J Pediatr Adolesc Gynecol (1996) 9:89-91

Book Reviews

Atlas of Vulvar Disease. Edward J. Wilkinson, M.D., I.Keith Stone, M.D., ISBN 0-683-09092-5.

Reviewed by: Dennis M. O'Connor, M.D., Depart­ment of OBIGYN and Pathology, University of Lou­isville School of Medicine, Louisville, KY.

The vulva is one of the most difficult sites of the femalegenital tract for the clinician to comprehend. This is be­cause the vulva is a specialized area covered mostly bykeratinized squamous epithelium; however, it also con­tains a nonkeratinized mucosal surface near the hyme­neal ring. The vulva is thus afflicted by a variety ofdermatologic (local and systemic) and gynecologic dis­eases. Compounding this problem is a confusing array ofterms used by gynecologists, surgical pathologists, anddermatologists to describe these conditions. Lastly, manyvulvar diseases are chronic and do not always respond toa single treatment plan. Clinicians and pathologists are,therefore, always on the lookout for a vulvar textbookthat can help clarify vulvar terminology and offer thebest immediate and follow-up management plan for aspecific vulvar disease. The present textbook goes a longway to fulfill this need.

The authors are active in the International Society forthe Study of Vulvar Diseases (ISSVD), and one of them(EJW) has written extensively on vulvar anatomy andhistopathology. Both are well qualified to discuss thevarious topics covered in this book. The terminologyused in the book is that approved by the ISSVD and theInternational Society of Gynecologic Pathology.

As the title implies, the book is an atlas. Each chapteris filled with generous photographic illustrations of thevarious vulvar lesions. All clinical photographs are incolor and clearly represent the diagnosis as described inthe text. The microscopic photographs are in black andwhite. This does not detract from their clarity and aug­ments the text microscopic descriptions. The only errornoted regarding the illustrations is in the first chapter.Figures 1.8 and 1.9, while referenced in the text, are notidentified in the associated illustrations. This is a minoroversight, as it is fairly obvious what these illustrationsrepresent when reading the text.

The beginning of the book contains a glossary thatincludes definitions for specific vulvar diagnoses andclinical descriptive terms. It would have been helpful ifdescriptors commonly used in dermatopathologic diag­noses, such as acanthosis, exocytosis, parakeratosis, andsimilar terms, were also included as their meanings arenot necessarily clear to the nonpathologist.

The book is divided into 12 chapters. Chapter Oneincludes a description of vulvar gross and microscopicanatomy. Chapters Two through Ten are divided by vul­var lesion type. This is useful because, when one exam­ines the vulva, the specific abnormality, such as a cyst, apapule, a macule, or an ulcer, is recognized although thediagnosis may not be evident. If the reader wishes toquickly find information on a specific diagnosis, there isa cross-reference for diagnoses following the introduc­tory glossary. Each chapter begins with a definition forthe lesion, followed by a list of differential diagnoses.Definitions, clinical features, microscopic findings, clini­cal behavior, and treatment options are given for eachdiagnosis. The text for all chapters is concisely writtenand contains information necessary to establish a differ­ential diagnosis and an appropriate management plan forany vulvar lesion. At the end of each diagnostic section,specific therapies are listed beginning with the most im­mediate, then progressing through further options if theinitial treatment fails. Therapeutic options are up-to-dateas exemplified by the authors' preference for topicalhigh-potency fluorinated steroids over testosteronetherapy in patients with lichen sclerosis. Chapter 11 isdevoted to pediatric lesions such as labial adhesions,hymeneal abnormalities, and redundant labia. The lastchapter discusses lesions from trauma, including infre­quently encountered conditions such as gunshot woundsand more common but not necessarily recognized con­ditions such as insect bites. References are included atthe end of the final chapter, and selected further readingsare listed at the end of the first and final chapter.

In summary, this book would be a welcome additionfor any clinician or pathologist who deals with diseasesof the vulva. Pediatric gynecologists will find it espe­cially useful as these diseases do present in children andsome are specific to children and adolescents. As moretextbooks like this are consulted, there will be less con­fusion regarding diagnosis and management of variousvulvar conditions. Many consider a good textbook onvulvar pathology to be worth its weight in gold; if so,then this textbook is an 18-karat ingot.

Principles and Practice of Assisted Human Repro­duction. Robert G. Edwards, Seven A. Brody. ISBN0-7216-3626-8. Philadelphia, W.B. Saunders, 1995.

Reviewed by Alberto J. Carrillo, Ph.D., University ofLouisville School of Medicine, and Fertility Center,Alliant Health System, Louisville, KY.

This 690-page, 15-chapter publication is a well-written,

90 Book Reviews

comprehensive, and current book that can serve as acombination textbook, guide, and source book coveringall aspects of assisted human reproduction (ART). Thefine quality of this book is reflected by the fact that oneof its authors, Robert Edwards, is one of the pioneers ofhuman in vitro fertilization (IVF). The contribution tothis field by Dr. Edwards is best described in the fore­word by Howard W. Jones, Jr., M.D., who used the fol­lowing quote by Aristotle, "Those who see things growfrom the beginning will have the finest view of them," todescribe Dr. Edward's accomplishments in ART.

The book begins with a very informative, current, andconcise chapter covering the epidemiology of human in­fertility, natural fecundity, and fecundity associated withART. It then follows with an interesting chapter thatdescribes some of the history involved in the first at­tempts of human IVF by Drs. Edwards and Steptoe andothers, as well as the ethics and political repercussions ofIVF in various countries. The next set of five chapterscomplement each other well in describing the biology ofsperm followed by the evaluation and treatment of theinfertile male and the physiology of ovulation and themenstrual cycle followed by the evaluation and treatmentof the infertile female. These chapters serve as an excel­lent background for the next chapter which describes thebiology and reproductive endocrinology of ovarianstimulation for ART.

As an embryologist I enjoyed and learned the mostfrom Chapters 8-10, which describe the cell biology ofoocyte growth and maturation, human fertilization, andhuman embryos in vivo and in vitro. These three chaptersprovide the type of information that expanded my knowl­edge base as well as provided me with information thatI can apply on a daily basis in the laboratory practice ofART. I was impressed with the detail of the cell biologyand the depth of the topics described in these three chap­ters. I also found the figures and micrographs used inthese three chapters as well as the rest of the book to bevery informative. Thanks to these chapters I have for thefirst time seen photographic documentation of the eventsthat take place around an oocyte during cryopreservation.

A practical feature of the book is the use of box insertsto outline protocols which are directly applicable to thetreatment of patients or the ART laboratory. For ex­ample, the box insert with the protocol for cryopreser­vation of embryos with propanediol on page 342 is ex­actly what we use in our embryology laboratory.

Chapters 11-14 provide the reader with significantand relevant information about implantation rates duringART, preconception and preimplantation genetics of hu­man eggs, spermatozoa and embryos, implantation andpregnancy after ART, and the diagnosis and managementof threatened pregnancies after ART. These chapters area must reading for anyone in ART.

The book ends with a well-written and informativechapter (including figures and tables) on the Fecundity,

Parturition and Birth after Assisted Conception. The lastsection, specifically the last paragraph and the last figure,are something that all of us in ART need to have readilyavailable during those times when our success rates arenot as good as we feel they should be.

In summary, this book provides an exceptionally goodcombination of an infertility laboratory manual and areproductive endocrinology textbook. It is the most cur­rent and comprehensive ART book available and some­thing that every fertility practice should have and use.

Clinical Applications of Doppler Ultrasound, 2nd ed.Edited by Kenneth J.W. Taylor, Peter N. Burns, PeterN.T. Wells. ISBN 0-7817-0184-8.

Reviewed by Vernon Cook, M.D., Department of Ob­stetrics and Gynecology, University of Louisville,Louisville, KY.

Doppler ultrasound and particularly color Doppler hasevolved rapidly since the beginning of the decade whenit was a new modality to the point where most cliniciansare knowledgeable about its uses and indications for im­aging the vascular system, in many cases, replacing an­giography. During this time, ultrasonography has cometo require perfusion studies where only imaging was pre­viously preformed. Thus, while ultrasound texts from thelate 1980s and early 1990s remain excellent imagingresources, they are outdated regarding spectral and colorDoppler perfusion studies.

The theme of the book is spectral and color Dopplerstudy on the vascular tree. It is presented by organ sys­tem; there is a section pertinent to each of the majorspecialities. Prior to getting to the clinical section it isnecessary to first pay one's dues by developing a solidbackground in ultrasound physics. This is crucial to op­timal performance of spectral and color Doppler studies.The initial five chapters (110 of the 399 pages) devotedto physics, hemodynamics, and artifacts are quite read­able. Numerous line illustrations and diagrams readilyconvey the concepts.

The text will find its main readership in radiologists,inasmuch as it covers all organ systems except the heart.Readers of Adolescent and Pediatric Gynecology willfind the sections on gynecology (27 pages), pregnancy(13 pages), venous imaging (23 pages), and the child'sabdomen (36 pages) to be most pertinent. The recentdevelopments in obstetric and gynecologic color Dopp­ler, including ectopic pregnancy, ovarian and intrauterinemasses, and umbilical vein pulsations as a sign of heartfailure or impending hydrops, are satisfactorily ad­dressed. However, when information regarding spectralor color Doppler images of the fetal heart is desired,other resources will have to be consulted; fetal echocar­diography is appropriately outside the scope of the text.

The editors have succeeded in assembling an excel­lent, superbly illustrated text which would bring the li-