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Pulmonary Circulation: Basic Mechanisms to Clinical Practice FREE TO VIEW

Maria L. Padilla
Chest. 2003;124(3):1183. doi:10.1378/chest.124.3.1183
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By J. M. B. Hughes and N. W. Morrell. London, UK: Imperial College Press, 2001; 320 pp; $58 (hardbound), $32 (paperback)

This is an excellent book destined to become an indispensable reference for students, researchers, and clinicians dealing with all aspects of the pulmonary circulation. The book is divided into two sections. Section I covers the basics of the pulmonary circulation, from structure to genetics, in a thorough, readable, and up-to-date manner. It begins with a delightful and greatly appreciated historical review of the important landmarks in the evolution of our knowledge of the pulmonary circulation. A chapter on vascular structure and function follows, describing the anatomic distribution of the vascular tree down to the level of the capillary network. The authors discuss morphologic features, forces, and mediators that impact the function of the vasculature in health and disease. The importance of the interstitium and matrix in relation to the vasculature is clearly addressed. Their discussion is organized so as to couple molecular biology with known anatomic, functional, and mechanical changes and with vascular remodeling in the pulmonary circulation. The chapters on the endothelium and smooth muscle are comprehensive and clearly detailed, and provide a sound underpinning for studying the mechanisms of, and the rationale for, new therapeutic modalities in diseases of the pulmonary circulation. The authors also discuss the frequently neglected bronchial circulation and its interplay with the pulmonary circuit.

Section II addresses the pulmonary and bronchial circulation in disease states. Here too, the authors have provided essential information in a concise style. They correlate disease states with basic science, and offer useful algorithms, examples, and tables for understanding the pathophysiology of disease and for the thoughtful investigation and management of patients. The chapter on pulmonary hypertension is particularly edifying and fairly inclusive. My only criticism would be the absence of in-depth discussion of secondary pulmonary hypertension in idiopathic pulmonary fibrosis/interstitial lung disease.

This is an impressive accomplishment for Drs. Hughes and Morrell, who seem to have authored the vast majority of the text: only two of the chapters list co-authors. In addition, the book is remarkable for the inclusion of extensive amounts of data, and its accuracy and consistency in format presentation. The use of a “learning points” section at the end of each chapter reinforces key facts. The illustrations were clear, easy to follow, and illustrative of the points made during the discussion. The references were divided into reviews and original articles, a nice touch, and most were fairly recent.

Pulmonary Circulation: Basic Mechanisms to Clinical Practice will be a treasured resource for everyone interested in learning about the pulmonary circulation in health and disease. Drs. Hughes and Morrell deserve our thanks for a valuable contribution to the pulmonary literature.




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