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Cardiovascular significance of endothelium-derived vasoactive factors
134
Book
Journal of VASCULAR SURGERY
reviews
The purely statistical analysis of risk factors highlights the essential role of arterial hypertension (one third of patients) and smoking (one third of patients). Heredity and a family history of cerebral vascular attacks are unfavorable prognostic factors. It is interesting that 13% of patients admitted with established stroke had intercurrent diseases (epilepsy, delirium, loss of consciousness, dementia). CT scanning was not routinely performed because of its cost. The most surprising chapter in this book concerns the value of carotid endarterectomy. According to the author, in the United Kingdom transient ischemic attack series a quarter of patients undergoing carotid endarterectomy suffer perioperative stroke. The conclusion is that “most centers in the U.K. will never do enough operations to achieve” a complication rate less than 2% to 3%. The chapter dealing with the outcome of stroke is the most instructive. The recurrence risk rate after established stroke is 10% per patient per year. Impaired consciousness, dysphagia, and urinary incontinence are unfavorable prognostic signs. The predictive value of these factors as early as the first week is consistently high. This book will primarily benefit epidemiologists and physicians treating patients who have already suffered a stroke. It likely will be of only incidental interest to the practicing vascular surgeon. R8bm Courbier, MD Marseille, France
Principles and practice of research: Strategies surgical investigators H. Troidl, New York, 1991, Springer-Verlag, pages, $99.00.
for 566
This is the second edition of Principles and Practice of Strategisjb Sur@al Invest&aturs. It is a larger and more complete volume than its 1986 predecessor. The list of contributors is long and international. The book’s original organization has been preserved and provides a comprehensive framework for those who wish to develop an interest in surgical research. The goal of the editors is to describe and update the methodology of surgical research for young investigators. They have succeeded. The result is a very readable and valuable reference text. The book is divided into six sections, beginning with an introduction to investigators and investigation. A stepwise approach then describes starting the research process, selected research strategies, communicating the results of research effectively, international perspectives, and future opportunities in research. Each section and many of the individual chapters stand alone as useful guides to specific challenges and problems in academic surgical practice. The chapters are brief, current, and have substantial lists of additional references. The introductory section traces the history of the development of investigators and investigation. It outlines the effort in Marburg to achieve close interaction between clinical surgery, basic science, and the care of surgical Research:
patients. The second section on starting the research process covers a variety of important issues. The chapter on biostatistics provides an excellent overview of the relevant theory and includes several clinical examples. Traditional epidemiologic principles are also well-covered. Much effort is devoted in this section of the book to delineating the numerous steps involved in formulating an idea into a researchable question. Although such methodologic considerations are frequently overlooked, here they are thoroughly explained and discussed. In the section on implementation of research, the focus is on several selected research strategies. As the authors admit, the book’s emphasis is a clinical one. Methods of clinical research are stressed over laboratory techniques. The history of surgical laboratory research, animal experimentation, isolated organ models, and recombinant DNA technology are each briefly addressed. If there is one shortcoming of this text, it is that laboratory research is less thoroughly covered. Nonetheless, the basic principles are there to offer a starting point. The chapters devoted to effective communication of research work are oriented to the young investigator. They are brief and outline practical suggestions often in a checklist format. Included are strategies for both short and long talks, how to approach writing a book chapter, and guidelines to organizing scientific meetings. This section covers a broad spectrum of activities and is quite effective. The final two sections review the international experience of several authors and outline the future of surgical research. It is here that the work’s international flavor and true breadth are apparent. The last chapter in this section makes interesting comparisons between graduate programs in surgery. These international comparisons and perspective provide an appropriate conclusion to an important work. This book stands alone as a comprehensive, wellorganized, and easy to read guide to clinical research in surgery. It is a valuable reference that will be useful in every surgical investigator’s library. Anita Courcoulas, MD Richard L. Simnwns, MD University of Pittsburgh School of Medicine
Cardiovascular significance of endothelium-derived vasoactive factors Gabor M. Rubanyi, ed. Mount Kisco, 1991, Futura Publishing Company, 357 pages, $85.00. For many years, the functional importance of the vascular endothelium has been grossly underestimated, even though its overall volume is comparable to that of a large organ, such as the kidney. A number of excellent books have recently been published on various aspects of endothelial cell diction, recognizing that it plays an essential role in cardiovascular homeostasis and disease. In this book, Rubanyi has focused on locally produced
Volume 16 Number 1 July 1992
Bookr&5
endothelial factors that modulate vascular smooth muscle tone. The stated goal of the book is to comprehensively summarize the “state of the art” knowledge of these factors. In particular, the book concentrates on their potential significance in the control of the cardiovascular system, their integral role in various cardiovascular beds, their implications for cardiovascular pathophysiology, and the efficiency of novel therapeutic modalities. The book is divided into four parts: Part I reviews the endothelium-derived relaxing factors (EDRF), prostacyclin (PGI,), the endothelium-derived contracting factors (EDCF), neurohumoral substances, and the endothelins. Part II discussesthe significance of the endotheliumderived vasoactive factors in the control of blood flow through the coronary, cerebral, pulmonary, and peripheral microcirculations under normal and pathophysiologic conditions. Part III analyses the potential pathophysiologic significance of endothelial dysfunction in hypertension, diabetes, hyperlipidemia, atherosclerosis and its interactions with platelets, and the thrombogenic process.Part IV focuses entirely on the therapeutic potential of the prostacyclin analogue, iloprost.
BOOKS
135
This book represents a collection of well-referenced monographs by acknowledged experts in the field. Each chapter provides considerable information, although there is unfortunately considerable interchapter information overlap. The expected variations in style, scholarly approach, and penmanship are encountered as a result of having many authors. The project would have benefited from more rigorous editing. Nevertheless, the book is informative and the figures and illustrations are clear and concise and convey a large body of information. In the rapidly expanding field of vascularphysiology and with the growing realization of the importance of endothelial dysfunction in a variety of diseases,this book provides a firm foundation from which to assessthe abundance of information presently appearing in the literature. It is highly recommended for those interested in vascular physiology and those intrigued by the complex interactions between the endothelium, blood elements, and smooth muscle cellsthat occur in normal and diseasedvasculature. Per-Otto Hagen, PhD Duke Untie&~ Me&al
Center
RECEIVED
Tbe receipt of the books listed be&w is mkmwle&ed. Thi lhtin~ is reflarded as appropriate return j&r the cuwtey of the sender The books that are ofpartiuhr intmest will be ret&wed and the revhv pa&shed as space permits.
Smoking: The artificial passion David Krogh, New York, 1991, W.H. Freeman & Company, 176 pages, $17.95. Understanding biostatistics Thomas H. Hassard, St. Louis, 1991, Mosby-Year Book, Inc., 292 pages, $27.95. Vertebrobasilar arterial disease Ramon Berguer, Louis R. Caplan, St. Louis, 1992, Quality Medical Publishing, Inc., 312 pages, $65.00. MlU primer William Oldendorf/William Oldendorf, Jr., New York, 1991, Raven Press, 238 pages, $48.00. The handbook of surgical intensive care: Practices of the surgery residents at the Duke University Medical Center H. Kim Lyerly, St. Louis, 1989, Mosby-Year Book, Inc., 665 pages, $24.95.
Statistics in medicine F. Dunstan/J. Pickles, New York, 1991, Oxford University Press,266 pages, $75.00. Migraine and other headaches: The vascular mechanisms (frontiers in headache research, volume 1) JesOlesen, New York, 1991, Raven Press,384 pages, $90.00.
The Mont Reid Surgical Handbook, Second Edition Darryl T. Hiyama, St. Louis, 1990, Mosby-Year Book, Inc., 688 pages, $23.95. Medical therapy of ischemic heart disease: Nitrates, beta blockers & calcium antagonists Jonathan Abrams, Carl J. Pepine, Udho Thadani, Boston, 1991, Little, Brown and Company, 527 pages, $75.00.
Book
Journal of VASCULAR SURGERY
reviews
The purely statistical analysis of risk factors highlights the essential role of arterial hypertension (one third of patients) and smoking (one third of patients). Heredity and a family history of cerebral vascular attacks are unfavorable prognostic factors. It is interesting that 13% of patients admitted with established stroke had intercurrent diseases (epilepsy, delirium, loss of consciousness, dementia). CT scanning was not routinely performed because of its cost. The most surprising chapter in this book concerns the value of carotid endarterectomy. According to the author, in the United Kingdom transient ischemic attack series a quarter of patients undergoing carotid endarterectomy suffer perioperative stroke. The conclusion is that “most centers in the U.K. will never do enough operations to achieve” a complication rate less than 2% to 3%. The chapter dealing with the outcome of stroke is the most instructive. The recurrence risk rate after established stroke is 10% per patient per year. Impaired consciousness, dysphagia, and urinary incontinence are unfavorable prognostic signs. The predictive value of these factors as early as the first week is consistently high. This book will primarily benefit epidemiologists and physicians treating patients who have already suffered a stroke. It likely will be of only incidental interest to the practicing vascular surgeon. R8bm Courbier, MD Marseille, France
Principles and practice of research: Strategies surgical investigators H. Troidl, New York, 1991, Springer-Verlag, pages, $99.00.
for 566
This is the second edition of Principles and Practice of Strategisjb Sur@al Invest&aturs. It is a larger and more complete volume than its 1986 predecessor. The list of contributors is long and international. The book’s original organization has been preserved and provides a comprehensive framework for those who wish to develop an interest in surgical research. The goal of the editors is to describe and update the methodology of surgical research for young investigators. They have succeeded. The result is a very readable and valuable reference text. The book is divided into six sections, beginning with an introduction to investigators and investigation. A stepwise approach then describes starting the research process, selected research strategies, communicating the results of research effectively, international perspectives, and future opportunities in research. Each section and many of the individual chapters stand alone as useful guides to specific challenges and problems in academic surgical practice. The chapters are brief, current, and have substantial lists of additional references. The introductory section traces the history of the development of investigators and investigation. It outlines the effort in Marburg to achieve close interaction between clinical surgery, basic science, and the care of surgical Research:
patients. The second section on starting the research process covers a variety of important issues. The chapter on biostatistics provides an excellent overview of the relevant theory and includes several clinical examples. Traditional epidemiologic principles are also well-covered. Much effort is devoted in this section of the book to delineating the numerous steps involved in formulating an idea into a researchable question. Although such methodologic considerations are frequently overlooked, here they are thoroughly explained and discussed. In the section on implementation of research, the focus is on several selected research strategies. As the authors admit, the book’s emphasis is a clinical one. Methods of clinical research are stressed over laboratory techniques. The history of surgical laboratory research, animal experimentation, isolated organ models, and recombinant DNA technology are each briefly addressed. If there is one shortcoming of this text, it is that laboratory research is less thoroughly covered. Nonetheless, the basic principles are there to offer a starting point. The chapters devoted to effective communication of research work are oriented to the young investigator. They are brief and outline practical suggestions often in a checklist format. Included are strategies for both short and long talks, how to approach writing a book chapter, and guidelines to organizing scientific meetings. This section covers a broad spectrum of activities and is quite effective. The final two sections review the international experience of several authors and outline the future of surgical research. It is here that the work’s international flavor and true breadth are apparent. The last chapter in this section makes interesting comparisons between graduate programs in surgery. These international comparisons and perspective provide an appropriate conclusion to an important work. This book stands alone as a comprehensive, wellorganized, and easy to read guide to clinical research in surgery. It is a valuable reference that will be useful in every surgical investigator’s library. Anita Courcoulas, MD Richard L. Simnwns, MD University of Pittsburgh School of Medicine
Cardiovascular significance of endothelium-derived vasoactive factors Gabor M. Rubanyi, ed. Mount Kisco, 1991, Futura Publishing Company, 357 pages, $85.00. For many years, the functional importance of the vascular endothelium has been grossly underestimated, even though its overall volume is comparable to that of a large organ, such as the kidney. A number of excellent books have recently been published on various aspects of endothelial cell diction, recognizing that it plays an essential role in cardiovascular homeostasis and disease. In this book, Rubanyi has focused on locally produced
Volume 16 Number 1 July 1992
Bookr&5
endothelial factors that modulate vascular smooth muscle tone. The stated goal of the book is to comprehensively summarize the “state of the art” knowledge of these factors. In particular, the book concentrates on their potential significance in the control of the cardiovascular system, their integral role in various cardiovascular beds, their implications for cardiovascular pathophysiology, and the efficiency of novel therapeutic modalities. The book is divided into four parts: Part I reviews the endothelium-derived relaxing factors (EDRF), prostacyclin (PGI,), the endothelium-derived contracting factors (EDCF), neurohumoral substances, and the endothelins. Part II discussesthe significance of the endotheliumderived vasoactive factors in the control of blood flow through the coronary, cerebral, pulmonary, and peripheral microcirculations under normal and pathophysiologic conditions. Part III analyses the potential pathophysiologic significance of endothelial dysfunction in hypertension, diabetes, hyperlipidemia, atherosclerosis and its interactions with platelets, and the thrombogenic process.Part IV focuses entirely on the therapeutic potential of the prostacyclin analogue, iloprost.
BOOKS
135
This book represents a collection of well-referenced monographs by acknowledged experts in the field. Each chapter provides considerable information, although there is unfortunately considerable interchapter information overlap. The expected variations in style, scholarly approach, and penmanship are encountered as a result of having many authors. The project would have benefited from more rigorous editing. Nevertheless, the book is informative and the figures and illustrations are clear and concise and convey a large body of information. In the rapidly expanding field of vascularphysiology and with the growing realization of the importance of endothelial dysfunction in a variety of diseases,this book provides a firm foundation from which to assessthe abundance of information presently appearing in the literature. It is highly recommended for those interested in vascular physiology and those intrigued by the complex interactions between the endothelium, blood elements, and smooth muscle cellsthat occur in normal and diseasedvasculature. Per-Otto Hagen, PhD Duke Untie&~ Me&al
Center
RECEIVED
Tbe receipt of the books listed be&w is mkmwle&ed. Thi lhtin~ is reflarded as appropriate return j&r the cuwtey of the sender The books that are ofpartiuhr intmest will be ret&wed and the revhv pa&shed as space permits.
Smoking: The artificial passion David Krogh, New York, 1991, W.H. Freeman & Company, 176 pages, $17.95. Understanding biostatistics Thomas H. Hassard, St. Louis, 1991, Mosby-Year Book, Inc., 292 pages, $27.95. Vertebrobasilar arterial disease Ramon Berguer, Louis R. Caplan, St. Louis, 1992, Quality Medical Publishing, Inc., 312 pages, $65.00. MlU primer William Oldendorf/William Oldendorf, Jr., New York, 1991, Raven Press, 238 pages, $48.00. The handbook of surgical intensive care: Practices of the surgery residents at the Duke University Medical Center H. Kim Lyerly, St. Louis, 1989, Mosby-Year Book, Inc., 665 pages, $24.95.
Statistics in medicine F. Dunstan/J. Pickles, New York, 1991, Oxford University Press,266 pages, $75.00. Migraine and other headaches: The vascular mechanisms (frontiers in headache research, volume 1) JesOlesen, New York, 1991, Raven Press,384 pages, $90.00.
The Mont Reid Surgical Handbook, Second Edition Darryl T. Hiyama, St. Louis, 1990, Mosby-Year Book, Inc., 688 pages, $23.95. Medical therapy of ischemic heart disease: Nitrates, beta blockers & calcium antagonists Jonathan Abrams, Carl J. Pepine, Udho Thadani, Boston, 1991, Little, Brown and Company, 527 pages, $75.00.