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the handbook of immunopharmacologyimmunopharmacology of joints and connective tissue. edited by m. elisabeth davies and john t. dingle. san diego academic press 1994. 263 pp. illustrated. indexed. 67.50

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LETTERS
arthritis. Arthritis Rheum 37:814-820, 1994). The impact of
such delays on patients’ overall health is not clear and
requires further study. To the extent that earlier (correct)
diagnosis would be better, I would take issue with my
colleagues’ recommendation that there should be interventions to promote early disease recognition by primary care
providers. The nature of such interventions is unclear. In
any case, the recommendation would surely apply also to
other rheumatologic entities, as well as to a host of disorders
in other specialties. I believe this is an impractical and
unrealistic approach that is unlikely to improve diagnostic
acumen. More likely it will lead to more false-positive and
449
false-negative diagnoses of rheumatoid arthritis, with the
rheumatoid factor test being the major diagnostic criterion.
Perhaps we should teach appropriate referral. Undiagnosed early arthritis presents a difficult diagnostic problem. If one is interested in managing care in a positive sense,
rather than a priori curtailing the use of specialists, rheumatologist referral is the better option. I suspect that this may,
in fact, be the cheaper option as well.
Joseph H. Korn, MD
Bosnon University Medical Center
Bosfon, MA
BOOK REVIEWS
The Ciba Collection of Medical Illustrations. Volume 8: Musculoskeletal System, Part 111: Trauma Evaluation and Management. Frank H . Netter. Summit, NJ, Ciba-Geigy Corp.,
1993. 220 p p . Indexed. $62.50.
Volume 8, Part 111 of the Ciba Collection of Medical
Illustrations was, in fact, Dr. Netter’s “swan song,” as put
by Philip B. Flagler in the acknowledgments section of this
eloquent atlas. Frank Henry Netter, MD, died on September
17, 1991 in New York City at the age of 85. Right up until his
death he collaborated with Dr. James D. Heckman, along
with renowned authorities at other institutions, to address
particular subjects on trauma in the evaluation and management of the musculoskeletal system.
What is so striking about this final series of 201
paintings and accompanying text by Dr. Netter is the simplicity and clarity with which he portrays concepts and
illustrations, which together form a complete, graphic, easyto-grasp summary of musculoskeletal trauma. Dr. Henry J.
Mankin, in the foreword to the atlas, notes Dr. Netter as
having “the works of a genius-not only because he saw so
much and so clearly, but because he could make us see it
with equal clarity.”
Following Dr. Netter’s death, this text was completed by the staff at Ciba-Geigy along with artists David
Mascaro and Craig Luce, and concepts were developed by
Dr. John A. Craig. Their contributions accounted for some
44 illustrations in all.
The atlas is divided into 4 parts: Injury to the
Musculoskeletal System, Infection, Amputation, and Rehabilitation. The majority of the atlas is composed of the
section on Injury to the Musculoskeletal System, and this is
an excellent, concise summary of musculoskeletal injury
including soft tissue injuries, compound fractures, compartment syndromes, wound healing, and injuries by anatomic
site. Completing the section are illustrations of replantation
techniques, fractures in children, stress and pathologic fractures, and fracture complications. As one goes through each
section, what is apparent is how thorough and concise each
portrayal is and the ingenuity with which the conceptual
illustrations are painted, with integration of illustrations,
text, graphics, radiographs, and logarithms to give the reader
a very good overall picture on a single illustrative plate.
Although the illustrations don’t always reflect the
most current and widely accepted methods of management,
current management techniques are discussed in the accompanying text, and the illustrations usually depict an acceptable method of treatment. This is a tribute to the selection of
consulting traumatologists andl orthopedists in their collaboration with Dr. Netter.
The final 3 sections, Infection, Amputation, and
Rehabilitation, round out the atlas to make it a very complete yet compact medical volume that is an asset to any
physician’s library. It would be a very useful aid in teaching
patients, medical students, anld residents, and a useful refresher even for orthopedists. Certainly for $62.50 it is an
excellent value. 1 highly recalmmend this medical atlas; I
marvel at the energy and conceptual clarity with which Dr.
Netter worked throughout his career, and in this final
accomplishment.
Tom Minas, MD, FRCS(C), MS
Brigham Orthopedic Associates
Boston, MA
The Handbook of Immunopharmacology:Immunopharmacology of Joints and Connective Tiissue. Edited by M . Elisabeth
Davies and John T . Dingle. Sun Diego, Academic Press,
1994. 263 p p . Illustrated. Indexed. $67.50.
Over the last 25 years, the field of immunology has
grown at an explosive pace. The development of new
technology in the form of semitive immunoassays, mono-
450
clonal antibodies, the polymerase chain reaction, and sophisticated imaging techniques has resulted in the identification of a host of cellular processes, cell markers, and
cytokines. In parallel with these events, the field of immunopharmacology has appeared and matured as a means to
therapeutically manipulate the immune system. The Handbook of Immunopharmacologq attempts to catalog this everenlarging body of knowledge in a monograph series in which
each individual volume addresses an immunology-related
topic with regard to 3 main themes, 1) cells types and
inflammatory mediators, 2) individual organ or tissue systems, and 3) classes of drugs.
Imrnunopharmacology of Joints and Connective Tissues, as its title implies, focuses on the subject of chronic
inflammatory arthritis. Following a brief introductory overview of autoantibodies in autoimmune diseases, the succeeding 10 chapters concentrate primarily on pathogenic mechanisms that offer potential opportunities for therapeutically
blocking or modifying the inflammatory process and its
associated destructive effects on cartilage and bone. Topics
include immunologic tolerance, peptide blockade, monoclonal antibody therapy, cytokineskytokine inhibitors, metalloproteinase inhibitors, and ly sosomal cysteine endopeptidases. Each subject is dissected in a systematic manner.
Major points are reviewed, with key supporting animal and
human experimental data presented in summary form. Current and potential problems with biologic immunotherapy
are also candidly discussed by the authors in the chapters on
drug therapy.
Although the volume is a multi-authored work with
18 leading contributors, the editors have made a significant
attempt to maintain consistency from chapter to chapter.
The sections are clear and tht: divisions of each chapter are
well organized. The information is up-to-date and extensively referenced throughout, with numerous well-placed
figures and tables to complement or summarize the written
text. All abbreviations and figures have been standardized in
the entire series, and their definitions can be quickly located
in the glossary at the end of the book.
This new publication I S important for its distillation,
in one compact, 263-page hard-cover volume, of the major
advances during the last decade in our understanding of the
cellular and molecular processes underlying chronic inflammatory diseases. It dfiers from previous publications in its
emphasis on the potential use of this research for drug
development. In their reviews of the literature, the chapter
authors acknowledge the major gaps in current understanding of the immune response and propose new goals and
directions for further study. Their discussions of the complex issues within this field range from the practical to the
highly theoretical. This monograph is meant as a working
reference for those with a research or teaching interest in the
clinical and basic sciences. It may also be of some value to
BOOK REVIEWS
the serious practicing clinician who desires a handy aid in the
interpretation of pertinent research studies.
Stephen J. Oliver, MD
Ernest Brahn, MD
UCLA School of Medicine
Los Angeles, CA
Lyme Borreliosis. Edited by John S . Axford and David H . E .
Rees. New York, Plenum Publishing, 1994. 332 p p . Illustrated. Indexed. $95.00.
This book summarizes the proceedings of the Second
European Symposium on Lyme Borreliosis, bringing together most European and several American experts in the
field. There is a broad range of topics, including clinical
manifestations, treatment, epidemiology, immunopathogenesis, and diagnosis. The book begins with the Henry Fuller
lecture, an overview of the pathogenesis, diagnosis, and
treatment of Lyme arthritis. It concludes with a section on
diagnosis of Lyme borreliosis, focusing on the clinical utility
of the polymerase chain reaction.
One of the strengths of this book is its breadth of
topics from geographically diverse authors. One chapter
discusses the parallels between Lyme disease and tick-borne
encephalitis in southern Germany, while another explores
whether there is an indigenous focus of Lyme borreliosis in
Australia. In other chapters the epidemiology of Borrelia
burgdorferi in France, Sweden, Scotland, and Italy is delineated. Timely subjects, such as the management of a deer
tick bite and the role of host density in the ecology of Lyme
borreliosis, are also discussed. This book does not avoid
controversy; one section is devoted to the pitfalls of laboratory diagnosis and another to polymerase chain reactionbased detection of spinal fluid B burgdorferi as a predictor of
treatment response in central nervous system disease. Some
of the book’s weaknesses are those inherent in a multiauthored international conference report (spelling and grammatical errors and chapter redundancy). The chapters vary
in length and writing style, and some original works draw
conclusions based upon small sample sizes.
Overall, this book is recommended for health professionals and academicians with a serious interest in Lyme
borreliosis. Clinicians who wish to gain additional clinical
and biologic knowledge from an international viewpoint
would also find this book a welcome addition to their
shelves.
Nancy Shadick, MD, MPH
Brigham and Women’s Hospital
Boston, MA
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diego, dingler, illustrated, joint, 263, handbook, tissue, academic, 1994, john, immunopharmacologyimmunopharmacology, connection, elisabeth, edited, indexes, san, davies, pres
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