myocardial preservation, medical and surgical treatment of unstable ... College of medicine. University of Saskatchewan. Saskatoon, Sask. Biochemistry.
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BOOK REVIEWS
Advances in Cardiology. Vol. 26. New Approaches in the Diagnosis and Management of Cardiovascular Disease. 9th Conference on Cardiovascular Disease in Snowmass-atAspen, Aspen, Colo., January 9-12, 1978. Edited by John H.K. Vogel. 139 pp. Illust. S. Karger AG, Basel, 1979. $49.25. ISBN 3-8055-2914-7 This book, written by a group of authors, presents data on the most recent research as well as on changing clinical techniques for the diagnosis and management of cardiovascular disease in both adults and children. The authors put special emphasis on the latest developments in noninvasive and invasive techniques for the diagnosis of cardiac disorders. Early detection of coronary artery disease by noninvasive techniques (exercise electrocardiography, cardiac fluoroscopy, cardiokymography and thalium scintigraphy) is described so that the probability of having coronary artery disease may reasonably be estimated for each patient. This section includes a discussion of the use of positron-emission transaxial tomography effected with various radionuclides for measuring and studying the features of regional myocardial metabolism. This type of tomography could help in the detection and measurement of cardiomyopathic processes and in the evaluation of the usefulness of therapeutic interventions in myocardial ischemia and infarction. A detailed account is given of infarct acid imaging with technetium-99m-pyrophosphate, technetium-99m-tetracycline or technetium-99m-glycoheptonate, and myocardial perfusion imaging with potassium-43 or thallium-201 for the detection of
ischemia and acute myocardial infarction. Details on the use of human serum albumin or erythrocytes labelled with 99mTc in the evaluation of ventricular function and myocardial wall motion are provided, as is a nice outline of the clinical application of myocardial imaging with radioisotopes for evaluating and managing patients with coronary artery disease. The section on cardiac pharmacology deals with antihypertensive drugs, the pathophysiology and pharmacology of angina pectoris, the treatment of patent ductus arteriosus and the use of provocative angiography in patients with chest pain. The chapter on antihypertensive drugs is poorly written, and it lacks information on the latest drugs of potential use in hypertension. Ergonovine is useful as a provocative diagnostic agent in patients with recurrent chest pain during a negative exercise test and at rest; it would also be useful to test the therapeutic efficacy of drugs used for coronary spasm. A good outline of the pharmacologic approach to the treatment of angina, based on the physiologic and pathophysiologic mechanisms of ischemia, is given. Indomethacin for the treatment of patent ductus arteriosus is shown to be very effective and is nicely described. The section on coronary artery disease deals with lysolipid and cardiac arrhythmias, intraoperative myocardial preservation, medical and surgical treatment of unstable angina and the angiographic definition of critical coronary artery stenosis. The well controlled study of lysolipid in the genesis of lethal cardiac arrhythmias during ischemia has good potential. Intraopera-
76 CMA JOURNAL/JANUARY 12, 1980/VOL. 122
tive myocardial preservation should have been presented in more detail and the mechanism of action explained; various other pharmacologic agents used in myocardial preservation have not been mentioned. The medical and surgical treatment of unstable angina is carefully described and a rational approach to the initial management of such patients is suggested. I believe the section on the angiographic definition of critical coronary artery stenosis is unique; it emphasizes the danger of relying. solely on coronary angiography to define critical coronary stenosis. In evaluating coronary angiograms one should consider the percent and the length of stenosis because they both influence the coronary blood flow. Also, angiographic artefacts produced by short narrowing tend to overestimate the percent of stenosis; hence, calipers should be used. The section on the relation of drugs, diet and exercise to cardiovascular disease is barely adequate, and only one case report is given for each chapter. The conclusions drawn from studies on drugs and diet are conflicting. One case study shows that lowering the level of cholesterol in the diet helps in revascularization, but another shows a lack of revascularization with a low fat diet and exercise. Indeed, in one marathon runner coronary occlusion occurred despite an excellent regimen of physical exercise. The section on congenital heart disease deals with the surgical treatment of patent ductus arteriosus in premature infants, palliative shunts, total anomalous pulmonary venous drainage and conduits. For palliative shunts the type of shunt should be carefully selected since any con-
genital cardiac lesion may prove to be correctible in time. It is important that an intact pulmonary bed be maintained as much as possible. Indications for, problems and future use of conduits are well presented. In summary, I feel that "Advances in Cardiology" covers the current methods of diagnosis and management of cardiovascular diseases. This book is of obvious importance to internists, family practitioners, cardiovascular surgeons, cardiologists and scientists who work primarily in the field of cardiovascular diseases. KAILASH PRASAD, MD, PH D, FICA, FACC
Department of physiology
College of medicine University of Saskatchewan Saskatoon, Sask.
Biochemistry. A Functional Approach. 2nd ed. R.W. McGilvery. 862 pp. Illust. W.B. Saunders Company Canada Ltd., Toronto, 1979. $35.40. ISBN 0-7216-59128 Professor McGilvery's book has found wide acceptance as a basic textbook of biochemistry. This second edition is organized in the traditional fashion, starting with chapters on the structures and functions of the main classes of molecules of biologic interest, then proceeding to a discussion of enzymes and intermediary metabolism. It also includes chapters on specialized topics, such as blood clotting, muscle contraction, transport, salt and water balance, and introductory endocrinology. Especially welcome are five chapters on nutrition and overall energy balance. Within this framework some subjects have been shifted from their usual place to one more in keeping with their function. Thus, the pentose shunt has been iioved from the section on intermediary metabolism of carbohydrates to the section on fat storage, in keeping with its function of providing reducing equivalents for fatty acid synthesis. The text is easy to read and well illustrated; there is a diagram on almost every page. In addition to making the text easier to understand, these diagrams have the psy-
chologic effect of giving the reader marily for the non-nephrologist". a sense of accomplishment from The book is divided into five main reading a large number of pages sections. In the first chapter Dr. Papper details the clinical apquickly. The aim of the book is to de- proach, including the history takscribe the chemical structure and ing and the physical examination required to diagnose renal disease. function of living organisms especially humans. Thus, it is con- He continues with the tabulation cerned principally with animal and and classification of renal diseases especially with human biochemis- and a brief outline of the structure try; important topics in plant bio- and function of the kidney. In chemistry, such as photosynthesis, chapters 2 and 3 he covers the most common renal diseases. He proare not covered. The subtitle of the book, "A vides a brief outline of each one, Functional Approach", underlines a definition of the disease state, a the attempt by Professor McGilvery description of the clinical syndrome and his collaborator Goldstein, a and appropriate investigative approfessor of internal medicine, to proaches, and a brief discussion of focus on biologic functions to show present methods of treatment. He that the biochemical data they pre- is always careful to indicate when sent are not esoteric observations his own bias enters into a particular but, rather, necessary components choice of therapy. One of the most of our understanding of both the engaging aspects of this text is Dr. normal and abnormal function of Papper's ability to discuss clearly the human body. In this they suc- and briefly the pathophysiology and the clinical presentation of renal ceed. In summary, this book is well diseases. His descriptions are comwritten and it is enlivened by a plemented by numerous schematic wry sense of humour that the read- drawings that are extremely helper will find engaging. Although it ful. Of interest, especially to the is meant primarily for students subspecialty student, is Dr. Paptaking biochemistry courses, espe- per's reference to controversy in all cially in schools of medicine, it aspects of management and treatshould continue to be of use ment. This second edition has been throughout their medical studies, both undergraduate and postgradu- brought up to date and includes a ate. It is also useful for physicians new section on common disorders who wish to understand the bio- of fluid and electrolyte metabolism chemistry of some of the pheno- and acid-base disorders. The last section contains a summena, from flatulence to blood clotting, that they encounter while mary of various tests, methods of caring for their patients. I believe treatment and microbiologic data that any physician who hasn't pertinent to nephrology and a usestudied biochemistry since leaving ful set of tables on nephrotoxic and medical school, but would like to dialysable drugs. I feel that "Clinical Nephrology< review some aspects of the subject, will find this book a useful, and should be of value to house officers and medical students at all levels even a delightful, reference work. of training, including those in HANS M.C. HEICK, MD, PH D, FRCP[C] programs. Although no nephrology Chief, division of biochemistry Children's Hospital of Eastern Ontario topic is covered in great depth, Ottawa, Ont. references are listed in each chapter. In addition, I can easily recommend this text to practising physicians because it contains brief, Clinical Nephrology. 2nd ed. Sol- clear and effective descriptions of omon Papper. 633 pp. Illust. Little, nephrology topics in a single refBrown and Company (Inc.), Bos- erence source. ton, Massachusetts, 1978. Price not MELVIN SILVERMAN, MD, FRCPfC] stated. ISBN 0-316-69045-7 Department of nephrology "Clinical Nephrology" is a highly Toronto General Hospital Toronto, Ont. readable text that is intended "priCMA JOURNAL/JANUARY 12, 1980/VOL. 122 81
