Mayo Clin Proc, October 1988, Vol 63 BOOK REVIEWS 1063

tance of upper airway function in the cause of sudden infant death syndrome and sleep apnea, the book appropriately includes a chapter devoted exclusively to upper airway function in the new­born. Surprisingly, however, none of the chapters addresses upper airway function during sleep, and the important functional considerations in the cause of sleep apnea are largely neglected.

The book includes a chapter that explores the relationship of respiration to the production of sound. Apparently, the purpose of this chapter is to bridge considerations of the respiratory func­tion of the upper airway and the study of phona-tion. The chapter is unavoidably incomplete be­cause of the large amount of literature available on phonation.

By presenting in one volume a definitive view of upper airway function, this book will be an invaluable resource for respiratory physiologists. In addition, it provides important background material for those in the clinical fields of oto-laryngology and pulmonology. This book will no doubt be the major reference source in this area for some time to come and should prompt further investigation in the still underdeveloped area of respiratory function.

Thomas V. McCaffrey, M.D. Department of Otorhinolaryngology

Ambulatory Monitoring of the Cardiac Pa­tient (Cardiovascular Clinics, Vol 18, No. 3), edited by Daniel David, Eric L. Michelson, and Leonard S. Dreifus, 218 pp, with illus, $50, Philadelphia, F. A. Davis Company, 1988

This 18th volume of the Cardiovascular Clinics series covers the use of ambulatory monitoring techniques in the diagnosis and treatment of com­mon cardiovascular conditions, including myo-cardial ischemia, arrhythmias, hypertension, heart failure, and valvular disease. Contributing ex­perts in the field discuss the application of both traditional and new approaches to many serious cardiovascular problems in the outpatient set­ting. Cost-efficacy is addressed both from the standpoint of approximately a 50% savings over inpatient assessment and from the perspective of the specific patient population in which each technique would be most cost-effective. For ex­ample, the usefulness of evaluating residual

ischemia in patients with myocardial infarction and arrhythmias with use of ambulatory electro-cardiographic monitoring is addressed in detail. I found the in-depth discussion of technical con­siderations in the accuracy of conventional am­bulatory electrocardiographic monitors and the limitations and advantages of various ambula­tory electrocardiographic monitoring systems for the detection of ST segment shift particularly interesting. The text also reviews transtelephon-ic electrocardiographic systems for monitoring myocardial ischemia, infarction, ventricular ar­rhythmias, and cardiac pacemakers. Other topics of discussion include the use of the signal-averaged electrocardiogram in the detection of ventricular late potentials and the interpreta­tion of their prognostic significance, the use of ambulatory blood pressure measurements and implications for the management of hyperten­sion, echocardiographic assessment of ambula­tory monitoring of valvular heart disease and radionuclide ventriculography, and ambulatory monitoring of patients with valvular heart disease.

This book will be useful to physicians involved in the ambulatory care of patients with common cardiovascular problems. The authors thoroughly review the latest ambulatory techniques and their applications to well-defined patient groups. Each chapter is well referenced, the illustrations are of high quality, and a complete index is included.

William T. Bardsley, M.D. Division of Cardiovascular Diseases and Internal Medicine

Acute Coronary Intervention, edited by Eric J. Topol, 302 pp, with illus, $49.50, New York, Alan R. Liss, 1988

This text is a compilation of the current knowl­edge on myocardial reperfusion therapy for evolv­ing acute myocardial infarction. It is logically divided into four sections encompassing 17 chap­ters and 302 pages.

The first section of the text consists of an excellent review of all the currently available thrombolytic agents, including pharmacologic considerations, mechanisms of action, and a thorough review of the literature. The relative efficacy, advantages, complication rates, and benefits in terms of morbidity, mortality, and

1064 BOOK REVIEWS Mayo Clin Proc, October 1988, Vbl 63

salvage of ventricular muscle associated with each of the agents are clearly outlined.

The second section of the text deals with emer­gency "mechanical" coronary revasculärization. In this section, the roles of emergency percu­taneous transluminal coronary angioplasty, emer­gency coronary artery bypass grafting, and the sequencing of percutaneous transluminal cor­onary angioplasty, either before or after throm-bolytic therapy, are reviewed. An excellent, concise discussion of appropriate selection of patients for each modality is presented. Addi­tionally in this section, the topic of coronary reocclusion after either thrombolytic or mechan­ical reperfusion therapy is reviewed. The current understanding of the pathophysiologic features, prevention, and management of reocclusion and future horizons in this area are discussed.

The third section consists of an in-depth dis­cussion of the four major clinical trials of reper­fusion therapy reported in the literature at the time of publication of this text. Although this section will surely become out-of-date, it provides a sound foundation in terms of our current knowl­edge of reperfusion therapy. In addition, the method of evaluating and comparing these trials, as well as assessing the issues affecting the trial results, demonstrated in the text provides an excellent insight into the evaluation of future information as it becomes available.

The fourth section of the book deals with new investigational techniques in myocardial reperfu­sion and associated topics of interest to those who treat patients who have undergone myocardial reperfusion or have acute coronary syndromes. These topics include the management of cardio-genic shock, the use of angioplasty in patients with unstable angina, the mechanisms of reperfu­sion injury, investigational techniques for limit­ing reperfusion injury, and "reperfusion" by cor­onary sinus cannulation in retroperfusion. In addition, a rational approach to the assessment, triage, and choice of management of the patient with an acute coronary syndrome is developed on the basis of the experience at Duke University.

This text provides a concise and well-executed review of the current knowledge of myocardial re­perfusion therapy for acute coronary syndromes. I highly recommend it to cardiologists, internists, family and general practitioners, emergency room physicians, and others who deal with pa­tients who have acute coronary syndromes, par­

ticularly acute myocardial infarction. The text also contains useful information for those who wish to use thrombolytic agents for other indi­cations. Although the section on the current ma­jor trials will become out-of-date, it does have long-term usefulness in providing a sound basis on which future data can be evaluated.

Andre C. Lapeyre III, M.D. Division of Cardiovascular Diseases and Internal Medicine

Neonatal Intensive Care (Clinics in Critical Care Medicine, Vol 13), edited by Robert D. Guthrie, 328 pp, with illus, $46, New York, Churchill Livingstone (distributed by Long­man, White Plains, New York), 1988

Because the field of neonatal medicine is rela­tively new, both the philosophy and the practice in this subspecialty have changed dramatically during the past 10 years. For example, technical advances have enabled neonatologists to push the limit of viability from 32 to 24 weeks' ges­tation. Additionally, better understanding of neo­natal pathophysiology has resulted in more judicious use of oxygen in preterm infants (to prevent retinopathy of prematurity) and more individualization of feeding regimens (to prevent necrotizing enterocolitis and nutritional deficien­cies). Although our small patients have benefited immensely from these and other advances, prac­ticing neonatologists have been overwhelmed by the plethora of publications resulting from the multifaceted and expanding frontiers of the field. Dr. Guthrie's book provides neonatologists and pediatricians with a concise review of the major areas of new knowledge in neonatal medicine.

Chapters 2 and 3 provide important updates of two emerging modalities of treatment for respi­ratory distress syndrome: intratracheal instilla­tion of natural or synthetic pulmonary surfactant and the use of a variety of types of high-frequency ventilation. Chapter 7 outlines the use of mag­netic resonance imaging in neonates, and chap­ter 9 describes the results of initial trials in programs for developmental intervention in re­covering preterm infants. Chapter 10 highlights the results of studies that focus on new treatment modalities for neonatal sepsis. Other chapters provide updates in areas that are not changing