Angina Pectoris

Angina Pectoris

Mayo Clin Proc, January 1986, Vol 61 BOOK REVIEWS Methods for Computer-Assisted Medical Decision Making," is the only chapter that was written solel...

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Mayo Clin Proc, January 1986, Vol 61


Methods for Computer-Assisted Medical Decision Making," is the only chapter that was written solely for this publication. The other 29 chapters are reprinted from material that had been published previously. (Half of these reprinted contributions were originally published before 1979.) I reviewed this book from the perspective of an interested reader and not as an expert in the computer field. The material in the first chapter is informative, and it is helpful for reading the rest of the chapters. Although these collected articles seem appropriately chosen, if the editors had added comments at the end of each section, this book would have been even more valuable to the nonexpert but interested reader. Carl F. Anderson, M.D. Division of Nephrology and Internal Medicine

Angina Pectoris, edited by Desmond G. Julian, 233 pp, with illus, $52, New York, Churchill Livingstone (distributed by Longman, White Plains, New York), 1985 The inherent difficulty in producing a monograph on a common clinical syndrome, such as angina pectoris, is that potential readers may be either specialists or generalists. Specialists are likely to suppose that a relatively concise review will add little to their expertise, whereas generalists may think that material that discusses specific technical diagnostic or therapeutic modalities will be outside their practical interests. The editor and British and American authors of this book, however, have succeeded in providing a text that is of value to all physicians who participate in the examination and management of patients with angina. All clinically pertinent aspects of angina pectoris, which is simply but thoughtfully defined as "a discomfort in the chest or adjacent areas associated with a disturbance of myocardial function but without myocardial necrosis," are addressed. Sections on physical examination, clinical diagnosis, and epidemiology are given balanced emphasis with exercise testing, assessment by radioisotopic studies and coronary arteriography, and pathophysiology. An early chapter on the history of angina as a clinically recognized entity merits particular mention, not simply because it is very good but because such chapters may often be overlooked by readers who are eager to get to the "hard data." In the chapters on treatment strategies, the recommendations are supported


by well-reviewed clinical studies and sound clinical judgment. The reasonably up-to-date discussions include short sections on coronary angioplasty and the Coronary Artery Surgery Study (CASS). The book has both unexpected pearls (for example, is the proper pronunciation angina or angina?) and shortcomings. The role of diltiazem is conspicuously short-shrifted. American readers may be perplexed by statements regarding the availability and use of such agents as isosorbide-5-mononitrate, perhexiline, and prenylamine—none of which is clinically available in the United States except for investigational studies. In the chapter on the selection of patients for surgical treatment, a "coronary index" is discussed but never adequately defined or referenced. Despite the burgeoning medical literature that surpasses anyone's ability to find the time to read—or perhaps because of it—this concise, informative review of a broad and relevant topic deserves high priority on the reading list of most physicians. Michael D. McCoon, M.D. Division of Cardiovascular Diseases and Internal Medicine

Speech Disorders: Clinical Evaluation and Diagnosis, by E. Jeffrey Metter, 230 pp, with illus, $40, Jamaica, New York, SP Medical & Scientific Books, 1985 In this book, Dr. Metter asserts the potential contribution of speech assessment to medical diagnosis and makes a case for its systematic inclusion in routine neurologic evaluations. An audiotape that summarizes crucial points in the text and provides samples of several forms of dysarthria and disturbances of speech programming is also available. The book, which consists of 15 chapters, is divided into two parts. In part 1, the author presents the rationale for classifying speech disorders; basic approaches to classification, particularly in regard to dysarthrias; an overview of the anatomy and physiology of the speech mechanism; the clinical characteristics of normal and abnormal speech; and procedures for the "bedside" evaluation of speech. Part 2 addresses the clinical manifestations of speech disorders associated with structural abnormalities (for example, cleft palate, dental malocclusion, lingual defects, and abnormalities caused by laryngeal cancer); sensory-related speech disorders (that is, those associated with hearing loss); flaccid, spastic,