Mayo Clin Proc, May 1985, Vol 60 BOOK REVIEWS 355

"Principles of Antimicrobial Treatment" are particularly concise and informative. Because the contributors are from many countries (the United States, Canada, Bel-gium, France, England, and Switzerland), occasionally drugs that are unfamiliar to the American reader are mentioned (only a minor inconvenience).

The unique organization and innovative approach in this book are useful. Medical students, residents, and practicing physicians who are responsible for the care of patients with infections should find this text a valuable source of information.

Conrad J. Wilkowske, M.D. Division of Infectious Diseases

and Internal Medicine

Major Issues in Critical Care Medicine, edited by Joseph E. Parrillo and Stephen M. Ayres, 297 pp, with illus, $38, Baltimore, Williams & Wilkins, 1984

This book presents a summary of the testimony given at a consensus development conference on critical-care medicine sponsored by the National Institutes of Health and held in Bethesda, Maryland, in 1983. The con-ference panel consisted of 16 experts in the medical and legal professions. Their charge was to develop a con-sensus statement on the six prepublished questions that the meeting was to consider: (1) Is there empiric evidence that intensive care units (ICUs) cause a decrease in pa-tient morbidity or mortality? Which patients are most likely to benefit from intensive care? (2) What skills are essential for personnel in a critical-care unit? How should these personnel be trained and organized to ensure the best care for patients most in need? (3) What special technology and therapeutic interventions should rou-tinely be available for the most effective ICU function? (4) How is a hospital's critical-care delivery system best structured: one large multispecialty unit or multiple small subspecialty units? (5) How has the development of ICUs affected the traditional functions of a hospital? (6) What direction should critical-care research follow?

The book is divided into the following six major sec-tions: "Overall Survival Results," "Critical Care Medi-cine and Cardiovascular Disease," "Critical Care Medi-cine and Pulmonary Disease," "Other Organ System Dysfunction," "Critical Care Medicine and the Issues of Training, Education, Staffing and Administrative Struc-ture," and "The Consensus Statement." The sections were seemingly designed primarily for the purpose of influencing the consensus development panel and not for

the purposes of teaching or informing medical peers of latest advances in knowledge. The most interesting part of the book for the critical-care specialist and other medical personnel is the 11 pages that present the con-sensus statement (Chapter 31), although some of the other chapters do provide helpful summaries of a particu-lar viewpoint (and allow considerable insight into the bias of specific authors).

In a variety of guises, critical care has become an established, albeit expensive, part of medical practice in most major medical institutions in the United States. Throughout the medical profession, attempts to control escalating costs have become important, and this con-ference focuses in part on the issue of costs versus ben-efits from ICU services. The foremost problem in the analysis of this issue is inadequate data, and although little new information is presented in the volume, the book does provide a useful compilation of the available data. In addition, a "turf" battle is currently raging within the confines of the American Board of Medical Special-ties, with medical and surgical subgroups vying for con-trol of the subspecialty training and certification for critical-care practice. This book provides some glimpses of the "smoke" generated by this battle but correctly leaves the outcome unresolved.

In my opinion, this book wil l have long-term appeal to only a few health-care planners who are interested in critical-care medicine. Practitioners in the field, how-ever, would be well advised to think about the issues raised in this text and to attempt to gain a voice in the debate. This book would then serve as a useful intro-duction to the issues.

H. Michael Marsh, M.B. Critical Care Service

Life Support Systems in Intensive Care, edited by Robert H. Bartlett, Walter M. Whitehouse, Jr., and Jeremiah G. Turcotte, 615 pp, with illus, $49.95, Chicago, Year Book Medical Publishers, 1984

As the practice of critical-care medicine becomes more prominent, authors continue to attempt to present the broad spectrum of knowledge about this field in one definitive textbook. Life Support Systems in Intensive Care is another such attempt. Like the previous pub-lications, this book does not achieve that goal.

As clearly stated in the preface, the book is not a primer or manual to be used by the initiate in the intensive care field. Nevertheless, when considered as a source to keep

356 BOOK REVIEWS Mayo Clin Proc, May T985, Vol 60

the practitioner abreast of latest developments, it is a disappointment. Much of the information presented is not new, and in some of the chapters on recent advances, no references beyond 1979 are provided. The book tends to be more didactic than controversial; in many in-stances, however, the stand chosen is not supported with scientific information.

Although a definite surgical bias is present in the text, this stance may be a strength rather than a problem. Because intensive care is depicted from a surgical stand-point, the contents can be of value to practicing internal medicine specialists who wish to understand the surgical approach to patients in the intensive care unit. Further-more, the title of the book suggests a technologically oriented work, but the anticipation is not fulfilled.

In summary, the editors of this book have attempted to provide the reader with too much information and in doing so have supplied only superficial coverage of the subject. We do not recommend that every practitioner of critical-care medicine purchase a copy of this book, but we do suggest that it has a place as a reference volume in a departmental library.

John C. McMichan, M.B.,B.S., Ph.D. Rolf D. Hubmayr, M.D. Critical Care Service

Liver Biopsy Diagnoses and Reports: SNOMED Codes, ICD-9-CM Codes, Nomenclature and Terminology, by Jürgen Ludwig, 156pp, $34.75, New York, Karger, 1984

This unusual book has no exact competitor as far as I am aware, although it is an offshoot of the Systematized Nomenclature of Medicine (SNOMED) and borrows from the booklet "Diseases of the Liver and Biliary Tract," sponsored by the International Association for the Study of the Liver (IASL). In this manual, hepatic lesions are classified, codified, and briefly defined. Ludwig is clearly well qualified to approach the orderly definition of hepatic diseases. Hepatology would obviously be advanced if all investigators and clinicians used uniform terminology, and the expanded SNOMED coding pre-sented in this book could be of considerable aid in establishing the records of a liver unit.

The book is well designed. The first few pages of explanation of the organization of the contents are fol-lowed by 20 pages of commonly used SNOMED codes; thus, the reader can expand, modify, or increase the specificity of the coding of the liver diseases that con-

stitute the bulk of the manual. Before the 113-page section entitled "Alphabetic List of Hepatobiliary Dis-eases, Conditions, and Structures," Ludwig offers 1 page of codes that do not denote diseases or anatomic struc-tures but deal instead with conditions that often are coding problems in surgical or autopsy pathology prac-tice. For example, the classification and storage of such nonspecific reports as "inadequate tissue" and "wrong specimen received" often involve more time and energy than would correction of the specimen deficiency.

The alphabetic list of hepatobiliary diseases—the main portion of the book—is brief and concise. The SNOMED code (or codes, in many instances) is given, followed by the International Classification of Diseases (ICD) code, if available, and a list of synonyms or related terms. The subsequent definitions vary in length from a brief sen-tence to a short paragraph and are usually followed by one or two references.

In general, the manual is well done. It serves a definite purpose and wil l be helpful in maintaining records of morphologic material in any liver unit. As with any such publication, however, it has deficiencies. The nature and existence of certain diseases are in dispute. One such disorder is referred to by most of the medical world as " lupoid" or "autoimmune" hepatitis. In the opinion of Ludwig, however, the condition is a nonentity, and he does not tell the reader what "al l those other doctors out there" are talking about in their reference to this non-condition. He does tel I the reader that the correct term for " lupoid hepatitis" is "idiopathic chronic active hep-at i t is , " but under that designation (for wh ich no SNOMED code is given), the syndrome with which most hepatologists are familiar is not described. . In the definitions of cirrhosis, Ludwig is thorough; several terms are appropriately indicated as obsolete, and the correct terminology is provided. The term "post-hepatitic cirrhosis" is retained, however, despite its de-letion by the IASL. Because the term "posthepatitic" implies "after infection," and the cirrhotic end stage of chronic active viral hepatitis represents an ongoing infec-tion, "B-viral cirrhosis" or "non-A, non-B viral cirrhosis" would have been better terms than "posthepatit ic cirrhosis."

The only morphologic terms supplied for cirrhosis are "macronodular," "micronodular , " or "m ixed . " Al -though this terminology is traditionally used, nodular size is less useful in relationship to etiologic distinction than is collagen density, nodular bulging, or nodular discreteness, and nodular size is less related to liver function than to liver size. Ludwig chooses 1 cm as the borderline between micronodular and macronodular, in conformity with IASL classification. In contrast, the Co-