After 17 years of private practice as a cardiovascular surgeon, my partners qu- tionedtherationalityofmydecisiontoleavetheclinicalpracticebehindandbecome acardiovascular pathologist. Infact,theirdisbeliefofmyintentiontomakethe“leap of faith” was understandable. For a surgeon, the operating room is where the action is. It is as simple as that. And when a cardiac surgeon can hold in his hand a beating heart, now off-bypass and improved by an operation just completed, satisfaction is real and profound. However, life is complex. Throughout my surgical career, questions regarding the pathogenesis of atherosclerotic cardiovascular disease arose; curiosities of va- ous phenotypes of the disease piqued my interest. I became aware of the power of investigative techniques that might address these questions. I then began to realize that my career in the operating room left me little time to address them. I needed to study the disease full time in order to contribute to my understanding of it. Ironically, my ?rst autopsy as a pathology resident was on an individual with a past history of coronary artery bypass surgery. When it came to examining the heart, the dissection, as all pathologists know, was complex. However, I found it to be straightforward and enjoyable. But I subsequently learned that my fellow re- dents and mentors did not share my intrigue and comfort in de?ning the nuances of the operated heart.

This guide offers pathologists the latest in how to deal, at the time of autopsy, with the anatomic complexity of a heart that has undergone previous surgery, irrespective of how recent or remote that surgery occurred. It includes over 90 color illustrations.

Arlie Hochschild examines two groups of public-contact workers: flight attendants and bill collectors. The flight attendant's job is to deliver a service and create further demand for it, to enhance the status of the customer and be "nicer than natural." The bill collector's job is to collect on the service, and if necessary, to deflate the status of the customer by being "nastier than natural." Between these extremes, roughly one-third of American men and one-half of American women hold jobs that call for substantial emotional labor. In many of these jobs, they are trained to accept feeling rules and techniques of emotion management that serve the company's commercial purpose. Like a physical laborer who becomes estranged from what he or she makes, an emotional laborer, such as a flight attendant, can become estranged not only from her own expressions of feeling (her smile is not "her" smile), but also from what she actually feels (her managed friendliness). This estrangement, though a valuable defense against stress, is also an important occupational hazard, because it is through our feelings that we are connected with those around us.

Whenever the heart is challenged with an increased work load for a prolonged period, it responds by increasing its muscle mass--a phenomenon known as cardiac hypertrophy. Although cardiac hypertrophy is commonly seen under physiological conditions such as development and exercise, a wide variety of pathological situa tions such as hypertension (pressure overload), valvular defects (volume overload), myocardial infarction (muscle loss), and cardiomyopathy (muscle disease) are also known to result in cardiac hypertrophy. Various hormones such as catecholamines, thyroid hormones, angiotensin II, endothelin, and growth factors have also been shown to induce cardiac hypertrophy. Although the exact mechanisms underlying or pathological forrns of cardiac hypertrophy are poorly under the physiological stood, an increase in the intraventricular pressure is believed to represent the major stimulus for the development of cardiac hypertrophy. In this regard, stretching of the cardiac muscle has been shown to induce the hypertrophic response, but the role of metabolic influences in this process cannot be ruled out. Furthermore, different hormones and other interventions in the absence of stretch have been observed to stimulate protein synthesis in both isolated cardiomyocyte and vascular myocyte preparations. Nonetheless, it is becoming dear that receptor as well as phospholipid linked signal transduction pathways are activated in some specific manner depend ing upon the initial hypertrophic stimulus, and these then result in an increase in the size and mass of cardiomyocytes.

Includes the transactions of the American Surgical Association, New York Surgical Society, Philadelphia Academy of Surgery, Southern Surgical Association, Central Surgical Association, and at various times, of other similar organizations.