Interpretation of Diagnostic Tests

6th ed, by Jacques Wallach, 1093 pp, with illus, $42, Hagerstown, Md, Lippincott-Raven, 1996.Interpretation of Diagnostic Tests, by Jacques Wallach, MD, and its companion text, Handbook of Interpretation of Diagnostic Tests, are intended to provide a ready reference for laboratory tests both to the clinician and clinical laboratory personnel. The CD-ROM edition can supplant the text if preferred. The texts are divided into chapters based on organ systems (cardiovascular, respiratory, gastrointestinal, hepatobiliary and pancreatic, central and peripheral nervous system, musculoskeletal and joint, hematologic, metabolic and hereditary, endocrine, genitourinary, infectious, miscellaneous, and disorders due to physical and chemical agents) with concluding chapters on the effects of drugs on laboratory test values and therapeutic drug monitoring and toxicology. The texts purposely omit technical aspects of laboratory testing. In addition to the individual organ system chapters, individual chapters on blood chemistries and urinalysis provide handy outlines with differential diagnoses provided for abnormal values. Most of the specific chapters provide disease correlates as well as diagnostic algorithms in flow chart form. The CD-ROM version provides handy buttons for menu selection, as well as blue-highlighted topics for cross-references within the text.Specifically, for example, the chapter on cardiovascular diseases in the Handbook version consists of 8 pages, 5 which are mainly text, 2 of charts, and 1 table, with the most space devoted to the diagnosis of acute myocardial infarction. The parent text consists of 16 pages on the same subject matter, with 4 pages consisting of mainly charts and tables. Both versions are highly selective and avoid verbosity. The texts only discuss the pertinent laboratory studies necessary to adequately support and augment clinical diagnoses. The chapter on hematologic diseases is introduced with 24 pages of hematology laboratory tests with their explanation and indications, followed by clinical approaches to the workup of anemias, cythemias, and leukemias and lymphomas, including use of gene rearrangement technology for detection of monoclonal cell populations. Immunodeficiency syndromes and coagulation medicine round out the topics for a most readable and exhaustive outline. One would rarely need more than this for typical hematology questions and daily laboratory issues concerning perplexed clinicians.The style of both editions is very direct. With the Handbook, one could quickly review a disease before rounds and sound quite knowledgeable should the need arise. I think these books would be most useful to clinicians actively trying to select appropriate laboratory tests quickly, as well as to those who would like something close by to refresh their memories. As a pathologist recently thrust into the world of clinical pathology, I have referred often to this text during prolonged periods on hold with some of my clinical colleagues. It is very readable and I think more useful to the generalist who may not work primarily in a particular clinical laboratory. I also believe pathology residents may profit from using this text as a review several months before the dreaded board exam. Equally useful to the medical technologist, the books would serve to remind us of the often elusive primary diagnosis and difficulty in correlating laboratory information with patient performances and clinical decision making. I recommend these clinical pathology texts (or the CD-ROM) as supplements to the larger exhaustive textbooks when a concise reference is needed.