Textbooks Vasculitis

ISBN 13: 9780192630537

Vasculitis

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9780192630537: Vasculitis

This book is a comprehensive review of vasculitis, a fascinating array of the life-threatening and minor conditions caused by inflammatory syndromes and diseases that affect the blood vessels. It brings together in a unique way, consepts from both the biology and clinical aspects of vasculitis. Research in clinical immunology now invigorates the entire area of vasculitis, and shape a rational approach to pathogenesis, diagnosis and treatment which is the substance of this text. Over 40 chapters cover known vasculitic conditions, and are illustrated with numerous photographs, diagrams and tables. Some chapters, such as that of aortitis, are brief, and others, such as those devoted to Behcet's disease, are much longer, in keeping with their prevalence. The authors have been chosen based on their unique experiences with vasculitic conditions. Most of these conditions are rare in most areas of the globe, and it is the exceptional clinician who has much experience with more than a few of these; thus, drawing upon authors from all over the world has enabled the editors to provide informed discussions of all of them.
The book is illustrated with numerous color illustrations of clinical manifestations and also contains superb illustrations of invasive and non-invasive imaging.

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About the Author:

Eugene Ball is at University of Alabama at Birmingham. S. Louis Bridges is at University of Alabama.

From The New England Journal of Medicine:

Vasculitis is often a clinical conundrum. It is uncommon, many of its signs and symptoms are nonspecific, and it can mimic many other diseases. Some forms of vasculitis are innocuous, whereas others can lead to the rapid development of irreversible organ failure and sometimes death if they are not promptly diagnosed and treated. Moreover, the standard treatments for the life-threatening forms of vasculitis are not benign. Textbooks on the diagnosis and treatment of vasculitis are notably few, perhaps reflecting the complexity of the problem.

This book takes a systematic and quite comprehensive look at vasculitis from a somewhat unorthodox, but very successful, point of view. Individual forms of vasculitis are described chapter by chapter, and the chapters, which cover every known form of named vasculitis, are uniformly excellent. The editors have gone out of their way to find authors from around the world to gather firsthand, detailed information, not only on the common entities such as Wegener's granulomatosis and polyarteritis nodosa but also on conditions that are rare in North America -- for example, Behcet's syndrome and Takayasu's arteritis. In addition, the editors have added several broad introductory sections. Under the heading of "Clinical Manifestations Common to Vasculitis," individual chapters deal with cutaneous, oral, pulmonary, ophthalmic, neurologic, renal, and distal ischemic changes in many different forms of vasculitis. These chapters are comprehensive overviews of each organ system and range, depending on the authors' interests, from signs and symptoms to radiologic and, in some instances, pathological findings. Separate discussions of conditions that mimic vasculitis, including an excellent chapter on the antiphospholipid-antibody syndrome, provide help with differential diagnosis. Although the approach of having both organ-specific and disease-specific chapters produces redundancy, the redundancy is probably beneficial since it allows the expression of several points of view.

A separate section is devoted to imaging studies, both angiographic and cross-sectional. It contains excellent chapters, with useful information on new techniques such as magnetic resonance imaging for demonstrating vascular-wall thickening and stenosis. Epidemiology receives its own coverage, a particularly valuable review of the frequency of the various forms of vasculitis; there probably is no more extensive summary in existence. The general approach to the diagnosis of vasculitis in children and adults is covered in separate chapters, and another chapter deals with assessing disease activity and damage, which are often overlooked but are becoming more important with attempts to tailor therapies for maximal benefit. The comparison of the various schemes for assessing disease activity, such as the Vasculitis Damage Index, the Five Factor Score, the Vasculitis Activity Index, and the Birmingham Vasculitis Activity Score, is enlightening, as much for informing the reader about what these schemes do not provide as for what they do.

No treatise on vasculitis would be complete without a commentary on pathogenesis, and this is provided in several initial chapters, as well as within chapters on specific diseases. The role of antineutrophil cytoplasmic antibodies in pathogenesis and diagnosis (and their limits in following disease activity) is stressed throughout the book. A careful reading of these sections suggests that we still do not know enough about pathogenesis to be able to state categorically just how vasculitis develops. This is seen to some extent in another unusual but interesting chapter on experimental therapies for vasculitis, which documents attempts to apply what has been learned about pathogenesis in molecular terms to the formulation of new therapeutic approaches, such as targeting lymphocytes or using soluble receptors to scavenge cytokine mediators. Although many of these approaches are, at present, still being developed, there is also quite valuable and down-to-earth information on new ways to apply the traditional therapies of steroids and immunosuppressive agents.

One very nice touch is the inclusion of illustrations in individual chapters as black-and-white images that are repeated in a separate center section in color. There is again some redundancy in the numerous illustrations of purpura, digital ischemia, and ulcerating lesions, but this on the whole is useful because it provides a spectrum of changes for the reader to examine.

The one surprising defect in this book is the lack of a chapter on pathology and the lack of images of the pathological characteristics of many conditions. What is illustrated varies considerably from chapter to chapter, but as opposed to the numerous images of some of the cutaneous manifestations listed above, there is only one microscopical figure of Wegener's granulomatosis, three of Churg-Strauss syndrome, none of microscopic polyangiitis, and none of pulmonary capillaritis in the whole book. The editors make the point in their introduction to the classification of vasculitic syndromes that imaging studies may be substitutes for a diagnosis based on pathological findings in many instances. Although this is in some sense true, many of the individual chapters and contributors in this book point out the importance of the biopsy as the gold standard for diagnosis. Certainly, it would have been useful for the pathologist and nonpathologist reader alike to have some fairly comprehensive and well-illustrated notion of what pathologic changes characterize particular diseases, what the differential diagnosis of specific findings -- for example, capillaritis -- might be, and what changes are seen in early lesions in, for instance, Wegener's granulomatosis or the Churg-Strauss syndrome, since early lesions are a relatively new area of diagnosis.

Despite the lack of information on pathology, this book is probably the most comprehensive and detailed single source of information available on vasculitis. It is highly recommended for physicians of any specialty who have an interest in this area.

Andrew Churg, M.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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