Fenoglio-Preiser CM Noffsinger AE Stemmermann GN Lantz PE Listrom MB, Rilke FO:

Gastrointestinal Pathology Plus on CD-ROM, Philadelphia, Lippincott Williams & Wilkins, 1999 ($350).

The second edition of Gastrointestinal Pathology is now available on CD-ROM. The electronic version contains an expanded text and more illustrations. It runs under Windows or Macintosh operating systems and requires at least 8 MB of RAM. I have run it on Windows 95, 98, and NT. Installation notes recommend setting virtual memory at 20 MB or greater for optimal pictorial quality. A good rule of thumb is to set virtual memory at twice the amount of RAM, but keep in mind that Windows prefers to self-manage virtual memory for most applications. The production disk contains 270 MB of data, with approximately 85% of the space devoted to pictures and diagrams. A combination of software products are bundled together to run this reference work. The vendors include Folio Corporation for text retrieval and Iterated Systems for image display.

Navigation around the disk is easy at the top level but awkward when paging through individual chapters. There are shortcuts to individual topics via the Go To option, but one needs to enter a numerical address. Hyperlinks to pictures and illustrations allow you to overlay windows for side-by-side comparisons with the written text, and there is a clever pop-up option to view immediately any cited reference. An effective search engine that uses Boolean logic is available for names or key words, and there are shortcuts to jump to your results. Instructions on printing text items and exporting images are available in the Read Me files. Overall, this disk contains sufficient tools to keep most users occupied for a long time.

The text and illustrations have been revised for the second edition, and references are updated through 1995 (some through 1996). A selective review of dysplasia in ulcerative colitis shows it to be clear, concise, and complete. The recommendations for dysplasia-associated lesions or masses are practical. The section on gastritis generally follows the Sydney System with the usual caveats. However, I was disappointed not to find the 1996 article by Dixon et al. concerning the updated principles and grading data. A discussion of gastroesophageal reflux disease, 24-h acid testing, and short-segment Barrett esophagus is lacking. Gross photographs, radiographs, and diagrams are of excellent quality. Unfortunately, photomicrographs appear pixelated and rapidly degraded when zoomed.

The combination of content, search capabilities, and the ability to print text and export images makes this CD a powerful reference work. The one disadvantage of this format is the quality of the photomicrographs. Keeping in mind that the capacity of an ordinary 75-cent disk is 650 MB and the availability of file compression technology, one would think that medical publishers could produce higher quality microscopic images.