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1210-11.

13. Veronesi U, Luim A, Galimberti V, et al. Extent of metastatic axillaryinvolvement of 1446 cases of breast cancer. Eur J Surg Oncol 1990; 16:127-33.

14. Cant ELM, Shivas AA, Forrest APM. Lymph-node biopsy duringsimple mastectomy. Lancet 1975; i: 995-97.

15 Kjaergaard J, Blickert-Toft M, Anderson JA, Park F, Pederson BV, andthe Danish Breast Cancer Cooperative Group. Probability of falsenegative nodal staging in conjunction with partial axillary dissection inbreast cancer. Br J Surg 1985; 72: 365-67.

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breast cancer: results of a national survey by the American College ofSurgeons. Cancer 1980; 45: 2917-24.

17. Richards MA, O’Reilly SM, Howell A, et al. Adjuvant CMF in patientswith axillary node positive breast cancer: an update of the Guy’s/Manchester trial. J Clin Oncol (in press).

18. Atkins HJB, Hayward JL, Klugman DJ, et al. Treatment of early breastcancer: a report after ten years of a clinical trial. Br Med J 1972; ii:

423-29.19. Hayward JL, Caleffi M. The significance of local control in the primary

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recurrence rates following mastectomy. Eur J Surg Oncol 1986; 12:267-71.

21. Matthiem W, Bougeois P, Delcorde A, et al. Axillary dissection in breastcancer revisited. Eur J Surg Oncol 1989; 15: 490-95.

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BOOKSHELF

Paediatric EpilepsyEdited by Matti Sillanpaa, S. J. Johannessen, G. Blennow, andM. Dam. Petersfield, Hants: Wrightson Biomedical. 1990. Pp377. 45. ISBN 1-871816076.

A special interest in epilepsy has been apparent for manyyears among workers from Scandinavia, and is reflected inthe wide range of subjects tackled by local authors. Thesecontributions are supplemented by chapters on genetics,seizures in developing animals and in newborn babies, andneuropathology from US authorities; that on neonatal

seizures, which includes a challenging review of recentcontroversies in both diagnosis and treatment, is particularlygood.The descriptions of epileptic syndromes are very variable

in quality and make up the least successful section.

Nevertheless, the chapters on primary generalisedepilepsies, the Landau-Kleffner syndrome, juvenilemyoclonic epilepsy, progressive myoclonic epilepsy, andlocalisation-related epilepsies are instructive and well

produced. Investigative techniques are reviewed separately.Pedersen’s chapter on cranial computed tomography is

particularly comprehensive: the contributions on magneticresonance imaging, SPECT, and PET, although adequate,seem diffuse by comparison. The rather naive descriptionsof epileptic syndromes in the chapter on

electroencephalography detract from an otherwise usefulsection. Treatment of childhood epilepsy is covered well:chapters on the logical basis for the use of antiepilepticdrugs, monitoring of therapy and side-effects, behavioural

treatment, and selection of patients for surgery are allexcellent. Habilitation is discussed at length in relation topractice in Norway and, much more briefly, for each of theother Scandinavian countries.The editors clearly place a great deal of emphasis on

recent advances in our understanding of childhood seizuredisorders: few of their comprehensive array of referencespredate 1980. Paediatric Epilepsy is attractively producedand easy to read. General paediatricians will find it anexcellent and easily comprehensible source of up-to-dateinformation. Workers with a special interest in epilepsy willfind it an invaluable source of recent references.

Department of Paediatric Neurology,University Hospital of Wales,Cardiff CF44XW, UK K SHEILA J. WALLACE

Working in Partnership: Clinicians and Carers inthe Management of Longstanding Mental Illness

By Liz Kuipers and Paul Bebbington. Oxford: Heinemann.1990. Pp 172. /;12.95. ISBN 0-43301606.

Nobody who works with patients who have recurrent orchronic mental illness can fail to be aware of a largely silentarmy of therapists, the patients’ relatives and other non-professional carers. The adjective long-suffering is over-used but could almost have been invented for this group,where stoics and saints abound. Like the poor bloodyinfantry of all silent armies, they are usually forgotten apartfrom the few occasions when their work is highlightedtemporarily, perhaps by an investigative journalist or anaspiring playwright-a process which usually leads to

unctuous murmurs of admiration but no compensatoryaction.The authors of this timely paperback are aware of the

problem. Their main aim in writing the book is to remind

224

professional carers in the mental health services to takeaccount of the implications of recent research studies whenplanning and providing services. This research shows

consistently that, in both the short term and the long term,patients with the diagnosis of schizophrenia fare muchbetter with regard to their social function and symptoms ifthey live in a setting where there are low levels of criticalcomment, hostility, and emotional overinvolvement-aconcept now known as expressed emotion (EE). Patientswho live with others in high-EE households can also behelped by procedures to reduce EE in relatives and carers.Although schizophrenia has been the main subject for study,the course of manic-depressive illness, unipolar depression,anorexia nervosa, and senile dementia may show a similarrelation with EE. The authors describe the implications ofhigh EE in an educative and sometimes evangelical text,which extends the help given to relatives by reduction ofcritical emotion and overinvolvement, but also emphasisesthe importance of modifying attitudes, problem solving, andoffering a safe forum for the expression of frustrations andfears.The book draws heavily on the authors’ own research

experience; as this is almost exclusively concerned withschizophrenia, other chronic mental disorders are relativelyneglected and some, such as personality disorder and

organic brain disease, are not mentioned at all. Nevertheless,their recommendations are likely to apply to other disordersas much as to schizophrenia. There still remains a yawninggap between research and clinical practice, the reasons forwhich are only hinted at: a combination of inadequateresources, a lack of interest in psychosocial interventionsamong psychiatrists in particular, and a resigned acceptanceof the status quo by many carers is likely to be responsible.However, there are also indications from other studies inScotland and London that EE is less homogeneous than itfirst appears, and that the essential elements of goodintervention in families could be further refined. Theseissues are likely to be addressed in future editions butmeanwhile this book is certainly recommended as a worthyintroduction to a novel area of inquiry and practice.St. Charles’ Hospital,London W10 6DZ, UK PETER TYRER

Obstetric Genetics

By Zoltan Papp. Budapest, Hungary: Akademiai Kiado. 1990.Pp 627. 39. ISBN 963-0556898.

This readable English translation of the interactionbetween genetics, prenatal diagnosis, and fetal medicinewithin obstetrics is presumably intended for a broadobstetric audience. The content falls into three mainsections. The first deals with principles and techniques ofcytogenetics, embryology, biochemistry, and moleculargenetics. The second covers techniques of prenataldiagnosis, obstetric ultrasound, genetic counselling, andtermination of pregnancy. The last section is an

idiosyncratic account of a wide range of genetic diseases andfetal malformations with which the author is most familiar.The first section is a success: clear, informative, though

rather basic. The rest of the book suffers from over-

ambition ; for one author to review adequately all the

subjects covered would be an astounding achievement. Notsurprisingly, Papp does not succeed; the chapters onprenatal diagnostic techniques are poor and the others in thesecond and third sections are superficial.

The reproduction of photographs of pathologicalspecimens is of high quality, but the ultrasonographs arepoor and add little to the text. Long lists of diseases and vasttables also add little whereas diagrams of genetic principlesare excellent and extremely helpful. The book is widelyreferenced. In the first few chapters, the literature lists arelimited to relevant text, including both classic and recentpapers. However, as the chapters become shorter with lessfactual information, so the references expand to resembleunselected lists of virtually every paper written on thatsubject: occasionally this list is as long as or longer than thecontent of the chapter.

Overall, I found it difficult to decide who the book isaimed at. It is too basic for geneticists and perinatologists,and the reference lists are too unselective for non-specialists.One is left with the feeling that this is an undergraduate texton a postgraduate subject.Fetal Medicine Unit,UMDS, Guy’s Hospital,London SE1 9RT, UK DARRYL MAXWELL

Pediatric Endocrinology: a Clinical Guide

2Kd edition-Edited by F. Lifshitz. New York: Marcel Dekker.1990. Pp 1104.$195 (North America),$234 (elsewhere). ISBN0-824781597.

This new edition of Pediatric Endocrinology follows thegeneral format of the first edition published in 1985, but thetext has been largely rewritten and greatly expanded so thatit now covers most aspects of paediatric endocrinology, andis more than double the weight (and the price) of theoriginal. As before, Dr Lifshitz has gathered a very

distinguished list of clinicians-mostly from NorthAmerica-to contribute individual reviews. In the first

section of the book, on growth disorders, new chapters havebeen added on failure to thrive in early infancy,psychological aspects of short stature, the skeletal dysplasias,and tall stature and associated syndromes. The secondsection, on the adrenals and sexual development, has newchapters on hirsutism, polycystic ovaries, hypogonadism,and chromosomal disorders. The sections on thyroiddisorders, calcium metabolism, and diabetes and

hypoglycaemia have been largely rewritten and brought upto date. Chapters on obesity and eating disorders have beenadded to the final section on miscellaneous conditions, as hasa chapter on growth standards for normal children andchildren with conditions such as Down’s syndrome orachondroplasia.

Pediatric Endocrinology is an easy book to read. Thestandard of virtually all the contributions is excellent andeach chapter ends with a list of appropriate references (up to1988), largely from US journals. There is little unnecessaryduplication or repetition between different chapters and,while there are not many clinical photographs, the layout ofthe numerous useful tables and figures is generally clear.There are few misprints and the book has an extensive andaccurate index. This is not a book to be used for a quickanswer to a clinical problem, as most of the chapters need tobe read in their entirety to be of full value. This new editionwill clearly be of interest to adult and paediatricendocrinologists, but will be especially useful for non-specialists who wish to update their knowledge of paediatricendocrinology or to prepare themselves for more detailedstudy of an aspect of endocrine disease in childhood.

Hospitals for Sick Children,London WC1 N 3JH, UK DAVID B. GRANT