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Vasodilatation: Vascular Smooth Muscle, Peptides, Autonomic Nerves, and Endothelium
Book Reviews Pediatrie Medicine, edited by Mary Ellen Avery and Lewis R. First, 1,409 pp, with illus, $79.95, Baltimore, Williams & Wilkins, 1989
that makes the material most meaningful to the clinician. The scope of the text is extremely broad, with topics ranging from single parenthood, fire-setting behavior, and motion sickness to bone marrow transplantation, gene therapy, and fetal surgical treatment. The editors wrote many of the chapters themselves (with specialists as consultants), a factor that certainly contributed to the uniformity of style throughout the book. Although some of the chapters were written by specialists outside the Boston area, the overall thrust of the book is the presentation of pediatrie care as practiced at the Boston Children's Hospital (where both of the editors and many of the authors practice). In reading through the text, I found some sections that I might have presented differently and in which I might have used different references, but these are minor criticisms. This new textbook is a clearly written, well-organized summary of general pediatrics. The editors and authors should be thanked for providing such a useful resource for clinicians and students of pediatrics.
Many physicians might be surprised to learn that a group of authors has gone to the trouble of compiling a new, comprehensive textbook on general pediatrics. Several such texts, including newly revised editions, are available and continue to be well accepted by practicing clinicians. Therefore, I undertook the task of reviewing this new 1,400-page work with some reservations about its need. After spending several hours with this book, I continued to gain respect and enthusiasm for this monumental achievement. Several features of the book make it unusual, and I predict that it will become a well-used resource for clinicians who treat children, as well as for many residents and medical students studying pediatrics. The most impressive features of the book are the consistency of style and the ease of use. The material is organized primarily according to organ system, with each specific topic divided into seven general headings—"Definition," "Basic Science," "EpiW. Frederick Schwenk II, M.D. demiology," "Natural History," "Diagnosis," "TreatDepartment of Pediatrics ment," and "Prognosis and Prevention." Because this format is used in almost every chapter, as the reader becomes familiar with the book it is easy to find answers to specific questions that one wishes to explore. For students, this format should make as- Vasodilatation: Vascular Smooth Muscle, Pepsimilation of the material easier. tides, Autonomie Nerves, and Endothelium, Occasionally, two additional subheadings are inedited by Paul M. Vanhoutte, 572 pp, with illus, cluded for a particular topic. Under the first, "New $125, New York, Raven Press, 1988 Developments," the authors discuss recent data that may not be fully accepted by practicing clinicians, This text, a compendium of new findings (up to 1986) and under the second, "Controversy," the authors in the control of the circulation, features both recent highlight areas of pediatrie care in which the best investigations and subject reviews. The list of conmeans of management have not yet been determined tributors to this symposium honoring John T. Shep(for example, the use of tympanostomy tubes). I herd is impressive, and the vast amount of new think both of these headings are particularly useful information concerning mechanisms of vasodilatato the clinician who wishes to refresh or update his tion and vasoconstriction and the possibilities of knowledge in a particular area and for students of abnormalities in disease states contained in the text pediatrics who need to gain a perspective of how the should impress investigators at all levels of experience. Young researchers will learn that it is not practice of treating children is evolving. Another feature of the text that I found useful was enough to know that agonists or agents cause vasothe illustrative case reports, followed by questions dilatation—the cellular mechanisms can and must and comments, that are interspersed in boxes be discovered. The book is divided into eight sections. The initial throughout the text. These case reports expand the discussion of a particular disease entity in a way chapter is actually not an introduction but rather Mayo Clin Proc 64:883-894, 1989
883
884
BOOK REVIEWS
presents strong evidence t h a t purines and purinergic receptors are important physiologic regulators of blood flow and t h a t endothelium-derived relaxing factor is involved. Table 1 is an impressive list of established and putative transmitters in perivascular nerves. The first section also contains loosely related chapters on the regulation of calcium channels in vascular smooth muscle and the role of the plasma membrane, inositol triphosphate, calmodulin, and guanylate cyclase. Some of this material is related to abnormalities in or the treatment of hypertension. The last two chapters are brief reviews of vasodilator nerves, the mechanisms of hypoxic vasodilatation, and the differences in the reactions of small resistance vessels and larger vessels. The second section is labeled "Neuropeptides." Experimental data are presented on the effects of neuropeptide Y, somatostatin, substance P, vasoactive intestinal polypeptides, met- and leu-enkephalin, calcitonin-gene-related peptide, and bradykinin on h u m a n mesenteric vessels. The results of animal studies—the action of thyrotropin releasing hormone on cerebral blood flow in rabbits and of vasoactive intestinal polypeptides on the cortical arachnoid vessels in cats—are subsequently presented. The section also includes subject reviews on calcitonin-gene-related peptide, the action of capsaicin, cholinergic vasodilator nerves in cerebral arteries, and the use of Doppler studies to analyze neuropeptide action on vasodilator axon reflexes. The third section covers some aspects of the effect of atrial natriuretic peptides on the vasculature and what is currently known about the mechanisms of action. Species and regional differences, short-term versus long-term administration in hypertensive rats, the effect on blood flow in the h u m a n forearm, and elevated plasma levels in h u m a n diseases are discussed. This section contains some repetition of material, especially in the introduction to each chapter, because of the multiple authorship of the chapters. The ensuing section, "Catecholamines," begins with two excellent chapters on a digital model of feedback regulation of sympathetic neurotransmitter release and how the level of vascular tone may be important in determining the accessibility of the sympathetic nerves in the arterial wall to circulating agents. Catecholamine kinetics in congestive heart failure, dilation of the microcirculation by sympathetic activity and circulating catecholamines, dopamine neuronal and vascular receptors, and the mechanism of action of norepinephrine are discussed in brief chap-
Mayo Clin Proc, July 1989, Vol 64
ters. The a- and ß-adrenoceptors receive some attention in the discussion of the characteristics of down-regulation and reserve capacity. Finally, the development of new drugs that affect only postjunctional a-adrenoceptors is covered. Section 5 consists of 10 chapters on the action of serotonin on the endothelium, sympathetic nerves, intact circulation, and arteriovenous anastomoses. Experimental data concerning the involvement of serotonin in the vascular responses in arteriosclerosis, subarachnoid hemorrhage, and hypertension are presented. Agents t h a t interfere with the action of serotonin are discussed selectively, and information on serotonergic receptors and platelet relationships is interspersed. Section 6 covers the neurogenic control of blood vessels in h u m a n skeletal muscle during rest and exercise, coronary circulation, pulmonary circulation, and arteriovenous anastomoses in the dog tongue. The section concludes with a chapter on the decrease in blood pressure with food intake in patients with autonomie insufficiency. The seventh section contains several chapters on the local regulation of the circulation that address the following topics: neurohypophysial vasodilatation with hypoxia; oxygen radicals as mediators of abnormal vascular responses; the action of hypoxia on vascular smooth muscle cells; the regulation of vascular smooth muscle by inorganic phosphates and adenosine, pulmonary circulatory vasoconstriction, and vasodilatation; and autoregulation of skeletal muscle blood vessels. Some of these contributions are subject reviews, but several chapters present recent research findings (to 1986). The final section concerns the endothelium and the continuing proliferation of new information about its control of the circulation. Evidence that endothelium-derived relaxing factor is a nitrous oxide that activates cyclic guanosine monophosphate is presented, including confirmation in cultured endothelial cells of the original studies with use of blood vessels. The interactions of endothelium-derived relaxing factor with a-adrenoceptors, histamine receptors, calcitonin-gene-related peptide, and bradykinin are discussed. Endothelial cell-mediated contraction (endothelin) is also mentioned, and evidence t h a t endothelial cells may be oxygen sensors is presented. Pathologic states that affect the release of endothelium-derived relaxing factor, such as arteriosclerosis, hypertension, hyperlipidemia, and coronary vasospasm, are addressed. This section contains interesting information about the mechanisms
Mayo Clin Proc, July 1989, Vol 64
and various actions of endothelium-derived relaxing factor but also considerable repetition. This book will be valuable to physiologists, pharmacologists, and clinical investigators as a reference text. It is not a book to read cover to cover, but it will be extremely useful as a source of updated material on current topics in this field. As the editor points out, the reader must be his own critic because many of the contributions were not reviewed by experts. Although no subjects are covered comprehensively, most of the chapters are well referenced to provide access to important investigations on the topics. The book includes a good index, which is a necessity in this type of text. One of the strong points of the volume is that many of the authors describe not only what is known but also what must be explored. I highly recommend this text for the libraries of cardiovascular investigators. Jay D. Coffman, M.D. Peripheral Vascular Section Boston University Medical Center Boston, Massachusetts
Clinical Gynecologic Endocrinology and Infertility, 4th ed, by Leon Speroff, Robert H. Glass, and Nathan G. Kase, 668 pp, with illus, $62.95, Baltimore, Williams & Wilkins, 1989 The rapid advancement in our understanding of reproductive endocrinology, especially at the molecular level, prompted the fourth edition of this wellknown textbook. Only 6 years have elapsed since the publication of the previous volume, yet one is immediately impressed by the vast amount of new material that has been incorporated into this edition. Although the chapter headings remain unchanged, the bibliographies have undergone major revision and expansion—the fact that most of the references are from the past 2 to 3 years and few are earlier than 1980 reflects the timeliness of the text. Some of the most impressive updating is evident in the first three chapters, which deal with the physiologic features of female reproduction. The first chapter presents the most current information available on the regulation of tropic hormones and the mechanisms of action of steroidal hormones. Important advancements include our understanding that receptors are nuclear proteins at all times and that activation occurs there rather than in the cytosol, as
BOOK REVIEWS
885
had been believed previously. The second chapter is devoted to neuroendocrinology and features a review of the current knowledge of the production and regulation of peptides that function as neurotransmitters, including endogenous opiates. In the third chapter on the regulation of the menstrual cycle, the authors describe the importance of growth factors and inhibin in the ovarian follicle. Although all the chapters have been updated, some—such as the ones on amenorrhea, polycystic ovarian disease, hirsutism, and obesity—have undergone less change because advancements in the therapeutic armamentarium in some clinical areas have been limited. Nevertheless, important additions can be found. In the chapter on hirsutism, the brief discussion of new therapeutic approaches in the previous edition has been expanded considerably to include a summary of experience with such agents as spironolactone, cyproterone acetate, cimetidine, and gonadotropin releasing hormone agonists. The chapter on the breast discusses the effectiveness of such diagnostic techniques as aspiration and mammography and summarizes the evidence that supports the importance of receptor assays in the management of patients with advanced carcinoma of the breast. The chapter on corticosteroid contraception reviews new drug formulations. The authors include some revised suggestions for patient care, such as their willingness to allow women who are nonsmokers and in good health to continue using oral contraceptives to age 50 years if low-dose formulations are prescribed. The chapter on endometriosis has clearly benefited from the passage of time. Available hormonal agents such as danazol, medroxyprogesterone acetate, and gonadotropin releasing hormone analogues are placed in appropriate perspective in the current edition. The section on male infertility now includes a discussion of the usefulness of sperm penetration assays and the indications for and timing of intrauterine insemination. The few brief paragraphs on in vitro fertilization in the previous edition formed the basis for the one new chapter in this text. The authors have done a commendable job of synthesizing the extensive literature on this subject by focusing only on evolving technology and the pregnancy rates that can be achieved. By continuing their philosophy of reviewing physiologic principles and then providing methods of clinical management, the authors have ensured in this new edition a continuation of the tradition of excellence and demand that the previous editions have
that makes the material most meaningful to the clinician. The scope of the text is extremely broad, with topics ranging from single parenthood, fire-setting behavior, and motion sickness to bone marrow transplantation, gene therapy, and fetal surgical treatment. The editors wrote many of the chapters themselves (with specialists as consultants), a factor that certainly contributed to the uniformity of style throughout the book. Although some of the chapters were written by specialists outside the Boston area, the overall thrust of the book is the presentation of pediatrie care as practiced at the Boston Children's Hospital (where both of the editors and many of the authors practice). In reading through the text, I found some sections that I might have presented differently and in which I might have used different references, but these are minor criticisms. This new textbook is a clearly written, well-organized summary of general pediatrics. The editors and authors should be thanked for providing such a useful resource for clinicians and students of pediatrics.
Many physicians might be surprised to learn that a group of authors has gone to the trouble of compiling a new, comprehensive textbook on general pediatrics. Several such texts, including newly revised editions, are available and continue to be well accepted by practicing clinicians. Therefore, I undertook the task of reviewing this new 1,400-page work with some reservations about its need. After spending several hours with this book, I continued to gain respect and enthusiasm for this monumental achievement. Several features of the book make it unusual, and I predict that it will become a well-used resource for clinicians who treat children, as well as for many residents and medical students studying pediatrics. The most impressive features of the book are the consistency of style and the ease of use. The material is organized primarily according to organ system, with each specific topic divided into seven general headings—"Definition," "Basic Science," "EpiW. Frederick Schwenk II, M.D. demiology," "Natural History," "Diagnosis," "TreatDepartment of Pediatrics ment," and "Prognosis and Prevention." Because this format is used in almost every chapter, as the reader becomes familiar with the book it is easy to find answers to specific questions that one wishes to explore. For students, this format should make as- Vasodilatation: Vascular Smooth Muscle, Pepsimilation of the material easier. tides, Autonomie Nerves, and Endothelium, Occasionally, two additional subheadings are inedited by Paul M. Vanhoutte, 572 pp, with illus, cluded for a particular topic. Under the first, "New $125, New York, Raven Press, 1988 Developments," the authors discuss recent data that may not be fully accepted by practicing clinicians, This text, a compendium of new findings (up to 1986) and under the second, "Controversy," the authors in the control of the circulation, features both recent highlight areas of pediatrie care in which the best investigations and subject reviews. The list of conmeans of management have not yet been determined tributors to this symposium honoring John T. Shep(for example, the use of tympanostomy tubes). I herd is impressive, and the vast amount of new think both of these headings are particularly useful information concerning mechanisms of vasodilatato the clinician who wishes to refresh or update his tion and vasoconstriction and the possibilities of knowledge in a particular area and for students of abnormalities in disease states contained in the text pediatrics who need to gain a perspective of how the should impress investigators at all levels of experience. Young researchers will learn that it is not practice of treating children is evolving. Another feature of the text that I found useful was enough to know that agonists or agents cause vasothe illustrative case reports, followed by questions dilatation—the cellular mechanisms can and must and comments, that are interspersed in boxes be discovered. The book is divided into eight sections. The initial throughout the text. These case reports expand the discussion of a particular disease entity in a way chapter is actually not an introduction but rather Mayo Clin Proc 64:883-894, 1989
883
884
BOOK REVIEWS
presents strong evidence t h a t purines and purinergic receptors are important physiologic regulators of blood flow and t h a t endothelium-derived relaxing factor is involved. Table 1 is an impressive list of established and putative transmitters in perivascular nerves. The first section also contains loosely related chapters on the regulation of calcium channels in vascular smooth muscle and the role of the plasma membrane, inositol triphosphate, calmodulin, and guanylate cyclase. Some of this material is related to abnormalities in or the treatment of hypertension. The last two chapters are brief reviews of vasodilator nerves, the mechanisms of hypoxic vasodilatation, and the differences in the reactions of small resistance vessels and larger vessels. The second section is labeled "Neuropeptides." Experimental data are presented on the effects of neuropeptide Y, somatostatin, substance P, vasoactive intestinal polypeptides, met- and leu-enkephalin, calcitonin-gene-related peptide, and bradykinin on h u m a n mesenteric vessels. The results of animal studies—the action of thyrotropin releasing hormone on cerebral blood flow in rabbits and of vasoactive intestinal polypeptides on the cortical arachnoid vessels in cats—are subsequently presented. The section also includes subject reviews on calcitonin-gene-related peptide, the action of capsaicin, cholinergic vasodilator nerves in cerebral arteries, and the use of Doppler studies to analyze neuropeptide action on vasodilator axon reflexes. The third section covers some aspects of the effect of atrial natriuretic peptides on the vasculature and what is currently known about the mechanisms of action. Species and regional differences, short-term versus long-term administration in hypertensive rats, the effect on blood flow in the h u m a n forearm, and elevated plasma levels in h u m a n diseases are discussed. This section contains some repetition of material, especially in the introduction to each chapter, because of the multiple authorship of the chapters. The ensuing section, "Catecholamines," begins with two excellent chapters on a digital model of feedback regulation of sympathetic neurotransmitter release and how the level of vascular tone may be important in determining the accessibility of the sympathetic nerves in the arterial wall to circulating agents. Catecholamine kinetics in congestive heart failure, dilation of the microcirculation by sympathetic activity and circulating catecholamines, dopamine neuronal and vascular receptors, and the mechanism of action of norepinephrine are discussed in brief chap-
Mayo Clin Proc, July 1989, Vol 64
ters. The a- and ß-adrenoceptors receive some attention in the discussion of the characteristics of down-regulation and reserve capacity. Finally, the development of new drugs that affect only postjunctional a-adrenoceptors is covered. Section 5 consists of 10 chapters on the action of serotonin on the endothelium, sympathetic nerves, intact circulation, and arteriovenous anastomoses. Experimental data concerning the involvement of serotonin in the vascular responses in arteriosclerosis, subarachnoid hemorrhage, and hypertension are presented. Agents t h a t interfere with the action of serotonin are discussed selectively, and information on serotonergic receptors and platelet relationships is interspersed. Section 6 covers the neurogenic control of blood vessels in h u m a n skeletal muscle during rest and exercise, coronary circulation, pulmonary circulation, and arteriovenous anastomoses in the dog tongue. The section concludes with a chapter on the decrease in blood pressure with food intake in patients with autonomie insufficiency. The seventh section contains several chapters on the local regulation of the circulation that address the following topics: neurohypophysial vasodilatation with hypoxia; oxygen radicals as mediators of abnormal vascular responses; the action of hypoxia on vascular smooth muscle cells; the regulation of vascular smooth muscle by inorganic phosphates and adenosine, pulmonary circulatory vasoconstriction, and vasodilatation; and autoregulation of skeletal muscle blood vessels. Some of these contributions are subject reviews, but several chapters present recent research findings (to 1986). The final section concerns the endothelium and the continuing proliferation of new information about its control of the circulation. Evidence that endothelium-derived relaxing factor is a nitrous oxide that activates cyclic guanosine monophosphate is presented, including confirmation in cultured endothelial cells of the original studies with use of blood vessels. The interactions of endothelium-derived relaxing factor with a-adrenoceptors, histamine receptors, calcitonin-gene-related peptide, and bradykinin are discussed. Endothelial cell-mediated contraction (endothelin) is also mentioned, and evidence t h a t endothelial cells may be oxygen sensors is presented. Pathologic states that affect the release of endothelium-derived relaxing factor, such as arteriosclerosis, hypertension, hyperlipidemia, and coronary vasospasm, are addressed. This section contains interesting information about the mechanisms
Mayo Clin Proc, July 1989, Vol 64
and various actions of endothelium-derived relaxing factor but also considerable repetition. This book will be valuable to physiologists, pharmacologists, and clinical investigators as a reference text. It is not a book to read cover to cover, but it will be extremely useful as a source of updated material on current topics in this field. As the editor points out, the reader must be his own critic because many of the contributions were not reviewed by experts. Although no subjects are covered comprehensively, most of the chapters are well referenced to provide access to important investigations on the topics. The book includes a good index, which is a necessity in this type of text. One of the strong points of the volume is that many of the authors describe not only what is known but also what must be explored. I highly recommend this text for the libraries of cardiovascular investigators. Jay D. Coffman, M.D. Peripheral Vascular Section Boston University Medical Center Boston, Massachusetts
Clinical Gynecologic Endocrinology and Infertility, 4th ed, by Leon Speroff, Robert H. Glass, and Nathan G. Kase, 668 pp, with illus, $62.95, Baltimore, Williams & Wilkins, 1989 The rapid advancement in our understanding of reproductive endocrinology, especially at the molecular level, prompted the fourth edition of this wellknown textbook. Only 6 years have elapsed since the publication of the previous volume, yet one is immediately impressed by the vast amount of new material that has been incorporated into this edition. Although the chapter headings remain unchanged, the bibliographies have undergone major revision and expansion—the fact that most of the references are from the past 2 to 3 years and few are earlier than 1980 reflects the timeliness of the text. Some of the most impressive updating is evident in the first three chapters, which deal with the physiologic features of female reproduction. The first chapter presents the most current information available on the regulation of tropic hormones and the mechanisms of action of steroidal hormones. Important advancements include our understanding that receptors are nuclear proteins at all times and that activation occurs there rather than in the cytosol, as
BOOK REVIEWS
885
had been believed previously. The second chapter is devoted to neuroendocrinology and features a review of the current knowledge of the production and regulation of peptides that function as neurotransmitters, including endogenous opiates. In the third chapter on the regulation of the menstrual cycle, the authors describe the importance of growth factors and inhibin in the ovarian follicle. Although all the chapters have been updated, some—such as the ones on amenorrhea, polycystic ovarian disease, hirsutism, and obesity—have undergone less change because advancements in the therapeutic armamentarium in some clinical areas have been limited. Nevertheless, important additions can be found. In the chapter on hirsutism, the brief discussion of new therapeutic approaches in the previous edition has been expanded considerably to include a summary of experience with such agents as spironolactone, cyproterone acetate, cimetidine, and gonadotropin releasing hormone agonists. The chapter on the breast discusses the effectiveness of such diagnostic techniques as aspiration and mammography and summarizes the evidence that supports the importance of receptor assays in the management of patients with advanced carcinoma of the breast. The chapter on corticosteroid contraception reviews new drug formulations. The authors include some revised suggestions for patient care, such as their willingness to allow women who are nonsmokers and in good health to continue using oral contraceptives to age 50 years if low-dose formulations are prescribed. The chapter on endometriosis has clearly benefited from the passage of time. Available hormonal agents such as danazol, medroxyprogesterone acetate, and gonadotropin releasing hormone analogues are placed in appropriate perspective in the current edition. The section on male infertility now includes a discussion of the usefulness of sperm penetration assays and the indications for and timing of intrauterine insemination. The few brief paragraphs on in vitro fertilization in the previous edition formed the basis for the one new chapter in this text. The authors have done a commendable job of synthesizing the extensive literature on this subject by focusing only on evolving technology and the pregnancy rates that can be achieved. By continuing their philosophy of reviewing physiologic principles and then providing methods of clinical management, the authors have ensured in this new edition a continuation of the tradition of excellence and demand that the previous editions have