Mayo Clin Proc, August 1987, Vol 62 BOOK REVIEWS 748

volume, would be as a beginning source for those interested in development of computer-based medical information or practice systems. Some portions of these volumes would also appeal to general medical readers who are interested in what may lie in their future, as computer appli­cations in medical and surgical practice ob­viously are here to stay, are progressively ex­panding, and are ultimately necessary in our increasingly technologic world.

Paul C. Carpenter, M.D. Division of Endocrinology

and Internal Medicine

Microcomputers and Physiological Simula­tion, 2nd ed, by James E. Randall, 287 pp, with illus, $29.50, New York, Raven Press, 1987

This book is the most recent of the author's efforts to aid others with imitative types of data processing on their personal computers. The book covers many general technical issues important for the understanding of how to choose among and use some of the most popular microcompu­ters. Slightly more than half of the first part of the book is devoted to an overview of technical issues. The remainder provides specific examples of selected experiments in physiology. All the illustrations are written in beginner's all-purpose symbolic instruction code (BASIC). The reader who wishes to invest a minimal amount of time in program development and to use the large amount of commercial software that already ex­ists will need to learn an additional programming language.

A sizable majority of medical students today believe that animals should not be used in teach­ing when the results of a well-executed experi­ment are known beforehand. This opinion is among the factors that have forced alternatives such as videotaped demonstrations to be used widely. The representation of a physiologic sys­tem or phenomenon by computers is another means of partial replacement of the valuable experience of critically observing and reacting to specific functions in a living body. Few, if any, computer simulations, however, contain the un­predictable occurrences that are also part of

experimentation with living systems. One is fre­quently cautioned instead to be watchful for un­expected results that can ensue because of such factors as the chosen method of integration or the size of an integration interval.

Those concerned with the distinction between illusion of life and its reality will find little in this book to help them answer philosophic ques­tions about the dangers of attempting to replace the uncertainties in live animal experimentation with the uncertainties in representing a biologic system with a model of mathematical equations. The apprehension and debate about the use of computers and computer models to teach physi­ology, perform laboratory tests, and make med­ical diagnoses are acknowledged, but the author does not dwell on these issues. One can easily find regular reminders about these matters from other sources (for example, Michael J: On teach­ing physiology to medical students. The Physi­ologist 30:13, 1987; Konner M: Love among the robots. The Sciences 27:12-14, March/April 1987; Joyce E: Software bugs: a matter of life and liability. Datamation 33:88-92, 1987).

Randall remains focused on his purpose, which is to update a self-study guide that can comple­ment traditional laboratory teaching. The book is primarily for those engaged in instruction and already leaning toward the idea that microcom­puters will considerably enrich the educational experience of their students. The reader should be convinced in advance that the progression from a prediction to the observation of the results of a given alteration in some condition permits instructors and students to interact uniquely with a dynamic biologic process, as well as with each other.

The writing style makes the book easy to read swiftly. The author uses the personal pronoun to indicate where his experience will direct him to limit the scope of a topic or to focus his emphasis. The index is good and itself can provide the reader with a quick overview of the contents of the book.

The book should also appeal to the person who is interested in the possibility of using computers in research but who has a limited budget. Many of the words, phrases, and acronyms that dom­inate the material in trade journals and more advanced textbooks are outlined here. Randall does not try to be comprehensive and carefully selects the material included. Consequently, the

749 BOOK REVIEWS Mayo Clin Proc, August 1987, Vol 62

casual reader will not be intimidated and might subsequently read elsewhere to learn about the rapid changes and complexity in the field of computers, which cannot be completely up-to-date in anything published less frequently than once every few weeks.

The instructor already convinced of the value of computer-assisted instruction will find this a useful book to begin exploring the details of implementing or improving such teaching meth­ods. As the author suggests, the book is probably most useful as a self-study guide in applied mathematics for the instructor whose students do not readily grasp abstract concepts from equa­tions and rate constants. Quantitative, interac­tive illustrations of physiologic phenomena can be valuable in this regard, and I look forward to an expanded, rapidly updated third edition to remain close to the constantly changing possi­bilities in this area.

Stuart R. Taylor, Ph.D. Department of Pharmacology

Anesthesia and Organ Transplantation, edited by Simon Gelman, 254 pp, with illus, $49.95, Philadelphia, W. B. Saunders Com­pany, 1987

The field of organ transplantation has required the dedicated efforts of members of multiple spe­cialty groups. This book is designed to present relevant information that would assist the anes­thesiologist as a member of the team involved in the care of patients undergoing organ transplantation.

The text consists of contributions from authors from five institutions, who focus initially on such general topics as immunology and immunosup-pressives, organ preservation, and infectious dis­ease before addressing specific organs individ­ually. The general topics are covered in a thorough and easily understandable fashion and provide the foundation for the subsequent dis­cussions on the individual organ systems. Kid­ney, heart-lung, liver, skin, and limb transplan­tations are extensively reviewed, whereas organ systems such as the pancreas, the bone marrow, and the intestines are not discussed. The editor explains that these omissions result from the

paucity of specific anesthesiologic problems re­lated to these areas.

For each organ system detailed in the text, an extensive overview is provided. This material includes organ anatomy, physiology, detailed descriptions of the surgical procedures, donor preparation and anesthetic management, and re­cipient preparation, with a discussion of the par­ticular concerns encountered in the patient with end-stage organ failure. A discussion of manage­ment of anesthesia during the transplantation procedure is followed by a summary of the results of this therapy and the potential early and long-term complications. Postoperative management is also briefly reviewed.

A particularly useful and well-written chapter is the one entitled "Brain Death and Ethics of Organ Transplantation." This portion of the text summarizes the criteria for brain death, complete with legal, medical, and theologic considerations. Also included is a chapter on blood transfusion that is uniquely addressed from an organ trans­plantation perspective.

As organ transplantation becomes a more vi­able therapy for the patient with end-stage organ failure, this book will serve as a valuable source of information for the health-care workers, par­ticularly anesthesiologists and intensive-care specialists, who contribute to the care of these patients.

David J. Plevak, M.D. Department of Anesthesiology

Local Anesthetics (Handbook of Experimental Pharmacology, Vol 81), edited by Gary R, Strichartz, 292 pp, with illus, $159, New York, Springer-Verlag, 1987

This book consists of a set of excellent, pro­vocative, and authoritative reviews aimed pri­marily at the experimental pharmacologist rather than the clinician. The material is current up to 1984. The eight chapters, written by dif­ferent authors, explore in depth the current state of pharmacologic research regarding local anes­thetics and their actions on nerves and cardiac muscle.

Local anesthesia has now been in use for ap­proximately 100 years, and surprisingly few