Second edition. Loscalze J, Creager MA, Dzau VJ; eds. 1220 pages. New York: Lippincott-Raven; 1996. $195.95. ISBN 0316534005. Order phone 800-777-2295.

Field of medicine: Vascular biology and vascular medicine.

Format: Hardcover book.

Audience: For a complete reading, this book will be useful for medical and surgical cardiovascular clinicians and investigators. For selected reading and as a reference, it will serve other internists and surgeons, family practitioners, dermatologists, interventional radiologists, neurologists, house officers, medical students, and investigators in vascular biology.

Purpose: To integrate a contemporary understanding of vascular biology with a detailed, thorough review of vascular diseases.

Content: The 56 chapters of this textbook are grouped into five sections. The first, "Biology of the Vasculature," starts with a remarkable 18-page chapter on normal endothelial-cell functions, which is documented with 743 references. It then goes on to discuss vascular connective tissue and smooth muscle, rheology, pharmacology, hemostasis and fibrinolysis, and other topics. These chapters, as well as those in the second section, "Pathophysiology of Vascular Disease," cover advanced areas of research and provide current, basic underpinnings for the more clinical sections that follow: "Diagnostic Methods in Vascular Disease," "General Principles of Therapy," and "Specific Disorders." The latter section comprises about 500 pages on vascular diseases and disorders, tying in, where possible, current information from basic research.

Highlights: The book is too large and complex to allow a listing of isolated highlights. What stands out is the impressive effort made to integrate the knowledge and views of almost 100 authors, basic scientists, and clinicians into an emerging definition of vascular medicine as a legitimate specialty with its own basic science.

Limitations: Some of the material, especially in the first two sections, demands more background knowledge than most readers who do not work in basic science laboratories will have. In addition, the print size is small. Stronger typographical emphasis on headings, especially in some tables, would be helpful. Not all of the photographs and radiographs are sharply reproduced.

Context: For perspective, one must refer to the great series of textbooks from the Mayo Clinic, edited first by Allen, Barker, and Hines and later by Juergens, Spittell, and Fairbairn, on peripheral vascular diseases; this series has been immensely influential for half a century. The contemporary (1996) textbook that deserves close attention is the second edition of Peripheral Vascular Diseases, edited by Young, Olin, and Bartholomew from the Cleveland Clinic. This text is reader-friendly and, as its title suggests, places emphasis on clinical matters.

Reviewer: Marvin L. Sachs, MD, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Commentary: Vascular Medicine reflects the dramatic increase in fundamental research in vascular biology that has been seen in the past decade or so. It points the way to an expansion of understanding of and interest in the field of clinical vascular medicine. This field was neglected for two or three decades, during which time vascular surgery thrived. To take advantage of the rapidly accumulating new knowledge, more internists will have to be trained in vascular medicine and more patient-centered research will have to be developed.

The editors conceive of the vasculature as an organ, the largest in the body, that has profound effects (many only recently discovered) on all other organ systems. They have presented material that strongly supports this concept.