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The Urticarias
Book Reviews have been devoted to many of these entities, one wonders whether much is gained by the very brief commentary and selected illustrations found here. The potential buyer of this book will certainly need other reference sources that address subjects in greater depth in order to function adequately as a practicing cytologist or cytopathologist.
Exfoliative Cytopathology, 3rd ed, by Zuher M. Naib, 629 pp, with illus, $55, Boston, Little, Brown & Company, 1985 This third edition of Naib's Exfoliative Cytopathology is one of a "Series in Laboratory Medicine," which also includes a well-known text on urinary cytology. The previous edition of Naib's book was published 10 years ago. In the interim, major changes have occurred in the practice of cytology, many of which are discussed in this book (such as the new chapter on needle aspiration cytology). The material in the book is organized by body systems—for example, female genital tract, respiratory tract, and urinary tract. After brief comments are presented on the techniques for obtaining and preparing specimens, the cytology of the normal and pathologic tissues for each organ site is discussed. Some of the entities included are extremely unusual and would be "once-in-alifetime" findings in most laboratories (toxoplasmosis in a Papanicolaou smear, amebiasis in a sputum specimen). The plentiful black and white illustrations are appropriately juxtaposed with the related text. The quality of the photomicrographs varies; some (especially low-power views) are less than optimal. These illustrations are liberally supplemented by line drawings that attempt to depict important concepts in idealized form rather than photographically. Although finding the "perfect" field to photograph to illustrate a certain point may be difficult, I believe that line drawings are a poor substitute for what is actually seen through a microscope. Perhaps drawings are most useful for demonstrating how three-dimensional structures translate into different appearances because of smearing in two dimensions on a glass slide and variations in plane of focus of the microscope. Overall, the author makes an admirable effort to review the range of material available in cytology. Unfortunately, the field is too broad and complex to be discussed comprehensively in a book of this size. Consequently, many subjects are mentioned rather briefly—for instance, fine-needle aspiration cytology is covered in 30 pages, a discussion that includes the thyroid gland, breast, lung, bone, and other sites. Inasmuch as entire textbooks Mayo Clin Proc 61:305, 1986
John R. Goellner, M.D. Department of Pathology
The U r t i c a r i a s , edited by Robert H. Champion, M. W. Greaves, A. Kobza Black, and R. J. Pye, 237 pp, with illus, $35, New York, Churchill Livingstone (distributed by Longman, White Plains, New York), 1985 "Chronic urticaria is a frustrating problem for both patient and physician. Frustration arises because the pathogenic mechanisms are often poorly understood, the aetiology frequently undetectable, and the therapy often unsatisfactory." These statements are made by Dr. E. W. Monroe at the beginning of his chapter entitled "Investigation of Chronic Urticaria," and most physicians who deal with this problem would agree with his comments. The Urticarias is the collective publication of material that had been presented at one of the European Society for Dermatological Research clinical symposia held in Cambridge, England, plus, the editors state, several other independent chapters. The book is divided into four areas: "Basic Mechanisms," "Clinical Causes," "Clinical Types of Urticaria," and "Therapy." The "Basic Mechanisms" section reviews mast cells, prostaglandins, complement, and kinins, although the exact role of these various factors in the pathogenesis of urticaria needs to be further clarified. In the clinical chapters, some of the topics addressed are the physical urticarias, urticarial vasculitis, causes of urticaria, food additives, and hereditary angioedema. Seventy-four authors, most of them from Europe, contributed the 34 chapters or articles. The result is an uneven mix, both in type of chapters (from excellent review articles to brief original 305
306
Mayo Clin P r o c , April 1986, Vol 61
BOOK REVIEWS
studies) and in quality. Some chapters are disappointing, and others seem out of place. The chapter on milk allergy is totally unrelated to urticaria but rather speculates on the possible role of milk in the pathogenesis of the sudden infant death syndrome and rheumatoid arthritis. A 5-page list of potential causes of urticaria has unintelligible figures. The chapter title "Assessment of Specific Desensitization in 'Aspirin-Sensitive' Urticaria" is titillating in that it implies a possible therapeutic approach for this difficult problem; yet the chapter is disappointing because of its lack of supportive data. In addition, the insertion of reference citations by author and year in the text rather than by use of numbers disrupts the reading of the substantive information. Despite these criticisms, I enjoyed reading the book. The European authors write of "weals," "aetiology," "oedema," and "factitious urticaria" (dermographism to me). Excellent review chapters are succinctly written. I learned of delayedpressure urticaria and the need for increasing doses in some patients with hereditary angioedema treated with androgens. The Red Cross in the Netherlands has been supplying a purified preparation of Cl inhibitor for treatment of acute attacks of hereditary angioedema; this therapy is unavailable in the United States. The Europeans always seem to find more causes for chronic urticaria than I do. Dr. L. Juhlin, in chapter 13, reports that 62 to 92% of patients with chronic urticaria studied had improvement after consumption of a diet free of all additives and preservatives. Drs. W. G. van Ketel and W. J. Boonk, in chapter 14, found that 28.4% of their patients had positive skin tests to penicillin; a diet free of possible penicillin-containing foods resulted in improvement in half of those patients. My experience is more like that reported in chapter 16 by Drs. Champion and Muhlemann, who had surveyed clinicians (primarily dermatologists) at the aforementioned meeting. These clinicians estimated that they failed to make an etiologic diagnosis in from 50 to 100% (a mean of 78.7%) of patients with chronic urticaria. Allergists, dermatologists, and all physicians who examine many patients with urticaria should enjoy reading this book. Richard G. Van Dellen, M.D. Division of Allergic Diseases and Internal Medicine
Medical Oncology: Basic Principles and Clinical Management of Cancer, edited by Paul Calabresi, Philip S. Schein, and Saul A. Rosenberg, 1,576 pp, with illus, $110, New York, Macmillan Publishing Company, 1985 In his popular book Megatrends, John Naisbitt claims that many arenas in our society have expanded to offer multiple choices rather than the "either/or" options previously available. That pronouncement has now been fulfilled regarding the selection of an oncology textbook. Medical Oncology: Basic Principles and Clinical Management of Cancer has emerged as the third comprehensive compendium of cancer care. It primarily addresses concerns of medical oncologists but also should be a useful resource for family physicians, general internists, and specialists who are broadly involved in the management of oncologic problems. The material is logically organized in three sections. The first segment deals with the basic scientific aspects of neoplasms and their treatment, such as the molecular biologic, cell kinetic, and immunologic features of tumors and the pharmacologic characteristics of antineoplastic agents. The basic clinical concepts including epidemiologic data, cancer staging, surgical and radiotherapeutic principles, paraneoplastic phenomena, and side effects of cancer therapy are also presented. The second section discusses individual neoplasms, and the final portion deals with supportive care. This last division describes the management of complications of cancer—for example, effusions, obstructive problems, pain, and infection. Nutrition, nursing considerations, psychosocial aspects, special geriatric problems, and rehabilitation of the patient with cancer are also discussed. Overall, the format of the book is very pleasing. Narrow columns of print permit quick scanning, and large type facilitates reading. The tables, illustrations, and photographs are generally clear and relevant to the text. The well-demarcated topical divisions add to the overall sense of careful organization. In comparison with its predecessors, Medical Oncology seems a considerably more concise oncology text, an advantage that enhances readability. Excluding information for the sake of brevity, however, sometimes leads to inconsistency and incompleteness. For example, the chapters on the
Exfoliative Cytopathology, 3rd ed, by Zuher M. Naib, 629 pp, with illus, $55, Boston, Little, Brown & Company, 1985 This third edition of Naib's Exfoliative Cytopathology is one of a "Series in Laboratory Medicine," which also includes a well-known text on urinary cytology. The previous edition of Naib's book was published 10 years ago. In the interim, major changes have occurred in the practice of cytology, many of which are discussed in this book (such as the new chapter on needle aspiration cytology). The material in the book is organized by body systems—for example, female genital tract, respiratory tract, and urinary tract. After brief comments are presented on the techniques for obtaining and preparing specimens, the cytology of the normal and pathologic tissues for each organ site is discussed. Some of the entities included are extremely unusual and would be "once-in-alifetime" findings in most laboratories (toxoplasmosis in a Papanicolaou smear, amebiasis in a sputum specimen). The plentiful black and white illustrations are appropriately juxtaposed with the related text. The quality of the photomicrographs varies; some (especially low-power views) are less than optimal. These illustrations are liberally supplemented by line drawings that attempt to depict important concepts in idealized form rather than photographically. Although finding the "perfect" field to photograph to illustrate a certain point may be difficult, I believe that line drawings are a poor substitute for what is actually seen through a microscope. Perhaps drawings are most useful for demonstrating how three-dimensional structures translate into different appearances because of smearing in two dimensions on a glass slide and variations in plane of focus of the microscope. Overall, the author makes an admirable effort to review the range of material available in cytology. Unfortunately, the field is too broad and complex to be discussed comprehensively in a book of this size. Consequently, many subjects are mentioned rather briefly—for instance, fine-needle aspiration cytology is covered in 30 pages, a discussion that includes the thyroid gland, breast, lung, bone, and other sites. Inasmuch as entire textbooks Mayo Clin Proc 61:305, 1986
John R. Goellner, M.D. Department of Pathology
The U r t i c a r i a s , edited by Robert H. Champion, M. W. Greaves, A. Kobza Black, and R. J. Pye, 237 pp, with illus, $35, New York, Churchill Livingstone (distributed by Longman, White Plains, New York), 1985 "Chronic urticaria is a frustrating problem for both patient and physician. Frustration arises because the pathogenic mechanisms are often poorly understood, the aetiology frequently undetectable, and the therapy often unsatisfactory." These statements are made by Dr. E. W. Monroe at the beginning of his chapter entitled "Investigation of Chronic Urticaria," and most physicians who deal with this problem would agree with his comments. The Urticarias is the collective publication of material that had been presented at one of the European Society for Dermatological Research clinical symposia held in Cambridge, England, plus, the editors state, several other independent chapters. The book is divided into four areas: "Basic Mechanisms," "Clinical Causes," "Clinical Types of Urticaria," and "Therapy." The "Basic Mechanisms" section reviews mast cells, prostaglandins, complement, and kinins, although the exact role of these various factors in the pathogenesis of urticaria needs to be further clarified. In the clinical chapters, some of the topics addressed are the physical urticarias, urticarial vasculitis, causes of urticaria, food additives, and hereditary angioedema. Seventy-four authors, most of them from Europe, contributed the 34 chapters or articles. The result is an uneven mix, both in type of chapters (from excellent review articles to brief original 305
306
Mayo Clin P r o c , April 1986, Vol 61
BOOK REVIEWS
studies) and in quality. Some chapters are disappointing, and others seem out of place. The chapter on milk allergy is totally unrelated to urticaria but rather speculates on the possible role of milk in the pathogenesis of the sudden infant death syndrome and rheumatoid arthritis. A 5-page list of potential causes of urticaria has unintelligible figures. The chapter title "Assessment of Specific Desensitization in 'Aspirin-Sensitive' Urticaria" is titillating in that it implies a possible therapeutic approach for this difficult problem; yet the chapter is disappointing because of its lack of supportive data. In addition, the insertion of reference citations by author and year in the text rather than by use of numbers disrupts the reading of the substantive information. Despite these criticisms, I enjoyed reading the book. The European authors write of "weals," "aetiology," "oedema," and "factitious urticaria" (dermographism to me). Excellent review chapters are succinctly written. I learned of delayedpressure urticaria and the need for increasing doses in some patients with hereditary angioedema treated with androgens. The Red Cross in the Netherlands has been supplying a purified preparation of Cl inhibitor for treatment of acute attacks of hereditary angioedema; this therapy is unavailable in the United States. The Europeans always seem to find more causes for chronic urticaria than I do. Dr. L. Juhlin, in chapter 13, reports that 62 to 92% of patients with chronic urticaria studied had improvement after consumption of a diet free of all additives and preservatives. Drs. W. G. van Ketel and W. J. Boonk, in chapter 14, found that 28.4% of their patients had positive skin tests to penicillin; a diet free of possible penicillin-containing foods resulted in improvement in half of those patients. My experience is more like that reported in chapter 16 by Drs. Champion and Muhlemann, who had surveyed clinicians (primarily dermatologists) at the aforementioned meeting. These clinicians estimated that they failed to make an etiologic diagnosis in from 50 to 100% (a mean of 78.7%) of patients with chronic urticaria. Allergists, dermatologists, and all physicians who examine many patients with urticaria should enjoy reading this book. Richard G. Van Dellen, M.D. Division of Allergic Diseases and Internal Medicine
Medical Oncology: Basic Principles and Clinical Management of Cancer, edited by Paul Calabresi, Philip S. Schein, and Saul A. Rosenberg, 1,576 pp, with illus, $110, New York, Macmillan Publishing Company, 1985 In his popular book Megatrends, John Naisbitt claims that many arenas in our society have expanded to offer multiple choices rather than the "either/or" options previously available. That pronouncement has now been fulfilled regarding the selection of an oncology textbook. Medical Oncology: Basic Principles and Clinical Management of Cancer has emerged as the third comprehensive compendium of cancer care. It primarily addresses concerns of medical oncologists but also should be a useful resource for family physicians, general internists, and specialists who are broadly involved in the management of oncologic problems. The material is logically organized in three sections. The first segment deals with the basic scientific aspects of neoplasms and their treatment, such as the molecular biologic, cell kinetic, and immunologic features of tumors and the pharmacologic characteristics of antineoplastic agents. The basic clinical concepts including epidemiologic data, cancer staging, surgical and radiotherapeutic principles, paraneoplastic phenomena, and side effects of cancer therapy are also presented. The second section discusses individual neoplasms, and the final portion deals with supportive care. This last division describes the management of complications of cancer—for example, effusions, obstructive problems, pain, and infection. Nutrition, nursing considerations, psychosocial aspects, special geriatric problems, and rehabilitation of the patient with cancer are also discussed. Overall, the format of the book is very pleasing. Narrow columns of print permit quick scanning, and large type facilitates reading. The tables, illustrations, and photographs are generally clear and relevant to the text. The well-demarcated topical divisions add to the overall sense of careful organization. In comparison with its predecessors, Medical Oncology seems a considerably more concise oncology text, an advantage that enhances readability. Excluding information for the sake of brevity, however, sometimes leads to inconsistency and incompleteness. For example, the chapters on the