Subject
of evaluationAxford J, O´Callaghan C (eds). Medicine, Ed 2. Blackwell Science Ltd, Oxford 2004.
How we wish to be cited:
Norberg B. Medicine – concentrated and structured [evaluation]. Rondel 2004;
19. URL: http://www.rondellen.net
Medicine – concentrated and structured
Subject
of evaluation
Axford J, O´Callaghan C (eds). Medicine, Ed 2. Blackwell Science Ltd, Oxford
2004.
The work provides a compact textbook of medicine, about 1200 pages. The outspoken objective is to teach students core medicine for exams and training at hospitals and in community medicine. The first chapter gives the human aspects of medicine, the second chapter the scientific basis of medicine. These chapters provide the point of departure for all readers. The following 16 chapters contain the conventional mixture of organs, etiologies, and contexts, although more concise, general and mainstream than usual. The referee of The Rondel considers the book to be valuable in the individual learning of physicians for a specialty in family medicine. Furthermore, MEDICINE is thought to be a convenient reference work for patients and paramedicals.
MEDICINE, like other successful textbooks of health care, mirrors its society and the health care of its society. The significant societies of MEDICINE are the United Kingdom and the USA. In these societies, there are still plenty of experts on cell morphology. The Schilling test is still the gold standard in the investigation of macrocytic anemia. In contrast to the classical incidence of pernicious anemia, 130 cases/100,000 persons and year (1), MEDICINE specifies an incidence of 25 cases/100,000 persons and year. It is reasonable to assume that the reduction of perniciosa incidence reflects a development towards diagnosis before the stage of actual anemia.
In its own concise style, MEDICINE recognizes the series linkage of vitamin B12 and folic acid in cell metabolism. The description of neurological lesions in B12 deficiency is worth quoting. "An important subgroup of patients present with neurological effects of B12 deficiency, without any macrocytosis or megaloblastic change. Neurological manifestations include peripheral neuropathy, optic atrophy, subacute combined degeneration of the cord, and mental abnormalities such as irritability, somnolence, and dementia."
Although oral preparations of cyanocobalamin, 1 mg daily, are available in Australia and USA, the management of B12 deficiency recommended by MEDICINE is parenteral hydroxocobalamin, 1 mg every three months for life. The remission treatment consists of 3-6 injections over 3 weeks.
In routine health care of Sweden, homocysteine and methylmalonic acid are about to replace serum cobalamin and serum folate in deficiency diagnosis (cf 2-4). Instead of antibodies towards intrinsic factor and parietal cells, serum gastrin and/or serum pepsinogen A (pepsinogen I) are used for the diagnosis of atrophic gastritis. The Shilling test is not used at all in Sweden nowadays. It should be emphasized that such cultural differences must be borne in mind, when Swedish physicians apply for training and positions in the UK – and vice versa. The moving clinician has to adapt to the laboratory praxis of new contexts.
Bo Norberg
References
Published november 12, 2004