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Book Review

Skeletal Muscle: Pathology, Diagnosis, and Management of Disease

N Engl J Med 2003; 349:512-513July 31, 2003

Article

Skeletal Muscle: Pathology, Diagnosis, and Management of Disease
Edited by Victor Preedy and Timothy Peters. 716 pp., illustrated. London, Greenwich Medical Media, 2002. $199. ISBN: 1-84110-029-3

The goal of this book, according to its editors, is to present an “integrated view of the function, structure, and biology of skeletal muscle.” The editors note in the foreword that such a synthesis is long overdue, and to accomplish their goal, they have elicited contributions from an international group of about 100 experts.

The main strength of the book is the range of subjects it covers. This array of topics should make the book appealing to almost anyone who is interested in muscle and its disorders. As would be expected, there are descriptions of muscle diseases and their pathology. Some chapters are devoted to techniques for evaluating skeletal muscle, including newer techniques such as magnetic resonance imaging (MRI), computed tomography, and dual-energy x-ray absorptiometry. Discussions often cover experimental approaches, such as infrared spectroscopy in patients with mitochondrial myopathies.

About 40 percent of the body mass is skeletal muscle, and the diverse chapters in this book suggest the wide range of physicians who would benefit from some knowledge of muscle disorders. For example, the chapters about changes in the skeletal muscle of patients with heart, renal, or liver disease should be of interest to internists, and geriatricians might be interested in the chapters about the biochemical aspects of aging muscle and methods for increasing muscle strength in the elderly. As a long-distance runner, I found it relevant that an increase in the MB fraction of creatine kinase in the serum after a muscle strain could indicate damage to the skeletal, not heart, muscle, because slow-twitch fibers have elevated levels of creatine kinase MB after a muscle insult.

Beyond the variation in the quality and clarity of writing that is to be expected in a multiauthored textbook, the weaknesses of the book are poor editing and poor organization. One might expect the initial chapter to deal with normal muscle anatomy and physiology. Instead, it discusses metabolic myopathies. There is a good, basic, but brief discussion of normal muscle anatomy and physiology, but it appears relatively late in the book in a chapter about electromyography.

In general, the organization of the chapters does not reflect a thoughtful approach to a target audience. Indeed, it is unclear who the target audience is. This book is not an introductory textbook, in terms of either its organization or its content. The material is not detailed enough for basic scientists. For clinicians, the discussions are of inconsistent value. Electron-microscopical and MRI findings of oculopharyngeal dystrophy are shown, but there is no clinical presentation. Even in valuable clinical chapters, the discussion of therapy is often limited and is not always compensated for by a separate chapter discussing immunomodulating treatments. The chapter on the effects of scleroderma on skeletal muscle is interesting but seems out of balance for the clinician, because some basic clinical descriptions are missing.

The book contains interesting material and is based on an excellent idea. I hope that in future editions, the editors will correct the obvious deficiencies.

Morris A. Fisher, M.D.
Hines Veterans Affairs Hospital, Hines, IL 60141

Citing Articles (1)

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