Price $42 (AACC members); $60 (nonmembers). ... my desk where I can refer to it regularly. ... My only criticism of this enjoyable little book concerns its.
Book Reviews Damjanov, I. and Rubin, E. Pathology: A Study Guide. J.B. Lippincott, Philadelphia. 1990. Price $19.95 (softbound).
Friedman, R.B. and Young, D.S. Effects of Disease on Clinical Laboratory Tests. Second Edition. AACC Press, Washington, D.C. 1989. Price $42 (AACC members); $60 (nonmembers). This is the second edition of a remarkable book that was first published in 1980. Ever since the first edition was published, I have been an enthusiastic supporter of the authors' efforts to compile a database on the effects of disease on clinical laboratory tests—a monumental undertaking! I have kept the first edition and will keep the second edition on the bookshelf right next to my desk where I can refer to it regularly. I consistently recommend it to medical students and residents in our hospital. As one would expect, the second edition is bigger and better than the first. The material in this book is indexed by either tests or diseases, and each disease is listed according to its ICD-9-CM classification. Laboratory tests are numerous and vary from routine tests, such as hemoglobin and glucose, to unusual tests, such as cyclic adenosine monophosphate and somatostatin. The extensive list of diseases includes common disorders, such as esssential benign hypertension, as well as unusual conditions, such as Tay-Sachs disease. For example, I counted 186 causes for a decreased blood
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MARK R. WICK,
M.D.
Department of Pathology Washington University School of Medicine St. Louis, Missouri
hemoglobin and 27 tests that may be abnormal in essential benign hypertension. All listings include a reference number, by which a specific journal or text can be identified in the back of the book as the source of the information. As the authors point out in the introduction, the listings in this book are neither exhaustive nor selective, and no attempt was made to verify the information. But it is a tremendous start toward placing medical decision making by clinical laboratory tests on a firm scientific footing. I believe that the 1990s will be a decade of increasing insights into the science of medical decision making, and the practical results of this inquiry will include the clarification and quantitation of medical decisions by laboratory tests. The database assembled in this book will provide building blocks to bring medical decision making by laboratory tests into the twentyfirst century. Every serious practitioner of laboratory medicine should have a copy of this book together with a companion copy of The Effects of Drugs on Clinical Laboratory Tests, the second edition of which will be published soon. Certainly I can list some areas where I wish this book was better, but I'm not going to do that. Instead, I'm going to com-
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Cynical, or perhaps wizened, medical educators were skeptical of the need for another general textbook when Pathology was authored by Emanuel Rubin and John Farber and published in 1988 by J.B. Lippincott. However, in its brief sojourn thus far onto the bookshelves of teaching pathologists, the latter treatise has proven to be a welcome surprise. This text is multi-authored but shows the expert and unifying touch of its two senior editors throughout. Its contents are current, uniformly accurate, wellintegrated, and beautifully illustrated. It can truly be said that this book masterfully presents the complexity and importance of our specialty to medical students and practitioners alike. Indeed, devotees of the time-honored Pathologic Basis of Disease (edited by Cotran and colleagues) have begun to "jump ship" in many instances to the Rubin/Farber text for use in sophomore pathology courses throughout our country and others. Perhaps in response to the mass appeal of Pathology, one of its editors has joined forces with Dr. Ivan Damjanov to assemble a companion study guide. The latter work was published this year and is tailored to the original text in a chapter-by-chapter fashion. Contrary to the many other texts of this type, it is not merely a listing of questions and unannotated answers. Rather, it takes the reader through a systematic inventory of major topics considered in the parent book and provides brief but meaty commentaries on responses to the question lists contained therein. Both correct and incorrect answers are addressed, along with reasons for possible confusion in regard to erroneous choices.
Medical students are likely to embrace this study guide warmly, in that it will be a great help in directing their attention toward important topics. Minutia and controversy have been avoided; in addition, the varied question formats (true-false; multiple choice; matching, etc.) provide a realistic simulation of standardized examinations, be they intra-institutional or national in scope. In fact, the Damjanov/Rubin study guide is recommended not only for medical undergraduates, but also for residents in pathology, Pathology Board examinees, and practicing pathologists wishing to update their general knowledge. My only criticism of this enjoyable little book concerns its illustrations, which are few in number and suboptimally reproduced. Inasmuch as the purpose of the text is certainly not that of an atlas, this drawback is admittedly very minor. However, our students routinely complain that practical-type questions on pathology exams often are accompanied by poorly prepared glass slides or out-of-focus photomicrographs. This fact must be acknowledged as such and certainly adds to the potential frustration of test-taking. It is hoped that in the future, Drs. Damjanov and Rubin will consider marketing a set of color projection slides to accompany their study guide, as a possible solution to such problems. In summary, I wholeheartedly endorse the use of this "spinoff" manual. It is a real bargain and promises to serve all of its readers well in the years to come.
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pliment the authors on the completion of an herculean task and encourage them to continue developing this database. I urge all of you to buy a copy of this book, not only because it will be very useful to you, but also because it will support the authors in the continuation of their work. Abendroth, T.W., Kxeig, A.F., and Bongiovanni, M.B. D-Tree: Decision Analysis for the IBM®. ASCP Press, Chicago. 1989. Price $180. (2 disks).
In the laboratory, decision analysis can be used to select the best cutoff for a diagnostic test— the value that will separate "positive" or diseased patients from the "negative" or healthy. It also can be used to examine the usefulness of a test in patient care, whether treatment is best given only to patients who test "positive" or should be given to everybody (or nobody). D-Tree, a decision analysis program for IBM and IBM-compatible personal computers, provides the laboratory clinician or scientist with a handy tool for performing their own decision analyses. D-Tree requires at least 256K of RAM, a graphics monitor, and a graphics card. The program can be run from either a floppy or fixed disk drive and is easy to install. My copy ran quickly on computers with either 8086 or 80286 microprocessors and produced good quality text and graphics with CGA, VGA, Widmann, F.K. An Introduction to Clinical Immunology. F.A. Davis Co., Philadelphia. 1989. Price $25. The author introduces the book as one of an "explanation of immunology for those with little or no experience in immunology or clinical medicine." It consists of three parts: one deals with principles of immune function, another with clinical applications, and a third with laboratory applications. The three parts contain between five and eight chapters, with suggested readings at the end of each one. There is a fairly extensive glossary near the end, followed by a usable index. The illustrations are almost totally black-and-white line drawings, which are appropriate, simple to understand, and well distributed. Most chapters contain tables that are useful and supplement the text and, in some instances, replace the need for a written text. Most tables are concise
CARL E. SPEICHER, M.D.
Professor and Director Clinical Laboratories The Ohio State University Hospitals Columbus, Ohio and EGA graphics cards. The program used only the upper half of the monitor when run with a Hercules monochrome/graphics card, but the text was still readable and the decision trees were clear. The manual is well written and oriented around practical applications that illustrate the features of the program. It begins with a brief introduction to decision analysis and a definition of chance, decision, and outcome nodes. The user is guided through the construction of several decision trees and shown how to evaluate each tree. Both sensitivity and threshold analyses are handled well, and the results can be displayed graphically or as numeric tables. Markov and Monte Carlo analysis are not supported, which may disappoint advanced users. Trees constructed with D-Tree can be saved to disc for future editing, and chance and outcome data can be pulled automatically into the tree from tables. Images of trees can be printed on a dot-matrix printer, but laser printers are not supported. The program handles multiple utility scales simultaneously, which is a boon to users who are reluctant to blend cost and medical outcome into a single scale. Newcomers to decision analysis will be hard pressed to find a software package as inexpensive and easy to use as D-Tree. The manual describes the program fully, but users without any exposure to decision analysis will have to supplement the manual with a few papers or chapters before they are ready to analyze many of their own decision problems. With a little background material, the manual and program could serve as an excellent introductory tutorial in decision analysis for residents and trainees. For the user who has had some experience designing trees and wants to apply decision analysis in the laboratory, D-Tree is all he or she is likely to need. PAUL VALENSTEIN, M.D.
St. Joseph Mercy Hospital Department of Pathology Ann Arbor, Michigan and helpful; a few contain too much data for this level. Generally the paragraphs are short and discuss only one item so that one can get some information about a given subject rather easily. Throughout the text most of the important words or terms are emphasized by being in bold print. The book is well written and easy to follow. Having one author makes the chapters flow nicely without shifts in expression or emphasis, and the illustrations fit in well with the text. The suggested readings are appropriate and current and not so extensive as to be overwhelming. Most of the topics considered important to clinical immunology are discussed, although some gaps are evident. AIDS is not mentioned in the section of immunodeficiency diseases, IL-6 is not discussed in the chapter on cellular products, and some of the commonly named autoantibodies are not listed in the chapter on immune-mediated diseases.
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Decision analysis is a quantitative approach to problem solving that makes a lot of sense but has few adherents. Most physicians prefer to tackle problems with a loosely structured, qualitative type of reasoning that feels more familiar and intuitive. In everyday practice this informal weighing of clinical experience, the medical literature, and patient preferences seems to serve us well. But on occasion we are called upon to chose between two (or more) alternatives that appear to hang in the balance. Should we order the best diagnostic test, which costs almost as much as a course of treatment, or settle for a less expensive test and treat an occasional patient who does not have the disease we are testing for? Should we prescribe the most effective drug, which has the most serious side effects, or a less effective, safer alternative? For these difficult choices, decision analysis offers a quantitative method for weighing costs and benefits that probably is better than the impressionistic thinking we rely upon most of the time.
A.J.C.P.-May 1990
Vol. 93 • No. 5
BOOK REVIEWS
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The author has attempted to do a very difficult thing: to write an introductory text to a complex, ill-defined, and ever-expanding subject. The result is an unevenness as to the depth of the "introduction." Some areas are just that, an introduction, particularly in the middle part, which discusses clinical applications, while some chapters go beyond what might be considered an introduction. The chapter on complement goes into significant detail, and each sentence seems to contain important facts and is a very good explanation beyond the introductory level. The last part, dealing with laboratory applications, does the best job of introducing, explaining, and illustrating at the introductory level. I found the book to be very readable and having some terms in bold print helps to focus on the main topic of the paragraph or section and sometimes is helpful in learning how a term was
derived, such as Tac. There are problems as to gaps, and what might be considered too much data, such as the discussion on immunizations, but where does one draw the line? In summary, I do not hesitate to recommend the text to anyone in the field for potential use in "introducing" the subject, particularly with the instructional aids, such as the bold print and the drawings. However, I also would recommend that the book be scanned for areas to modify to give an explanatory introduction to the field as viewed by that individual for his or her needs.
Harmening, D., Calhoul, L., and Polesky, H. (eds). Modern Blood Banking and Transfusion Practices. Second Edition. F.A. Davis Co., Philadelphia. 1989. Price $39.95.
tern, and laboratory medicine is the basis for his priority in claiming the role of consultant in transfusion medicine. This second edition is an admirable aid to pathologists in practice who wish to review the principles of procedures performed in the blood bank. It is equally valuable for pathology residents desiring to learn them. New features have been incorporated into each chapter to enhance learning and review. A comprehensive outline precedes each chapter, and multiple choice review questions follow. A large glossary of terms, which is very useful to refresh the foggy memory, has been added at the end of the book. The liberal use of tables and charts facilitates remembering similarities and differences in characteristics of antigens and antibodies. Illustrations and flow charts provide visual "hooks" upon which to hang concepts. The 16 brightcolored pages are almost startling in a blood bank textbook. They certainly catch the eye and are, for the most part, useful. Make no mistake, this is a laboratory-oriented book. The chapter on transfusion therapy is only 11 pages, and the chapter on adverse effects is 15 pages. However, these aspects of transfusion medicine are covered in overwhelming detail in other recently published texts that have "clinical" in their titles. The writing of multiple authors results in some repetition and inconsistencies between chapters. What is "apheresis" in one chapter, is "pheresis" in another. Transfusion-transmitted viral diseases receive scant mention, but this is a field that is changing so rapidly that today's doctrine is tomorrow's heresy, and new advances are reported daily in the Wall Street Journal. This book can be recommended for pathologists who wish to review and pathology residents in training, as well as medical technologists and blood bank specialists, even if they never intend to become practitioners of transfusion medicine.
Epstein, J.I. Prostate Biopsy Interpretation. Biopsy Interpretation Series. Raven Press, New York. 1989. Price $69. This is one of the latest in a series of monographs designed to assist the pathologist in certain specific areas of diagnosis.
M.D.
Department of Pathology Marshall University School of Medicine Huntington, West Virginia
ASA BARNES,
M.D.
Department of Pathology Long Beach Memorial Medical Center Long Beach, California When I first saw the title concerning prostate biopsy interpretation, I wondered how anyone could tell an active surgical pathologist anything he did not know already in this field, but I found that there was considerable new material of interest and of help to me, and probably to others. The style is very practical,
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"Transfusion medicine" is the new buzz word eponym for that subdivision of laboratory science formerly known as "blood banking." This change of alias seems appropriate because the era of AIDS and DRGs has radically altered the responsibilities and practices of blood bankers or transfusion medicinists. In the simple days of yore, whole blood was cross-matched and provided on order of the prescribing physician. Today whole blood has disappeared like the dodo bird. There are more than 20 components and products available through the hospital transfusion service or local blood center. NIH consensus conferences, assorted authorities, and lawyers are telling us transfusion therapy should be tailored to the specific needs of the individual patient. The subject matter ofjournals, papers, workshops and textbooks reflects this shift of emphasis toward clinical applications and effects of transfusion therapy. It has been suggested that busy pathologists are not the appropriate professionals to be today's practitioners of transfusion medicine (Klein HG. Transfusion medicine: the evolution of a new discipline. JAMA 1987;258:2108-2109). The clinical orientation of modern transfusion medicine is undeniable and appropriate. Does that mean that pathologists should docilely step aside and make way,for the clinicians? Is immunohematology no longer relevant? Have laboratory procedures evolved to such perfection that all a physician ever needs to know is the test result? The answer to these questions is obvious, certainly not! The pathologist should recognize and fulfill his evolving clinical responsibilities in transfusion medicine but must not neglect the advantages accruing from a comprehensive understanding of immunohematology and the blood bank laboratory procedures. The pathologist's knowledge of laboratory management, blood groups, pathology of the hematopoietic sys-
STEBBINS B. CHANDOR,
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A.J.C.P. -May 1990
with excellent photomicrographs illustrating the text and in many instances reminding me of a live short course with speakers and accompanying slide projections. Although I have taken Dr. Gleason's short course on grading of prostatic adenocarcinomas, I found chapter five in this monograph to be an excellent review, and it would stand alone as an instructive manual for those unfamiliar with Gleason's system. Chapter six, concerning atypical hyperplasia, is an excellent reference source in this new area of prostate pathology. Throughout the text the author offers many practical tips regarding interpretation of small samples
that we often receive, and I am impressed that he speaks from a broad experience. One area that is lacking is a discussion of the cytologic findings in fine-needle aspiration of the prostate, but the author provides references to other recent texts already available on this topic.
Scully, C. and Flint, S. Color Atlas of Oral Diseases. J.B. Lippincott Co., Philadelphia. 1989. Price $95.
For pathologists the book can serve two purposes: (1) provide an acquaintance with the clinical appearance of oral lesions, and (2) increase diagnostic ability through the many criteria and correlations in the text. The correlations make the book of value also to gastroenterologists, infectious disease specialists, dermatologists, ENT physicians, rheumatologists, and developmental disease specialists. Undergraduate students of medicine and dentistry will profit from the book but may not appreciate its sophisticated diagnostic capabilities until further into their careers. There is little to criticize adversely. A more substantial binder should be available for a book otherwise of such quality and worth.
RONALD A. WELSH,
M.D.
Department of Pathology LSU Medical School New Orleans, Louisiana
RONALD CARR
Department of Pathology LSU Medical School New Orleans, Louisiana
• Books Received Through February 28, 1990 Cohen, J., Bonfiglio, M., Campbell, C. J. Orthopedic Pathophysiology in Diagnosis and Treatment. Churchill Livingstone, Inc, New York. 1989. Price $95. 526 pages, including index. Fenoglio-Preiser, C. M., Wolf, M., and Rilke, F. Progress in Surgical Pathology. Volumes 9 and 10. Field and Wood Medical Publishers, New York. 1989. Price $75 (each). Volume 9 contains 220 pages; Volume 10 contains 200 pages. McGahan, J. P. (ed). Interventional Ultrasound. Williams and Wilkins, York, Pennsylvania. 1990. Price $59.50. 283 pages, including index.
Rudowski, W. J., Pawleski, S. J. Surgery of the Spleen. National Center for Scientific, Technical, and Economic Information, Warsaw, Poland. 1987. 330 pages, including index. Sotrel, G. Tubal Reconstructive Surgery. Lea and Febiger, Philadelphia. 1990. Price $75. 281 pages. Staub, N. C. The Pulmonary Intravascular Macrophage. Futra Publishing Co, Mt. Kisco, New York. 1989. Price $37.50. 180 pages, including index.
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The book is largely clinical photographs, which are of good quality and adequately magnified. There are 12 pages devoted to differential diagnosis both by symptom and by site. Current references for further reading are listed by title chapter at the back of the book, before the index. The focus is on lesions of the oral cavity, but there is a total approach to human disease, and oral lesions are placed within the context of a particular system (e.g., gastrointestinal, circulatory) or basic pathologic process (e.g., infection, neoplasia). Particularly well done are Chapters 1, "Infections—" (especially candidosis) and 9, "Diseases of the Digestive System," the latter comprising a basic core of non-neoplastic oral pathologic entities. Equally as valuable as the illustrations are the succinct, informative sentences that accompany them. The wide experience and expertise of the authors in diagnosing human disease is evident.
