Cardiovascular Pathology I. [antikvár]

Preface This book represents the viewpoint of a pathologist, who, since 1948, has worked in close association with colleagues distinguished in the study and practíce of cardiovascular disease at the National Heart Hospital and Institute of Cardiology in the University of London. It is designed primarily as an up-to-date reference work for my colleagues in pathology who are confronted with cardiovascular problems, but I hope that it may prove of value to the experienced cardiologist and to the cardiac surgeon. My publisher calls it a "peculiar book" because I have devoted much space to clinicopatho-logical studies, and have included brief discussion of current medical and surgical management of cardiovascular diseases. But intimate and constant consultation with my colleagues has taught me that the pathological aspects must be considered in the general setting of the disease as a whole. Any other approach to modern cardiovascular pathology would be narrow and unrewarding. I have not hesitated to fill in an explanatory background note, often historical, in places of special interest where reference might be a tedious task for the reader. All this has had the disadvantage, fully appreciated by the writer, of making the book larger (and, alas, more expensive)than was originally intended in 1959, but I believe this to be justified in order to gain a reasonable perspective of the avalanche of literature which has accompanied the dramatic advances of the past 20 years. These include two entirely new aspects ; one is cardiac surgery which has each year grown in boldness and enterprise, and the other is the study of human chromosomes in which technical ingenuity first enabled the correct number to be devalued from 48 to 46 and then permitted the discovery of chromosome abnormalities in certain inherited disorders. It remains to be seen whether the considerable labour of covering such a wide field is thought worthwhile. One thing I have tried to avoid, on the other hand, is the tedium of over-repetition; this is easier with single- than multi-authorship. My Department, although modest in size, is actively concerned with all the routine disciplines of pathology, and this has enabled me to include consideration of matters such as electrolyte balance, anticoagulation therapy and the bacteriology of infective endocarditis. Atheroma, and to a lesser degree, hypertension, remain the chief unconquered cardiovascular menaces of our civilization and both subjects receive fairly full discussion. Indeed, the worker in vascular disease might do worse than study the chapter on the aetiology of atheroma and note the numerous angles of approach to the problem. Despite the efforts of thousands of workers the world over for many years, it would not be unfair to say that, as yet, we have progressed little towards solving the problem since the time of Virchow and Rokitansky. It may be that the fundamental fault is some subtle developmental abnormality in the artery wall itself, allowing the leakage of fatty material and the simultaneous deposition of platelets and fibrin from the blood at affected sites, the process being aggravated by physiological trauma, raised blood lipids and by hypertension. The reader seeking help with a "non-coronary cardiomyopathy" will be dismayed at the enormous number of possibilities to be considered. These defy any proper classification; all I have been able to do is to adopt a crude working arrangement by which a particular specimen may be categorized. I consider that if the aetiology is not determined in life, then routine necropsy examination, however thorough, is unlikely to do so. Unfortunately, this does not absolve the pathologist from making the attempt, but he (or she) may take courage in the knowledge that most of my specimens end in the idiopathic, non-specific group. Electronmicroscopy, with its impressive photomicrographs, is now being used to study deviations in myocardial ultrastructure, but such studies are as yet in their infancy; no doubt the future will see further progress in this field, as well as in the study of disorders of myocardial metabolism