Musch, Relaxants a contribution London,
( M a j o r P r o b l e m s in A n a e s t h e s i a , Vol. 1), b y S. A. FELDMAN, w i t h
o f M . A . SKIVINGTON, x i + 190 p a g e s , 63 i l l u s t r a t i o n s , S a u n d e r s ,
1973, £ 4.00.
This is Volume 1 of a series of monographs on "'Major Problems in Anaesthesia" edited by Professor Mushin. It is an extensive review of the actions, administration and uses of the major relaxant drugs. I11 the discussion on the possible eftkcts of curare on the CNS, I could find no references to the effect of the preservatives used in the curare preparation. From the clinical point of view the section on myasthenia gravis and the Eaton Lambert syndrome is confusing and there is scant reference to the effects
Muscle Biopsy: A Modern Approach
of relaxants in other neurological diseases. There is no reference to the work of Lambert in the assessment of the extent of neuromuscular block. Malignant hyperpyrexia is barely mentioned. The literature on muscle relaxants is now so large that this guide to it will be most welcome to anaesthetists wishing to know the background pharmacology and effects of these important drugs. R. G. Wn.LISON
in N e u r o l o g y ,
Vol. 2), b y
V. DUBOWlTZ AND M . H . BROOKE, w i t h a c o n t r i b u t i o n b y H. E. NEVmLE, X + 475 p a g e s , 677 i l l u s t r a t i o n s , 5 t a b l e s , S a u n d e r s , L o n d o n , The title of this excellent book belittles its scope; it is more than a guide to the performance and interpretation of muscle biopsies. Nearly threequarters of the text is devoted to a detailed description of the clinical features of the neuromuscular diseases and their muscle pathology. The sections on spinal muscular atrophy, the muscular dystrophies and the congenital myopathies are particularly valuable to the clinician and the pathologist, and reflect the great personal experience of both of the authors in these fields. Fortunately, they have made generous use of case reports and of well-reproduced photomicrographs of their own cases. The information here is fully up to date and many readers will, for example, find this the first easily available account of "congenital fibre type disproportion" and "reducing body myopathy", disorders recently described by Dr. Brooke. However, the detailed and often quantitative accounts of the pathology of some commoner disorders such as the spinal muscular atrophies and that increasingly nebulous entity "limb girdle dystrophy" are even more valuable. The account of the pathology of 18 cases of the latter usefully emphasises some points of distinction from the Becker type and especially the frequency of fibre hypertrophy and of "moth-eaten" and ring fibres and the paucity of necrosis or regeneration in the limb girdle cases. The frequency of an inflammatory response in biopsies from cases of facioscapulo-
humeral dystrophy is justly emphasised, which perhaps puts into proper perspective some recent reports of "familial polymyositis imitating facioscapulohumeral dystrophy", and at the same time raises the question of whether and how it is justifiable to use steroids in this disorder. Four initial chapters describe briefly how to take a muscle biopsy, how to process and stain it and, more fully, the normal histology of muscle and the definition and methods of quantitation of pathological changes. The account of muscle histochemistry, in which both authors have been acknowledged pioneers, is a clear account of the development and present complexities of the subject. At a time when there is still too little uniformity of method and nomenclature of fibre typing they use the ATPase reaction to define Types 1, 2A and 2B fibres for all clinical purposes. There is a summary chapter on interpretation of biopsies and a useful and well-illustrated one by Dr. Neville on electron microscopy. Although it does have the limitation that it reflects the authors' personal approach, especially to techniques, this book is one of the best available on muscle pathology, and if it had a better title and some information on electrophysiology and genetics it would compete successfully as a guide to diagnosis in the clinical field. Everyone who has to try to diagnose muscle diseases should have one.
Brain-Pituitary-Adrenal Interrelationships Pituitary-Adrenal
(International Symposium on BrainC i n c i n n a t i , O h i o , 1 4 - 1 6 J u n e , 1972), b y A.
BRODISH AND E. S. REDGATE (Eds.), xii + 340 p a g e s , 182 i l l u s t r a t i o n s , 29 t a b l e s , K a r g e r , Basel, 1973, S F r 146.00, U S $45.30, D M 132.00, £18.55. This volume adds another to the rapidly increasing
number of volumes available on the brain and