Sadly. congenital heart disease gets only a brief mention in part of one chapter. Only poor quality intravenous digital angiography images are shown in the illustrations and it is stated that digital subtraction angiography cannot be substituted for conventional angiography. With the quality of digital angiography now obtained with intracardiac injections, and consider- ing that many infants now undergo operation on the basis of echocardiography alone, this viewpoint is surprising. Digital angiography has surely meant that costly biplane installations are no longer needed and that paediatric cardiologists can happily share the same catheter laboratory with radiologists. Practical points, such as imaging framing rates and the capability of reducing patient X-ray dose by this and other ap- proaches. are not covered. There is also no mention of the use of combined cineangiography and digital angiography and its advantages.

A major limitation to the development of all digital cardiac laboratories has been the problem in archiving the very large amounts of digital data produced. The practical aspects of this are not really addressed in the chapter on archiving digitally formatted data. Some mention of digital tomosymphysis, although it is still experimental, would also have been of value.

In conclusion, this book forms an excellent summary of digital cardiac angiography despite the subject being a new and rapidly changing field. This book will form a useful reference source for physicists, cardiologists and radiologists involved in digital cardiac imaging. This review is a joint one from a radiologist and physicist.

Dept. of Radiology

Guy’s Hospital

London, U.K.

J.F. Reidy

D. Hawkes

Exercise in the Practice of Medicine (2nd revised

ed.) Editor: Gerald F. Fletcher Futura Publishing Company, Mount Kisco, New York, 1988; 515 pp.; $62.00; ISBN 0-87993-310-O

This very readable book concerns the study of exercise physiology and of its prophylactic and therapeutic roles in medicine. The topics covered range from a traditional discussion of cardiopulmonary effects and benefits, to a consideration of exercise and its effects in other cir- cumstances (haematology, infection, immunity, psychi- atry, obstetrics and gynaecology). There is even a chapter on the deleterious effects of exercise unwisely taken. Although a multi-author book, the format of each sec-

tion is similar, beginning with a broadly based introduc- tion before honing down on the changes induced by various forms of exercise. In this way, large areas of both normal and abnormal physiology are covered, yet the non-expert. in say immunology, need feel no qualms. On the contrary, the inclusion of such diverse topics in well referenced chapters gives the book a unique per- spective.

The book begins with a crisp and direct account of exercise physiology by Schlant supported by 333 refer- ences! Sheffield produces the next authoritative chapter on exercise stress testing and 53 references. There is inevitably some overlap with the third chapter on the exercise prescription by Mikolich and Fletcher but the repetition pays dividends. This section burgeons with exercise performance norms and has a useful table of the metabolic costs of a wide variety of leisure pursuits. Yet amongst the hard earned data are the quaint pre- scriptions for the acute coronary patient. e.g. “day 2 ~ bed bath. staff to assist with back and lower legs”, “day 4 - may sit at sink to shave”, “days 8 to 10 - may shower”.

The prophylactic benefits of exercise against the development of ischaemic heart disease are aired in two chapters by Fletcher and Hyde and Paffenbarger. Both chapters abound in observations and speculate on puta- tive mechanisms, but the sceptic will need to look hard at the “evidence”.

I consider this to be a well written, clearly il- lustrated, practical and exceedingly well referenced book. Although cardiopulmonary topics dominate, I found the fringe topics equally interesting. This book will prove useful to all who use exercise in the rehabili- tation of patients and is a useful source of references on the effects of exercise in a wide variety of physiological

and pathological states.

Reader in Medicine

University of Nottingham Nottingham. U.K. R.G. Wilcox

Noninvasive Cardiac Imaging - Recent Develop- ments Editors: R.S. Meltzer, S. Vered and H.N. Neufeld Futura Publishing Co., Mount Kisco, New York, 1988; 376 pp; $75.00; ISBN O-87993-314-3

Cardiac imaging is such a visually attractive subject that there are a number of good books already available. This one differs from others in that it attempts to emphasise new developments but, as often in a multi-

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author book, the quality is nonuniform. Approximately half is devoted to echocardiography and there are excel- lent discussions of quantitative echocardiography and Doppler assessment of prosthetic valves and regurgita- tion. Much less good are the chapters on colour-coded Doppler flow imaging and on transoesophageal echo- cardiography (only three transoesophageal images are shown).

Nuclear cardiology is incompletely covered but there are excellent chapters on thrombus imaging and on positron emission tomography. The book might be worth buying for the positron chapter alone. because it covers very clearly some of the physical principles that are unique to positron imaging and it summarises the devel- opment of the technique into an important clinical tool. Only the basics of radionuclide ventriculography are described and there is no coverage at all of thallium-201 imaging or new perfusion agents, both areas in which nuclear cardiology is expanding rapidly.

Digital subtraction angiography is described with much technical detail but very little on its potential for the assessment of coronary flow reserve. Ultrafast X-ray computed tomography deserves a chapter of its own and, whilst anatomical imaging with magnetic reso- nance is well covered, there is very little on functional imaging and nothing on flow.

In summary therefore, a mixed bag. But it would be worth dipping into for some of the better chapters.

Cardiac Imaging National Heart & Lung Inst. London. U.K. Richard Underwood

New Perspectives in Cardiac Pacing Editors: S. Serge Barold and Jacques Mugica

Futura Publishing Co., Mount I&co, New York,

1988; 441 pp.; $60.00; ISBN o-87993-330-5

This is a very useful text. It is well organised and comfortable to read. The chapters are well organised and their content accessible to the reader who wishes to make quick reference, but equally thorough for the reader who wishes an expert review. The illustrations are of high quality and easy to understand with good legends. All the chapters are well written and compre- hensive. A small criticism (essentially for its own sake) that could be levelled at the editors is that more space could be given to the investigational approach in de- termining the optimal pacemaker for a given patient.

The chapter dealing with optimal pacing mode selection discusses the indications for the various pacing modes but does not really address the investigational ap- proach. This book, however, is a thorough overview of cardiac pacing in the late ’80s and will be well read in most pacing units by medical, technical and nursing staff.

National Heart Hosp. London, U.K. John Morgan

Brain Injury and Protection during Heart Surgery Editor: Mark Hilberman Martinus Nijhoff Publishers, Boston/ Dordrecht/ Lancaster, 1988; 173 pp.; DF1150, $58.50, E40.95; ISBN O-89838-952-6

Some excellent reviews on important aspects of brain injury and protection during heart surgery are found in this book. It is obviously written by clinicians for clini- cians and covers various topics, such as the regulation of cerebral blood flow, low flow/low pressure perfu- sion, total circulatory arrest, micro/ macroemboli, in- vestigational tools and protective agents. A fairly repre- sentative glimpse is obtained of the current knowledge in this rapidly developing field with many yet unsolved issues.

Particularly interesting parts of the book are those dealing with the regulation of cerebral blood flow. The roles of anaesthetic agents, hypothermia and pH management are thus clarified. The section which analyzes the potentials of protective agents is also in- structive.

While the book provides valuable background for cerebral protection in patients without preoperative cerebro/cerebro-vascular disease, the specific aspects when treating high risk patients are approached only vaguely. With the impressive body of expertise gathered for this book, a more deliberate attempt may have been rewarding.

The book is recommended as a brief update for those already in the field, and as an introduction for those without previous knowledge in the subject of protecting the brain during heart surgery.

Cardiothoracic Surgery Brompton Hospital London, U.K.

R. Ekroth J. Vanderlendem