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Immunology of behçet's disease
Synopsis: A small, paperback review manual that concisely and accurately lays out the basics of neuroophthalmology. Target Audience: Medical students, residents, fellows, general ophthalmologists, neurologists and neurosurgeons. Neuro-ophthalmology is complicated. Most medical students don’t get it and residents, especially ophthalmology residents, may even fear it. There is an obvious niche for a small, paperback review manual that concisely and accurately lays out the basics. This book continues to fill that niche. The primary author of this manual, Lanning Kline, is a seasoned neuro-ophthalmologist with many years of practice as a clinician, educator, and chairman of a department of ophthalmology. There are a few other contributing authors. This edition of the manual follows the prior editions in its organization of chapters. Although no new chapters have been added, various subjects have been updated and clarified, including management guidelines for the patient with a third nerve palsy, an algorithm for the approach to the patient with anisocoria, and a guide to the new treatments of multiple sclerosis. The style continues to be telegraphic, in outline form, emphasizing the role of this book as a true review manual, rather than a primary text. The references have been nicely updated throughout, with a good balance of the classics and groundbreaking news. A minor criticism is the organization of the chapters with the afferent and efferent systems intermixed somewhat arbitrarily. A suggestion for the next edition would be the incorporation of automated perimetry printouts in the chapter on visual field analysis, especially in the quiz at the end of the chapter. The niche is still there – one only has to look at the previous edition of this manual on our shelf in the residents’ library with its dog-eared pages and spine retaped four times because of use. This book will be used by medical students, residents, fellows, general ophthalmologists, neurologists and neurosurgeons, and even neuro-ophthalmologists looking for a better way of teaching the nuts and bolts of neuroophthalmology. This manual remains true to its goal to be“ a readable compendium of ‘no-nonsense’ neuro-ophthalmology.” Immunology of Behc¸et’s Disease Manfred Zierhut and Shigeaki Ohno. Swets & Zeitlinger: Lisee, The Netherlands; 2003. 178 pages $89.00 USD ISBN 90 265 1960 5 Media type: Textbook Reviewed by Kenneth T. Calamia, MD; Jacksonville, FL Synopsis: A clearly written review of the directions of research into the pathogenesis of Behc¸ et’s disease, providing the rational for new and future treatment. Target Audience: Ophthalmologists, rheumatologists, and immunologists The title of this book does not reflect the diverse aspects of Behc¸ et’s disease presented. Twenty short, concise, and readable chapters written by a multinational group of experts address the epidemiology, clinical manifestations, and treatment of the disorder as well as its immunology. The editors are recognized leaders in the field of uveitis, both in the clinic and laboratory. The understanding of Behc¸ et’s disease is a work in progress. The reader has the opportunity to enjoy investigating the immunopathogenesis of the disease, including chapters on potential triggering infectious agents, cytokines, immune cells, and immunogenetics. While far from completely understood, the book presents a convergence that relates the genetics, infectious agents, neutrophil hyperactivity, and autoimmunity, all likely playing a role in pathogenesis. Other immune mediated inflammatory diseases may share in some of these mechanisms. The ocular manifestations of Behc¸ et’s disease are well described. The chronic, relapsing course leading to visual loss is emphasized, underscoring the need for early diagnosis and aggressive treatment. A high index of suspicion for the disease is particularly important in the US where the disease is rare. There is no clear treatment consensus, and treatment failures are common. However, several potential new treatment targets can now be recognized, and the very promising preliminary results of two new agents, interferon␣ and infliximab, an anti-tumor necrosis factor (TNF) antibody, are reviewed. There are no controlled trials of anti-TNF treatment of uveitis, but results of open trials of these agents from Turkey and Greece
were not included in the chapter and data from the Japanese trial is limited in this review. The preliminary results of a large open experience with interferon-␣2a by Ko¨ tter is presented in the book, but has subsequently been published (Br J Ophthalmology, 2003) and a controlled study is now underway. The epidemiology of Behc¸ et’s disease is presented in detail and the non-ocular clinical manifestations of the disease are also well reviewed, based on large series of patients from Iran, Japan and other countries. In both sections, differences in disease manifestations in different populations might possibly be explained by methodological differences and diagnostic criteria, but are otherwise unexplained. The chapter on immunopathology relies heavily on previous reviews. The section on the treatment of Behc¸ et’s also largely relies on a review of controlled studies through 1998 and is largely limited to the treatment of uveitis. Controlled treatment studies of other manifestations in this disease are limited, but I would like to have seen an expanded review of the treatment of non-ocular disease, including the most recent studies and consensus opinion. The authors do point out that the treatment of Behc¸ et’s is “empirical” and may differ widely, depending on the experience of practitioners in different countries. This book should be of interest to ophthalmologists with an interest in uveitis, rheumatologists, and immunologists. It nicely summarizes the state of the art and aptly anticipates future developments sure to come. Manual of Endoscopic Lacrimal and Orbital Surgery John J. Woog. Butterworth-Heinemann: Philadelphia, PA; 2004. 206 pages $ 99.00 USD ISBN 0-7506-7326-5 Media type: Textbook and CD-ROM Reviewed by James R. Patrinely, MD, FACS; Houston, TX Synopsis: This detailed multimedia resource is an excellent new surgical manual on common endoscopic techniques in oculoplastic and orbital surgery. Target Audience: Ophthalmic plastic surgeons and fellows, otolaryngology residents, fellows and staff There are a handful of important techniques in oculoplastic and orbital surgery that lend themselves to an endoscopic approach. These include dacryocystorhinostomy (either primary or secondary), Jones tube placement, lacrimal intubation and dilation, orbital decompression, selected fracture repairs, optic canal decompression and some deep orbital apex biopsies. Surprisingly few educational resources have targeted this surgical subset in a comprehensive manner. Dr. Woog and a group of highly esteemed collaborators have produced an excellent multimedia surgical manual that covers in depth all but the latter two procedures. Endoscopic techniques are difficult to teach and illustrate in a standard textbook without extremely high quality color photographs and detailed corresponding surgical artwork. While this book is well illustrated with numerous black and white photos and excellent line diagrams this manual best accomplishes its goal by using an accompanying CD-ROM with video clips and a detailed user friendly text that explains the nuances of the techniques and specific instruments used. The first half of the book covers basic orbital anatomy, evaluation and management of the lacrimal and Graves’ orbitopathy patients, radiology, and review of standard external DCR. The anatomy section does not specifically cover topographical anatomy as seen by the endoscope but this is addressed by excellent line artwork in the surgical technique sections later in the book. The second half of the book covers the surgical techniques in detail. The editor wisely includes other surgeons’ perspectives and techniques on endoscopic DCR so the reader can pick and choose different aspects they may find helpful. It wasn’t clear why the CDCR with Jones tube placement wasn’t done entirely endoscopically rather than using a transcaruncular open approach while other authors in the book describe removing the anterior lacrimal crest endonasally. Other procedures described are not stand alone endoscopic approaches either but more “endoscopic-assisted” such as the fracture repair and balloon dacryoplasty which is fine since the endoscope can be a powerful enhancer to traditional approaches and need not totally replace these procedures. Overall Dr. Woog and his associates have assembled a very useful and needed multimedia resource on endoscopic lacrimal and orbital techniques that will be appreciated by surgeons of all experience levels.
were not included in the chapter and data from the Japanese trial is limited in this review. The preliminary results of a large open experience with interferon-␣2a by Ko¨ tter is presented in the book, but has subsequently been published (Br J Ophthalmology, 2003) and a controlled study is now underway. The epidemiology of Behc¸ et’s disease is presented in detail and the non-ocular clinical manifestations of the disease are also well reviewed, based on large series of patients from Iran, Japan and other countries. In both sections, differences in disease manifestations in different populations might possibly be explained by methodological differences and diagnostic criteria, but are otherwise unexplained. The chapter on immunopathology relies heavily on previous reviews. The section on the treatment of Behc¸ et’s also largely relies on a review of controlled studies through 1998 and is largely limited to the treatment of uveitis. Controlled treatment studies of other manifestations in this disease are limited, but I would like to have seen an expanded review of the treatment of non-ocular disease, including the most recent studies and consensus opinion. The authors do point out that the treatment of Behc¸ et’s is “empirical” and may differ widely, depending on the experience of practitioners in different countries. This book should be of interest to ophthalmologists with an interest in uveitis, rheumatologists, and immunologists. It nicely summarizes the state of the art and aptly anticipates future developments sure to come. Manual of Endoscopic Lacrimal and Orbital Surgery John J. Woog. Butterworth-Heinemann: Philadelphia, PA; 2004. 206 pages $ 99.00 USD ISBN 0-7506-7326-5 Media type: Textbook and CD-ROM Reviewed by James R. Patrinely, MD, FACS; Houston, TX Synopsis: This detailed multimedia resource is an excellent new surgical manual on common endoscopic techniques in oculoplastic and orbital surgery. Target Audience: Ophthalmic plastic surgeons and fellows, otolaryngology residents, fellows and staff There are a handful of important techniques in oculoplastic and orbital surgery that lend themselves to an endoscopic approach. These include dacryocystorhinostomy (either primary or secondary), Jones tube placement, lacrimal intubation and dilation, orbital decompression, selected fracture repairs, optic canal decompression and some deep orbital apex biopsies. Surprisingly few educational resources have targeted this surgical subset in a comprehensive manner. Dr. Woog and a group of highly esteemed collaborators have produced an excellent multimedia surgical manual that covers in depth all but the latter two procedures. Endoscopic techniques are difficult to teach and illustrate in a standard textbook without extremely high quality color photographs and detailed corresponding surgical artwork. While this book is well illustrated with numerous black and white photos and excellent line diagrams this manual best accomplishes its goal by using an accompanying CD-ROM with video clips and a detailed user friendly text that explains the nuances of the techniques and specific instruments used. The first half of the book covers basic orbital anatomy, evaluation and management of the lacrimal and Graves’ orbitopathy patients, radiology, and review of standard external DCR. The anatomy section does not specifically cover topographical anatomy as seen by the endoscope but this is addressed by excellent line artwork in the surgical technique sections later in the book. The second half of the book covers the surgical techniques in detail. The editor wisely includes other surgeons’ perspectives and techniques on endoscopic DCR so the reader can pick and choose different aspects they may find helpful. It wasn’t clear why the CDCR with Jones tube placement wasn’t done entirely endoscopically rather than using a transcaruncular open approach while other authors in the book describe removing the anterior lacrimal crest endonasally. Other procedures described are not stand alone endoscopic approaches either but more “endoscopic-assisted” such as the fracture repair and balloon dacryoplasty which is fine since the endoscope can be a powerful enhancer to traditional approaches and need not totally replace these procedures. Overall Dr. Woog and his associates have assembled a very useful and needed multimedia resource on endoscopic lacrimal and orbital techniques that will be appreciated by surgeons of all experience levels.