NIH: gearing up for the twenty-first century.

by the author. Some of the chapters lack the sophistication of presentation appropriate for this focused monograph. The chapter on “Cardiopulmonary Exercise Testing and the Evaluation of Systolic Dysfunction” by K. T. Weber provides material at a second-year medical student level, includes an incorrect statement about ventilatory limitation to exercise, and cites only five references (all by Weber). Some of the topics chosen, such as exercise testing in preoperative elderly patients or postoperative exercise testing in cardiac surgery patients, are peripheral to the focus of the book and include no significant insights into exercise responses of cardiac patients. Although the intended audience for the monograph was never explicitly identified in the preface or introduction, there apparently was an intent to introduce exercise testing to readers unfamiliar with the subject. A number of the chapters begin by describing test protocols and equipment at a very basic level. However, due to elisions, repetition, and a general lack of coordination among these chapters, none of them can be recommended as an introduction to gas exchange exercise testing of cardiac patients. These introductory issues are far better covered in current texts, including one written by the editor of this book (2, 6). A number of redundancies occur among the chapters. As noted above, several of the chapters with an introductory intent discuss analytical equipment, exercise protocols, and interpretation of findings without coordination among the chapters. Four of the five chapters included in the section entitled “The Ventilatory Response to Exercise in Patients with Heart Disease” cover essentially the same material. Of these chapters, the contribution by Metra et al. provides the most sophisticated and complete discussion, while the other chapters provide very little additional material. Another example of redundancy comes with the multiple descriptions of the lactate hypothesis that arise throughout the book. The chapter by Wasserman and Stringer on “Critical Capillary PO2, Net Lactate Production, and Oxyhemoglobin Dissociation: Effects on Exercise Gas Exchange” is by far the most complete defense of the hypothesis, and no repetitions are necessary. The weaker chapters show a lack of sophistication in the interpretation of their progressive work test findings. The authors of