Reviews and notices of books

The Etiology of Human Breast Cancer A. N . Papaioannou, Athens. 2 4 0 ~ 165 mm. Pp. 228, with 2 illustrarions. 1974. Berlin: Springer- Yerlog. DM.56. THIS is an excellent book and its arrival on the oncology scene is timely. The past few years have produced a wealth of infor- mation and speculation concerning the aetiology of human mammary cancer. In this book the author meticulously sifts and analyses all the available evidence and presents his con- clusions to the reader in a clear and concise manner.

The author looks first a t endocrine considerations and in some ways this is the most provocative part of the story. To quote the author: ‘Endocrine factors play a n unquestionable, clearcut and fundamental role in experimental breast carcino- genesis.’ The evidence in humans is less convincing, but never- theless many of the factors which undoubtedly influence the relative risk of developing the disease have an endocrine basis. The author makes a very reasoned evaluation of these factors and gives due prominence to the excellent international epi- demiological studies of MacMahon and his colleagues.

Chapters 2 and 3 deal with genetic and viral considerations respectively. The former is full of interesting detail, much of it anecdotal. The latter has a more scientific flavour and pro- vides a thoughtful account of a subject which has interested research workers for many decades.

In the fourth and last major chapter of the book the author devotes disproportionate space to immunological considera- tions, and this is perhaps understandable in view of his own special interests, but the welcome objectivity of the previous chapters is lost as a result. The list of references at the end of this particular chapter is formidable and many are irrelevant to the main theme of the book.

The concluding section deals with a number of miscellaneous factors which may be involved in the aetiology of breast cancer. Of particular interest is a short but intriguing examination of the role of ‘psychological stress’ in carcinogenesis.

This book is a welcome addition to the already vast literature on mammary cancer and is unreservedly recommended to all who have an interest in the subject.

IAN BURN

Radiology of Bone Diseases George B. Greenfield, Chicago. Second edition. 210 x 280 mm. P p . 667+xui. Illustrated. 1975. Oxford: Blackwell Scientific Publications. f27.50. IN the second edition of this most valuable and useful book on the differential diagnosis of bone disease, Dr Greenfield has greatly expanded the text, brought the topic up to date and added a new chapter on arthritides. The author has adhered to the concept of presenting his material according to radio- logical features of the various conditions, clearly describing each entity in some detail, profusely illustrating it and adding helpful basic clinical, biochemical and pathological informa- tion.

The main sections of the book include a general description of an analytical approach to bone radiology, and loss of bone density, including osteoporosis, osteomalacia, hyperpara- thyroidism and other entities. There is a comprehensive chapter on alterations of bone texture, an extensive description of lesions affecting the epiphyseal region and an equally com- prehensive section on changes in size and shape of bone. There I S a very helpful chapter on the cardinal radiographic features which deals very fully with the main diagnostic appearances of specific conditions. Bone tumours are dealt with in a section on solitary lesions. There is a useful chapter on soft tissue appearances and finally a very comprehensive section on joint disease.

The part of the book dealing with metabolic bone diseases has been completely rewritten and a great deal of new informa- tion has been presented on bone changes in renal disease. There is a fully illustrated description of the various types of bone dysplasia, which are well annotated and tabulated.

As in the first edition, the large number of illustrations are of high quality, well chosen and used as a key to interpretation with clear, descriptive captions. Each chapter carries its own bibliography, which is very extensive, bringing the radiological literature well up to date.

The book is eminently readable, a mine of information, and although expensive it is nevertheless a valuable addition to one’s library. It will certainly be of great help to orthopaedic surgeons, radiologists and all who are interested in bone disease. Dr Greenfield has done a great service to the speciality of radiology in producing this monumental text which can be highly recommended in every respect.

Advances in Surgery, Volume 8 Edited R. M . Zollinger, Columbus, Ohio. 230 x 155 mm. Pp. 333 tx iu . Illustrated. 1974. London: Lloyd-Luke. f 13.50. THIS volume deals with a number of important topics where significant change has taken place in surgical practice. It would be difficult to criticize the scholarly review on the surgical treatment of duodenal ulcer by Professor Goligher or the section on hepatic resection by William P. Longmire. The sections on biliary atresia, the surgical approach to nutritional problems and the management of malignant melanoma are perhaps more controversial, but nevertheless provide a great deal of useful information and much food for thought.

There are two excellent sections, one on the effect of halogen anaesthetics on liver metabolism and the immune response and the other on the contributions of immuno-assay to surgery, both of which provide full information on two rather complex changes which affect the management of surgical patients.

The final sections on problems in the intensive care unit and the treatment of wound failure would be of interest to all surgeons.

This book continues to maintain the reputation of its predecessors in providing the surgeon with up-to-date infor- mation on topics of general interest.

R. E. STEINER

C . G. CLARK

Clinical Embryology for Medical Students Richard S. Snell, Washington. Second edition. 185 x 255 mm. Pp. 481. Illustrated. 1975. Boston: Little, Brown and Co. $12.50 paper, $17.50 cloth. THE first edition of this book in 1972 drew attention to the value of embryology during the student’s clinical studies, par- ticularly in relation to congenital abnormalities. The text and its accompanying line drawings provided the essentials of developmental anatomy in an attractive, agreeable way and appealed to the student. The extra 120 pages in the second edition are accounted for by the inclusion of many excellent photographs of congenital abnormalities and by the introduc- tion of a series of clinical problems or exercises at the end of each chapter. In attempting these, the student is expected to test his knowledge of embryology in the clinical context and thereby appreciate its relevance. To derive the full benefit of the scheme, however, it will be necessary to mix embryology with clinical study (or vice versa) in far greater measure than most curricula allow at present.

Stress Fractures Michael Devas, London. 195 x 250 mm. Pp. 240+uiii. Illus- trafed. 1975. Edinburgh: ChurchiN Livingstone. €15. THIS monograph represents a very personal and unique experi- ence of several hundred stress fractures and avulsions which the author has described from ‘purely’ clinical and radiographic standpoints. It began over 15 years ago when the Stress Fracture Bureau at the Middlesex Hospital was set up. There are examples from almost every long and short mature bone of the human skeleton, and all are well illustrated and dis- cussed. Even the horse and the greyhound are shown to have their problems of a similar nature. Biopsy material is naturally very limited and this makes it difficult to add to present day knowledge about the aetiology or indeed aetiologies of these conditions. Under the heading of ‘Epilogue’ Mr Devas con- siders very carefully the effects of muscle contraction, and osteoporosis, and their interaction. He also emphasizes that a great deal of experimental work has yet to be done to demon- strate why cellular and hence structural failure has occurred.

The literature has been thoughtfully reviewed and such a grouping for this relatively rare pathology is most helpful.

JOHN MCKENZIE

R . B . OUTHIE

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