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Viral Encephalitis. Pathology, Diagnosis and Management
112
BOOK REVIEWS
provoking manuscripts contained in this edition of Modern Trends in Human Leukemia, as it summarises much of the current research into cellular oncogenes and puts the results and conclusions into badly-needed perspective. For those with a more clinical orientation, the papers on empiric antimicrobial therapy and blood product support provide valuable guidelines. Despite the delay between the meeting itself and publication of the book, the majority of the data remains relevant, even though there has been a rapid expansion of knowledge in these areas. The extraordinary breadth of the topics covered ensures that virtually anyone interested in leukemia and cancer will find this book well worth reading. Harry Iland
Subcellular Taxonomy - an UltrastructuralClassification Syslem and Diagnostic Applications. A. L. c. MCLAYAND P. G . TONER. Hemisphere Publishing Corporation, New York, 1985. US$41.50. ISBN 0-89116-293-3, pp. 86. In this manual the authors have presented a logical and comprehensive coding system designed for the electron microscopist. They have focused on the widely used SNOMED system of disease classification and have critically reorganised and greatly expanded the codes designated for subcellular topography (T-YX). In addition they have edited the rank for cellular and subcellular morphology (M-6), detailed other existing M codes suitable for abnormalities of subcellular organelles and given a list of proposed new M Codes. The compilers of SNOMED (2nd ed.) had not attempted any detailed coding for ultrastructural data. The system described is designed to provide a range of subcellular topography which will satisfy the needs of the pathologist, bacteriologist and even the general biologist. Although the system is based on SNOMED it is compatible with SNOP and may also be used independently. It is clear that the use of this system in diagnostic pathology will lead to a proliferation in the number of codes allocated for each case. For practical purposes the use of a computer would be necessary to allow for efficient data retrieval. The value of this form of coding to the pathologist lies in the capacity to define diagnostically useful observations as well as the ability to retrieve cases for teaching purposes. In summary the manual effectively meets a need by electron microscopists for a means of coding their observations. It will be interesting to note whether the system proposed gains formal approval by the authors of SNOMED. R . C . Newland
Viral Encephalitis. Pathology, Diagnosis and Management. JOHN AND MARGARET M. ESIRI.Blackwell Scientific Publications, Oxford, 1985. $128.00. ISBN 0-632-01151-3. The wide experience of the authors in the clinical diagnosis, management and pathology of viral encephalitisin humans is evidenced by their lucid style and practical approach. They have obviously been confronted by almost every conceivable stumbling block and have attempted to provide us with helpful hints and suggestions in the understanding of such cases. As a pathologist I was a little disappointed in the quality of some of the microscopic illustrations, e.g., Fig. 1.3, although I realise that many of these changes are difficult to illustrate in black and white. There is some duplication of material in different chapters of the book. This is largely because of the format, in that the first three chapters provide an introduction to the pathology, clinical features and general principles of patient management, whereas the remainder of the book is divided into chapters dealing with specific groups of encephalitides. The contents of these latter chapters is not obvious from the title, e.g., Sporadic encephalitis 11, but there is an excellent index and in several chapters there is a summary paragraph which serves as an introduction. I would recommend that the authors include a summary for each chapter in the next edition. The authors have included some unusual conditions
Booss
Pathology (1987), 19, January such as Reye’s syndrome, which has yet to be shown to be viral in origin. They provide all the current documentation of potential etiological factors in this disease which I found most illuminating. There is an excellent chapter on encephalitis in immunocompromised patients (including AIDS), which is of course becoming increasingly common and relevant to all clinicians and pathologists. One of the most pleasing and helpful features of this book is the inclusion of many tabular summaries regarding clinical signs, differential diagnosis, management objectives, etc. In summary, I feel that this is an excellent reference book which could be used easily as a practical guide in the clinical and pathological diagnosis of viral encephalitis and in patient management. The authors’ many helpful hints and suggestions will prove invaluable to those confronted by such cases. C. G. Harper
Blood Viscosity - Hyperviscosity & Hyperviscosaemia. L. DINTENFASS, MTP. 1985. ISBN 0-85200-413-3, pp. 482. The author’s own contribution to the literature on blood viscosity is quite amazing and represents an enormous amount of work since he first joined the Surgical Research Unit at Sydney Hospital in 1961. This is reflected by the fact that Dr Dintenfass’s own bibliography comprises 10 of the 120 pages of reference included in this book. The author has described many rheological phenomena and these are presented in a scholarly, thought-provoking and inventive manner in the first half of the text. The second part of this book includes a discussion of various clinical conditions and the role that rheological factors may play in the pathogenesis of these conditions. However, it is somewhat disappointing that this latter portion of the book does not carry the same thrust and persuasion as the descriptions of the purely physical phenomena. As clinicians we avoid being drawn into discussion about complex in-vitro rheological phenomena but more importantly we feel quite awkward when discussing blood viscosity syndromes and their management. Even the simple measurement of the ‘bulk’ viscosity of a sample of blood is not routinely available in many minor hospitals, yet the test itself takes only 10 to I5 minutes to perform. Perhaps the concepts of these physical phenomena are not made sufficiently clear to us as students. Despite the author’s collaboration with many clinicians he has not taken the initiative established by his knowledge of the basic science in developing guidelines for clinical practice. Even if one accepts the concept that abnormalities of blood viscosity could be involved in all the conditions mentioned the thesis is not facilitated by the apparently random consideration of these various conditions. For example, polycythaemia and paraproteinaemia - classical hyperviscosity syndromes - receive relatively minor attention at the end of the chapter that begins with a discussion of thyroid diseases, and includes sections on heat transfer, stress and anxiety. The problem is one of perspective. The credibility and acceptance of a text such as this depends upon an organized presentation of evidence for the pathophysiological role of rheological factors in the established hyperviscosity syndromes such as polycythaemia and paraproteinaemia, and then developing the thesis that certain of these factors could also be important in other conditions. The interested reader will be presented with many provocative and tantalizing concepts but, unfortunately for the reader making his or her debut into this topic, the author does not provide any guide as to what might be ‘established’ and what might reasonably be considered as ‘speculative’. Within the discussion of this pot-pourri of clinical disorders there are many original thoughts, unencumbered by disciplinedtraditional clinical teachings, that will sustain the informed and interested reader. However, unfortunately this text does not have the stepwise organization necessary to provide an easy introduction to the role and practical management of blood viscosity factors in medical sciences and in clinical medicine. Michael A . McGrath
BOOK REVIEWS
provoking manuscripts contained in this edition of Modern Trends in Human Leukemia, as it summarises much of the current research into cellular oncogenes and puts the results and conclusions into badly-needed perspective. For those with a more clinical orientation, the papers on empiric antimicrobial therapy and blood product support provide valuable guidelines. Despite the delay between the meeting itself and publication of the book, the majority of the data remains relevant, even though there has been a rapid expansion of knowledge in these areas. The extraordinary breadth of the topics covered ensures that virtually anyone interested in leukemia and cancer will find this book well worth reading. Harry Iland
Subcellular Taxonomy - an UltrastructuralClassification Syslem and Diagnostic Applications. A. L. c. MCLAYAND P. G . TONER. Hemisphere Publishing Corporation, New York, 1985. US$41.50. ISBN 0-89116-293-3, pp. 86. In this manual the authors have presented a logical and comprehensive coding system designed for the electron microscopist. They have focused on the widely used SNOMED system of disease classification and have critically reorganised and greatly expanded the codes designated for subcellular topography (T-YX). In addition they have edited the rank for cellular and subcellular morphology (M-6), detailed other existing M codes suitable for abnormalities of subcellular organelles and given a list of proposed new M Codes. The compilers of SNOMED (2nd ed.) had not attempted any detailed coding for ultrastructural data. The system described is designed to provide a range of subcellular topography which will satisfy the needs of the pathologist, bacteriologist and even the general biologist. Although the system is based on SNOMED it is compatible with SNOP and may also be used independently. It is clear that the use of this system in diagnostic pathology will lead to a proliferation in the number of codes allocated for each case. For practical purposes the use of a computer would be necessary to allow for efficient data retrieval. The value of this form of coding to the pathologist lies in the capacity to define diagnostically useful observations as well as the ability to retrieve cases for teaching purposes. In summary the manual effectively meets a need by electron microscopists for a means of coding their observations. It will be interesting to note whether the system proposed gains formal approval by the authors of SNOMED. R . C . Newland
Viral Encephalitis. Pathology, Diagnosis and Management. JOHN AND MARGARET M. ESIRI.Blackwell Scientific Publications, Oxford, 1985. $128.00. ISBN 0-632-01151-3. The wide experience of the authors in the clinical diagnosis, management and pathology of viral encephalitisin humans is evidenced by their lucid style and practical approach. They have obviously been confronted by almost every conceivable stumbling block and have attempted to provide us with helpful hints and suggestions in the understanding of such cases. As a pathologist I was a little disappointed in the quality of some of the microscopic illustrations, e.g., Fig. 1.3, although I realise that many of these changes are difficult to illustrate in black and white. There is some duplication of material in different chapters of the book. This is largely because of the format, in that the first three chapters provide an introduction to the pathology, clinical features and general principles of patient management, whereas the remainder of the book is divided into chapters dealing with specific groups of encephalitides. The contents of these latter chapters is not obvious from the title, e.g., Sporadic encephalitis 11, but there is an excellent index and in several chapters there is a summary paragraph which serves as an introduction. I would recommend that the authors include a summary for each chapter in the next edition. The authors have included some unusual conditions
Booss
Pathology (1987), 19, January such as Reye’s syndrome, which has yet to be shown to be viral in origin. They provide all the current documentation of potential etiological factors in this disease which I found most illuminating. There is an excellent chapter on encephalitis in immunocompromised patients (including AIDS), which is of course becoming increasingly common and relevant to all clinicians and pathologists. One of the most pleasing and helpful features of this book is the inclusion of many tabular summaries regarding clinical signs, differential diagnosis, management objectives, etc. In summary, I feel that this is an excellent reference book which could be used easily as a practical guide in the clinical and pathological diagnosis of viral encephalitis and in patient management. The authors’ many helpful hints and suggestions will prove invaluable to those confronted by such cases. C. G. Harper
Blood Viscosity - Hyperviscosity & Hyperviscosaemia. L. DINTENFASS, MTP. 1985. ISBN 0-85200-413-3, pp. 482. The author’s own contribution to the literature on blood viscosity is quite amazing and represents an enormous amount of work since he first joined the Surgical Research Unit at Sydney Hospital in 1961. This is reflected by the fact that Dr Dintenfass’s own bibliography comprises 10 of the 120 pages of reference included in this book. The author has described many rheological phenomena and these are presented in a scholarly, thought-provoking and inventive manner in the first half of the text. The second part of this book includes a discussion of various clinical conditions and the role that rheological factors may play in the pathogenesis of these conditions. However, it is somewhat disappointing that this latter portion of the book does not carry the same thrust and persuasion as the descriptions of the purely physical phenomena. As clinicians we avoid being drawn into discussion about complex in-vitro rheological phenomena but more importantly we feel quite awkward when discussing blood viscosity syndromes and their management. Even the simple measurement of the ‘bulk’ viscosity of a sample of blood is not routinely available in many minor hospitals, yet the test itself takes only 10 to I5 minutes to perform. Perhaps the concepts of these physical phenomena are not made sufficiently clear to us as students. Despite the author’s collaboration with many clinicians he has not taken the initiative established by his knowledge of the basic science in developing guidelines for clinical practice. Even if one accepts the concept that abnormalities of blood viscosity could be involved in all the conditions mentioned the thesis is not facilitated by the apparently random consideration of these various conditions. For example, polycythaemia and paraproteinaemia - classical hyperviscosity syndromes - receive relatively minor attention at the end of the chapter that begins with a discussion of thyroid diseases, and includes sections on heat transfer, stress and anxiety. The problem is one of perspective. The credibility and acceptance of a text such as this depends upon an organized presentation of evidence for the pathophysiological role of rheological factors in the established hyperviscosity syndromes such as polycythaemia and paraproteinaemia, and then developing the thesis that certain of these factors could also be important in other conditions. The interested reader will be presented with many provocative and tantalizing concepts but, unfortunately for the reader making his or her debut into this topic, the author does not provide any guide as to what might be ‘established’ and what might reasonably be considered as ‘speculative’. Within the discussion of this pot-pourri of clinical disorders there are many original thoughts, unencumbered by disciplinedtraditional clinical teachings, that will sustain the informed and interested reader. However, unfortunately this text does not have the stepwise organization necessary to provide an easy introduction to the role and practical management of blood viscosity factors in medical sciences and in clinical medicine. Michael A . McGrath