Bockus Gastroenterology. 5th ed

Bockus Gastroenterology. 5th ed

GASTROENTEROLOGY 1 9 9 5 ; 1 0 9 : 1 4 0 3 - 1 4 0 4 BOOK REVIEWS Jonathan E. Clain, M.D. Book Review Editor Mayo Foundation 200 First Street S.W. R...

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GASTROENTEROLOGY 1 9 9 5 ; 1 0 9 : 1 4 0 3 - 1 4 0 4

BOOK REVIEWS Jonathan E. Clain, M.D. Book Review Editor

Mayo Foundation 200 First Street S.W. Rochester, Minnesota 55905

Bockus Gastroenterology. 5th ed. Edited by W i l l i a m S. Haubrich, Fenton Schaffner, and J. Edward Berk. 4008 pp. $595.00. W. B. Saunders Company, Philadelphia, Pennsylvania, 1995. ISBN 0-7216-3687 (four-volume set, nor sold separately).

The editors and their 260 contributors have accomplished the Herculean task of updating Bockus Gastroenterology, the only major comprehensive text in our field that attempts to be all inclusive and thus must be "comparison shopped" against the purchase of separate similar hepatology and digestive diseases texts. As with much of the rest of health care these days, there is some good news and some bad news. First to the good news. By enlarging the page size, the authors have been able to reduce the size of the book to four volumes from the sevenvolume fourth edition published in 1985. The 187 chapters and 38 subchapters span the broad spectrum of the knowledge base of our specialty with special attention given to wellreproduced illustrations of radiographs and histological material. The information contained within the volumes is truly encyclopedic, extending from the most recent molecular biology to personal vignettes about patients. I particularly enjoyed the chapters on "Eliciting and Interpreting Symptoms and Signs" by Sheldon W o l f and "Laboratory Testing in Gastroenterology" by Paul Griner, Edgar Black, and Robert Panzer. The knowledge gained from reading these two chapters will be pertinent long after the facts in the rest of the text have been disproved by the next generation of scientists. Put simply, the fifth edition of Bockus' Gastroenterology is just about everything you could possibly expect to stuff into a single textbook that ambitiously attempts to both aid clinicians who want to better understand the "pathophysiology, diagnosis, and management" of digestive diseases and stimulate investigators "to envision new areas of research." This charge has been accomplished in a remarkably uniform fashion with content, figures, and tables constructed in a similar manner across multiple disciplines and authors. Although I could quibble with the approach to clinical problems or selected emphasis by individual authors, overall the assessments and recommendations are sound. As in any undertaking of this size, redundancy is unavoidable but does not substantially detract from the overall effectiveness of presentation of the educational content. The almost 29,000 bibliographic citations are current, relevant, and thoughtfully applied. In most, but not all, of the chapters, the authors have taken the time and effort to not just enumerate papers but to place them in a context for the reader by evaluating the quality of our current database. Gaps in knowledge are frequently and appropriately emphasized. I

made 10 attempts to search for relevant articles on individual patient-related problems in MEDLINE as well as in Bockus Gastroenterology and could only generate one additional important reference. The indexing, which has thoughtfully been reproduced in each of the four volumes, is adequate to the task, and topics could be found within a short period of time. Put in current jargon, Bockus Gastroenterology is educationally effective in achieving its goals. Now to the bad news. The four-volume set costs $595. In a marketplace in which there are many similarly effective educational tools, cost-effectiveness should enter into decision making by increasingly resource-constrained individual and institutional purchasers. Although this may change when new editions of other texts are repriced, the cost of the fifth edition of Bockus Gastroenterology is 3 0 % - 5 0 % more than the combined cost of separately purchasing standard texts in digestive diseases and hepatology. That additional $ 1 5 0 - $ 2 0 0 can purchase access time on one of the standard bibliographic databases, and 2 or 3 years from now that information will be more up to date than in any text. This is a small point, but the binding of one of my volumes has already begun to loosen and disengage after 3 months of use. I don't expect leather binding, but for this price I am old-fashioned enough to expect a better quality product. In summary, the editors of Bockus Gastroenterology have admirably achieved their goal of creating an expansive and wellconstructed evocation of the current knowledge base in digestive diseases and hepatology. However, unless the reader finds the style particularly appealing or plans to use the text to the exclusion of a computerized database, I cannot recommend the purchase of the text on the basis of lower educational costeffectiveness when compared with similar products that are currently available. JOEL S. LEVINE, M.D.

Division of Gastroenterologyand Hepatology University of ColoradoSchoolof Medicine Denver, Colorado

Surgery of the Colon, Rectum and Anus. Edited by W . Patrick Mazier, David H. Levien, Martin A. Luchtefeld, and Anthony J. Senagore. 1218 pp. $225.00. W. B. Saunders Company, Philadelphia, Pennsylvania, 1995. ISBN 0-7216-4689-1.

The aim of this multiauthored text is to provide a comprehensive source of information reflecting the body of knowledge in colorectal disorders. This aim is ambitious, but it succeeds to