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Tbrombozytenaggregationshemmung durch Azetylsalizylstiure Wirkung und Wirk- samkeit

Erhard Walter Gustav Fischer Verlag, Stuttgart, New York, 1985; 216 pp.; DM78; ISBN 3-437-

10996-0

This book is mainly devoted to four problems: first, the dynamics of platelet aggregation in

patients under different plasma levels of acetylsalicylic acid and salicylic acid; second, the

dose-response curve of the antithrombotic effect of acetylsalicylic acid in humans; third, the effect of acetylsalicylic acid in secondary prevention after acute myocardial infarction and its

effect on the well known cardiovascular risk factors and finally a synopsis of the practical results obtained by the author.

The book is largely based on Dr. Walter’s thesis. It contains many important aspects, mainly related to platelet aggregation and to the quantitative effect of antiaggregating drugs.

A very precise description of the tests available to study platelet function is also given. This book deserves special merits as all the investigations were performed in humans in vivo, so

that the results are of direct clinical relevance and have, therefore, great implications. This book can be recommended to all interested in platelet function and in the action of

antiaggregating substances.

Medical Clinic

University of Heidelberg

Heidelberg, F.R.G. W. Kubler

Traitement Actuel de I’Infarctus Myocardique g la Phase Aigui!

Coordinated by J. Lequime Masson, Paris, 1985; 105 pp.; FFr125; ISBN 2-225-80664-O

This small booklet of 105 pages represents the reports presented during one of the sessions of the 45th French Congress of Medicine, held in Paris in 1985, and devoted to the treatment of

acute myocardial infarction. The session was coordinated by J. Lequime (Brussels), and includes reports written by groups from Belgium, France, Switzerland and The Netherlands.

The first report (14 pages) is an excellent and very complete review by the French group of the medical treatment of cardiac failure after myocardial infarction, including pathophysi-

ology, diagnosis and therapy; the use of the different therapeutic approaches is discussed in relation with the severity of the clinical situation (KILLIP classification).

The second report (21 pages), by the Thorax Center of Rotterdam, covers the problem of thrombolysis in the acute phase of myocardial infarction, including the choice of the fibrinolytic agent and the way of administration, the effects on ventricular function and survival rate. The survey of 17 randomized trials is in favor of thrombolysis by the intravenous route, with a positive effect on death or reinfarction. The results of treatment by intracoronary infusion remain negative. New and important studies, on large groups of patients using the plasminogen activator are announced, in Europe as well as in U.S.A.

The third report (25 pages) by the Belgian group covers the problem of arterial hyperten- sion during the acute phase of myocardial infarction, including the mechanism of this

hypertension (probably related to an increase in sympathetic tone in some patients). In some

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cases, hypertension could be related to an increase of the vascular resistance and/or of the cardiac output. The treatment is related to the hemodynamic situation (presence or absence

of cardiac failure). The last report (24 pages), by the French group, covers the problem of surgical treatment

during the acute phase: revascularization on the one side, and on the other, treatment of complications (perforation in the septum, cardiac rupture, acute mitral insufficiency,

aneurysms, etc.). These excellent reports are followed by a few complementary papers concerned with

intravenous thrombolysis, right ventricular infarction and bypass after thrombolysis. In spite of the fact that some important problems are not covered - such as the medical

treatment of arrhythmias - this booklet represents an excellent summary of our present

knowledge in the treatment of the acute phase of myocardial infarction.

The bibliography is well prepared and the book will be very useful for French-speaking cardiologists or those involved in intensive care.

Bruxelles 1180

Belgium Henri Denolin

L-Carnitina ed Ischemia. Atlante Morfologico del Cuore e de1 Muscolo

Renzo Las&i

Edizioni Libretia Cortina, Verona, 1986; 106 pp.. 60 figs.; Lire 50,000; ISBN

88-85037-69-o

This atlas is designed to provide a morphological contribution in the debate concerning the role played by L-carnitine in myocardial and skeletal muscle ischaemia. A notable feature of

the book is the considerable number of .electron micrographs, both scanning and transmis- sion. These were obtained from three different experimental models, namely extremely

intense fatigue produced by swimming rats, myocardial ischaemia in vitro and lower limb muscle ischaemia in patients with intermittent claudication. The overall end result, however, is disappointing despite the good quality of the illustrative material.

Biochemical and molecular characterizations of ischaemia and of the supposed benefits

induced by I*-carnitine are disconcertingly omitted. Similarly, the author does not provide any quantitative evaluation to support the results obtained. In essence, the analysis of the results is confined to a sequence of pictures obtained by optical and electron microscopy. Unfor-

tunately, the different magnification of the images does not allow for easy comparison. In addition, the images to be compared are not contiguous. It is arguable that such presentation of crude and experimental data is out of place in an atlas which aims primarily to be didactic. At the same time, the introductory chapters lack detail and substance.

For all these reasons, it is difficult to justify the cost of this book and we are unable, therefore. to give it our recommendation.

Cardiothoracic Institute Annalisa Angelini London. U.K. Giorgio Vescovo