James C. Eisenach, M.D., Editor.

Nitric Oxide and Radicals in the Pulmonary Vasculature. Edited by E. K. Weir, S. L. Archer, and J. T. Reeves. Armonk, New York, Futura Publishing, 1996. Pages: 509. Price:$85.00.

Nitric oxide (NO), a simple free radical molecule, was classified for many years as a noxious air and smoke pollutant, but since 1986, it has become an exponentially increasing focus of biomedical research. (Figure 1). The seminal observation that NO was endothelium-derived relaxing factor, and that NO was involved in the regulation of blood pressure, was also important as a neurotransmitter, and functioned as a defensive molecule to kill invading microorganisms has stimulated an enormous variety of research projects. The discovery of the use of inhaled gaseous NO as a selective pulmonary vaso- and bronchodilator rapidly transported this molecule into the fields of anesthesiology and critical care medicine, where we currently use it as an experimental therapeutic agent to reverse pulmonary hypertension and improve ventilation-perfusion matching in the lung. Nitric oxide interacts with oxygen and oxygen-derived molecules and radicals in the lung, reducing toxic effects. Balancing its beneficial roles, NO can bind with oxygen-derived superoxide to form the toxic radical peroxynitrite.

Figure 1. Number of references retrieved from Medline-search (9/96), using the keywords “nitric oxide” or “nitric oxide and lung.”

Figure 1. Number of references retrieved from Medline-search (9/96), using the keywords “nitric oxide” or “nitric oxide and lung.”

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Drs. Weir, Archer, and Reeves compiled the results of their own research studies and the contributions of 66 authors from 14 states, Canada, and five European countries within the 27 chapters of this hardcover book. This compendium compresses an enormous variety of information (e.g., 1,700 references) between its covers. Unfortunately, it contains neither an introduction nor a preface by the editors. Each chapter appears to be written independently, some in the style of a review article, some original manuscripts with detailed methods. The 137 figures often have long legends, and many seem reprinted from the original reports. The 17-page index is quite inclusive and useful.

After an initial review of the chemistry and physiology of oxygen and oxygen-derived species, 15 chapters compose a section describing a variety of physiologic and biochemical interactions of various radicals and NO with mammalian cells (i.e., lipid and protein oxidation, endothelial function, phosphodiesterase isoenzymes, oxidant defense mechanisms). The subsequent 10 chapters depict the close relation of NO metabolism to clinical pulmonary pathophysiology (i.e., inducible NO synthase in sepsis, the interaction with cyclic guanosine monophosphate, the regulation of pulmonary vascular tone, the roles of exhaled and inhaled nitric oxide in the neonate, lung-, and heart transplant patients).

Who should buy and read this book? The resident, fellow or attending, who uses NO in clinical anesthesiology or intensive care medicine, or the researcher with an M.D. or Ph.D. background who is beginning a NO-related project? Each could profitably read at least one or two chapters and obtain a very good review of their subject. Thereafter, they would need to read the well-cited original references and textbooks to more completely understand the more complex molecular and biologic-related chapters, or obtain a broader overview of the clinical experience reported in the literature. Almost every chapter can be read easily as an isolated report, but it is almost impossible to read this book from beginning to end, because it is not written in textbook format. Chapters jump between cellular biochemistry, molecular biology, physiology, and clinical experience. In our opinion, the book could have benefited from greater guidance of the reader through the various topics of the chapters. This book provides a broad overview of what is known about NO, radicals, and the lung in various research areas in 1996. As such, it serves as a compendium of reviews that would be a worthy addition to a reference library. Casual readers may find it difficult to navigate through the book; researchers may wish to rely on the original reviews or articles in the appropriate journals.

Wolfgang Steudel, M.D., Clinical and Research Fellow; Warren M. Zapol, M.D., Reginald Jenney Professor of Anaesthesia, Department of Anaesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114.