Muscle Biopsy – A Practical Approach (3rd edition)

Dubovitz, Victor and Sewry, Caroline A. Muscle Biopsy – A Practical Approach (3rd edition) Elsevier , Philadelphia, PA , October 2006 . 626 Pages. Price £149.00 ($199) ( hardback). ISBN 1-4160-2593-6 This is a welcome successor to the popular second edition, and has been extensively updated to include the numerous advances in the classification and diagnosis of muscle disorders over the past 20 years. Although the book uses many of the illustrations from the previous edition, the majority are now in colour and the format no longer uses the case studies. The images are generally of high quality and include numerous immunocytochemical preparations, and there are a number of helpful tables and diagrams throughout the book. The page numbers and chapters are written on the right hand edge of each page, and the text is laid out clearly, broken down by numerous subheadings into relevant sections, with key words highlighted in bold font, all of which makes finding relevant information quick and easy. The authors aim to provide a ‘comprehensive and up to date overview of muscle pathology’, including relevant clinical and molecular information, aimed specifically at pathologists. The book is divided into two sections, the first giving an overview of normal and diseased muscle and the second covering specific disorders Initial chapters cover the muscle biopsy techniques and, although open biopsies are not described in any detail, there are a number of useful sections describing basic specimen preparation including details of the common histological and histochemical techniques. Basic muscle structure is described both at light microscopy and the ultrastructural level, including sections on muscle plasticity and development. The common basic pathological changes seen in muscle diseases are described individually with their likely significance and there are sections on quantification (with descriptions of atrophy and hypertrophy factors) and common artefacts. Although the electron micrographs illustrating common abnormalities are generally of high quality, a few would benefit from being at higher magnification. There is a particularly useful chapter on immunocytochemistry, which includes a list of all relevant commercially available antibodies indicating their use in detecting primary and secondary changes in protein expression in a range of disorders. There is detailed practical advice on each of the individual steps, from the choice of glass slides to mounting media, including discussion of the various detection systems and range of fluorescent labels that are now available. The sections describing how to interpret the results of immunocytochemistry for each of the antibodies will also be of great use to most readers and reflects the authors' extensive experience in this area. There is a fairly basic chapter on how to interpret biopsies which contains a number of lists including: questions one should ask when trying to assess whether the biopsy is normal or not; the potential significance of abnormalities; lists of findings seen in each of the common muscle disorders. Although some may find this a useful aide-mémoire, I did not find this a useful approach, particularly as much of the information is present in more detail elsewhere in the book. The second section of the book starts with a brief chapter illustrating the various defects in neuromuscular disorders, followed by a series of chapters describing each of the major muscle diseases. These are divided into traditional muscle disease groups, most of which start with a brief historical background and include clinical, genetic and pathological findings. There are a series of excellent chapters describing the muscular dystrophies, which are littered with numerous illustrations of the morphological and immunocytochemical changes, again including detailed advice on interpretation and common ‘pit falls’. There are a number of helpful tables, listing key clinical features and up to date information on the genetic changes for these diseases. There are separate chapters on the congenital myopathies, myofibrillar myopathies, metabolic disorders (including mitochondrial diseases), endocrine disorders, ion channel and myasthenic syndromes. Perhaps the most disappointing chapter in the book is that covering inflammatory myopathies which, in contrast to the chapters on muscular dystrophies, lacks detail and does not mention a number of the less common inflammatory muscle disorders. The final chapter covers toxic and drug-induced myopathies, and briefly describes therecently identified macrophagic myofaciitis. The references are followed by two appendices, the first giving a glossary of the genetic terms used, the second a list of useful neuromuscular web sites. This book fills an important gap in providing an up to date and practical book for the diagnosis of muscle disorders. My only real criticism is the omission of some conditions, so that it does not completely fulfil one of its aims of being comprehensive. However, the layout of the book is easy to follow and it contains a wealth of useful practical information which will make it an essential bench book to any department involved in muscle biopsy reporting.