Technical methods

Cooper, H. L., and Rubin, A. D. (1965). RNA metabolism in lympho-cytes stimulated by phytohemagglutinin: initial responses tophytohemagglutinin. Blood, 25, 1014-1027.

Gardikas, C., and lsracis, M. C. G. (1948). The Feulgen reaction ap-plied to clinical haematology. J. clin. Path., 1, 226-228.

Gillis, E. M., and Baikie, A. E. (1964). Method for the demonstrationof nucleoli in lymphocytes and other blood and bone marrowcells. J. clin. Path., 17, 573-574.

Greig, H. B. W. (1959).A substitute for the Feulgen staining technique.J. clin. Path., 12, 93-94.

Huhn, D., and Stich, W. (1969). Fine Structure of Blood and BoneMarrow, pp. 100-107. Lehmann, Munich. Hafner, New York.

PotmAtil, M., Smetana, K., and Wienerovi, E. (1965). The nucleolarcoefficient of the lymphocytes in the peripheral blood ofpatients with Hodgkin's disease. Neoplasma, 12, 205-214.

Smetana, K., Janele, J., and Malinsk*, L. (1966). Nucleolar coefficientof lymphocytes in the peripheral blood of female patients withbreast carcinoma. Neoplasma, 13, 643-648.

Smetana, K., Lejnar, J., and Potmnfil, M. (1969). A further contribu-tion to the demonstration of RNA and nucleoli of blood cellsin smear preparations. Folia haemat. (Lpz.), 91, 381-394.

Studzinski, G. P., and Gierthy, J. F. (1972). Cytologic appearance ofthe nucleolus of normal and neoplastic cells in relation to thesynthesis of RNA. Acta cytol. (Baltimore), 16, 245-248.

Letter to the EditorCandida Isolates

Regarding Dr R. C. Bartlett's letter com-menting on our paper (Stieritz, Law andHolder, J. clin. Path., 1973, 26, 405-408),we did not mean to imply all Candidaisolates from any patient should bespeciated. Our paper concerned burnedpatients infected with Candida and in thecontext of Candida isolated from thewounds, urine, and blood of compro-mised hosts we still feel that speciation isimportant.While I concur with Dr Bartlett's

comment that 'the decision to treat shouldbe based on clinical evidence of infection,not the species isolated', we have foundthis not to be the case when dealing withCandida infections. Because of the highlytoxic nature of Amphotericin B, thedecision to treat Candida infections isfrequently delayed until the clinician isforced to treat or lose the patient. As wepointed out, many clinicians consider C.albicans the only Candida which is ofclinical concern. When they receive aculture report stating that Candida otherthan albicans has been isolated from aninfected patient, they may be lulled intoa false sense of security and then finallybe forced to treat with too little too late.Our data showed that while all of the

Amphotericin B MICs for C. albicanswere 0 16 ug/ml or below, most of theMICs for C. tropicalis were at least onedilution higher, and in some cases twoand three dilutions higher. This mayimply that C. tropicalis infection couldbe a treatment problem, whereas C.albicans infection may not be. Support forthis idea may be found in the fact thatthe first report, to my knowledge ,ofclinical isolates of Candida being resistantto Amphotericin B has recently been

published (Woods, R. A., et al, 1974),These resistant isolates were C. tropicalisnot C. albicans.While we all would like to keep the

costs of health care to a minimum, theattitude that we should only do thatclinical microbiology which is 'essentialto diagnosis and treatment', I believe tobe incorrect. In the evolution of infectiousdiseases and in defining infection prob-lems, the microbiology that was 'essentialto diagnosis and treatment' yesterday isnot the same as the microbiology that is'essential to diagnosis and treatment'today; nor will today's microbiologysuffice tomorrow. We, the clinical micro-biologists, must be alert to identifyingnew infection problems; the latest 'emer-ging' pathogens, and it must be ourresponsibility to warn the medical frater-nity of these new dangers. If we don't,who then?

IAN ALAN HOLDERDepartment of Microbiology,

Shriners Burns Institute,Cincinnati, Ohio 45219

ReferenceWoods, R. A., et al (1974). Resistance to polyene

antibiotics and correlated sterol changes intwo isolates of Candida tropicalis from apatient with an amphotericin B-resistantfunguria. J. infect. Dis., 129, 53.

Book reviews

Transplacental Carcinogenesis Proceed-ings of a meeting held at the MedizinischeHochschule, Hanover, 1971 (IARC Scien-tific Publications No. 4). Edited by L.Tomatis and U. Mohr. (Pp. xiii + 181;illustrated. £5{00; $12-00; Sw. fr. 40.-)Geneva: World Health Organization.International Agency for Research onCancer. 1973. Available from HMSO,London.

Interest in the transplacental action ofcertain carcinogens was widely stimulatedby the report from Boston in 1971 of acluster of eight cases of adenocarcinomaof the vagina in young women; themothers of all but one of them hadreceived stilboestrol during their preg-nancy. Although the transplacental car-cinogenic activity of stilboestrol has notyet been reproduced in experimentalanimals, the general subject of trans-placental carcinogenesis has been exten-sively investigated. A useful summary ofcurrent knowledge is presented in thisbook. Particular attention has been paidto the nitrosamines, and one group ofthem-the nitrosoalkylureas-has beenclearly shown to act as transplacentalcarcinogens with the brain as the maintarget organ. The dose of the compoundgiven and the stage of foetal developmentboth appear to be crucial in determiningthe outcome-in particular, death orinduction of malformations rather thantumours. Predictably, no tidy relationshipappears to exist between teratogenic andcarcinogenic activities, and many detailsof the actual mechanisms of transplacentalcarcinogenesis are still quite unknown.The subject is, however, one of consider-

able potential importance. Tumours arenow a major cause of death amongchildren in advanced societies, and the

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high incidence of transplacentally inducedgliomas and nephroblastomas reportedby the experimentalists has attracted muchattention from the clinicians. Despitecertain defects (notably the lack of anindex), the present account provides atimely introduction to what is likely tobe a rapidly expanding subject in clinicaland experimental oncology.

RICHARD CARTER

Chromosomes in Human Cancer ByJaroslav Cervenka and Lucien Koulischer.Edited by Robert J. Gorlin. (Pp. viii +203; 22 figures. $13.75.) Springfield,Illinois: Charles C. Thomas. 1973.

The authors have gathered together mostof the available information on thechromosome complements of malignanttumours (almost always abnormal) andof leukaemias, benign tumours, and pre-neoplastic lesions (frequently, though lessconsistently, abnormal). The first sectionis devoted to general considerations,including the question of specific changesin solid tumours (the highly consistentloss of a G group chromosome inmeningiomas is not mentioned at thispoint). There follows a commendableaccount of the chromosome changes inleukaemias and preleukemic conditions.The final section is devoted to solidtumours.

This is a stimulating and on the wholecomprehensible treatise which deals witha large amount of data. Unfortunately,there are many minor errors, particularlymisspellings of authors' names, and somethat are less trivial. A discussion onclonal evolution is accompanied by atable of karyotypes which may wellpuzzle the reader (it is not explained thatthe leukaemic patient concerned hadcongenital trisomy-21; the source of thetable is given as Lejeune et al, 1963, butthis paper has been omitted from thereferences at the end of the chapter). Attimes, there is confusion over nomen-clature. Thus, the terms 'cyst' and'cystadenoma' are used for malignanttumours, and in a report on ovarianteratomas their benign or malignantstatus is not given.

N. B. ATKIN

Diagnostic Orthopaedic Pathology By C.G. Woods. (Pp. ix + 298; illustrated.£8-50.) Oxford, London, Edinburgh,Melbourne: Blackwell Scientific Publica-tions. 1972.

This book is intended to be a practical aidto the diagnosis of bone and joint lesions.There is certainly a need for such a book.It is written by the pathologist at theNuffield Orthopaedic Centre, Oxford,and reflects his extensive experience inthe field of pathology as applied to ortho-paedics. The author adds his emphasis tothe very sound view that diagnosis ofmany diseases of bones and joints (andpresumably of other systems, too) is notto be established on the basis of one pieceof evidence alone. Histopathology, radiol-ogy, biochemical data, and clinical infor-mation are often concerned together, invarious combinations, and the wisehistologist knows when to call on infor-mation from other disciplines at the sametime as looking down his microscope.The question is how the book measures

up to its very laudable aim. It is relativelyshort and easy to read. Its illustrations,from a wide variety of lesions, includemany radiographs as well as photomicro-graphs. One serious defect is the very limit-ed bibliography provided. Another, at leastin the experience of the present reviewer,is that the general arrangement of thematerial is not well suited to the practicaldiagnostic purpose which is put forwardas the chief aim of the book. Perhaps itis likely to be of more use to the under-graduate student who wishes to have apractical account of bone and jointpathology than to the pathologist search-ing for the solution to a difficult diagnosticproblem.

H. A. SISSONS

Muscle Biopsy: A Modern Approach(Major Problems in Neurology, volume 2)By Victor Dubowitz and Michael H.Brooke (Pp. 486; illustrated. £7-50.)London, Philadelphia, Toronto: W. B.Saunders. 1973.

Interpretation of muscle biopsy sectionscan often pose considerable diagnosticproblems for the histopathologist who isnot accustomed to dealing with thisspecialized field. Professor Dubowitz andDr Brooke are to be congratulated onproducing a readable, well illustratedaccount of the histology of both normaland diseased muscle. The first section ofthe book is devoted to the techniquesused in performing, processing, and stain-ing biopsy material. Histochemicalmethods are dealt with in some detailand the importance of accurate fibrediameter measurements is stressed. Thesecond section gives a detailed clinico-

pathological description of muscle dis-orders illustrating the use of these tech-niques, and in particular of enzyme histo-chemistry. The section concludes with anadmirable summary of the analyticalprocesses needed to arrive at a diagnosis.The third and final section, written by DrHans Neville, is devoted to the ultra-structural changes in muscle disease andis a first-class, concise account of thisrapidly expanding field. This book repre-sents excellent value for money and shouldfind a place on the bookshelf of everyroutine histopathology laboratory.

M. S. DUNNILL

Medicine and Mycology

A course on common fungal infectionswill be held at Fitzwilliam College,Cambridge, on 25, 26 and 27 September1974.The course is intended for all clinicians

and laboratory workers interested indiseases caused by fungi.The lecturers will include: Professor

R. A. Cawson (Guy's Hospital), Dr G. P.Clein (St George's Hospital), Dr R. R.Davies (St Mary's Hospital), Dr D. B.Evans (United Cambridge Hospitals),Mr E. G. V. Evans (Leeds GeneralInfirmary), Dr Andrew Henderson (Uni-versity Hospital, Cardiff), Dr B. M.Herbertson (Dept. of Pathology, Cam-bridge), Professor J. R. Hobbs (West-minster Hospital), Dr Rosalinde Hurley(Queen Charlotte's Maternity Hospital),Dr David Kerridge (Dept. of Bio-chemistry, Cambridge), Dr D. W. R.Mackenzie (London School of Hygiene),Dr M. F. Madelin (Department ofBotany, Bristol), Dr R. R. Marples(Central Public Health Laboratory, Colin-dale), Dr S. 0. B. Roberts (UnitedCambridge Hospitals), Dr Arthur Rook(United Cambridge Hospitals), Mr M. E.Snell (St Mary's Hospital), Dr D. C. E.Speller (United Bristol Hospitals).Enrolment forms may be obtained

from the Secretary, Cambridge UniversityMedical School, Hills Road, CambridgeCB2 2QL.

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