Infection remains the number one killer worldwide. Nevertheless, it is the expectation that bacterial infections can be eliminated with antibiotics. Unfortunately, there remain infections due to bacteria that are difficult to detect and difficult to reach, because of minimal blood supply, with even the most potent of antibiotics. One of the diseases in this category is infections that initiate on the inner lining of a vital organ, the heart. These infections are referred to as endocarditis since they involve the endocardium, the inner lining of the heart and valves. The initial site of infection is generally in areas exposed to mechanical trauma or prosthetic device. Unfortunately the damage to the heart if not treated can be fatal and often survival requires surgical replacement of one of the valves. Despite the tremendous array of antibiotics and the marked increase in potency of these drugs to eradicate bacterial infection, the efficacy of treating the relatively avascular lining of the heart or its valvular apparatus often eludes the desired effect. This is further complicated by the changing substrate for bacterial endocarditis, namely, artificial valves and devices and the increasing number of individuals who are imuno-suppressed because of drug use, human immuno deficiency virus infections or other debilitating conditions. Endocarditis due to bacteria and other agents remains a continuing threat as well as a challenge in terms of diagnosis, management and treatment.

Drs Chan and Embil have brought together the expertise of pathologists, infectious disease experts, cardiologists, pharmacologists and surgeons to provide a comprehensive approach to the problem of endocarditis. The book is organized to include a chapter on the pertinent pathology followed by population studies. The diagnostic section is extensive, comprehensive and very clearly written so that both medical and paramedical personnel can appreciate the armamentarium and its application. The management section is broad based to include treatment of the acute and chronic forms as well as potential sequelae that may occur. Echocardiography has become a major tool in the management of endocarditis and transesophageal echocardiography is now essential in the diagnosis and management of suspected prosthetic valve endocarditis. The role of echocardiogra-phy is critically assessed in several chapters dealing with specific clinical situations. The chapters reflect the authors' first-hand experience in dealing with endocarditis. The book in essence brings together the most current and evidence-based approaches as practiced by a group of experts who are intimately involved in the management of this disease.

In a world in which longevity is sought by all and lifespan has doubled just in the past century, it is expected that bacterial infections will not rob us of this expanding lifespan. The fact that they can and do in today's world of modern technology and ever revolving therapies remains a sobering thought. This book is an example of the thoughtful analysis that is required if we are to prevail in our long battle with serious infections such as endocarditis. It is a gem for the student, the teacher and the practitioner.

Robert Roberts MD, FRCPC, FACC President

Chief Executive Officer and Chief Scientific Officer University of Ottawa Heart Institute Ottawa, Ontario, Canada

How To Add Ten Years To Your Life

How To Add Ten Years To Your Life

When over eighty years of age, the poet Bryant said that he had added more than ten years to his life by taking a simple exercise while dressing in the morning. Those who knew Bryant and the facts of his life never doubted the truth of this statement.

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