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diseases, the cells responsible might be vulnerable to

clone-specific antibodies or other techniques which mayenable more effective treatment.

REFERENCES

1. Patterson JAK, Edelson RL. Cutaneous T-cell lymphoma and otherleukaemic and lymphomatous infiltrates of the skin. In: Fitzpatrick TB,Eisen AZ, Wolff K, Freedberg IM, Austen KF, eds. Dermatology ingeneral medicine, 3rd ed. New York: McGraw-Hill, 1987: 1086-118.

2. Mackie RM. Dermatological aspects of the leukaemias and lymphomas.In: Rook A, Wilkinson DS, Ebling FJG, Champion RH, Burton JL,eds. Textbook of dermatology, 4th ed. Oxford: Blackwell, 1986:1727-53.

3. Kadin ME. Common activated helper-T-cell origin for lymphomatoidpapulosis, mycosis fungoides, and some types of Hodgkin’s disease.Lancet 1985; ii: 864-65.

4. Goudie RB, Macfarlane PS, Lindsay MK. Homing of lymphocytes tonon-lymphoid tissues. Lancet 1974; i: 292-93.

5. Griesser H, Tkachuk D, Reis M, Mak TW. Gene rearrangements andtranslocations in lymphoproliferative diseases. Blood 1989; 73: 1402-15.

6. Gowans JL, Knight EJ. The route of recirculation of lymphocytes in therat. Proc R Soc Lond 1964; 159: 257-82.

7. Streeter PR, Berg EL, Rouse BTN, Bargatze RF, Butcher EC. Atissue-specific endothelial cell molecule involved in lymphocytehoming. Nature 1988; 331: 41-46.

8. Burnet FM. The clonal selection theory of immunity. Cambridge:Cambridge University Press, 1959: 122.

9. Goudie RB, Lee FD. Does occult monoclonal proliferation of non-malignant T cells cause secondary immunopathological disorders?J Pathol 1989; 158: 91-92.

10. Goudie RB, Jack AS, Goudie BM. Genetic and developmental aspects ofpathological pigmentation patterns. In: Berry CL, Grundmann E,Kirsten WH, eds. Current topics in pathology, 74. Dermatopathology.Berlin: Springer-Verlag, 1985: 103-39.

11. Goudie BM, Wilkieson C, Goudie RB. Skin maps in vitiligo. Scot Med J1983; 28: 343-46.

BOOKSHELF

Principles and Practice of Pediatric OncologyEdited by P. A. Pizzo and D. G. Poplack. Philadelphia:Lippincott. 1989. Pp 1129.$125. ISBN 0-397508212.

I opened Pizzo and Poplack’s huge tome with the

preconception that the day of the all-embracing opusmagnum had passed, at least for fast-moving subjects suchas paediatric oncology where the time latency to get reviewchapters into print can vitiate the whole venture. On my firstpicture-flick-through the illustration of the 1960sstereotactic frame for brain biopsy and a prehistoriccraniospinal irradiation immobilisation mask onlystrengthened this belief. Then I read the book.The first 323 pages include a succession of excellent

well-referenced reviews on the background to the subject.The high quality of these opening chapters-onepidemiology, genetics, cell biology, and pathology-lay asuperb foundation for the whole book. In the clinical sectiona chapter on special considerations for therapy in infants is auseful innovation. (I felt that only the chapters on radiationand surgical therapy carried some irrelevancies.) Similarly,the last 250 pages carry much wisdom on supportive careduring aggressive oncology treatment protocols; the

haematological and febrile neutropenia support chapters areparticularly good. The contributors on psychosocial supportare worthwhile but very US oriented. The chapter onantiemetics omits discussion of 5-HTg antagonistsprobably for "delay to print" reasons.The middle section of the book deals with the

management of specific cancers and is as comprehensive asany text I have read. It is generally up to date; however, inthe chapter on Wilms’ tumour the absence of discussion ofsalvage strategies for relapsing patients, in theneuroblastoma review the omission of MIBG data, and inthe germ cell tumour chapter the almost one-line referenceto etoposide-containing chemotherapy should be rectified inthe next edition. The discussion of Hodgkin’s disease mightusefully have expanded upon the philosophies of groupsusing clinical staging, involved field radiotherapy, andnon-alkylating agent (and non-ABVD) chemotherapy. TheEwing’s sarcoma chapter does not reflect the current

aggressive surgical strategies in this disease nor does it

attempt to place surgery and radiotherapy into the overallmanagement plan. The section on pituitary tumour

management is a very low point in the endocrine chapter,with its unhelpful and too brief description of dopamineagonist therapy and its advocacy of excessive dosage externalbeam radiotherapy. However, the rhabdomyosarcomachapter is excellent and reflects the better management ofthis disease in the USA than in Europe; contributors toSIOP studies should scrutinise the IntergroupRhabdomyosarcoma Study Group survival datasummarised in tables 30-17 and 30-18.

It is easy to find enough faults in 1100 large pages of text toearn oneself a "mean critic" accolade but I was veryimpressed by the background reviews on all aspects of

paediatric oncology; and, apart from my specific criticisms(mainly in individual disease chapters), I am delighted tohave this vast American work on my study shelf and shallconsult it over and over again.Department of Haematology and Oncology,The Hospital for Sick Children,London, UK P. N. PLOWMAN

The Molecular Biology of Neurological Disease

Edited by R. N. Rosenberg and A. E. Harding. London:Butterworths. 1989. Pp 263. /;39.50. ISBN 0-40702400X.

Butterworth’s have produced an excellent series of

monographs on "topics in which progress through researchhas altered the management of patients with neurologicaldisease". By necessity this volume (the ninth) is moreconcerned with areas that will, rather than already do, affectclinical practice.The first chapter, by the editors, reviews basic principles

and methods. It is entirely satisfactory for those with someknowledge of the techniques being discussed but I suspectwould be hard going for the clinically able but biochemicallynaive reader. As so often, the experts are overestimatingtheir audience’s knowledge. Subsequent chapters deal withgene expression in the brain, visualisation of brain

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messenger RNA, and the molecular biology ofneurotransmission. These are excellent reviews but arerather distant from the aims of the series. The aminoacid

sequence of the nicotinic acetylcholine receptor will notexcite most clinicians, whereas an illustration of the

proposed overall structure of the receptor channel mighthave offered something a little more tangible. Knowledge ofthe receptor structure has given us new insights into some ofthe congenital myasthenic syndromes and "antibody-negative" myasthenia gravis, but this is not discussed.

Finishing the more scientific part of the book are usefulreview chapters on gene expression in muscle, viral

neurotropism, neuro-oncogenes, and transgenic mice.The first chapter devoted to a clinical topic comes more

than half way through the book and deals with Josephdisease. This is not a condition that most neurologists willever see although it may give insight into other forms ofolivopontocerebellar atrophy. The chapter on Huntington’sdisease details the search for the gene but there is noimmediate clinical applicability. Peter Harper provides anexcellent review of the muscular dystrophies, taking thestory to the cloning of the Duchenne gene and anticipatingthe discovery of its corresponding protein, dystrophin.Inevitably there have been several major advances since hewrote. Most neurologists will have seen patients with muscleor multisystem disorders due apparently to mitochondrialdysfunction, and Harding and Holt’s chapter provides agood review of such conditions. Those who are puzzled bythe relation between certain HLA types and neurologicaldisease will be helped by Compston and Swingler’s review.

All neurological libraries should be collecting this series.This particular volume does not fit in quite so obviously asthe other titles with respect to the aims of the series, and Ifear that a clinician who has decided to spend time and effortto become conversant with the new genetics may find itsomewhat offputting, at least as a first venture into the area.However, those with a little knowledge will find it a usefulreview volume.

Department of Neurology,Radcliffe Hospital,Oxford OX2 6HE, UK DAVID HILTON-JONES

Assessment of the Behavioural Consequences ofHead Trauma

Edited by Muriel D. Lesak. New York: Alan R. Liss. 1989.Pp 224.$79.50. ISBN 0-845145061.

Head injury is common-twenty times more frequent thanspinal injury. The great majority of patients survive, manywith disability that results in loss of both job and friends,with devastating consequences for social and family life.The aftermath of head injury may include combinations

of physical disability, mental and physical slowing, impairedconcentration, attention, and memory, as well as alterationof behaviour (almost always for the worse). Such changes areoften difficult for people to understand and accept.Unfortunately, this includes many doctors, nurses, andtherapists: "he just won’t try"; "he soon loses interest";"there’s so little carry-over from his last session of therapy".This small volume contains a wealth of information about

the ill-effects of head injuries, both severe and mild, andabout ways of assessing patients that bring to light in anobjective way the considerable difficulties that head injurysurvivors often experience. Inevitably, there is some overlap

between chapters-for example, the Paced Auditory SerialAddition Test is described several times. The repetitiondoes, however, emphasise the importance of measuring therate at which patients process data, because impairment canbe found after even mild head injury.Even those who think they know a lot about head injury

will profit from reading this book. British clinicians willlearn of possibilities for patients that are not generallyavailable in their practice. There is an increasing tendency inthe UK to regard head injury rehabilitation as a service to beprovided outside of the NHS-presumably for those whohave access to insurance settlements or large private means.This is quite wrong when head injury is so common andpost-head-injury disability is so widespread. Health servicemanagers and policy makers should also read this book andfind out what can be done for patients. We may yet see theday when society will show real understanding and providehelp for all of those who have suffered after head injury, andnot just a privileged few.

Department of Clinical Neurosciences,Western General Hospital,Edinburgh EH4 2XU, UK J. DOUGLAS MILLER

The Kidney in Diabetes Mellitus

Edited by B. M. Brenner and J. H. Stein. Edinburgh: ChurchillLivingstone. 1989. Pp 234. 42.50. ISBN 0-44308632X.

Diabetes offers an unusual challenge to nephrologistsbecause they are able to watch the evolution of the renaldisease from the very beginning. Much has been learnt inthe past ten years and it is well summarised here.Two ideas underlie most current research. The first is

that patients with microalbuminuria will progress to renaldisease some years later. From this it is assumed thatmeasures which reduce the excretion rate of albumin beforethe onset of overt diabetic nephropathy are protective: thisremains to be proven. The second is that glomerular damageis mediated by "hyperfiltration". This term describes thehigh renal plasma flow and high glomerular filtration ratefound in newly diagnosed diabetes. Micropuncture studiesin diabetic rats have shown that it is associated with anincrease in the pressure of the glomerular capillaries,reduction of which protects the kidney. Hypotensivetherapy usually reduces the pressure of the glomerularcapillary, and angiotensin converting enzyme inhibitorsseem to be particularly effective. It is not clear how a rise inglomerular capillary pressure leads to progressiveglomerular sclerosis and this uncertainty is evident in thechapter on metabolic and biochemical mechanisms ofdiabetic nephropathy. Therefore, most of the telling clinicalstudies have been aimed at measuring the effect of goodglycaemic control (which reduces glomerular filtration rate),good blood pressure control (which reduces glomerularcapillary pressure), and a low protein diet (which does both)in patients with different stages of diabetic nephropathy.Several good chapters review these different studies.

However, we still do not know whether these advances areresponsible for the observed reduction in the proportion ofpatients who get diabetic nephropathy.The last section deals with treatment of patients with

end-stage renal failure and the clear message is that, despitemany advances, the quality and quantity of life of thesepatients remains poor. Of course, many patients manage toovercome their multiple handicaps and live a life that is

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rewarding to them and their families; others are lessfortunate. It is to be hoped that the present generation ofdiabetic patients will benefit from the three-pronged attackof good glycaemic control, effective hypotensive therapy,and the early introduction of a protein restricted diet. Thisbook is a useful guide to the current state of knowledge andmay thereby contribute to this goal.Royal Infirmary,Glasgow G4 05F, UK J. M. BOULTON-JONES

Colour Atlas of Paediatric Facial DiagnosisEdited by Trevor Mann. Bristol: Clinical Press. Dordrecht:Kluwer. 1989. Pp 195. 70. ISBN 0-8545570013 or

0-852007779.

As parents of most children with Down syndrome know,prompt diagnosis and a sensitive explanation of thecondition can do much to ease the initial shock and fear.Facial features are equally important in many other

disorders, but recognition and appropriate advice are oftensadly delayed. Why is paediatric facial diagnosis so

neglected? One of the reasons is the lack, until now, ofcarefully researched and well illustrated books such as DrMann’s. Mann believes that a general paediatrician withskills in facial diagnosis and dysmorphism would be in atleast as much demand as a colleague with a special interest ingastroenterology or renal medicine. After reading this bookmany may perhaps agree.Over 100 topics are featured, 27 from the neonatal period

and the rest from later childhood. Concise descriptions ofthe conditions draw on advice from seventeen specialists.Essential further reading is provided for each topic, oftenwith references to the original descriptions. All descriptionsare accompanied by good colour photographs, most of themoriginating from Mann’s own practice over 30 years.

This book is likely to become a classic, and will be apopular companion to the more formidable texts on

congenital malformations. Its scholarly content is enrichedby a sprinkling of clinical anecdotes which help fix a messagein the reader’s mind (eg, the severe pallor of a newborn babywith acute hypothermia who was rescued by the family dogafter live burial by her teenage mother). As a result the text isnever dull: doctors will consult it frequently-not as anunwelcome chore, but with pleasure.Ninewells Hospital,Dundee DD1 9SY, UK WILLIAM TARNOW-MORDI

Isolated Adult CardiomyocytesEdited by H. M. Piper and G. Isenberg. Boca Raton, Florida:CRC Press. 1989. 2 vols, pp 290. 122.50 and 117.00. ISBN0-849347416 and 0-849347424.

The numerous advances in the treatment of cardiovascularconditions in the past twenty years have been based on

technology (non-invasive imaging, angioplasty),pharmacology, and an improved knowledge of diseaseprocesses. Much early work was undertaken in intactanimals or isolated perfused hearts (the Langendorf orworking heart preparations). The limitations of experimentson multicellular preparations soon became apparent andisolated myocytes (single myocardial cells obtained fromheart muscle) have become a standard preparation for the

study of electrophysiology, drug effects, biochemistry, andpathophysiology. Lately, myocytes have been used forinvestigations of cell growth and interactions betweendifferent types of cell.

Single cardiac cells were first isolated over 37 years agoand Powell and co-workers isolated human ventricular cellsin 1981. Heart cells are attached to adjacent cells by acollagen network and by specialised regions called theintercalated disc which permit cell-to-cell electrical

signalling. The intercalated discs between cells are separatedby exposure of heart muscle to a low calcium, and thecollagen network by enzymes. The ends of the cellstherefore have holes in them, but these spontaneously healover so that single cells can be maintained in a contractingstate for many hours and even days, allowing the study of theproperties of the cells and the effects of interactions. Adultheart muscle cells do not divide in vivo and to date no one has

persuaded isolated adult (as opposed to neonatal) myocytesto divide in culture.

Piper and Isenberg provide here a sununary of currentknowledge of isolated myocytes. There are 24 chapters, 47contributors, and thousands of references. Several chapterscontain useful tables summarising, for example, methods ofisolation, the electrophysiological characteristics of cellsfrom different species, and the identification of receptors indifferent species. The two volumes will be standardreferences for those working with isolated myocytes and forthe clinical scientist. They are not for the casual reader or forthe clinically committed physician. They are heavy inweight and content. They are beautifully produced and are apleasure to handle, but have a commensurate price.National Heart and Lung Institute,London SW3 6LY, UK PHILIP A. POOLE-WILSON

Clinical Dermatology

J. A. A. Hunter, J. A. Savin, and M. V. Dahl. Oxford: BlackwellScientific Publications. 1989. Pp 272. £17.50. ISBN 0-632019557.

Clinical Dermatology, written by three experienceddermatologists, two from Edinburgh and one from

Minnesota, is clearly intended for a world-wide readership.The back cover tells us that it is suitable for a wide sweep ofmedical students, general practitioners, physicians, andtrainee dermatologists. All true! It does contain considerablymore than most clinical students learn or even than theirteachers aspire to instil into them; but it could usefully betreasured. The clinical messages are entirely conventional,sensible, practical, and reliable, with emphasis on diagnosisand therapy rather than on mechanisms. References andbibliography are left to larger books. But there are a score ofcomparable small or middle-sized books on clinicaldermatology, at least nine from other highly reputablesources. In what way does this one differ? Perhaps the mainfeature is the very elegant spacious lay-out, the text brokenup by over 300 excellent colour photographs and diagrams,tables, flow charts, and pithy, even witty, learning points.Inevitably all this involves a larger format (too big for thestudent’s pocket) and a price a little above the average, albeitreasonable. Personally I consider it a good buy. One veryminor point but often misspelt elsewhere as well as

here—Mohs or Mohs’ but never Moh’s surgery.

Addenbrooke’s Hospital,Cambndge CB2 2QQ, UK R. H. CHAMPION