JOURNAL OFCLINICAL

PATHOLO.GYTfrJWwindq'urA Cwim4GdcPoat&dqsi

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Editor: David LoweAssistant Editor: Helen HolzelTechnical Editor: Caroline WhiteEditorial Assistant: Mavis BurrellBMA House, Tavistock Square, London WC 1H 9JR; Tel 071 383 6209

DA WinfieldB Woodcockand the Editor,Bnitish Medical lournal

Former Editors

Association ofClinical Pathologists

AG Signy 1944-72 HEM Kay 1972-80 G Slavin 1978-88 John Lilleyman 1986-92

President: Professor FD Lee; President-Elect: Dr WR Timperley; Vice-Presidents: Dr JP O'Shea, Dr PJ Fitzpatrick;Chairman of Council: Dr DM Harris; Honorary Secretary: Dr AJ Malcolm; Honorary Treasurer: Dr AC AmesGeneral Secretary: Mrs JS Turner, 221 Preston Road, Brighton BN1 6SA; Tel: (0273) 561188; Fax: (0273) 541227

Information for Authors

Papers should be sent in duplicate to the Editors,Journal of Clinical Pathology, BMJ Publishing Group,BMA House, Tavistock Square, London WC1H 9JR.Telephone numbers: 071 383 6209/6214. Fax number:071 383 6668. They should be typewritten with doublespacing on one side of the paper only. The names of theauthors with initials or one forename should be followedby the name of the institution where the work was per-formed. An indication of the position held by each authormust be given in an accompanying letter to the Editors,and this should include the signatures of all authors onpapers with joint authorship. Guidelines on authorshipare detailed in J Clin Pathol 1986;39: 110. Results shouldnot be shown as both tables and graphs, and histogramsshould not be used where tabular information would bemore appropriate.ARncLEs Papers should usually be no more than 2000words long and should report original research of rele-vance to the understanding and practice of clinical pathol-ogy. They should be written in the standard format with astructured abstract. The abstract should contain the head-ings Aims, Methods, Results and Conclusions and be nomore than 300 words long. The body of the paper shouldhave separate sections for the introduction, the methodsand the results, and the discussion. If statistics are usedthe methods and confidence intervals should be stated.Authors are urged to seek expert advice if in doubt.Occasional Articles have a less rigid format, being1500-2000 words in length. They are usually invited bythe editors, though unsolicited submissions will be con-sidered. Single case reports and brief papers (such asthose describing negative findings) will usually be consid-ered only as Short Reports. The format for these is anunstructured 150 word summary, up to 1500 words oftext, up to two tables or figures (or one of each) and nomore than 10 references. Letters to the Editor should nor-mally refer to previously published papers or make somepoint about the practice of pathology. They are notintended to be a vehicle for the presentation of new dataunrelated to earlier Journal articles.

ACKNOWLEDGMENT OF RECEIPT A stamped addressedpostcard should be enclosed for return to the author asacknowledgment of receipt of the manuscript. Overseasauthors should enclose international reply paid coupons.ETHICS The critical assessment of papers submitted willinclude ethical considerations.

ILLusTRTnoNs Diagrams should be reproduced photo-graphically. The legends for illustrations should be typedwith double spacing on a separate sheet. Photographs andphotomicrographs must be of high quality in full tonalscale on glossy paper, and unmounted. Only salient detailshould be included. Areas without tissue ("background")should be as near white as possible. The width of illustra-tions should be 6-7 cm, 10-2 cm, 13 7 cm or, in excep-tional circumstances, 17 4 cm, to fit the column layout of

the Journal. Colour reproduction is welcomed and is sub-sidised by the Journal; for details of costs to the authorplease contact the Journal office.ABBREVIATIONS Abbreviations must be spelt out on firstuse or be accompanied by explanation in the text. Theuse of non-standard abbreviations and acronyms shouldbe avoided.Symbols and abbreviations should be in the Vancouverstyle.UNITS All measurements shotuld be given in SI units.

REFERENCES The references must be given in theVancouver style.REPRINTS These may be ordered when the proof isreturned. Prices for large numbers of reprints available onrequest.NOTICE TO ADVERTISERS Applications for advertisementspace and for rates should be addressed to theAdvertisement Manager, Journal of Clinical Pathology,BMJ Publishing Group, BMA House, Tavistock Square,London WC IH 9JR.The 7ournal of Clinical Pathology is published monthly.The annual subscription rates are £188.00; USA$341.00. Orders should be sent to The SubscriptionManager, Journal of Clinical Pathology, BMJ PublishingGroup, BMA House, Tavistock Square, London WC1H9JR. Subscribers may pay for their subscriptions byAccess, Visa, or American Express, by quoting on theirorder the credit or charge card preferred, together withthe appropriate personal account number and expiry dateof the card. Orders can also be placed with any leadingsubscription agent or bookseller. (For the convenience ofreaders in the USA subscription orders, with or withoutpayment, may also be sent to the British Medical Journal,Box 560B, Kennebunkport, Maine 04046, USA. Allenquiries, however, must be addressed to the publisher inLondon.) All enquiries regarding air mail rates and singlecopies already published should be addressed to the pub-lisher in London.COPYRIGHT G 1994 Journal of Clinical Pathology. Thispublication is copyright under the Berne Convention andthe International Copyright Convention. All rightsreserved. Apart from any relaxations permitted undernational copyright laws, no part of this publication may bereproduced, stored in a retrieval system or transmitted inany form or by any means without the prior permission ofthe copyright owners. Permission is not, however requiredto copy abstracts of papers or of articles on condition thata full reference to the source is shown. Multiple copyingof the contents of the publication without permission isalways illegal.Second class postage paid, at Rahway N.J. Postmaster tosend address changes to: Journal of Clinical Pathology c/oMercury Airfreight International Ltd. Inc., 2323Randolph Avenue, Avenel, NJ 07001, USA.ASTM CODEN:JCPAAK 47(6) 481-572 (1994) ISSN0021-9746.

EDITORIALBOARD

AJ BellinghamCC BirdAW BoylstonDR DaviesFV FlynnDJ Goldie

J GoughMR HaeneyJHE HayekFD LeeJS LilleymanAJ Malcolm

DY MasonJH McCarthyRN PeelRS PereiraA RaineyGL Ridgway

C RobertsRC SpencerJ StuartJ SwansonDR TurnerDL Williams

Published by BMJPublishing Group andprinted in England byEyre & SpottiswoodeLtd, London andMargate

A School of the University ofLondon

Royal PostgraduateMedical SchoolDiploma in Clinical

PathologyThis course is designed to provide an advanced training in one or more

disciplines of clinical pathology. It is a modular course (ChemicalPathology, Haematology, Histopathology, Immunology and Microbiology)taught on a full-time basis. Each module lasts for approximately fivemonths: the MICROBIOLOGY and IMMUNOLOGY modules are

taught every year between February and July; the remaining three modulesare offered in altemate years HAEMATOLOGY in the even years (1994,1996, etc) and HISTOPATHOLOGY and CHEMICAL PATHOLOGYin the odd years (1995, 1997, etc) in the months October to February.In order to be awarded the Diploma in Clinical Pathology a candidatemust pass the University of London's examination in two of the fivesubjects.Each module is also available as a post-experience course in its own rightfor which students may register without being candidates for the Diploma.CHEMICAL PATHOLOGY

This module provides good grounding in the biochemical and molecularbases of disease, modem analytical methods used in laboratory diagnosis,and the selection, performance and interpretation of diagnostic tests. Itincludes sections on: principles of laboratory practice and quality assurance;kidney functions - liver functions; fluid, electrolytes, acid/base balance;endocrinology - clinical enzymology; lipids, proteins; paediatricbiochemistry and inborn errors of metabolism; molecular biologicaltechniques in disease investigations.The Chemical Pathology module provides the ground-work for candidates

intending to enter for higher degrees and diplomas, including those of the

Royal College of Pathologists, and is also recognised as the first part of theRPMS Diploma in Chemical Pathology.HAEMATOLOGY

This nmodule covers both laboratory and clinical aspects of diagnosis and

management of blood diseases.

The course consists of an intensive programme of formal lectures,laboratory practicals with detailed protocols, slide seminars, clinical case

discussions and research seminars. The following topics will be included:

principles of laboratory practice and quality assurance; blood cell

morphology; molecular biology of blood cells; erythropoiesis and anaenmias;leucocytes and leukaenmias; lympho-proliferative disorders; morphologyand pathology of the bone marrow; haemostasis; haemolytic disorders;immunohaematology and blood transfusion.

HISTOPATHOLOGY

This module is designed to give a comprehensive coverage of systemicpathology, consisting of: 2 weeks of training in modern histologicaltechniques, 2 weeks cytopathology and 15 weeks of diagnostichistopathology. There are extensive reference and homework slide setsand time is given to slides seminars where practical problems anddifferential diagnoses can be discussed. Instruction in macroscopicpathology anid autopsy techniques is also included.

IMMUNOLOGY

This module provides an advanced academic and laboratory training in:modern cellular and molecular immunology, with emphasis on theinterface between the basic and clinical aspects of the subject; a range ofmodem immuniological techniques - including monoclonal antibody andDNA technology as well as more traditional methods; the clinical

applications of these techniques - as in immunoassays, differential diagnosis,cell sorting, clinical transplantation and tumour imaging.MICROBIOLOGY

This module consists of four weeks of training in systematic bacteriologyand microbial genetics, eight weeks in clinical bacteriology and five weeksin clinical virology. Medical mycology and parasitology wvill also beincluded in the course. Much of the course is spent in practical exercises

designed to give experience in all branches of clinical microbiology as

actually practiced in a service laboratory. Aspects of laboratoryadministration and the control of hospital infections will be included.

For application forms and further details please contact:

The School Registry, Royal Postgraduate Medical School,Du Cane Road, London W12 ONN.

Telephone +44 (0) 81-740 3118; fax +44 (0) 81 743 6764.

A School of the University of London

Royal PostgraduateMedical School

Cardiovascular Pathology Course19 - 23 September 1994

his is a one week practical course in vascular and cardiac pathology designedTfor trainees preparing for the MRCPath. examination. consultant pathologists.vascular and cardiac surgeons.

Lectures will include practical aspects and recent advances in cardiovascularpathology. Topics include normal vascular structure and function: arteriosclerosis;atherosclerosis: theories of atherogenesis: the vasculitides: vascular tumours:aneurysmal disease: practical aspects of vascular surgery: normal cardiac morphol-ogy: congenital heart disease: cardiac conducting system: ischaemic heart disease:myocarditis: cardiomyopathy: valvular heart disease: transplantation pathology:practical aspects of sudden cardiac death and medico-legal aspects of examinationof the cardiovascular system.

Practical sessions on these topics include slide studies. examination of fixed heartspecimens and videos.

A course book will contain handouts on the lectures and practicals and appropriatereferences on each topic.

Lecturers:Professor RH Anderson (London)Professor ME Billingham (Stanford)Dr N Cary (Papworth)Dr CDM Fletcher (St Thomas')Dr SY Ho (NHLI)Dr MJ Mitchinson (Cambbndge)Dr DV Parums (RPMS)

Course Organiser:

Course fee (inc. catering):

Professor AE Becker (Amsterdam)Dr M Burke (Harefield)Professor J Fallon (MGH. Boston)Dr PJ Gallagher (Southampton)Mr B Keogh (RPMS)Dr P Nihoyannopoulos (RPMS)Mr N Standfield (RPMS)

Dr Dinah V Parums

£330.00

Further details from: Wolfson Conference CentreRoyal Postgraduate Medical SchoolHanntermith Hospital

Tel: 081 740 3117/3245 Du Cane RoadFax: 081 740 4950 London W12 ONNPlaces wil be allocated on a first come first served basis and wil be limited to 40 participants

This course receives fuoi US-CME accreditation

A School of the University of London

Royal PostgraduateMedical School

Diagnostic Histopathologyof Breast Disease26th - 30th September 1994

A week long course designed for pathologists at Consultant and SeniorRegistrar level, and suitable for the final examiiination for M.R.C.Path. The course will provide a comprehensive coverage of the

histopathology of breast disease, wvith special emphasis on areas wvhich posediagnostic difficulties, and is based on the extensive referral collection ofProfessor J G Azzopardi. Basic cytopathological diagnosis by FNAtechniques, and immunohistochemistry in breast disease will be included asslide demonstrations. The course wvill be slanted to practical diagnosticpathology including pathology of breast screening biopsies and participantswill be given ample timiie to study histological preparations. This will befollowed by an illustrated discussion of the cases.

Course teachers will include:Dr R MillisDrJ SloaneDr T KrauszDr F BarkerDr D BamesDr A HanbyDr G StampDrJ SchofieldDr M Pignatelli

Original course director:Course organiser:Course fee:Application forms from:

Tel:

Fax:

081-740 3117081-740 3245081-740 4950

Guy's HospitalRoyal Marsden HospitalRoyal Postgraduate Medical SchoolRoyal Postgraduate Medical SchoolGuy's HospitalIlmpenial Cancer Research FundRoyal Postgraduate Medical SchoolRoyal Postgraduate Medical SchoolRoyal Postgraduate Medical SchoolProfessorJ G AzzopardiDr G Stamp£330.00Wolfson Conference CentreRoyal Postgraduate Medical SchoolHammersmith HospitalDu Cane RoadLondon W12 ONN

This course now receives full US-CME accreditation

JOURNAL OFCLINICAL PATHOLOGYBorderline nuclear changes in cervical smears:

Guidelines on their recognition and management

The guidelines on borderline nuclear changes provide definitive, clear and Ip-to-date guidance on theinterpretation and reporting of cervical smears. They offer a framework for uniformity of practice, ancd chart

a helpful course through the many subtleties and distinctions in cell changes seen ofn cervical smears.

Commissioned by the National Coordinating Network of the National Cervical Screening Programme andwritten by representatives of the British Society of Clinical Cytology and the Royal College of Pathlologists,

the gulidelines clarify and expand on previoLls recommendations, and acddiress the vital questions:

l--0-t~C-- b0 -:&:`i 6: d':'fi-0000000nwacrustne alrie,- bodelie ucea *w en do the aprncs ustf such adeitonpchnges fn et * wen do changes idate theed for

* whaistheappropriate followupprcedure? ; coiposdcpy? f

* inwhat circumstalnesisit moreappropriate to * what is e isintion b een elreotmaralegtvorinsaisfctry?nucea change and mildskayois

In the light of the recent changes to the cervical screening programme announced by Sir Kennethl Calman, clhiefmedical officer, these guidelines are of particular relevance for resouLrce managemiient in the NHS ancd the long terillhealth of women. They can help avoid unnecessary andl costly investigations andl alleviate the anxiety of patients.

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;; g ;|.UrT gideln tare00;e ;* 4jufl illstrated in colr1

|~MC .1tf0X00;;W; ;i, 0vt*$3 t'b t f

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The Guidlelines will be published in the June 1994 issue ofjournal of Clinical Pathology. A limited nuLmberof copies of the paper will be available from BMJ Publishing Group subscription department at ,5.00/US$7.50*.To guarantee your copy order now using the form below or by calling our credit card hotline on 071 383 6270.

Book reviews

minor inaccuracies such as the diagram of a

cell with cilia all around the circumferencerather than on the luminal surface. Therationale and practice of screening are wellcovered, with useful graphs incorporatingdata from our own and other cervicalscreening programmes.The section on basic anatomy and histol-

ogy is covered completely, although again a

novice might assume from the diagramma-tic representation that ovulation takes placesimultaneously from both ovaries and theova aggregate in the uterine cavity. Themethod of relating the histological sectionsto the relevant areas of the cervix is excel-lent and the photomicrographs are good.

Sampling techniques are discussed, butthe slide appears to be labelled after thesmear was taken rather than just before.Laboratory procedures are well covered, butit might have been more appropriate to dis-play an obviously fictional name on therequest form. Also the names on the slideswere not checked before the slide labelswere attached. Although these may appearto be minor faults, they cause tremendousproblems in laboratories if slides are misla-belled; the cervical screening programmecannot afford to have any more mistakesmade.The second section, alluded to as the

video reference library, does cover all theimportant topics but could be improved.Several of the photomicrographs are slightlyfuzzy, ciliated endocervical cells and imma-ture metaplastic squamous cells are notshown, neither is the "exodus" demonstra-ted. Smear patterns should have beenincluded. The list of specific infectionsincludes rickettsiae for some unknown rea-son. The histology of CIN is covered indetail and good examples of dyskaryoticcells are shown, but I take exception to thestatement that dyskaryotic cells containabnormal numbers and forms of nucleoli. Itis widely accepted internationally that thepresence of nucleoli in dyskaryotic cells isan indicator of microinvasion/invasion. Thesection on glandular disease is very skimpyand the photomicrographs do not illustratethe features described-namely, vacuolesand acini.

This video is too elementary for traineepathologists but will be useful for rawrecruits to the cytology laboratory beforethey embark on the recommended fourweek introductory course. There are notenough photomicrographs illustrating thenumerous varieties of benign and abnormalcells and patterns seen in routine screeningto describe it as a video reference library,especially in comparison with the Cyto-vision video training package which doesprecisely that.My overall impression is that this video,

which is well presented, is best suited tomedical students and to practice nurses

(who must be advised to also see the pre-vious video Taking cervical smears forthorough instruction in technique).

GRACE McKEE

Fine Needle Aspiration Cytology. EdJennifer A Young. (Pp 355; £85.) BlackwellScientific Publications. 1993. ISBN 0-632-02393-7.

During the past decade the cytopathologylibrary has expanded from a mere handfulof textbooks, which were eagerly absorbed

by the specialty, to a much wider selectionfrom which pathologists will wish to choose.In the field of fine needle aspirationcytopathology Jennifer Young's volume willcontend for first place, especially for thosecytopathologists who want to see illustra-tions of May-Griinwald-Giemsa stainedexamples as well as the more conventionalPapanicolaou and haematoxylin and eosinstains.A wide range of systems is covered,

including bone and soft tissues, the eye andits adnexa, and smear preparations of cen-

tral nervous system material. The editor hasmaintained a consistency throughout the 21chapters by 20 authors which include tech-nical procedures, interpretation, diagnosticproblems, advantages and limitations ofcytopathology in the various systems andquantitative estimates of diagnostic accu-

racy. The prose style is discursive and so

easy to read that lists of diagnostic featuresand differential diagnoses are not missed.The full treatment of non-neoplastic condi-tions of the salivary gland and the chapteron the biliary system and pancreas attractparticularly favourable comment. Above all,the presentation in two columns of clearlyprinted text and the generous size, number,and quality of the figures provides a highstandard throughout.The photomicrographs are all in colour

and the same size so that comparisons-forexample, between types of lymphoma-areeasily made. However, there are a fewimportant conditions which are not illus-trated-notably lactation and tubular carci-noma in the chapter on the breast.

This is an excellent book which will be a

good investment for any pathologist or

departmental library where fine needle aspi-ration is practised or being developed.

E A HUDSON

Carcinogenesis. Ed MP Waalkes, JMWard. (Pp 492; $126-00.) Raven Press.1993. ISBN 0-7817-0124-4.

This book is part of a series on target organtoxicology. For this reason, it deals princi-pally with the role of chemicals in carcino-genesis with little mention of other agents,such as viruses or radiation. It is also a bookclearly aimed at experimental animal toxi-cologists, with most of the chapters concen-

trating on specific animal models likehepatic tumours in rats or skin tumours inmice. The clinically orientated pathologist islikely to find this approach too narrow forhis or her requirements but it will be usefulto the specialist looking for a review ofchemical carcinogens affecting a particularorgan.The book starts by reviewing the general

principles of chemical carcinogenesis andthen devotes chapters to organ systems cov-

ering liver, gastrointestinal tract, kidney,bladder, respiratory tract, skin, nervous sys-tem, male reproductive tract and haemopoi-etic system. The final chapter details how toperform and document necropsies on

experimental animals. The best chapters forhuman pathologists are those on the gas-trointestinal tract, respiratory system, andmale reproductive tract.My main criticism concerns the index.

I'm sure that many pathologists might lookup a particular chemical or drug in theindex. However, much of the most useful

information is tabulated and does not getinto the index. For example, phenacetinfeatures in at least three tables, indicatingits putative role in human renal tumours,rodent bladder tumours, and rat nasaltumours. It is not mentioned in the index.Even drugs such as cyclophosphamide,which are included in the index, are onlyreferenced where they occur in the text.This fairly simple fault will limit the use ofthis book.

SUSAN DILLY

NVotices....................................................... ........................

Second International Congress on

Vitamins and Biofactors in LifeScience (ICVB)

February 16-19 1995Sheraton Harbor Island, San Diego,

California

The purpose of this international Con-gress is to encourage transfer of basicinformation concerning the chemistry,biochemistry, and functions of vitaminsand biofactors to clinicians and healthoriented professionals, as well as toscientists specialising in this area.

For further information contact:Department of Academic Affairs, 403C,The Scripps Research Institute,10666 N. Torrey Pines Road, La Jolla,CA 92037Telephone: (619) 554-8556Fax: 0101 (619) 554-6310

Association of Clinical Pathologists

Trainee Membership

Trainee membership of the Association isavailable to medical practitioners who arein training in pathology. Trainee mem-bers are able to remain in this categoryuntil they achieve consultant or othercareer grade status (this includes staffgrades). The annual subscription is,£32.50 for those resident in the UnitedKingdom and Republic of Ireland and,£75 for those overseas. The annual sub-scription may be claimed against tax.

Trainee members receive the 7ournal ofClinical Pathology each month. Otherbenefits are reduced registration fees toattend ACP scientific meetings, all thedocuments regularly sent to full membersof the Association including ACP News,which has a regular column for trainees,and the twice yearly summary of patho-logy courses included in the ACP pro-gramme of postgraduate education.Trainee members have their own repre-sentative body, the Trainee Members'Group, which has a direct input toCouncil.

For Trainee Membership apply to:The Honorary Secretary, Associationof Clinical Pathologists, 221 PrestonRoad, Brighton BN1 6SA. Tel: (0273)561188. Fax: 0273 541227.

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