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Am Fam Physician. 1999;59(9):2661-2662

Handbook of Interpretation of Diagnostic Tests

By Jacques Wallach. Pp. 464. Price, $24.95. Lippincott-Raven, 227 East Washington Square, Philadelphia, PA 19106-3780, 1998.

The jacket of this textbook accurately describes it as a portable “quick-reference guide to common laboratory tests.” This is a condensation of Dr. Wallach's larger volume Interpretation of Diagnostic Tests. It is intended to be a pocket compendium of useful laboratory determinations for common diagnoses, and it lives up to that promise. It does fit in a lab coat pocket, but it will face stiff competition from the numerous other pocket “brains” designed for the same purpose.

It is a useful book for several reasons. First of all, it is complete and covers numerous common diagnoses and laboratory studies likely to be ordered in a family practice. However, the scope of the book goes beyond that: it is divided into four separate sections dealing with normal values, specific laboratory examinations, an extensive section on diseases by organ system, and a final section on drugs and laboratory test values.

The opening chapter is worth reading as a refresher on the value of laboratory testing and the link that it has to a patient's clinical condition. It reviews the general principles of testing, including testing that is done to reduce clinical uncertainty, and points out the fallibility of testing. The book includes a good discussion on the significance of a positive or negative laboratory test based on the probability that the condition tested for is present. It points out that clerical errors are far more likely than technical errors to be the cause of incorrect results and that a skeptical mind is always of value in reviewing the results of laboratory testing.

The book also contains a 31-page discussion of the core chemical analyses that are present on most screening panels and their significance to various pathologic conditions. Urine testing is covered in equal detail, given 20 pages.

The chapters covering diseases of organ systems range in length from eight pages on cardiovascular disease to 86 pages on endocrine disease. Hematology is covered in 85 pages, and discussions of most of the other organ systems range from 12 to 35 pages. Within each organ system, testing is broken down by clinical condition, and the positive tests likely to be associated with that condition are discussed in some detail. Tests that are of little proven value are also discussed. Given the rapid advances in diagnostic testing, each of these chapters is current and relevant to the day-to-day decision-making of family physicians.

The concluding two sections briefly discuss the effects of drugs on laboratory test values. Therapeutic drug monitoring and toxicology are discussed for medications in which measurements of peak and trough and steady-state levels are of value.

An extensive index helps guide the reader to appropriate sections of the textbook. There are five pages devoted to abbreviations and acronyms for common laboratory tests, which should help standardize communication when notes are written in the course of a busy day or when laboratory tests are ordered. Again, the caveat by the authors is that clerical errors in ordering tests, appropriate timing of testing and interpretation of testing in light of the clinical situation are all of great value in deriving meaningful test results.

This textbook will be of value to practicing physicians who are unlikely to see many of the conditions discussed in the textbook more than once or twice in their professional careers, as well as in helping make expedient diagnoses for conditions that they see frequently. Having a quick reference for these conditions would assist in making a diagnosis and in following therapy.

I was pleased to receive this textbook for reviewing. This book is a useful addition to the busy clinician's bookshelf of quick references.

Fracture Management for Primary Care

By M. Patrice Eiff, Robert L. Hatch, and Walter Calmbach. Pp. 283. Price, $49.95. Saunders, 625 Walnut St., Philadelphia, PA 19106, 1998.

This is a comprehensive textbook that covers all fractures, both in the extremities and in the axial skeleton. In the authors' experience, evaluation and management of acute musculoskeletal injuries is a routine part of primary care practice. Thus, the text is designed to assist the primary care physician in the evaluation of these injuries and to guide them in making clinical decisions.

The authors stress the need for primary care physicians to distinguish fractures from soft tissue injuries and to deal with both problems effectively, whether that includes comprehensive management or specialty referral.

The first chapters are devoted to assessment of the injury, identifying related problems (such as arterial or nerve injuries), and alerting the reader to any acute or late complications that are frequently associated with fracture management. The remaining chapters deal with specific injuries by region. The emphasis is on fractures and soft tissue injuries that are common and likely to be managed in an ambulatory care setting. Discussions include management of fingertip fractures, fractures of the fingers and metacarpals, and the importance of recognizing less obvious problems, such as gamekeeper's thumb and the Bennett's fracture at the base of the thumb. The illustrations, drawings and radiographs are excellent.

Obviously, displaced or open fractures will require orthopedic referral; even nondisplaced fractures can be difficult to manage without good orthopedic back-up. We live in a very litigious society, and our patients and their families have come to expect an anatomic reduction and an excellent result. The manipulation and reduction of fractures is fraught with problems. Usually, the bony injury is the most apparent problem on the radiographs. However, the less visible soft tissue problems can lead to a poor result, despite a beautifully reduced fracture.

For the primary care practice, this textbook covers the subject thoroughly. I don't find any problems with its organization or style. The language is very easy to read, with a good format that allows the book to be conveniently used as a reference. It is very nicely indexed with the outline in the beginning and an extensive table of contents. I don't think anyone will have any trouble using this book.

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