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Thyroid Diseases
BOOK REVIEWS
Edited by H. Stanley Thompson, M.D.
many clinicians would disagree with the author's statement that the visual-evoked potential and pupillography are among "ancillary tests and studies useful in the evaluation of thyroid ophthalmopathy patients with reduced vision." Two separate chapters deal with medical and radiation therapy for orbitopathy. The author's recommendations for management of optic neuropathy coincide with those of most others, that is, primary treatment with corticosteroids or radiation followed by surgical decompression if this fails. However, the author also uses a ten-day course of corticosteroids in patients without visual loss who have recent onset ("less than six months") of thyroid ophthalmopathy, "especially those with predominantly inflammatory soft tissue signs or proptosis." He states that "approximately 30% of patients treated with the above regimen appear to get a relatively permanent effect." It would certainly be fair to state that this conclusion and this form of therapy are controversial, although the author does not point this out. The same consideration applies to the author's use of radiation for patients with soft tissue signs or ophthalmoplegia (without visual loss). He states that radiation "can be used with profit after a short steroid course." This statement is not universally accepted and a more balanced treatment of the subject would accurately reflect the current lack of consensus. Each chapter is well referenced, however, and the reader who senses a controversial or difficult area has all of the current and historic references provided for personal decision-making. The final chapters deal with surgical management. Separate chapters on eyelid retraction, orbital decompression, and ocular muscle surgery are well illustrated. Indications and complications are thoroughly discussed. The use of preserved sclera is appropriately relegated to second priority with major emphasis on Muller's muscle resection and levator palpebrae superioris muscle recession. The chapter on ocular muscle surgery stresses the use of adjustable sutures, currently the most effective method. Although each chapter contains a complete review of the subject, the first-time
Thyroid Diseases. By Devron H. Char. Baltimore, Williams & Wilkins, 1985. 227 pages, index, illustrated. $42.50
Reviewed by
JOEL
M.
Madison, Wisconsin
WEINSTEIN
The diagnosis and treatment of thyroid ophthalmopathy has been a troublesome area since the disorder was first recognized almost 200 years ago. The author's stated purpose is to "consolidate current ideas of pathogenesis, diagnosis, and management." He certainly succeeds in doing this in the realm of diagnosis, where major advances have occurred during the last ten years, especially in the areas of radiology, ultrasonography, and immunochemistry. In the realm of pathogenesis and mangement, however, it would be difficult for anyone to "consolidate" the vast amount of conflicting and controversial information. Nevertheless, the author does arrive at a synthesis of current concepts and a set of therapeutic guidelines for the practicing ophthalmologist. Though some might disagree with his conclusions, the book is well referenced, allowing the reader to consult primary source material if further documentation is desired. The early chapters elucidate the normal regulatory mechanisms for thyroid hormone synthesis, and describe the biochemical and immunologic tests used in the diagnosis of thyroid disease. These chapters will help the ophthalmologist to understand some of the newer, more specific tests of thyroid function, as well as the immunologic alterations that may occur. The largest chapter, entitled "Eye signs and diagnosis of thyroid ophthalmopathy," deals specifically with the interpretation of physical signs and with orbital ultrasonography, computed tomographic scanning, and magnetic resonance imaging. The major clinical signs are well illustrated with black-and-white photographs. The computed tomographic and magnetic resonance imaging scans showing the characteristic radiologic signs are excellent reproductions of newest-generation studies. A clear explanation of the theory of magnetic resonance imaging is also included. However, 257
258
AMERICAN JOURNAL OF OPHTHALMOLOGY
surgeon would probably want to look elsewhere for more detail before actually performing the procedure. This book would be a valuable adjunct to any general ophthalmologic library. The excellent bibliography provides ready access to most of the important developments in this area. Many complex issues remain unresolved, however, and the book should be read critically both by residents in ophthalmology and by practicing physicians dealing with thyroid eye disease.
Practice Enhancement. A Physician's Guide to Success in Private Practice. By Greg N. Korneluk. New York, Macmillan Publishing Company, 1985.284 pages, index, illustrated. $22.50
Reviewed by MALCOLM A. MCCANNEL
Minneapolis, Minnesota
Practice Enhancement is a splendid book. The author is a responsible authority on such matters. His writing is clear and lucid. Most practitioners are beginning to realize that the traditional practice of medicine is undergoing a metamorphosis: that there is an oversupply of physicians, that the cost of delivering medicine has increased, and that there is a consumer health movement spreading rapidly over the country. This book deals forthrightly with all of these things and does it in a way that makes enjoyable reading. The author pinpoints exactly the questions that come up in managing the problems that practicing physicans face. The contents are divided into four portions: patients; the doctor's own staff; the doctor's own way of practicing, scheduling, and doing things; and the doctor's relationship with colleagues. There is a spate of available books along this line, but this one seems to be superior. The aspect of the job descriptions, hiring and firing people, personnel policy, and staff recruitment are things that doctors have to learn outside their medical training. This small volume also concerns itself with the doctor's relationship to the patient load and deals with such things as seeing patients on time, giving the patient information booklets, the proper use of the telephone, and, of course, being meticulous with all medical records and the proper recording of data for future reference. There is even a section on computers which can
February, 1986
be useful both at home and in the office. The section on relationships with colleagues is exceptionally good because of the way it treats working with referral sources and delegation of responsibility. I recommend this book highly. It will be useful to any doctor in practice, but the doctor's staff should read it as well.
Retinal Degeneration. Experimental and Clinical Studies. Edited by Matthew M. LeVail, Joe G. Hollyfield, and Robert E. Anderson. New York, Alan R. Liss, 1985, 485 pages, index, illustrated. $69.50
Reviewed by MICHAEL A. BLOOME
Houston, Texas
This book is a compendium of articles, many of which were presented at the VI International Congress of Eye Research held in Alicante, Spain (October 1984). The editors, all wellknown investigators in their field, emphasize that there has been tremendous growth in our knowledge of retinitis pigmentosa and allied disorders in recent years, and state in their preface that they have attempted "to take stock of the exciting experimental and clinical research being done in this field" and "capture the flavor of the variety of studies being pursued today." Many of the articles not only present recent findings, but are also extensive reviews accompanied by thorough reference lists (among these are the chapter on the genetics and immunology of retinitis pigmentosa and the article on metabolism of cyclic nucleotides and membrane lipids in normal and degenerating retina). Notwithstanding some variations in the quality of the paper and print, it is an attractive book, and the black-and-white photographs and graphics are of good quality. This book is an excellent and comprehensive guide to recent studies in hereditary retinal degenerations and I recommend it highly for anyone interested in the clinical or experimental aspects of these disorders. Although the book is not intended as a clinical reference for the diagnosis and treatment of patients with retinitis pigmentosa, it does afford the clinician an excellent opportunity to gain insight into the many new and exciting studies coming from our colleagues in the laboratory sciences.
Edited by H. Stanley Thompson, M.D.
many clinicians would disagree with the author's statement that the visual-evoked potential and pupillography are among "ancillary tests and studies useful in the evaluation of thyroid ophthalmopathy patients with reduced vision." Two separate chapters deal with medical and radiation therapy for orbitopathy. The author's recommendations for management of optic neuropathy coincide with those of most others, that is, primary treatment with corticosteroids or radiation followed by surgical decompression if this fails. However, the author also uses a ten-day course of corticosteroids in patients without visual loss who have recent onset ("less than six months") of thyroid ophthalmopathy, "especially those with predominantly inflammatory soft tissue signs or proptosis." He states that "approximately 30% of patients treated with the above regimen appear to get a relatively permanent effect." It would certainly be fair to state that this conclusion and this form of therapy are controversial, although the author does not point this out. The same consideration applies to the author's use of radiation for patients with soft tissue signs or ophthalmoplegia (without visual loss). He states that radiation "can be used with profit after a short steroid course." This statement is not universally accepted and a more balanced treatment of the subject would accurately reflect the current lack of consensus. Each chapter is well referenced, however, and the reader who senses a controversial or difficult area has all of the current and historic references provided for personal decision-making. The final chapters deal with surgical management. Separate chapters on eyelid retraction, orbital decompression, and ocular muscle surgery are well illustrated. Indications and complications are thoroughly discussed. The use of preserved sclera is appropriately relegated to second priority with major emphasis on Muller's muscle resection and levator palpebrae superioris muscle recession. The chapter on ocular muscle surgery stresses the use of adjustable sutures, currently the most effective method. Although each chapter contains a complete review of the subject, the first-time
Thyroid Diseases. By Devron H. Char. Baltimore, Williams & Wilkins, 1985. 227 pages, index, illustrated. $42.50
Reviewed by
JOEL
M.
Madison, Wisconsin
WEINSTEIN
The diagnosis and treatment of thyroid ophthalmopathy has been a troublesome area since the disorder was first recognized almost 200 years ago. The author's stated purpose is to "consolidate current ideas of pathogenesis, diagnosis, and management." He certainly succeeds in doing this in the realm of diagnosis, where major advances have occurred during the last ten years, especially in the areas of radiology, ultrasonography, and immunochemistry. In the realm of pathogenesis and mangement, however, it would be difficult for anyone to "consolidate" the vast amount of conflicting and controversial information. Nevertheless, the author does arrive at a synthesis of current concepts and a set of therapeutic guidelines for the practicing ophthalmologist. Though some might disagree with his conclusions, the book is well referenced, allowing the reader to consult primary source material if further documentation is desired. The early chapters elucidate the normal regulatory mechanisms for thyroid hormone synthesis, and describe the biochemical and immunologic tests used in the diagnosis of thyroid disease. These chapters will help the ophthalmologist to understand some of the newer, more specific tests of thyroid function, as well as the immunologic alterations that may occur. The largest chapter, entitled "Eye signs and diagnosis of thyroid ophthalmopathy," deals specifically with the interpretation of physical signs and with orbital ultrasonography, computed tomographic scanning, and magnetic resonance imaging. The major clinical signs are well illustrated with black-and-white photographs. The computed tomographic and magnetic resonance imaging scans showing the characteristic radiologic signs are excellent reproductions of newest-generation studies. A clear explanation of the theory of magnetic resonance imaging is also included. However, 257
258
AMERICAN JOURNAL OF OPHTHALMOLOGY
surgeon would probably want to look elsewhere for more detail before actually performing the procedure. This book would be a valuable adjunct to any general ophthalmologic library. The excellent bibliography provides ready access to most of the important developments in this area. Many complex issues remain unresolved, however, and the book should be read critically both by residents in ophthalmology and by practicing physicians dealing with thyroid eye disease.
Practice Enhancement. A Physician's Guide to Success in Private Practice. By Greg N. Korneluk. New York, Macmillan Publishing Company, 1985.284 pages, index, illustrated. $22.50
Reviewed by MALCOLM A. MCCANNEL
Minneapolis, Minnesota
Practice Enhancement is a splendid book. The author is a responsible authority on such matters. His writing is clear and lucid. Most practitioners are beginning to realize that the traditional practice of medicine is undergoing a metamorphosis: that there is an oversupply of physicians, that the cost of delivering medicine has increased, and that there is a consumer health movement spreading rapidly over the country. This book deals forthrightly with all of these things and does it in a way that makes enjoyable reading. The author pinpoints exactly the questions that come up in managing the problems that practicing physicans face. The contents are divided into four portions: patients; the doctor's own staff; the doctor's own way of practicing, scheduling, and doing things; and the doctor's relationship with colleagues. There is a spate of available books along this line, but this one seems to be superior. The aspect of the job descriptions, hiring and firing people, personnel policy, and staff recruitment are things that doctors have to learn outside their medical training. This small volume also concerns itself with the doctor's relationship to the patient load and deals with such things as seeing patients on time, giving the patient information booklets, the proper use of the telephone, and, of course, being meticulous with all medical records and the proper recording of data for future reference. There is even a section on computers which can
February, 1986
be useful both at home and in the office. The section on relationships with colleagues is exceptionally good because of the way it treats working with referral sources and delegation of responsibility. I recommend this book highly. It will be useful to any doctor in practice, but the doctor's staff should read it as well.
Retinal Degeneration. Experimental and Clinical Studies. Edited by Matthew M. LeVail, Joe G. Hollyfield, and Robert E. Anderson. New York, Alan R. Liss, 1985, 485 pages, index, illustrated. $69.50
Reviewed by MICHAEL A. BLOOME
Houston, Texas
This book is a compendium of articles, many of which were presented at the VI International Congress of Eye Research held in Alicante, Spain (October 1984). The editors, all wellknown investigators in their field, emphasize that there has been tremendous growth in our knowledge of retinitis pigmentosa and allied disorders in recent years, and state in their preface that they have attempted "to take stock of the exciting experimental and clinical research being done in this field" and "capture the flavor of the variety of studies being pursued today." Many of the articles not only present recent findings, but are also extensive reviews accompanied by thorough reference lists (among these are the chapter on the genetics and immunology of retinitis pigmentosa and the article on metabolism of cyclic nucleotides and membrane lipids in normal and degenerating retina). Notwithstanding some variations in the quality of the paper and print, it is an attractive book, and the black-and-white photographs and graphics are of good quality. This book is an excellent and comprehensive guide to recent studies in hereditary retinal degenerations and I recommend it highly for anyone interested in the clinical or experimental aspects of these disorders. Although the book is not intended as a clinical reference for the diagnosis and treatment of patients with retinitis pigmentosa, it does afford the clinician an excellent opportunity to gain insight into the many new and exciting studies coming from our colleagues in the laboratory sciences.