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Internal Medicine: Diagnosis and Therapy, 2d ed.

The goal of Internal Medicine: Diagnosis and Therapy is a bold one: to provide a practical, portable source of essential information needed for the effective management of the most important medical syndromes and diseases. Its organization and scope are belied by the chapter headings, which are by medical specialty, with the exception of the first chapter, which is on general aspects of medical therapy. This first chapter is remarkable, providing excellent tables (therapeutic drug levels, drug interactions, effects of dialysis on common drugs, narcotic analgesics), as well as sections on pain management with analgesic drugs, sedative-hypnotics and anxiolytes, and psychoactive drugs.

Given the size, spiral-bound format, and scope of this book, one cannot avoid comparing this 2nd edition of Internal Medicine, Diagnosis and Therapy with the Manual of Medical Therapeutics (known by house staffs as "The Wash Manual), now in its 26th edition. The concept is the same: take the way a department of medicine and all of its sub-specialties at a particular medical school do medicine, and write a book on it. (With "The Wash Manual," the school is Washington University in St Louis; with Internal Medicine Diagnosis and Therapy, it is the University of Texas Health Sciences Center in San Antonio.) Some differences need mentioning. In "The Wash Manual," references are listed in the text with an average of two to three per page, whereas in Internal Medicine: Diagnosis and Therapy, the references are listed at the end of the chapter. I prefer the former approach. In "The Wash Manual" the references are also more specific and more numerous.

The chapters are well written, covering the breadth of internal medicine. One particularly excellent section is chapter 16, "Emergencies." It covers cardiopulmonary arrest, upper airway obstruction, epistaxis, shock, anaphylactic shock, poisoning and overdose of many common drugs, ophthalmologic problems, hypothermia, heat illness, and near drowning. All of the sections of this chapter were excellent, yet I have two complaints. The general introduction to the section on poisoning and overdose does not mention calling the Poison Control hotlines available, a practice in our department in the case of every poisoning or overdose. Also, at the beginning of the chapter there is a section entitled "Emergencies Discussed in Other Chapters" with corresponding page numbers. Unfortunately, every single page number referenced is incorrect -- something that could be very frustrating in a real emergency. This error in cross-referencing occurs at other points in the book as well.

As to medical content, there were some oversights. For example, there is no mention of priapism as an adverse effect of Desyrel (p.15); no mention of adenosine or esmolol (Brevibloc) in the treatment of paroxysmal supraventricular tachycardia (p 47); no mention of magnesium infusion as treatment of torsade de pointes (p 51) nor a list (getting longer every day) of the drugs that cause it; no mention of cigarette smoking as an "allergen" in asthma (p 100); and no statement was made regarding the lack of efficacy of mineralocorticoid replacement in adrenal insufficiency, but it does appear in the section on secondary adrenal insufficiency, and causes confusion nonetheless (p 497).

In regard to its applicability or usefulness in family practice settings, this book is clearly an internal medicine text written by internists. The focus is geared toward inpatients, and the failure to address psychosocial issues is evident.

Len Scarpinato, DO Truman Medical Center East University of Missouri Kansas City School of Medicine
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Author:Scarpinato, Len
Publication:Journal of Family Practice
Article Type:Book Review
Date:Feb 1, 1992
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