Textbook of Diabetic Neuropathy
http://www.100md.com
《新英格兰医药杂志》
Neuropathy is one of the earliest — and most common — chronic complications of diabetes. For some patients, the condition is simply an annoyance and results in occasional numbness and tingling here and there. But neuropathy can forebode infection, loss of a limb, death as a result of peripheral neuropathy and vascular disease, and dangerous disturbances in blood pressure, nutrition, and urinary tract function. All this is true because diabetic neuropathy affects components of the autonomic nervous system that regulate the functioning of the heart, the vasculature, and the gastrointestinal and urinary tracts. It can be a source of heartbreak, since, in conjunction with peripheral vascular disease, it causes impotence and incontinence. Thus, diabetic neuropathy can affect a wide spectrum of systems with varying degrees of severity.
This textbook will therefore be a welcome addition to the libraries of practitioners who want to keep up to date on the rapid changes in diabetes research and care. The book provides basic information regarding the pathophysiology of diabetes and the anatomy and biochemistry of the nervous system and offers clinical descriptions and guidelines for treatment of diabetic neuropathy. It also explores the epidemiology and socioeconomic aspects of the condition and provides recommendations for structured care. The pluses of this multiauthored book include the breadth of its point of view; the minuses include the variations in the fluidity of the writing. The book, which is well referenced, encompasses research findings through late 2002. Informed readers will view some chapters as reflecting content that is widely accepted. Other chapters will be seen as heavily emphasizing the authors' own work, some of which is widely accepted and some of which is not. Thus, this is really a textbook for the critical reader who is able to judge which approaches are "gospel" and which require a "grain of salt."
The sections dealing with the treatment of peripheral neuropathy, which are likely to be of the greatest interest to the general practitioner, provide a fair reflection of the state of the art, with both a mechanistic approach to therapy and a practical approach to the care of the patient who has particularly severe pain. The section on autonomic neuropathy of the gastrointestinal tract considers both drug and nonpharmacologic therapy and alludes to electrical pacing without offering any details. Sections on such syndromes as hypoglycemic neuropathy and neuropathy of rapid glycemic control discuss potential disease mechanisms but ultimately do not explain these poorly understood phenomena.
As a diabetes investigator, teacher, and clinician, I found this book to be an intriguing resource on diabetes in general and on basic neurobiology; contrary to its title, it is not simply a textbook on neuropathy (for which I value an update). For the graduate student, the basic background information about diabetes will complement the primary literature; for the medical student, the comprehensive clinical portions of the book will be useful and timely.
I would certainly recommend this book to librarians in medical schools, hospitals, and research institutes, as well as to clinicians and investigators who have a strong interest in diabetes, neurology, or endocrinology.
Robert M. Cohen, M.D.
University of Cincinnati Medical Center
Cincinnati, OH 45267-0547
robert.cohen@uc.edu(Edited by F. Arnold Gries)
This textbook will therefore be a welcome addition to the libraries of practitioners who want to keep up to date on the rapid changes in diabetes research and care. The book provides basic information regarding the pathophysiology of diabetes and the anatomy and biochemistry of the nervous system and offers clinical descriptions and guidelines for treatment of diabetic neuropathy. It also explores the epidemiology and socioeconomic aspects of the condition and provides recommendations for structured care. The pluses of this multiauthored book include the breadth of its point of view; the minuses include the variations in the fluidity of the writing. The book, which is well referenced, encompasses research findings through late 2002. Informed readers will view some chapters as reflecting content that is widely accepted. Other chapters will be seen as heavily emphasizing the authors' own work, some of which is widely accepted and some of which is not. Thus, this is really a textbook for the critical reader who is able to judge which approaches are "gospel" and which require a "grain of salt."
The sections dealing with the treatment of peripheral neuropathy, which are likely to be of the greatest interest to the general practitioner, provide a fair reflection of the state of the art, with both a mechanistic approach to therapy and a practical approach to the care of the patient who has particularly severe pain. The section on autonomic neuropathy of the gastrointestinal tract considers both drug and nonpharmacologic therapy and alludes to electrical pacing without offering any details. Sections on such syndromes as hypoglycemic neuropathy and neuropathy of rapid glycemic control discuss potential disease mechanisms but ultimately do not explain these poorly understood phenomena.
As a diabetes investigator, teacher, and clinician, I found this book to be an intriguing resource on diabetes in general and on basic neurobiology; contrary to its title, it is not simply a textbook on neuropathy (for which I value an update). For the graduate student, the basic background information about diabetes will complement the primary literature; for the medical student, the comprehensive clinical portions of the book will be useful and timely.
I would certainly recommend this book to librarians in medical schools, hospitals, and research institutes, as well as to clinicians and investigators who have a strong interest in diabetes, neurology, or endocrinology.
Robert M. Cohen, M.D.
University of Cincinnati Medical Center
Cincinnati, OH 45267-0547
robert.cohen@uc.edu(Edited by F. Arnold Gries)