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Colour atlas of bone, joint and soft tissue pathology. Nicholas A Athanasou. (£140.) Oxford: Oxford University Press, 1999. ISBN 9–780192–627926.
Here is a wonderful introduction to the often underappreciated world of bone and other musculoskeletal pathology. Medical students, residents, fellows in pathology and rheumatology and orthopaedics who have an interest in musculoskeletal pathology would probably enjoy going through the excellent pictures and the short, informative descriptions. The book has a wide scope and thus gives a “bird's eye” glimpse of many conditions without necessarily considering them in depth. For breadth, one must make sacrifices. Consequently, this guide is better as a reference book than bench side guide. Although a practising pathologist may find it lacking pertinent information at the bench, practising rheumatologists may find it just the book to look for in the library when faced with a patient with a puzzling biopsy report. One will probably find this book on a library shelf for, at £140, it is expensive for individual purchase.
I enjoyed looking at the pictures. I compliment the author on including such a variety of orthopaedic and rheumatological conditions, including some uncommonly seen problems. A traditional approach to musculoskeletal pathology is taken, and there is a short chapter on soft tissue lesions at the end. This makes it easy to use by students and residents as an atlas to supplement their reading.
Dr Athanasou has produced an amazing collection of photomicrographs. This can be a wonderful reference source to begin a search for pathologic information for rheumatologists not familiar with more detailed studies on synovium or as a starting point from which to pursue treatment of the occasional patient who presents to us with bone tumours or soft tissue tumour-like lesions. The author can show only the main features of most lesions. A bibliography is provided, but specific references to many of the key statements would have been even better. I have already used this for a patient referred to me with an inguinal mass, possibly caused by retroperitoneal fibrosis. This would have been a rare cause of such a mass and the atlas helped guide me towards a desmond tumour, which our pathologist then confirmed.
When the author turns to the synovium the terse descriptions are generally accurate but frustratingly incomplete for rheumatologists and clearly not intended as having an element of inflammation, but the author then concludes that this needs to be distinguished from rheumatoid arthritis, without sticking his neck out as to how to do this. Haemochromatosis, pigmented villonodular synovitis, and haemosiderin in synovium from trauma are all lumped together as siderotic without much of an attempt to tell us how to distinguish them. Rheumatoid arthritis is dealt with in four pages, which does not get beyond routine histology. There is a description of early rheumatoid arthritis but no basis is given for statements made.
I will use this more for a quick introduction to areas with which I am not familiar, like bone and soft tissue lesions, and I expect it to be a useful occasional source that I will keep available.
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