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Color Atlas of Muscle Pathology.

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    Color Atlas of Muscle Pathology. Edited byw j kenneth cumming, john fulthorpe, peter hudgson, and michael mahon. (Pp 202; price £95.00 hard back). London: Mosby Wolfe, 1994. ISBN 0-7234-2016-5.

    The authors’ stated aim with this atlas is to produce a bench book of practical application for clinicians and pathologists. Chapters on technical aspects and general approaches to the muscle biopsy are followed by chapters covering groups of muscle disorders in a systematic fashion. Several useful appendices are included.

    The overall presentation of the book is attractive and well set out. As befits an atlas, the illustrations, both colour photographs of histological sections and many electron micrographs, are mostly of high quality and convincingly demonstrate the features which the authors intend.

    The chapter on preparation of the muscle biopsy, including both open and closed approaches to the biopsy procedure itself, is practical and succinct. The authors cover the preparation of tissue for histochemistry, immunohistochemistry, electron microscopy, and morphometry. The appearances of both normal muscle and the pathological reactions demonstrable by these various techniques are well illustrated. The potential pitfalls of technical artefacts are included and there is a useful practical scheme of systematic analysis. The following chapters only briefly describe broad categories of disease. The adjuvant role of immunohistochemistry in the inflammatory myopathies and the importance of using these techniques in the dystrophies is emphasised. However, coverage of dystrophies other than Duchenne and Becker dystrophy is cursory and the book does not include the emerging classification of the many limb girdle syndromes. A short chapter on miscellaneous disorders glosses over several of the most difficult and diagnostically challenging categories in muscle disease.

    The authors rightly emphasise the need for good clinicopathological correlation and the use of a broad range of histological techniques, both of which are particularly essential in the proper evaluation of muscle biopsies. However, it must be questioned why these clinicians find it necessary to alienate the very pathologists with whom they wish to cooperate and to enlighten. Pathologists who read the preface will discover that they above all are considered woefully ignorant and the “traditional histopathological reliance on one or two poorly orientated and often badly fixed H and E stained sections” is hardly a fair description of the modern diagnostic specialty.

    This is a small slim volume that will serve as a useful overview and introduction to muscle pathology; nevertheless there is considerable difference between a diagnostic manual and a reference atlas. The text of this book is superficial and, given that muscle pathology is never a simple matter of picture matching, those actively engaged in biopsy diagnosis will find it very limited as a diagnostic bench manual. However, other larger more comprehensive texts are available and I did buy this book and wish to recommend it, but mostly for the high quality images that are currently unsurpassed and will provide a valuable source of reference.