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Practical Strategies in Pediatric Diagnosis and Therapy.
  1. PENELOPE J DISON, Consultant paediatrician

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    Practical Strategies in Pediatric Diagnosis and Therapy. Edited by Robert M Kliegman et al. (Pp 1097; £55 hardback.) W B Saunders, 1996. ISBN 0-7216-5161-5.

    Reviewing a textbook as detailed as this is indeed a daunting task. My initial response to the request was an anguished ‘Why me?’ but on reflection, having studied the book, I decided that a paediatrician in a district general hospital was exactly the right person to review such a tome. The layout and approach is novel and as such challenges the reader. Assessment based on a symptom or sign is a very practical approach. This provides a sense of security that all diagnoses have been considered when dealing with an unusual problem. I found, however, that the cross referencing was not as detailed as I expected. For example, in an infant presenting with abdominal pain and vomiting, intussusception is only mentioned under vomiting, although pain is more common. Similarly, constipation warrants a detailed section of its own but it is not mentioned as a possible cause of chronic abdominal pain. Despite these difficulties, I enjoyed browsing through the book and I could not think of a symptom or sign that was not covered in depth. I particularly enjoyed the orthopaedic reviews of gait disorders and back pain which were extremely practical and user friendly.

    My main criticism is that the print font is too small. Some of the tables and flow diagrams are very complicated, hence visually disconcerting. I would undoubtedly have opened and closed the book with one glance had I come across it in a bookshop. This would have denied me access to a wealth of applied physiology and anatomy, not to mention clear explanations of correct history and examination techniques. The descriptions of practical procedures, such as lumbar puncture, are excellent with clear detail of anatomy, possible complications, and pitfalls in data interpretation.

    Each section is neatly summarised with key points described as ‘red flags’. The references are as up to date as can be expected with a work of this magnitude; most are North American in origin. The index is full and is both disease and symptom based for ease of use.

    I am uncertain whom the book is written for. Junior doctors will find that theory and practice are brought together more effectively than in a traditional textbook but the degree of detail can be overwhelming. Consultants may find it useful to refresh the memory of basic science as it applies to every day practical problems. Overall it is an extremely detailed review of general paediatrics and surgery which suffers from too much information rather than too little. Nevertheless I think it is excellent value for money and I am glad I got past my initial visual aversion. I doubt that it will replace the standard ‘big paediatric textbooks’ on my bookshelf but it will certainly complement them.

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