Sternberg SS Sinard J (CD-ROM ed):

Diagnostic Surgical Pathology, 3rd Ed, Vols 1 & 2, CD-ROM version, Philadelphia, Lippincott Williams & Wilkins, 1999 ($325).

I am among those old-fashioned conservatives who cannot do away with books. I still have my 1968 (2nd) edition of Robbins Textbook of Pathology in mint condition. I know that this behavior is impractical. Robbins sits accessibly on my bookshelf because I have it and regard it respectfully as a landmark in pathology teaching. Despite this attachment to paper, I have become reasonably computer literate. But until the opportunity came to review a textbook on CD-ROM, I had never tried an electronic version of a book. I like the weight of a book in my lap, leafing, turning the pages. Sternberg on CD was a revelation. Installation on my desktop (a PIII 450 with 128 MB of RAM) and on my notebook (a PII 350 with 64 MB of RAM) was no big deal. The use is quite intuitive; when comfortable with Windows, you can get along right away.

What is much faster than paper is searching. Search results are given as hits in text, figures, and references. I found great pleasure in chasing key words in the work, seeing in which different contexts they were used. This is something I had never done before; you cannot get that fast through the paper version. The text is as on paper and has been reviewed before. The references come out in a contrasting color on the screen and are partly provided with abstracts, which is extremely useful. A search of a name rapidly yields the number of citations of any one pathologist in the book.

The images are mostly of excellent quality and come out great on a good 17″ screen but also on the 14″ LCD screen of my notebook. Rapid access to the wealth of images is in fact the most important asset of the CD. Rather than leafing, I found myself increasingly searching the CD in everyday practice. In doing so, two things became more and more clear. The first is that more images would be nice. For a paper version, a limitation in the number of images is unavoidable, but the CD could stock many more. The second is that one can do with less text, provided that the essentials in the text are presented in an accessible format. Reading of lengthy paragraphs on screen is rather annoying. Replacing them with abbreviated problem-oriented tables that list differential diagnoses and diagnostic criteria would be a definitive improvement. One could even dream of adding interactive diagnostic algorithms.

Overall, Sternberg on CD is value for money. It is useful in daily practice and user friendly, but it marks a start rather than the endpoint of an evolution. A specially developed CD-ROM version of a textbook, that takes full advantage of the possibilities of this medium, would have more impact.