Reviews of Books Biochemical Disorders of the Skeleton ROGER SMITH, Radcliffe Infirmary and Nuffield Orthopaedic Centre, Oxford. London: Butterworths. 1979. Pp. 293. 19.50. CROSS-SPECIALISATION is especially valuable in the related branches of orthopaedic surgery and metabolic bone disease, but textbooks along these lines usually come to be written either by orthopaedic surgeons delving, it often seems to the reader, into foreign soil or by chemical pathologists and endocrinologists who have little feel for the clinical problems. Orthopxdic physicians are thin on the ground. Few of them have as much experience as Dr Roger Smith at the Nuffield Orthopedic Centre and none is able to survey the subject with more clarity. "Biochemical disorders of the skeleton" may be synonymous with "metabolic bone disease" but the different title clearly seeks to dissuade the potential reader from thinking he is about to plunge into yet another update of research into calcium endocrinology of the kind that seem to appear every six months. It is hoped that this device succeeds, for this book describes clearly and concisely most of the disorders relevant to orthopaedic surgery that have, or are likely to be shown to have, their basis in structural and/or enzymatic biochemical disturbance. The book embraces common conditions, such as osteoporosis, osteogenesis imperfecta, and Paget’s disease, and the rare bone dysplasias, mucopolysaccharidoses, and conditions such as fibrogenesis imperfecta ossium and hypophosphatasia. Dr Smith’s own research interest has concentrated more on defects of bone matrix and collagen with the result that a new, and welcome, slant is introduced. Every section is concise and readable, and the book will appeal more widely than to the orthopaedic fraternity alone: biochemists, physicians, and medical students alike should find it satisfying. It is also profusely illustrated; the X-rays are well reproduced and in most instances the illustrations illuminate the text with precision. There are few omissions. Fluorosis is one; and in so informative a book the author might have been encouraged to use his clinical experience of "the osteogeneses imperfecta" to tackle the thorny problem of classification, instead of being satisfied with careful description of variable clinical features. The book will deserve a prominent place long after its final "stop-press" chapter on most recent research is out of date.

Cardiovascular Function and Applications. Edited by FRANCIS L. ABEL, and ERNEST P. MCCUTCHEON, University of South Carolina School of Medicine. Boston: Little, Brown. London: Quest. 1979. Pp. 424.


$35;/;23.4$. THIS moderately advanced textbook on the physiology of the cardiovascular system keeps to well-established mechanisms and has a bias to medical applications such as interpretation of the electrocardiogram. The groups of American stuy dents for whom it was written-second-year graduate students or medical students who have already taken a medical physiology course--do not have a close parallel in Britain, where the book will be of most value to third-year students in physiology

27. Hökfelt T, Elder R, Johansson O, Luft R, Nilsson G, Arimura A. Immunohistochemical evidence for separate populations of somato-statin-containing and substance P-containing primary efferent neurons in the rat. Neur-

oscience 1976; 1: 131-36. 28. Chan-Palay V, Jonsson G, Palay SL. Serotonin and substance

P coexist in of the rat’s central nervous system. Proc Nat Acad Sci USA 1978; 75:1582-86. 29 Lance JW, Anthony M. The cephalgias, with special reference to vascular and muscle-contraction headaches. In: Goldensohn ES, Appel SH, eds. Scientific approaches to clinical neurology. Philadelphia: Lea and Febiger, 1977: 1959-79. 30 Fozard JR. The animal pharmacology of drugs used in the treatment of migrane. J Pharm Pharmacol 1975; 27: 297-321. neurons

working for either medical or non-medical degrees, to candidates for higher degrees in medicine, and to people just embarking on research on the heart or blood vessels. The bookprovides a well-balanced and generally clear introduction to advanced study of cardiovascular function. It does not attempt to be analytical or to identify major areas of interest for future work. For example, indices of ventricular performance and ,their possible clinical value are described adequately, but their theoretical justification and the theoretical requirements for better indices receive little mention. The difficult subject of the mechanism of the cardiac action potential is well covered at a simple level, and is described in a way which will be comprehensible to readers with a basic understanding of electrochemistry of cell membranes. The book provides a useful bridge between undergraduate texts and research reviews. Specific research is not analysed in detail, but references provide an opportunity to go to original papers. Reviews and books which can provide more advanced general coverage are generally not given. Cirrhosis

Major Problems in Internal Medicine no. 17. By JOHN T. GALAMBOS, Emery University School of Medicine, Atlanta, Georgia. Philadelphia and Eastbourne: W. B. Saunders. 1979. Pp. 376.16. PROFESSOR Galambos follows conventional lines by outlining, in sequence, the aetiology, pathogenesis, and pathology of cirrhosis, the pathophysiology and clinical features, and then the presentation and management of the main complications of the

disease, including parenchymal failure, portal hypertension, encephalopathy, ascites, and hepatocellular cancer. He uses an aetiological classification of cirrhosis based on the 1974 meeting of the International Association for the Study of the Liver, in which most of the familiar disorders appear, some in unfamiliar groupings. The book reflects the author’s very wide experience with cirrhosis. He stresses the benefit of intravenous hyperalimentation in decompensated alcoholic cirrhosis, while eschewing the use of corticosteroids. He is critical of the role of immunological mechanisms in alcoholic liver disease and has an interesting, but confusing, concept of chronic hepatitis. The chapters on abnormal function in cirrhosis and on the evaluation and therapy of parenchymal failure are very good but the account of the clinical features of chronic liver disease is brief and disappointing, and the final chapter on cancer and cirrhosis is also superficial. While much of the book deals with the problems of hepatic cirrhosis regardless of aetiology there are concise sections which cover particular aspects of diagnosis and treatment for some of the more important specific causes of cirrhosis (e.g., hasmochromatosis and Wilson’s disease). This monograph contains a great deal of information tightly packed. An excellent feature is the clear recommendations made for management of the important complications of cirrhosis. The book can be commended to all clinicians who care for patients with cirrhosis.

Rheumatology and hnmunology The Science and Practice of Clinical Medicine, Vol. iv. Edited by A. S. COHEN, Boston University School of Medicine, Boston, Massachusetts. New York and London: Grune and Stratton. 1979. Pp. 497.$32.50.

THE combination of rheumatology and immunology in one volume reflects the obsession that rheumatologists have with the’ immunopathogenesis of inflammatory joint disease. Whether this emphasis will, in the long term, prove to be in the patient’s best interest remains to be seen. At present, however, the need to pursue the immunology of rheumatic diseases cannot be disputed. In this volume the scientific background comes off best. There is an impressive list of authors, many of them world authorities on their subjects. The first threequarters of the book includes many short, self-contained chapters which cover all the major aspects of rheumatological practice-from symptoms and local anatomical problems,



886 and descriptions of all the imporrheumatic diseases. The disadvantage of much repetition within the book is offset by the considerable advantage that each contribution can be read as a complete unit, with a few key references to aid entry to the literature. This formatis particularly suitable for description of the less common conditions, of which there are some very useful accounts. However, the sections


investigative techniques


themajor diseases, such as rheumatoid arthritis, osteoarthritis, and disc disease, are disappointing; here the emphasis seems to be on the scientific background, little space being left for detailed analysis of clinical manifestations and treatment. In this respect the book differs from many of its competitors which give greater emphasis to the important and difficult art of management of the rheumatic diseases. The last part of the book covers the scientific basis of immunological disease-the mechanisms of immunological damage, and diseases such as deficiency syndromes, allergic phenomena, and serum sickness. It is, in the main, a readable and authoritative account, which will be of great benefit to all who are not specialists in immunology. The book is beautifully bound and produced. The text is clear and concise, and the reproduction of X-rays, histological sections, and line drawings is of a high standard. Those wanting a good account of present-day knowledge on the background to, and nature of, rheumatic disease need look no further; those wanting a guide to the practical management of patients who are disabled or in pain might not be so tempted to purchase this book. on

Clinical Radiology in the Tropics PETER COCKSHOTT, McMaster University, Hamilton, Ontario, and HOWARD MIDDLEMISS, University of Bristol. Edinburgh: Churchill Livingstone. 1979. Pp. 232. 17.

"THis book is written

primarily for those working

in the expect that the contents will be useful to radiologists in other climes who have patients who come from, or have lived in the tropics" (from the preface). The same authors’ Tropical Radiology from the 1960s had similar objectives, and their new book is better still. There is a salutary introduction on the radiological staffing problems in the Third World. The text is then organised in large chapters by body systems. Soft tissues and bone diseases lead off, followed by the alimentary, respiratory, cardiovascular, genitourinary, and central nervous systems. Brief clinical and pathological sketches are given for each disease. The radiological discussion is illustrated by superb radiographs, including up-to-date material such as computerised tomographic scans. Dr Cockshott and Professor Middlemiss’ experience is prodigious, but they put it across in terse, simple paragraphs, and cut a clear path through confusing subjects such as the tropical aortitis syndromes. The Western reader is continually pulled up by the unexpected, and the nature and scale of the problems faced by his tropical colleagues is hammered home. Under "mycetoma" he will find not lung cavities but fascinating bone lesions; ascariasis affects hundreds of millions of people, and is so prevalent on barium examinations that it scarcely invites comment ; in India 15% of all barium studies are on patients with intestinal tuberculosis; in the world 200 million people suffer from urinary schistosomiasis. Cockshott and Middlemiss describe, discuss, and illustrate these awesome facts-there are more abnormal radiological lesions within this book of modest size than most Western Horatios have dreamt of, let alone seen. This text will be warmly welcomed by workers in the tropics to whom it is primarily addressed, and medical libraries elsewhere should own at least one copy, for it is certain to be well used.

tropical world, though


Functional Neurosurgery Edited by THEODORE RASMUSSEN, McGill University, Montreal, and RAUL MARINO, JR, University of Sao Paulo, Brazil. New York: Raven Press. 1979. Pp. 278.$28.60.

IT is difficult to find a satisfactory definition of functional neurosurgery, and certainly the introductory chapter of this volume will leave many people baffled. However, this weakness should not detract from the value of this book. There are 21

contributors and every one is an authority. The emphasis is on recent developments which depend on the increased potential of electronic equipment for the stimulation of, recording from, and ablation of small parts of the nervous system. Parallel developments have led to a better location of targets through stereoscopic angiography and computerised tomographic scanning. There is much in these developments that is of value to the research-worker interested in the limbic system and function of the basal ganglia. Knowledge of physiological responses and the modern stereotaetic devices enable neurosurgeons to place lesions accurately and to predict the response to treatment. This volume provides a perspective to these developments, but it is highly technical and will be of interest only to the specialist. The excellent chapters on electrocoagulation of the gasserian ganglion for the treatment of trigeminal neuralgia and on the treatment of pituitary disorders due to microadenomas and the review of the Montreal experience with cortical resection for medical refractory epilepsy will be of particular value and interest to practitioners who encounter these disorders. Other subjects covered include the neurosurgical treatment of movement disorders and spasticity and the use of electrical stimulation. In the chapter on surgical treatment of psychiatric and behavioural disorders there is a section devoted to the sociopolitical problems of psychiatric surgery, but this fails to distinguish adequately between the treatment of acquired illness and modification of sociallv undesirable behaviour, a confusion which bedevils clear thinking on this con-

troversial subject.

Haemorrhage, Ischaemia, and the Perinatal Brain Clinics in Development Medicine, Nos. 69/70. - By KexEa PAPE, Hospital for Sick Children, Toronto, and J. S. WIGGLESWORTH, Institute of Child Health, Hammersmith Hospital, London. London: Spastics International Medical Publications. Philadelphia : Lippincott. 1979. Pp. 196. 9.50.

THIS book is based on considerable experience and much research in a branch of medicine with which only pxdiatricians, neurologists, and neuropathologists have much contact. Other members of the profession do come across "spastics", but few understand what lesions have caused the spasticity, let alone have any idea of the pathogenesis of these lesions. The authors of this book have done a great service to their subspecialty by providing a detailed account ofhaemorrhagic and ischaemic lesions in the brains of these newborn infants, and by indicating when these lesions were probably formed and what factors may have contributed to their formation. Exactly how these factors produce haemorrhage or ischxmia is a great deal less clear. The authors make some suggestions for treatment (but are they worthwhile in those with already severely damaged brains?). They have more to suggest for prevention, which they rightly stress. Some knowledge of neuroanatomy and embryology (but not necessarily in great depth) is desirable for the reader of this book, which is the kind that should be in all psediatric, neurological, and neuropathological departments and should be read by all doctors who have anything to do with the physical and mental welfare of children. The layout is good and the reproduction of the illustrations cannot be faulted, except for those of the injection studies of the necropsy brain which had too many vessels overlying each other-simplification into diagrams here might have been better. New Editions The Use of Antibiotics 3rd ed. By A. Kucers and N. McK. Bennett. London: William Heinemann. 199. Pp. 1014. 25.00. Venereology & Genito-Urinary Medicine 2nd ed. By R. D. Catterall. Sevenoaks: Hodder & Stoughton. 1979. Pp. 211. 3.2$. Casualty Officer’s Handbook 4th ed. By David H. Wilson and Malcolm Hall. London & Boston. Butterworths. 1979. Pp. 294. 9.9$. The Normal Child 7th ed. By Ronald S. Illingworth. Edinburgh: Churchill Livingstone. 1979. Pp. 353. 9.00. The Human Nervous System 3rd ed. By Murray L. Barr. London. Harper & Row. 1979. Pp. 339.,6.95. Communicative Disorders Related to Cleft Lip-Palate 2nd ed. By Bzoch. Boston: Little Brown. London: Quest. 1979. Pp. 368.$16.50;


Hereditary angioedema.

885 Reviews of Books Biochemical Disorders of the Skeleton ROGER SMITH, Radcliffe Infirmary and Nuffield Orthopaedic Centre, Oxford. London: Butterwo...
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