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THE BOOKSHELF HEART DISEASE, A TEXTBOOK OF CARDIOVASCULAR MEDICINE. By EUGENE BRAUNWALD. Philadelphia : W. B. Saunders, 1980, 1,943 pp, $65.00 (US) single \'01; $75.00 (2 vol set). Prior to this text, cardiology texts lacked organization and a full spectrum of modem approaches to diagnosis and treatment of the vast array of cardiovascular diseases . This textbook is organized in a fashion that makes reviewing a subject not only easy, but pleasurable. Dr. Braunwald has organized and edited the contributions of these well-known authors in such a fashion that each chapter generally fits in with preceding and subsequent chapters. The first part of the book begins with the basics of the cardiovascular examination and reviews the techniques and indications for various noninvasive and invasive diagnostic tests . The second part deals with derangements of the physiology of the cardiovascular system such as heart failure , dysrhythmias and shock , among others. The third section deals with abnormalities in the structure of the cardiovascular system and diagnosis and management of these problems. The chapters are divided logically and such topics as diseases of the pericardium or cardiomyopathies are dealt with fully and in a wonderfully understandable fashion. The final section deals with systemic, noncardiovascular diseases which affect the heart such as endocrine, neurologic and renal diseases. A chapter is devoted to pregnancy and the heart and another to general anesthesia in patients with cardiovascular disease. The text is extremely well illustrated with examples which help to demonstrate the points in the text. Echocardiograms, radionuclear images, angiographic photos , hemodynamic illustrations, electron microphotographs and electrocardiographic examples all serve to expand on the text. Modem approaches such as the use of intravenous nitroglycerin, the use of calcium channel blocking agents and coronary angio-

plasty are discussed but not without standing along side the basics of the cardiovascular history and physical exam. An extensive bibliography is provided with each chapter, giving at least 300 references for each chapter to complement the ideas in the text. This book should be well accepted by house officers, cardiology fellows and practicing cardiologists and all will find it informative, interesting and, in my opinion, the best cardiology text available, Bruce E. Mirbach , M.D. Burlington, Massachwetts VENOGRAPHY OF THE INFERIOR VENA CAVA AND ITS BRANCHES. By]. CHERMET and] . M. BIGOT. Berlin: Springer-Verlag, 1980, 232 pp, $116.90. New hope for patients suffering from infradiaphragmatic venous disease has arisen. Those with chronic venous hypertension , for example, may be cured with a cross-over graft if they have unilateral iliac vein occlusion. Similarly, selected patients with Budd-Chiari syndrome who are unsuitable candidates for mesocaval shunts may benefit from a mesoatrial shunt. Patients with acute iliofemoral venous thrombosis may likewise be helped by fibrinolytic agents. It is thus timely that a monograph emphasizing the technical and interpretive nuances of cavography has appeared. Many radiologists and surgeons will benefit from the expert radiosemiologic guidance contained herein. For example, because the left common iliac vein compression syndrome is so common, the question of how much compression is abnormal is emphasized. (Those symptomatic cases with venous synechiae and extensive collateral circulation probably warrant surgical correction.) Interpretive pitfalls, due to physiologic reflux, dilution phenomena, and pseudostenosis artifacts from the Venturi effect , are all well illustrated, as are the embryologic origins of venous variations that may complicate cardiovascular surgery. The role of descending retrograde cavography to demonstrate the head of a poorly adherent intracaval thrombus and other emboligenic states that may benefit from intracaval umbrella insertion are also well illustrated.

When writing pI ca se mention CHEST

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The Bookshelf, continued from page 45 Renal, hepatic, adrenal, lumbar, and even spermatic venography receive substantial coverage. Procedures of limited practical value, such as pelvic venography, are included for completeness. Contrary to classical notions, it seems that pelvic veins can rarely be blamed as a source of pulmonary emboli. Regarding extrinsic compression of the cava, the role of cavography in the diagnosis of hepatic, intraperitoneal, and retroperitoneal disease is discussed as well. Cavography remains the method of choice for the timely diagnosis of retroperitoneal fibrosis-a condition that can only be well treated if recognized early. Whether it is explaining the general principles of collateral circulation, or pointing out rareties such as common iliac vein obstruction by a paraganglioma of the organ of Zukerkandle, this book opens many clinical horizons. Alan T. Marty, M.D., F.C.C.P. Eoomville, Indiana ECHOCARDIOGRAPHY (3rd Ed.). By HARVEY FEIGENBAUAI. Philadelphia: Lea & Febiger, 1981, 580 pp, $35.00. The third edition of this text is a worthy successor to those which preceded it. This new edition has undegone extensive revision and reorganization. Many chapters have been rewritten or incorporated into others. The conception of echocardiography that emerges is of a more utilitarian cardiac diagnostic tool with less emphasis placed on its use for the diagnosis of specific entities pet" se. This is reflected in the inclusion of such new chapters as those on hemodynamic information derived from echocardiography and findings with altered electrical activity. There are really two textbooks here: a textbook of M-mode echocardiography and, through extensive expansion of content from previous editions, a textbook of two-dimensional echocardiography. Dr. Feigenbaum's writing style is quite readable. The discussions are thorough, but purposely not exhaustive. For those with a particular interest there are extensive bibliographies at the end of each chapter which provide a ready source for additional readings. Controversies are presented thoughtfully and objectively. A pleasant innovation is the reproduction of figures from other chapters in the current chapter when the figures are relevant to the topic under discussion. The appendices have been expanded to include newer data based on the measurement recommendations of the American Society of Echocardiography and on normal values in different age groups. The current edition would probably be difficult for the uninitiated or for those seeking only a general overview of the field. It can be enthusiastically recommended to the cardiac fellow and clinical cardiologist as an excellent and readable reference book and for those with a research interest as a reference and source book. Ira S. Cohen, M.D. Wtuhington, D.C.

REVIEWS OF CONTEMPORARY LABORATORY METHODS. Edited by A. M. WEISSLER. Dallas: American Heart Association, 1981, $16.00. This is a book designed to update cardiologists in nine different subjects by as many diJlerent authors. Although the chapter on phonocardiography seemed impractical since it is not a recommended procedure, it contains a wealth of information on the physiology of heart sounds and murmurs. The chapter on treadmill testing is a comprehensive review. Although most of the section reviews the methods of doing and interpreting stress tests in order to diagnose the presence of significant coronary obstruction, the not illogical conclusion stated is that in patients with classical or known anginal chest pain "stress testing has little role to play diagnostically," and should only be used in patients with atypical chest pain. Since in such states there are false positives and negatives, one might just as well recommend going directly to coronary angiography in such patients. It is to be hoped that the future of stress tests lies in their prognostic value to which too little space is devoted in this chapter. In the 40-page chapter on echocardiography, excellent as it is, there is simply not enough space for the innumerable illustrations that are necessary and two-D echcocardiography is only barely touched upon. A complete book on the subject is now necessary

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for the cardiologist, and there are many excellent books on this subject. Dr. Popp ought obviously be the author of one. There are several chapters for the supersubspecialists in cardiology of little interest to the clinical cardiologist. One is the chapter on left ventricular function by radiographic techniques, which is useful to angiographers who can understand complex mathematical formulae and graphs. Other such chapters are the two on precordial electrocardiographic mapping. The one on coronary angiography contains many pearls for the cardiology fellow. The chapter on systolic time intervals should be read by every cardiologist. This section shows that systolic time intervals are an art worthwhile spending the time learning. The methodology is simple, but the results are staggering in their complexity and usefulness. For this chapter alone, it is worthwhile having the hook. Jules Con.tftJnt, M.D. Buffalo MANAGEMENT OF THE CARDIAC PATIENT WITH RENAL FAILURE (1st Ed). By DAVID T. LoWENTHAL, RONALD S. PENNOCK, WILLIAM LIKOFF, and GADDO ONESTI. Philadelphia: F. A. Davis Co., 1981, 204 pp, $30.00. This small (200 page) book brings together much interesting, although little new, material on cardiovascular disease and hypertension, but approaches this knowledge from the aspect of the patient with compromised renal function. While the material may not be new, it is well organized. The importance of diminished renal excretion of cardiovascular drugs is appropriately well emphasized. Such caution need not be stressed for the nephrologist and one has the impression that this book is directed toward the general internist and the medical student. The chapter on dialysis in patients with cardiovascular disease is especially weD suited to this purpose. Cardiologists also may find little truly new material in this book, but may appreciate the well-formulated outlines of conventional therapies as they may be modified for this expanding group of patients with renal insufBciency. In short, this book brings together much practical and clinically applicable information in logical and easily readable form. It is particularly recommended for the cardiology and/or nephrology fellow who is on his consultation rotation and involved with house staff teaching.

Frank 1. Takacs, M.D. Burl.ngton, MA RESPIRATORY PATIENT CARE. By KANuTE P. RARE, JOHN W. YOUTSEY. Englewood CWfs, New Jersey: Prentice-Hall, Inc., 1981, 400 pp, $22.95. This elegant text on respiratory care by two respiratory therapists exemplifles the sophisticated expertise that associated health professionals are striving for and achieving in the current medical milieu. It is not just another copy of a medical text, but rather an expert distillation of basic scientific principles and clinical procedures for the management of patients with respiratory problems, particularly those requiring adjunct respiratory therapy. The topics covered include: medical gas administration, oxygen analyzers, humidity and aerosol therapy, respiratory pharmacology, chest physical examination, chest physical therapy, airway management, intensive respiratory care, mechanical ventilation equipment, pulmonary function testing, electrocardiogram testing, and equipment sterilization and cleaning. To cover all of this in just 400 pages is, if anything, overly precise in presentation. As such, however, it is an excellent quick and ready reference for professionals at all levels from beginning student to chest specialist. The numerous graphs, tables, and line drawings are particularly helpful for reference and visual learning. Needless to say, a text of this length is incomplete which it must be to fulfill its mission. Ah, but that is the rub, to include enough to be effective without diluting so much as to destroy the efficiency of the learning process. There are other more voluminous texts on each topic for further reference if needed. From the physician's viewpoint this is an important text to illustrate the degree of sophistication today's respiratory therapist should have at his command. It also provides, for example, principles and mechanical details such as respirator design and oper(continued on 'Page 49)