Renal Physiology

importance of recalcification of lytic lesions as an indicator of progress against the systemic disease, the value of bone marrow biopsy, urinary hydroxyproline levels, or serial bone scans in monitoring various malignancies have yet to be worked out but are receiving attention in hospitals and laboratories worldwide. In short, the enormous amount of uncertainty about these widely separated issues is spawning a great deal of seemingly unrelated research. The problem of bone metastasis is, for both researcher and clinician, central to the overall problem of cancer but is rarely addressed as an individual entity. This well-edited collection of specially written reviews attempts to bring together expertise from the many biomedical fields which touch on this area. Though there is some duplication in the papers, the span of information that makes up our present-day understanding of cancer's spread to bone is largely contained or referenced herein. This span reaches from the developmental biology of osteogenic cell differentiation to the psychology of counseling the patient with malignant bone pain. Most of the scientific and clinical topics are dealt with cogently and thoroughly. Papers on the pharmacologic inhibition of tumor osteolysis and its relationship to the hypercalcemia of malignancy and papers on the basic science of the osteoblastic response to metastasis both bring up the role of prostaglandins in the control of calcification. These papers are quite interesting and suggest future work in these areas. This book's biggest problem is one which confounds the medical literature in general: the less that is known about a subject, the more is written. This is especially evident in the chapters in the mechanisms of tumor osteolysis and the monitoring value of serial bone scans. This latter chapter is also overly detailed in its presentation of the research of one of the editors. Chapters on orthopedic and neurosurgical methods of treatment are somewhat less detailed but excellent summaries nevertheless. Overall, the book is very well written and, while probably directed to the internist or oncologist, it would serve well the interested bone radiologist or orthopedic surgeon.