The presentation is pleasing to the eye and simple linediagrams are used liberally to illustrate basic concepts andprinciples. I was also pleased to see the now trendy andobligatory shaded boxes that summarize the main messages.My only criticism is that basic pathological processes are

rather tedious to read about in isolation. There are no clinicalexamples in the book which might stimulate students to see therelevance and potential clinical application of the subjects. Icannot speak for veterinary medicine, but I know that mostundergraduate curricula for health care professionals, includ-ing dentists, are taking a more integrate and/or problem-basedapproach. In this context, the book may have limited appeal.Having said that, I shall recommend it to my students as a

reasonably priced, ‘no frills’ basic pathology text.

C BSouthampton General Hospital

New Concepts of a Blood–Brain Barrier.J G, D J. B and M B. S(Eds). Plenum Publishing Corporation, No. of pages: 331.Price: $89.50.

This book is a record of the symposium held to mark theretirement of Mike Bradbury, Professor of Physiology atKing’s College London. As such, chapters have been contrib-uted by many key international experts and represent a variedspectrum of topics in relation to the blood–brain barrier inboth normal and disease states. Discussion of the embryonicdevelopment of the blood–brain barrier is followed by a widerange of studies on the transport of molecules across fromblood to brain and how this is altered in particular diseases.The effect of endothelin and serotonin on these processesand the role of second messenger systems is also examined.Later chapters look at cerebral spinal fluid in relation to theblood–brain barrier, including drainage and the treatmentof hydrocephalus. Both in vivo and cell culture studies ofimmune function of the blood–brain barrier are included, aswell as applications, such as drug targeting, opening of theblood–brain barrier, and CNS transplants.Each chapter gives very detailed information concerning

the experimental approaches used by the individual groups.These range across physiology, chemistry, physics, molecularbiology, immunology, and pathology. It is therefore probablydifficult for individuals from different disciplines to assimilatefully all the information given, although summaries at the endof each chapter are helpful in this respect. The book primarilyserves as a useful reference source for those involved inblood–brain barrier research who wish to cross interdisci-plinary barriers to widen their understanding of the subject.

S. L. CDepartment of Pathology

The Queen’s University of Belfast

Renal Biopsy Interpretation.S, D’A and N (Eds).

We have a problem with the nomenclature of renal diseases;we have terms which are pure morphological descriptions,terms which define disease processes, and terms where we areunsure whether a description defines a disease process or not.Similar appearances may result from various processes andone disease may have several clinical presentations. The limitsof our understanding make it difficult to synthesize a coherentplan for a textbook of renal pathology and the tendency toconfuse morphological terms with disease entities is hardto resist.

Starting to read this book, I was filled with hope. Theproblems are acknowledged and the aims are set out clearly: toprovide a systematic approach to the renal biopsy for thediagnostic pathologist. We are promised algorithms which willguide the newcomer to the field through the maze of non-specific hints and suggestions provided by the morphology ofrenal disease, to a rational and clinically useful conclusion.Despite the relatively small size of the book, there are 18contributors, so it is perhaps not surprising that these aims areachieved to a variable extent.In the chapter on ‘Approach to the Interpretation of Renal

Biopsy’, algorithms and flow-charts are provided in abun-dance. This is of value to the newcomer to the field, but it leftme doubting whether they would be helpful in a difficult oratypical case. The following chapter (Nephritic Syndrome andGlomerulonephritis) is also rich in algorithms and flow-charts,but most of the subsequent chapters take a more conventionalapproach. Throughout the book we are provided with solid,sensible descriptions of the relevant features with which Ifound little fault. Explanations of underlying disease processesare kept to an absolute minimum. This is occasionally frustrat-ing, but the detail provided is compatible with reaching asensible diagnosis and it keeps the book small. The emphasisis strictly on biopsy interpretation, so diseases which onewould not expect to see in a biopsy (e.g., polycystic kidneys)are omitted, and there is almost no mention of paediatricnephropathology. Tumours are not covered.The decision to arrange the book by morphology, rather

than by the nature of the processes, is a logical conclusionfrom the recommended approach to the diagnostic process,but it leads to some unconventional bedfellows. Fibrillaryglomerulopathy, an immunologically mediated glomerulone-phritis, is placed with amyloidosis in a chapter entitled‘Hematopoietic Disorders’. Vasculitis is spread betweenchapters, depending on the size of vessel involved. This may beof benefit in diagnostic problem-solving, but it results in asense of fragmentation when reading the book cover-to-cover.The illustrations are well chosen, though not particularly

numerous. They are all monochrome. This detracts from theenormous aesthetic pleasures of studying glomerular disease,but is probably quite adequate for the purpose and no doubtreduces the cost.The first and last chapters stand separately from the rest of

the text. The first is a fascinating account of the history of therenal biopsy by Conrad Pirani, who had the benefit of seeing itall happen in the 1950s and who uses this experience to goodeffect. The last is a speculation on the future of the renalbiopsy, discussing proliferation markers, mRNA measure-ment, and improved assessment of the extracellular matrix.These two chapters, especially the first, are more of a ‘bedtimeread’ than a laboratory bench-book. The authors recognizethis anomaly, and these chapters are sufficiently concise toremain a sensible part of a work of this type.Who will buy this book? Renal pathology is a relatively

specialized field, practised by a subset of diagnostic histo-pathologists. The editors acknowledge that Renal BiopsyInterpretation is not intended to replace the multi-volumereference books, which will continue to be the main resource ofestablished practitioners of renal pathology. At the otherextreme, trainees studying for their examinations would prob-ably be better advised to study Renal Pathology by Dische (2ndedition, OUP, 1995), as it has a more conventional approachto the subject and it covers the whole of non-neoplasticrenal pathology. Dische provides shorter descriptions of themicroscopic appearances, but he discusses mechanisms, patho-genesis, and clinical correlation in more detail, and is moreconcise.

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The person to whom I think Renal Biopsy Interpretation isideally suited is a pathologist who for the first time takes upa post which carries full responsibility for reporting renalbiopsies. It may also appeal to general pathologists whooccasionally have to report a renal biopsy. If the algorithmapproach appeals, it will provide sensible and authoritativeadvice to steady the nerve through the initial learning curve.

P. N. FLeicester General Hospital

Atlas for Cardiovascular Pathology. Atlases in DiagnosticSurgical Pathology.R. V, A. F and A. B. Contribution by J. B.A. W. B. Saunders, Philadelphia. No. of pages: 224.Price: £124.

With autopsy, cardiac and vascular pathology being wellcovered in standard texts, the authors of this atlas have aimedto meet the real need for a well-illustrated reference book tosupport the relatively new and growing discipline of surgicalpathology of the cardiovascular system. The book consists ofsix sections comprising endomyocardial biopsy, pathologyof native and prosthetic cardiac valves, surgical pathology ofcardiac masses, diseases of the pericardium, diseases of thegreater vessels and pulmonary circulation, and finally, diseasesof the peripheral vessels. This means that the pathologicalentities are discussed essentially organ by organ, which isa successful format. A section on cardiac and pulmonaryvascular explant pathology would have contributed to thebook, since cardiothoracic transplantation is increasing anddeveloping in new centres.Several of the sections begin with an ‘approach to . . .’

chapter, which is particularly useful for those pathologistsencountering cardiovascular surgical pathology for the firsttime. The best of these introductory chapters are in the sectionson endomyocardial biopsy and on the pathology of native andprosthetic cardiac valves. The introductory chapters lendthemselves to headings with ‘bullet’ lists followed by selectedillustrations, but the separation of text and photographs worksless well in the other chapters. There is some unnecessaryduplication in the sections on diseases of the great vessels andperipheral vessels. The descriptions of some of the entities andclinical details varies between these two sections withoutexplanation, as in the case of giant cell arteritis.The term ‘atlas’ is interpreted in different ways by different

authors. I would have preferred to see the emphasis on picturesrather than text, but in this book, text dominates. Forexample, in the chapter on endomyocardial biopsy in thenon-transplant setting, there are as many pages of text as thereare illustrations. The endomyocardial biopsy of cardiacallografts and transplant atherosclerosis is reasonably welldescribed, but is illustrated with only 22 figures, giving insuf-ficient coverage for a practising cardiac transplant pathologist.The section on pulmonary hypertension is rather short,with too few illustrations to be of use in assessing cases ofunexplained pulmonary hypertension. The authors’ aim toproduce a useful reference book with ample illustrations hasbeen met in part, but it is more of a well-illustrated textbookthan an ‘atlas’.Whether an ‘atlas’ or not, the picture quality with modern

production methods should be of a more uniformly highstandard than this volume achieves. Several photomicrographshave unacceptable yellow or blue backgrounds which areparticularly noticeable on double spread pages of illustrations.There are also a fair number of black and white gross pictures,which would have benefited from being in colour for the sakeof uniformity. The legends of the figures are not always

adequate, with the reader having to refer back to the previouspages of text. This could have been largely avoided by eitherinterspersing the figures with the text, or simplifying the textand having more description and differential diagnosis in thelegends.When I first received the book for review, I was rather

disappointed for the reasons given above, but having workedmy way through the book systematically and having used it forthe reporting of specific specimens, I found the informationeasy to access. I particularly enjoyed using the sections onvalves, cardiac masses, and pericardium.The book would certainly be a useful addition to the

reporting room library, particularly for use by trainees. Theyshould also find a great deal of interesting pathology toenhance their post-mortem examination of the cardiovascularsystem. The organization of the text into headings, lists, andtables could be a very useful template on which to organizetutorials or lectures for trainees, both in pathology and in thecardiothoracic specialties. Trainees in both cardiology andcardiac surgery will find this book of value; the balance of textto figures may be more to their taste than to that of thehistopathologist!

S. SPapworth Hospital NHS Trust

Essential Clinical Pathology.D V. P (Ed.). Blackwell Science, Oxford, 1996.

The preface to this book states that it originates from thecombined pathology course at Oxford University ca. 1991–1993 and that it is written in ‘spirit of the changes in medicaleducation, the new core curriculum and evidence basedmedicine’. Does this undergraduate pathology textbook boldlygo where no pathology textbook has gone before?In common with many recently introduced undergraduate

texts, it has soft covers and is attractively presented. It islavishly illustrated throughout with colour specimen photo-graphs and photomicrographs which are, in general, of excel-lent quality. Unfortunately, the electron micrographsillustrating glomerulonephritis in Chapter 21 (a topic thatstudents invariably find difficult) are a bit small and lacking incontrast. Full colour cartoons are also interspersed throughoutbut their purpose was lost on me and eventually I began to findthem rather annoying.The first section of the book is an introduction to the

laboratory specialities. This works well and contains lots ofinformation that would be useful to senior clinical students.The third and last section of the book. ‘Essential SystemicPathology’, is very comprehensive and successfully interweavesthe relevant chemical pathology and microbiology, at leastfrom the perspective of the histopathologist! There aretables describing the pathological causes of symptoms such asdyspnoea and the occasional CT scan and ECG.I found the second section of the book, entitled ‘Essential

General Pathology’, both disappointing and confusing. Thepreface states that it deals with disease processes involvingmultiple systems, which is true enough, but it does not providea balanced account of fundamental disease processes, or to usethe traditional terms, basic or general pathology. Whilst thereis a detailed chapter on the immune system and immuno-deficiency, there is no explanation of inflammation. The chap-ter on neoplasia is poorly written and incomplete—I could notfind a single reference to tumour suppressor genes.This book, then, provides a comprehensive review of system-

atic pathology and throws in a lot of integrated microbiologyand chemical pathology. As a bonus, it is almost atlas-like inits illustrations. The book will be of most use to the more

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