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Pulmonary and Critical Care Medicine
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Roger C. Bone, David R. Dantzker, Ronald B. George, Richard A. Matthay, and Herbert Y. Reynolds; eds. St. Louis, Missouri: Mosby-Year Book; 1993. $225.00.
If each member of a group of accomplished and erudite medical scientists in the field of pulmonary medicine was asked to write a short treatise, a book such as Pulmonary and Critical Care Medicine would probably be produced. This substantial text is presented in two three-ring binders that occupy about 8 inches of shelf space. The text is set in an attractive typeface, and the figures are clearly drawn and well labeled. The paper stock allows for only adequate reproduction of radiographs, precluding demonstration of subtleties. Occasional color plates are peppered throughout the two books. References are well chosen and up-to-date, and current information is found in the body of the text as well. For example, the chapter on antibiotics includes a discussion of clarithromycin and azithromycin.
One fourth of the total number of pages is devoted to the scientific underpinnings of pulmonary medicine. The chapter devoted to the upper respiratory tract is to be prized for its lucid presentation of topics that too often remain on the periphery of pulmonary medicine. The chapter on mechanisms of lung injury represents a tour de force of current thinking about cellular and molecular mechanisms of clinical lung injury. A chapter on mechanics artfully combines decades-old concepts and data with current approaches, presenting a fluid integration of basic principles and current applications. Indeed, these scientific foundations should be required reading for all pulmonary fellows and should serve as an excellent reference for any pulmonary physician.
The clinical portions of the text, composing the middle half of the book, are less consistent. Notable sections include that on infectious diseases, which comprises eight chapters on topics such as community and nosocomial pneumonia, infectious and noninfectious complications of human immunodeficiency virus infection, and immunodeficiency and transplant considerations. Specific organisms are covered in an additional ten chapters devoted to pulmonary infections. A lucidly written chapter on pulmonary manifestations of collagen vascular diseases examines each major clinical entity from the perspective of common histologic patterns. Especially noteworthy is a chapter devoted to preoperative evaluation of patients with pulmonary disease.
The section on critical care, composing approximately one sixth of the book, is more aptly described as a pulmonary critical care section, although it does include more general topics such as nutrition and sepsis. With its focus on respiratory muscle fatigue, ventilatory failure, respiratory monitoring, and cardiopulmonary interactions, this section clearly will not substitute for a text of general critical care, but it does offer some in-depth reviews of topics that the pulmonary-based critical care physician will encounter.
Some information is unintentionally repeated, such as the similar sets of computed tomographic scans of the chest—one in the section on the chest wall and mediastinum and another in the section on radiography. Some of the chapters are available in other texts and monographs, albeit in altered form. Certain topics are simply missing, such as a consideration of pregnancy or sickle-cell anemia. Basic elements of history, physical signs, and symptoms of pulmonary disease are absent but are promised in a supplement. Certain peculiarities are evident, largely concerning allotment of space. For example, just 14 pages of text are devoted to bronchoscopy, whereas 17 pages discuss the use of bronchoalveolar lavage in interstitial lung disease. Only 11 pages are allotted to chronic obstructive pulmonary disease.
What does the text accomplish? It presents a thoroughly up-to-date and well-written series of "pulmonary grand rounds" on many basic and clinical topics. Because of this format, the work is not a seamless whole that provides an overview of clinical pulmonary medicine in an integrated style; for this, the reader should look to the other texts. The loose-leaf format invites revision and supplementation at modest expense.
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