces the clinical usefulness and practical applications