Diseases. Edited by Kirby I. Bland and Edward M. Copeland ... danus. 240 pp. Illust. Hanley &. Belfus, Inc., Philadelphia. 1990. $33 (US). ISBN 1-56053-028-6.
sections are supplemented with tables, flow diagrams and colour illustrations. This timely publication is clear and useful. The colour illustrations are excellent and provide the reader with indispensable information. The book is also well organized. For the practising clinician there is valuable information not only on clinical presentation but also on the management of specific conditions such as HIVassociated periodontitis. At the same time, if one were to prepare a lecture on AIDS and its oral manifestations the book would be useful as a reference text. It therefore provides both practical and educational material. It is highly recommended. Howard C. Tenenbaum, DDS, PhD Head Division of Periodontics Department of Dentistry Mount Sinai Hospital Toronto, Ont.
Major work on breast disease The Breast: Comprehensive Management of Benign and Malignant Diseases. Edited by Kirby I. Bland and Edward M. Copeland III. 1 128 pp. Illust. W.B. Saunders Company/Harcourt Brace Jovanovich, Inc., Philadelphia; HBJHolt-Saunders Distribution Services, Toronto. 1991. Price not stated. ISBN 0-7216-2234-8
his book gives an excellent presentation of the current state of knowledge about breast disease, beginning with interesting historical comments and progressing to complex formulations of management for malignant disease. It is successful in its aim to "organize in a comprehensive, readable text the basic principles necessary for the diagnosis and treatment of various benign and malignant breast diseases." MAY 15, 1991
Despite the 107 authors the style is consistent throughout, and there are clear, comprehensive discussions. Illustrations are generous and particularly helpful in the sections on pathology, in which large photomicrographs depict the histopathological features of both common and less common entities. Each chapter is complete, has an extensive bibliography and may be read on its own as a reference (which may explain the repetition in the management sections). The book begins with an overview of the historical aspects of breast disease followed by a clear discussion of anatomy and physiology. The focus then shifts to the pathological aspects of benign and premalignant lesions and subsequently to a detailed exploration of the pathological and epidemiologic features of malignant disease (including a suggestion that one-third of breast cancers are familial). The section on the mechanisms of oncogenesis and metastasis is helpful for those who specialize in the management of malignant disease. Of particular interest to surgeons is the detailed review of the evolution of the treatment of malignant diseases of the breast, which begins with Imhotep's recognition of breast tumours and writings of the same period from India and Assyria and continues through the Middle Ages to the present, with rationalization of current forms of management. It serves to expose our limited understanding of breast cancer and its treatment. The one disappointment in the book is the large number of xeromammograms in the chapter on diagnostic imaging; these may be difflcult to interpret for those unfamiliar with xerography. Although a leading radiographic tool in the past xerography has been superseded by mammography. The discussion of imaging techniques is excellent nevertheless.
The shortcoming in the radiologic illustrations is offset by the excellent descriptions of and rationales for surgery and other treatments. The chapter on reconstruction is conservative and benefits from inclusion of the psychologic aspects of recovery. This complete and detailed text deserves a place in all significant medical libraries and should be basic reading for those involved in the treatment of breast disease. I predict that it will be recognized as a major work in the field. M. Graham Clay, MD, FRCSC Clinical associate professor Department of Surgery University of British Columbia Vancouver, BC
Concise and practical primer AIDS and other Sexually Transmitted Diseases. Edited by Manuel Schydlower and Mary-Ann Shafer. Adolescent Medicine: State of the Art Reviews, vol. 1, no. 3. Editors-in-chief, Victor C. Strasburger and Donald E. Greydanus. 240 pp. Illust. Hanley & Belfus, Inc., Philadelphia. 1990. $33 (US). ISBN 1-56053-028-6 I n 13 well-written chapters this excellent primer covers most aspects of the main sexually transmitted diseases (STDs) in adolescence: epidemiology and control, diagnosis, management, complications and the psychosocial, behavioural and educational factors important in prevention. Though not of practical value the chapter on the history of these diseases helps put them in perspective and is enjoyable reading. Although the data on epidemiology are primarily from US statistics they do parallel the Canadian data. As in the United States, Canadian teenage girls now possess the dubious honour of CAN MED ASSOC J 1991; 144 (10)
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having the highest rate of gonorrhea of any age group. The sharp decline during the past decade in the rate among adults, particularly men, has not been reflected in the adolescent population. General practitioners, family physicians and primary care pediatricians must therefore be alert to the possibility that an adolescent is suffering from an STD; this is particularly important for girls, who bear the brunt of long-term serious sequelae. The one deficiency in the book is the lack of a full discussion about condom use. Many physicians are unfamiliar with the many types of condom available and with the concerns and difficulties adolescents have in purchasing condoms and negotiating their use with a partner. Although information is spattered throughout the text there is not a whole section devoted to this complex area, and not all the relevant issues are covered. The text is easy to read and well indexed, and there are useful tables and charts. This relatively inexpensive book should be read by the primary care physicians who deal with adolescents, so that they can diagnose and treat STDs early and work toward prevention in this high-risk population. Noni E. MacDonald, MD, FRCPC Head Division of Infectious Disease Children's Hospital of Eastern Ontario Ottawa, Ont.
Stimulating critique Learning Disabilities: a Review of Available Treatments. William Feldman. 141 pp. Charles C. Thomas, Publisher, Springfield, Ill. 1990. $31.75. ISBN 0-39805703-6 T n his well-written book is designed, according to William Feldman, "for profes1284
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sionals whose opinion may be sought regarding one or more forms of treatment, as well as for parents of learning-disabled children who wish to understand more." He states that the objectives of the book are "to describe the different treatments being offered and to help the reader evaluate the quality of the evidence that the treatment really works." After an extensive review of the relevant literature, Feldman assesses the quality of evidence in each article. The highest value is given to the treatment methods evaluated in properly conducted randomized controlled trials. Case-control, cohort and beforeand-after studies are also reviewed but given lower values because they have inherent biases that result from lack of randomization. Each chapter deals with a different category of treatment. The longest chapters are dedicated to the fields in which most research has been done (i.e., education, psychology and medicine). Other chapters deal with occupational therapy, speech and language therapy, optometry, manipulation of nutrition and modification of the physical or social environment of the child. Unconventional treatment methods such as patterning and wearing coloured glasses for reading are also briefly mentioned. Ironically, a weakness of this book is in the chapter "The physician and the learning-disabled child." Here Feldman appears to use the accepted guidelines for critical appraisal of literature less vigorously. For example, when discussing the biophysical basis of learning disabilities he describes a study of positron-emission tomography in dyslexic and nondyslexic adults and mentions only the small size and the lack of blindness as weaknesses of the study. He does not, however, mention another important weakness: the fact that such studies do not tell
us whether diminished or asymmetric activities in various parts of the brains of dyslexic adults during reading are the cause or the result of their poor ability to read. Similarly, in discussing the effects of stimulant medications on behaviour, learning and selfesteem Feldman states that "20 to 25 percent of children with ADD(H) are thought not to respond to stimulant drugs" but does not provide a reference. If there are no reports on this topic in the literature this form of treatment should have been discarded as lacking scientific merit. In the same chapter Feldman recommends that "many parents and teachers need to be made aware of the evidence, which is that the risk of treated ADD(H) children becoming addicted to these or any other drugs is no greater than that of the general population." The study supporting this recommendation is cited by Feldman but not critically reviewed even though it is immensely important to the parents and teachers of these children. Even though the author has frequently attempted to explain scientific terms, for the parents of learning-disabled children the language is perhaps too technical. Many parents will have a difficult time understanding such phrases as "bilateral otitis media with effusion" and "planum temporale." This is an inherent difficulty with any book that attempts to address both professional and "lay" readers. For professionals, this book is an excellent source of information on various approaches to the treatment of learning disabilities. They will find Feldman's critical review of the literature stimulating. Hossein K. Moghadam, MD, FRCPC Alberta Children's Provincial General Hospital Calgary, Alta. LE 15
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