J. Anat. (1998) 192, pp. 315–317 Printed in the United Kingdom 315

Book Reviews

Muscle Damage. Edited by S S. (Pp.

xvi­243; illustrated; £34.95 hardback; ISBN

0 19 262753 8.) Oxford: Oxford University Press.

1997.

That the intricate, ordered and cellularly complex biologicalmachine that is muscle can be damaged by excessive orinappropriate use is not in itself surprising. Force candamage a muscle as it can damage a beautifully craftedclock or ever miraculous computer. The paradox is thatmuscle not only is anatomy’s principal means of generatingforce but in everyday life it is also the most important meansof absorbing force. Unlike the damaged clock or computer,muscle possesses the remarkable capability of regeneratingand restoring the intricate mechanism. Beyond this, and theprincipal achievement of this book, is the insight that muscledamage and its correlates of structure, chemistry andfunction provides to the understanding of muscle physiologyin health and disease.

In his preface, Stanley Salmons explains how he sat-isfactorily dealt with securing the issue of peer review in theissue of the journal Basic and Applied Myology which he hadbeen invited to edit in 1992, given that the most prominentresearchers in the field were invited contributors. Thesesame authors were subsequently invited to contribute to thisbook to which other invited authors added chapters. Asomewhat similar caveat is perhaps needed from me becauseI have collaborated in muscle research with (or knowpersonally) the senior contributors of 8 of the 11 chaptersand observed with interest (from a greater distance) theprevious publications of the remainder. This said, I havemoved on to other challenges and have had no com-munication on muscle damage with any of the contributorsfor nearly 2 years. I trust therefore that any comments onthe book can be accepted as objective from someonesufficiently close to be well informed but where newgeography and the passage of time serve to protect againstbias.

Themes addressed in several of the chapters deal with thedamage induced in human muscle by exercise, especiallyeccentric exercise in which muscles are lengthened whileholding force. Following exercise, evidence of damage in theform of soreness or pain is often delayed (hence DelayedOnset Muscle Soreness—DOMS), but its time course doesnot closely mirror the cellular damage as indicated by releaseof soluble cytoplasmic constituents especially creatine kinaseand myoglobin. Different again is the time course of themuscle dysfunction (e.g. fatigue) which has a slow recovery.To this must be added the indicators of cellular damage(prostaglandins and other free radical-mediated or relatedcompounds) which may have significance to the physiologyof pain mediation or the processes involved in repair.

From the biochemical approach in experimental modelsystems comes better understanding of intracellularmechanisms involved and interesting attempts to protectagainst muscle damage pharmacologically, e.g. by seekingto prevent the damaging accumulation of intracellularcalcium ions by pretreatment with dantrolene sodium orpreventing free radical-mediated damage by pretreatmentwith an antioxidant. From the observation of lower CKrelease after comparable exercise in women than men theprotective effects of oestradiol and converse effects oftamoxifen are providing insights into hormonal influenceson membrane integrity under mechanical stress. Drug-

induced muscle damage and the effects of ischaemia andreperfusion serve as further parallels sharing some commonmechanisms to those associated with muscle damage.

Mechanical damage has been explored using isolatedmuscle systems. This has revealed the importance ofredistribution of sarcomere length as a consequence ofeccentric as a fundamental consequence of over-stretchingthe mechanically weaker sarcomeres and allowing thestronger sarcomeres in series to become over-contracted.This process has led to the ideas of ‘popping’ of sarcomeres,the extraction of thick (myosin) filaments from their normalrelationship with the thin (actin) filaments and Z-diskarchitecture. The susceptibility to such damage appears todepend on whether the muscles are of the slow or fast-twitchtype.

Molecular markers are now used to map progress ofmuscle damage, regeneration, repair and the study of theplasticity of fibre type characteristics in response to cross-innervation (transplantation) or chronic electrical stimu-lation. To these indicators of damage or strain injury areadded imaging by magnetic resonance or use of technetiumpyrophosphate.

It may be asked why do all this work if the only problemis some muscle stiffness at the beginning of the footballseason! Apart from scientific curiosity as to how muscleswork and repair themselves, an important reason is to learnabout cellular damage in diseases of muscle (the myo-pathies). Finally and not least (given the focus of the editor’sinterest) comes the still not entirely resolved problem ofenabling skeletal muscle to go on working consistently andreliably enough to provide support for the failing humanheart with a suitably constructed surgical autograft prep-aration. In this lies the hope for a possible alternative toheart transplantation but there is still more research to bedone before this becomes a routine, effective and cost-effective treatment.

This book is an authoritative, concise account of anexciting saga. While much has been learned there are stillmany questions to answer with further research. It will makefascinating reading for sports scientists, pathologists andmuscle physiologists and biochemists.

. .

Elsevier’s Interactive Anatomy, vol. 2. I: Shoulder

Joint and Axilla. By B. H and G. J. G.

(CD-Rom, CD and user guide; $465; code no.

FCN.) Amsterdam: Elsevier Science. 1997.

Elsevier’s Interactive Anatomy, vol. 2. II: Hand and

Wrist. By B. H and G. J. G. (CD-Rom,

CD and user guide; $395; code no. FGH.)

Amsterdam: Elsevier Science. 1997.

This is part of a growing series of interactive CDs coveringdifferent areas of the body, from the standpoint of sectionalanatomy. Each particular area is presented as a completeseries of 2±25 mm sections taken in each of the 3 primary setsof planes. The system is based on 1 series taken through atissue block derived from a cadaver. A video image was madeof each section. The images were digitised, virtually recon-structed in 3D and then serially resectioned electronicallyin each of the other 2 primary planes. This resulted in 3complete, mutually perpendicular series of images throughthe specimen.

316 Book Reviews

The images within each series can be studied in severalways. For example, they can be examined in sequence bydriving through the series from beginning to end. This canbe done at 3 speeds: frame by frame, and by taking either aslow or a fast tour through the series, while being able tostop at any level along it. Taking the fast tour gives agenuine impression of travelling through the specimen.Another option is to select any frame within the series usingclearly designed key reference diagrams. This allowsimmediate viewing of a particular plane of section. It is alsopossible to call up sections showing any particular structureby clicking on its name in a comprehensive index in Latin orEnglish. Access is thus rapid, user-friendly and helpfullydesigned.

Once a particular plane has been selected, the same areacan be viewed in 4 ways, showing its anatomy, its histology,its MR or its CT scan image. The CT scans were madefrom the specimen sectioned. The MR images were obtainedfrom a volunteer. Each image can be looked at separately,or all 4 can be viewed together. Zoom facilities are availablefor the anatomy and histology modes.

The basic approach adopted is to present an unlabelledsection on the screen. The anatomy series consists of imagesof the actual individual sections in natural colour. Thecolour range is limited, being that of embalmed material.Nevertheless, the various structures are well differentiatedby differing colours, tints and tones. There is no evident lossof detail between the primary series of images and thosewhich have been reconstructed. While structures are notlabelled, all of those of significance can be immediatelyidentified by clicking over the particular profile, whereuponits name appears in a label on the screen.

The primary value of the system will be for postgraduateand professional training and reference, for which itconstitutes an indispensable resource. The thinness of theanatomical sections means that they can match the ever-increasing resolution of scanned images as the relevanttechnology advances. By its nature, any series of sections ofthis kind includes only a limited number of levels whichshow most features in a familiar way. The correlationbetween the CT scans and the anatomy images is very close.The correspondence between the MR image and theanatomical section is not always exact, but it is sufficientlygood to enable easy cross reference between the two. Theinclusion of all sections, and the possibility of rapid transitthrough the series, places these literally in context. For thosewanting to interpret sectional scanning images necessarilylying at atypical or unfamiliar levels, this system will be ofgreat value. For undergraduate training its main appeal liesin those images showing structures sectioned in familiarplanes. Because these are few in number its value isrestricted in this regard. Nevertheless, it provides anexcellent means of learning how to interpret scanned imagesby relating these to anatomical material. The possibility oftravelling through the series and of following a particularstructure through it provides a unique view of its course andrelations. However, to benefit significantly from this requiresa considerable depth of knowledge, perhaps more than isattained in many contemporary anatomy courses.

Installation is simple, quick and easy to perform. Clearinstructions are given on the use of the system. Much efforthas been applied to making both access and display rapidand user-friendly. The addition of a zoom facility andimproved screen layout are new features compared withprevious discs in the series.

Each part of the series is provided in CDI-I and CD-Romformats. One set covers the hand and wrist. The other coversthe shoulder joint and axilla. There were no evident faults inthe former. Strangely, in the latter the master inset image,

which is intended to continually indicate the position andorientation within the series of the section under study, wasthat of the wrist and hand rather than that of the shoulderregion. Four different levels of zoom are possible, but onlythe lowest is really of value, since the pixels obtrude at thehigher levels, so that no significant gain in detail ensues.

In summary, this system will be of enormous benefit forlearning, cross-referencing and revising cross-sectionalimages. The greater the cross-referencing detail required thegreater will be its relevance and value, which means that itwill be mainly of use at postgraduate and specialist levels.

Essential Anatomy for Anesthesia. By S M. B

and W. A C. (Pp. x­198; fully

illustrated; £50 hardback; ISBN 0 443 05054 6.)

Edinburgh: Churchill Livingstone. 1997.

The anaesthetist requires a peculiarly specialised knowledgeof topographical anatomy. Some regions of the body (forexample the respiratory passages, the major veins and theperipheral nerves) the anaesthetist must know in intimatedetail and with an understanding of anatomical anomaliesthat rivals that of the surgeon; other areas may be almostignored. The importance of the subject for the safe practiceof anaesthesia is well recognised—not least by examiners forhigher qualifications in the subject.

The role of anatomy in anaesthetic teaching and practicetoday goes far beyond being a prerequisite for the safepractice of local anaesthetic blocks. It is also important inthe understanding of the airway, the function of the lungs,the circulation, venous access, pain control, the monitoringof neuromuscular blocks and many other aspects of practicalanaesthesia.

This new book has as its authors Dr Sue Black, ananatomist at the University of Glasgow, and Dr W. A.Chambers, consultant in anaesthesia and pain relief inAberdeen. They have combined to produce a clearly writtentext, elegantly illustrated by clear line diagrams and -rays.The wide field of anatomy relevant to the anaesthetist iscovered and the book can be recommended to theanaesthetic trainee as well as to the teacher.

MCQs in Anatomy for Undergraduates and Medical

Students. By M. J and B. S. M. (Pp.

v­303; illustrated; paperback; ISBN 0 7506

3591 6) Oxford: Butterworth–Heinemann. 1997.

The left-hand page displays the questions, the facing pagedisplays the answers and explanations. The book is arrangedon a regional basis, with final sections devoted to histology,neuroanatomy and embryology.

I find this book intensely depressing. A Chinese proverbstates that if one views a leopard through a sufficiently small-bore tube, all one sees is a spot. It has also been said that ifone views a student through an MCQ, all one sees is a fact.How strongly does this apply to many of the questionsasked in this book?

A great deal of the anatomy learned as a result of workingthrough this book is trivial and some of it is nonsense. Is itreally worth our students being given the mnemonic thatreminds them of the sequence of insertion of the sartorius,gracilis and semitendinosus on the medial aspect of theupper tibia?

Am I dim, or senile, when I look at the answer to the

Book Reviews 317

question on the aditus to the lesser sac? The question is,‘The lesser sac has an aditus which has free communicationwith the hepatorenal pouch’. Answer: ‘False. This isrubbish! The aditus is in free communication with thegreater sac, a small part of which is the hepatorenal pouch,though this latter structure (sic) is some distance from thelesser sac, being the right posterior subphrenic space. ’ Getit? I don’t.

Real knowledge of functional anatomy cannot be learned,revised or tested by MCQ. Unfortunately such books,together with ‘spot ’ tests, in which students need to givenames to structures flagged using Blue Tack, set an unofficialcurriculum for students preparing for examination.

. .

Photographic Atlas of Practical Anatomy, part 1:

Abdomen, Lower Limb, ­companion volume

including Nomina Anatomica and index. By

W T. (Pp. xviii­844; 414 figures in

colour and black & white ; £205}$298 hardback;

ISBN 3 540 61195 9.) Berlin : Springer. 1997.

This atlas presents the most beautiful and vivid colourphotographs of dissections that this reviewer has ever seen.It represents the first of what will be two, two-volume sets

and deals with the abdomen and the lower limbs. The firstvolume of this pair comprises unlabelled colour photo-graphs on the right hand page with detailed explanatorynotes on the left. The companion volume has the samephotographs, this time in black and white, which aremarked with arrowheads. Numbers in the margins line upwith these symbols and are keyed to the list of anatomicalterms on the facing page. By using both the volumes, thereader can locate the names and positions of structureswithout having the large colour photographs obscured inany way.

The author, who is Professor at the Anatomical Instituteof the University of Graz, Austria, carried out the greatmajority of the dissections and also took the photographs.The quality of the preservative technique which was usedhas resulted in an almost lifelike appearance of the material,so that it resembles closely that of the tissues and organsencountered at surgical exposure.

This is undoubtedly an exciting study in anatomicalphotographic illustration. Structures not usually easy todemonstrate, such as fascial layers, are visualised moreclearly than I have seen in other photographic atlases andhave a more realistic appearance than can be achieved indiagram form. It is a work that will be of value toanatomists and surgeons and is both useful and aestheticallypleasing.