Human genetics

Human genetics

284 Journal of the American Academy of Dermatology Book reviews ple, under Raynaud's phenomenon, everything from griseofulvin to biofeedback to arm...

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Journal of the American Academy of Dermatology

Book reviews

ple, under Raynaud's phenomenon, everything from griseofulvin to biofeedback to arm swirling is given a fair shake. A classy touch is that each of the thirty-five chapters is preceded by a 1-page biography of a pioneer in studying peripheral vascular disease. In addition to the expected (Harvey, Osler), there are some surprises (Helmholtz, Sir Thomas Lewis [he of the triple response]). The titles of the three chapters dedicated to the founding authors show the slant of the book: Alien, "Clinical Manifestations"; Barker, "Venous Thrombosis"; and Hines, "Principles of Medical Treatment." As I hope the reader has discerned, this is an enthusiastic review. I feel that Allen-Barker-Hines' Peripheral Vascular Diseases is both a monumental text and a practical daily tool. The third edition intrigued me in medical school, the fourth edition stood me in good stead as a resident, and I am sure this fifth edition will enable me and all other physicians to provide better care to a variety of patients with peripheral vascular disease.

Walter H. C. Burgdorf, M.D. Oklahoma City, OK

Current concepts in genetics Reprinted from New England Journal of Medicine, Boston, 1980, Massachusetts Medical Society. 117 pages. $5.00.

Genetics in medicine James S. Thompson and Margaret W. Thompson, Philadelphia, 1980, W. B. Saunders Co. 396 pages. $16.00.

Genetics: Human aspects Arthur P. Mange and Elaine J. Mange, Philadelphia, 1980, Saunders College/HRW. 675 pages. $22.95.

Human genetics F. Vogel and A. G. Motulsky, New York, 1979, Springer-Veflag. 700 pages. $54.60. These four books are recent attempts to survey human and medical genetics in varying degrees of depth. While none is directed specifically to the dermatologist, all four can be read with profit by those interested in cutaneous disease. Current Concepts in Genetics is a collection of

superb review articles which originally appeared in 1976 in the New England Journal of Medicine. Herein lie both the strength and the weakness of the book. Most of the articles are somewhat dated; the text is nowhere near as current as the title might suggest. Furthermore, the coverage is somewhat uneven, with dermatologic diseases almost ignored. Nonetheless, for relatively little financial outlay, the clinician c an easily bring himself almost up -to-date. Turning now to the more substantive textbooks, I was most pleased by the efforts of both the Manges and the Thompsons. Genetics: Human Aspects is designed for an introductory college course in genetics, using primarily examples of human disease as well as the traditional plant (Mendel's peas) and animal (fruit flies) models. It assumes no knowledge of genetics and is perhaps too simple for many readers of this review. If you feel hopelessly lost whenever anyone even mentions genetics, but feel at least as smart as your collegeage children or patients, then this is a good place to start learning (or re-learning) genetics. On the other hand, the Thompsons, in Genetics in Medicine, have aimed their book toward medical students, assuming a college background in science and relying almost entirely on human examples. Rather than providing considerably more detail than the Manges, they have in most cases just produced a shorter text. For example, the corresponding sections on HLA and disease are almost identical in content. Finally, Vogel and Motulsky have written a monumental textbook of human genetics, which has received almost uniformly rave reviews from geneticists. In every area in which I compared the three larger texts, their book was clearly superior. But there is one major drawback; for the nongeneticist, it is a much harder book to read, with many more references, more use of mathematics, and considerable altention to detail. All of the works present similar deficiencies to the dermatologist reader. None make any attempt to address the problem of clinical diagnosis of genetic syndromes, so supplementary atlases or keys must be used. Then, too, none devote much space to genodermatoses. For example, the chromosomal instability in Bloom's syndrome is alluded to in all

Volume 6 Number 2 February, 1982

Book reviews

three, but the Ehlers-Danlos syndrome receives only one line in one text and acrodermatitis enteropathica is not mentioned. All three have bibliographies rich in useful review articles; unfortunately, most of the references are in journals the dermatologist is unlikely to have readily available. An attractive feature of both Genetics: Human Aspects and Hw~an Genetics is the emphasis given to the numerous philosophic or moral issues now so important to human genetics. Environmental carcinogenesis, evolution, eugenics, prenatal diagnosis, and related topics are covered in a balanced fashion. The Manges even include a " n a m e " index, citing unexpected characters such as John Quincy Adams (male pattern baldness) and Babe Ruth (will eugenics produce more sluggers?). I have purchased, read, and continued to use all of these books. There is no question that Human Genetics provides the most information in the most sophisticated fashion. Any dermatologist who fancies himself as an amateur geneticist will want this book; those with semiprofessional leanings probably already own it. For those seeking a somewhat easier introduction and review of the field, Genetics in Medicine provides a compact discussion at an unbeatable price. I recommend it to the busy practitioner. On the other hand, if one wants an equally good introduction, but with more basic material and sociohistorical digressions, then Genetics: Human Aspects is the logical choice. Current Concepts in Genetics cannot compete with these books, but still serves a useful purpose.

Walter H. C. Burgdol~ M.D. Oklahoma City, OK

Skin microbiology: Relevance to clinical infection Howard I. Maibach and Raza Aly, New York, 1981, Springer-Verlag. 354 pages. $38.50. Normally, I would not have the courage to review a book on skin microbiology, but the subtitle, "Relevance to Clinical Infection," gave me the idea of reviewing this book strictly as a clinician with no expertise in microbiology. In the preface, the authors express the hope that the book


"will be of value to dermatologists, microbiologists, pediatricians, surgeons, public health workers, nurses, and others involved in the diagnosis and treatment of dermatologic problems caused by bacteria." Drs. Maibach and Aly's efforts certainly will be of value to dermatologists, so they have achieved part of their stated goal. When I start a book on skin microbiology, I first check to see how successful the authors have been in eliminating the somewhat overwhelming bacteriologic nomenclature. When I was greeted by phrases like "M. nishinomiyaenis can be recognized by its small bright orange colonies that are convex to slightly umbonate in profile," I knew that certain parts of the book would be of little interest to me. Sections include "The Cutaneous Flora and Its Control," "Topical Skin Antibacterials," "Bacterial Adherence," "Infections and Epidemiology," " A c n e , " and "Skin Infection: Treatment." If this sounds like a rather artificial grouping of topics, it is. In many ways, the wide diversity of chapters and their uneven quality suggest that Maibach and Aly have gathered papers from a symposium and arranged them as best they could. As far as I could tell from the introduction, this is not the case. After all of this nitpicking, let me reassure prospective purchasers that Skin Microbiology does include a number of chapters dealing with topics that are very relevant to clinical dermatology, many authored by writers well known to dermatologists. For example, there are a group of articles providing a balanced discussion of topical antimicrobial soaps, covering their efficacy, safety, and even the interactions of microbial inhibitors with organic matter such as blood and pus. In another chapter, the editors and H. R. Shinefeld discuss their work studying the adherence of Staphylococcus aureus to the nasal mucosa. Their analysis of the apparent first step in bacterial infection serves to remind us that classical antibiotics need not be the whole answer, but that other agents may well block adherence. Albert Kligman and James Leyden carefully review the considerable data they have accumulated that an interaction between bacteria and dermatophytes is responsible for the more severe form o f symptomatic "athletes' f o o t . " Thus,