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BOOK REVIEWS

Volume 342 Number 20 ·1533

Book Reviews

DIABETES : CURRENT PERSPECTIVES

Edited by D. John Betteridge. 359 pp., illustrated.

London, Martin Dunitz, 2000. $99.95. ISBN 1-85317-555-2.

IABETES mellitus is becoming one of the most im-

portant health problems not only in developed coun-

tries but also in developing countries. Worldwide, more than

140 million people are estimated to have diabetes, and pro-

jections indicate that there will be over 230 million people

with diabetes by the year 2010. More than half of this pop-

ulation will be in Asia, because of the overall increase in

population and the rapidly increasing prevalence of diabetes

in this region. Because of the high morbidity and mortal-

ity associated with complications of diabetes, such as renal,

retinal, and vascular diseases, diabetes mellitus is a burden on

both patients and society. Primary prevention of the disease

and the prevention of diabetic complications are of great

practical importance.

Diabetes: Current Perspectives focuses on these issues.

Chapter 1 discusses the remarkable increase in the direct and

indirect costs of care for patients with diabetes in the past

decade. Although a projection of these costs has not been

done, they will become enormous. The prevention of dia-

betes mellitus is therefore an urgent issue all over the world.

For effective primary prevention, the causes and mecha-

nisms of the disease must be understood. There are two ma-

jor types of diabetes mellitus: type 1 and type 2. Both are

based on genetic predispositions that are quite complex, as

discussed in chapter 2. Progress in the Human Genome

Project and many other genetic studies will certainly help

elucidate the multiple genes involved in type 1 and type 2

diabetes mellitus.

Type 1 diabetes is caused by autoimmune destruction of

pancreatic islets; this immunologic process seems to be ge-

netically determined, at least in part. Since autoantibodies

against islets or insulin can be detected in the prediabetic

stage and some predisposing genetic factors — such as cer-

tain HLA alleles — are known, immunologic interventions

to prevent type 1 diabetes are of great interest. As discussed

in chapter 3, the results of trials of preventive strategies are

far from conclusive, but they do suggest the potential use-

fulness of immunologic intervention.

Type 2 diabetes, which is more prevalent than type 1, is

a multifactorial disease. The genetic basis of type 2 diabe-

tes is complex, and so far it is understood only in a subtype

of diabetes known as maturity-onset diabetes of the young,

which is caused by a single gene defect. By contrast, most

cases of type 2 diabetes appear to be polygenic in origin.

Moreover, insulin resistance caused by factors such as obe-

sity and aging is an important precipitating factor for diabet-

ic states. Clarifying the pathophysiology of impaired glucose

tolerance and the development of type 2 diabetes is an im-

portant aim of this book.

A major theme of this book, however, is the pathogenesis

of diabetic complications. Since the Diabetes Control and

Complications Trial demonstrated that intensive glycemic

control reduced the risk of disease-related complications in

patients with type 1 diabetes and since similar, though less

conclusive, results were obtained in studies of patients with

type 2 diabetes, it has been generally accepted that hyper-

glycemia is the main cause of these complications. However,

the way in which glucose exerts toxic actions on blood ves-

sels and other tissues has not been established. Possible

mechanisms of glucose-induced toxicity are reviewed in sev-

eral chapters in this book.

The goal of therapy for diabetes is to normalize blood

glucose levels, thereby optimizing blood lipoprotein levels

and preventing complications. To achieve this goal, new

therapeutic agents have been identified. One is a group of

rapid-acting insulin analogues that, once administered, reach

levels that mimic postprandial plasma insulin levels in nor-

mal subjects and to prevent high blood glucose levels after

a meal. In addition, new oral agents can reduce insulin re-

sistance, a characteristic feature of type 2 diabetes. These

advances are discussed extensively in this book. Another

important issue in management is helping patients develop

the proper knowledge, skills, and attitudes, because effec-

tive self-care is indispensable for the treatment of lifelong

diseases such as diabetes mellitus.

Although there have been many good books on diabe-

tes, Diabetes: Current Perspectives is a concise book focusing

on subjects of practical importance. It does not deal thor-

oughly with basic mechanisms of the control of glucose me-

tabolism, insulin secretion, and insulin action. Most of the

chapters are well written and fully referenced.

HIROO IMURA , M.D.

Kobe City General Hospital

Kobe 650-0046, Japan

CLINICAL P RACTICE OF G ASTROENTEROLOGY

Edited by Lawrence J. Brandt, with nine others. 1793 pp. in two

volumes, illustrated. Philadelphia, Current Medicine, 1999.

(Distributed by Churchill Livingstone, New York.) $235.

ISBN 0-443-06520-9.

HE stated purpose of this book is "to offer the latest

clinical information in an easy-to-read-format, thereby

aiding the busy practitioner to care for his or her patients."

The editors have tried to accomplish this by limiting "chap-

ter content to the essentials of patient care." This ambitious

endeavor, however, cannot accommodate all styles of clin-

ical practice. Some clinicians comfortably rely on empiri-

cism, but others prefer the state of the art, even if it is ru-

dimentary or uncertain. Whereas many editors would err on

the side of completeness and allow the reader to decide what

is germane, the editors of this book have attempted to es-

tablish the appropriate canon of ideas. This is an impossible

task, well illustrated by the three chapters on inflammatory

bowel disease, which pay scant attention to epidemiology,

causes, and pathophysiology. Such an approach is unre-

warding to those who think in mechanistic terms and is in

definite contrast to that in other chapters.

Interestingly, the attempt to include only the essentials

of patient care seems overly restrictive for the large survey

chapters, yet it allows specialized subjects to be treated in

detail. For example, chronic viral hepatitis is allotted 10 pag-

es, whereas gastric infection receives 12 pages, even though

there are also two chapters devoted to Helicobacter pylori.

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1534 ·May 18, 2000

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Another topic covered in depth is "pill-induced esophagitis,"

which is discussed in a comprehensive, six-page chapter that

reviews all 828 reported cases of injury, including new cases

reported in this chapter. Although such depth makes the

chapter comprehensive, the level of detail is inappropriate

in relation to that provided for other subjects and is in con-

trast to the stated aim of the editors.

This two-volume book is organized, according to anat-

omy, into sections on the esophagus, stomach and duode-

num, small bowel, colon, liver, gallbladder and biliary tract,

and pancreas. There is also an extensive, 245-page section

on pediatric gastroenterology and hepatology as well as a

section on special topics. I found the book's organization

to be problematic. A book designed to help busy clinicians

might best be organized according to clinical syndrome or

presentation rather than according to organ. Some chap-

ters discuss symptoms, syndromes, and presentations, but

these chapters are included in the section on the most rel-

evant organ. Thus, the chapters entitled "Abdominal Pain"

and "Nausea and Vomiting" are included in the section on

the stomach and duodenum, "The Acute Abdomen" and

"Infectious Diarrhea" in the section on the small bowel,

and "Secretory Diarrhea" and "Gas and Flatulence" in the

section on the colon.

In addition to making it difficult to search for informa-

tion on a specific symptom, this approach to organization

leads to overlap and repetition among some chapters. The

chapter on infectious diarrhea is comprehensive, whereas the

chapter on infectious colitis, in the section on the colon,

deals only with infection relative to this organ. Careful study

of overlapping material did not reveal substantial disagree-

ment among the chapters. However, the chapters entitled

"Gallstones," "Cholelithiasis and Cholecystitis," and "Lap-

aroscopic Cholecystectomy" all list indications for prophy-

lactic cholecystectomy, and each of these lists is different

from the others.

The design and presentation of information in this book

are pleasing and clear. There are numerous charts, graphs,

radiographs, endoscopic photographs, intraoperative photo-

graphs, photomicrographs, tables, and algorithms. The fig-

ures are in shades of green, black, and white, a combination

that is easy on the eyes. When a photograph would benefit

from color presentation, it is reproduced in black and white

within the chapter, with a reference to its color plate at the

end of the volume. Although it would be preferable to see

color photographs in the body of the chapters, I find this

arrangement a cost-effective compromise. In general, the

text and figures are complementary; scanning the figures

usually provides a good sense of the material that is present-

ed in the text.

The liberal use of diagnostic and therapeutic algorithms

is a valuable feature. Although one might quibble about the

evidentiary basis for these algorithms, they allow the reader

to benefit from the judgment and experience of experts in

their discipline. A few of the authors simply discuss the ef-

ficacy and side effects of various therapeutic options, but

most commendably stick out their necks by presenting ex-

plicit algorithms. I found one instance in which a diagnostic

algorithm is misleading. The chapter on gas and flatulence

contains a very reasoned and thoughtful discussion of the

workup based mainly on historical clues, but the accompa-

nying algorithm makes it seem that the first step after rul-

ing out aerophagia (by asking the patient about belching)

is to analyze a sample of rectal gas by gas chromatography.

The editor-in-chief and the section editors have done a

superb job of recruiting national and international author-

ities to discuss their areas of expertise. Other strong points

of this book are its liberal use of diagnostic and therapeu-

tic algorithms and its eye-pleasing format. The inconsisten-

cy in the presentation of pathophysiologic mechanisms, the

varying depth with which subjects are treated, and the strict

organ-based organization are weaknesses. This book may

be useful for empiricists who do not have a strong interest

in the mechanisms of disease or for internists who prefer to

avoid the expense of more complete textbooks of hepatol-

ogy and gastrointestinal disease.

PETER ELLS , M.D.

State University of New York at Stony Brook

Stony Brook, NY 11794-8173

MULTIPLE S CLEROSIS T HERAPEUTICS

Edited by Richard A. Rudick and Donald E. Goodkin.

574 pp. London, Martin Dunitz, 1999. £79.95.

ISBN 1-85317-812-8.

T was not long ago that the combination of the words

"therapeutics" and "multiple sclerosis" verged on the

oxymoronic. If there are investigators who still have this

point of view, they are not represented among the authors

of the 40 chapters in this well-produced book. The many

topics discussed include clinical research methods, outcome

measures, and the fine details of magnetic resonance imag-

ing and spectroscopy. It is a sign of the times that three

chapters describe the process of drug approval in the United

States, Canada, and Europe. The general stance of most of

the authors is remarkably upbeat, perhaps reflecting the pro-

longed dearth of reproducible advances in the treatment

of this often tragic disease.

There is much useful information in this book, and the

enthusiasm is refreshing, even for students of multiple scle-

rosis whose ears ring with the cries of "wolf." However, it

would be easy to gain the impression that treatment with

a wide variety of agents has had a major effect on this most

difficult disease. Only a single chapter, by Rice, reports neg-

ative results but does so clearly and definitively.

In the first chapter, the editors appropriately state, "No

surrogate measure has acceptable validity for predicting

eventual disability." However, there is a relative absence of

reservations, caveats, critiques, and contradictions, which

would have balanced the generally enthusiastic tone of the

text. Readers will have to look elsewhere for thoughtful dis-

cussions of the limitations of existing data (all very short-

term), the pitfalls of the surrogate markers on which great

reliance is placed, and the potential methodologic limita-

tions of the numerous studies with positive results.

There is no accounting for taste, but the index does not

contain the entries "blinding," "dropouts," or "withdraw-

als." Some of the findings of research into this complex

disease can be difficult to interpret by persons outside the

field and even by those within it. But the opinions of inves-

tigators directly involved in specific studies, who are familiar

with the soft underbelly of otherwise definitive data, often

provide unique insights. Unexpectedly, the fact that the

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BOOK REVIEWS

Volume 342 Number 20 ·1535

results of so many well-designed, randomized trials involv-

ing multiple sclerosis have not been reproducible is neither

explained nor acknowledged.

A chapter on standardized reporting leaves readers won-

dering why the contributors have not, in some of their own

studies, followed the useful advice they offer here. In "The

Negative Clinical Trial," readers are told that the negative

results of many trials may really be positive. "Several stud-

ies have illustrated the powerful placebo effect in [multiple

sclerosis] patients, which makes it difficult to demonstrate

a significant beneficial effect of the agent to be tested." This

perspective is not supported by any data and is at odds with

the rate of deterioration in placebo groups, which at least

equals and in many positive trials surpasses rates in studies

of the natural history of the disease. Included in the table

of reasons for negative clinical-trials results are "Type 1 er-

ror" and "technical problems, including unblinding of ex-

aminers and patients." It is stated in the same chapter that

copolymer 1 "was beneficial in one center and not in the

other, whereas the larger multicenter trial led to [Food and

Drug Administration] approval." Perhaps someday type II

errors will be shown to have been common in studies of

multiple sclerosis, but readers are not told in this instance

that the center-specific effect concerned one indication (the

progression of disease), whereas approval for efficacy was

for another (the prevention of relapse).

Suitable sobriety is maintained in the chapter by Con-

favreux on combination therapies. However, Frohman's en-

thusiasm for treating patients with relapsing and remitting

multiple sclerosis is unbridled, and the author provides a

detailed protocol for the use of cyclophosphamide, a treat-

ment that has been unsuccessful in the only two blinded,

controlled studies of its effects.

It is difficult to read this book without being concerned

about the general dwindling of government funding for uni-

versities and for clinical trials. Is independent-mindedness

among clinical investigators in jeopardy? The key words in

this evolving story are striking: a tragic disease, expensive

therapy, surrogate markers, and short-term efficacy. Even

short-term efficacy — an imperfect goal, to be sure — will

be difficult to demonstrate, because under most circum-

stances, new therapies must be validated in relation to exist-

ing ones. Although it is recognized that the use of existing

therapies is supported by studies in which the period of eval-

uation was often less than two years and rarely as long as

three, how much more difficult will it be to make advances

in treatment? New drugs will need to be more effective and

will pose greater risks with respect to capital expenditures

by industry, in the context of a shortage of untreated pa-

tients.

The views expressed in this book reflect the high spirits

accompanying the emergence of the field from decades of

skepticism, false dawns, and considerable frustration. The

hope is that the next few years will see the accumulation of

data on longer-term outcomes, so that the high spirits in

this book will prove to have been justified.

GEORGE C. EBERS, M.D.

Radcliffe Infirmary

Oxford OX2 6HE, United Kingdom

PHARMACOTHERAPY : A PATHOPHYSIOLOGIC

APPROACH

Edited by Joseph T. DiPiro, Robert L. Talbert, Gary C. Yee,

Gary R. Matzke, Barbara G. Wells, and L. Michael Posey. 2440 pp.,

illustrated. Stamford, Conn., Appleton & Lange, 1999. $150.

ISBN 0-8385-7691-5.

EDICINES," wrote Leonardo da Vinci, "will be

well used when the doctor understands their na-

ture, what man is, what life is, and what constitution and

health are. Know these well and you will know their op-

posites; you will then know well how to devise a remedy."

As the coauthor of a textbook on clinical pharmacology

and drug therapy for medical students, in which this prin-

ciple is espoused, I applaud any attempt by others to do

likewise. That is indeed the basis for this textbook on drug

therapy for clinical pharmacists.

An introductory section on some of the basic principles

of clinical pharmacology is followed by 16 sections on the

management of diseases, organized according to systems

of the body. In each of the chapters dealing with individ-

ual diseases, the authors first discuss the pathophysiologic

principles and then outline the methods of drug therapy

appropriate to each, firmly grounding the therapy in the

context of the pathophysiology. Some of the sections on

systems of the body include accounts of the evaluation of

the diseases to which the system is prey. In each case, the

arguments for using one drug or another are based on the

most recent evidence, cited in the bibliography at the end

of each chapter, although one of the cornerstones of evi-

dence-based medicine, the number of patients who would

need to be treated to produce a given outcome (known as

the number needed to treat), is conspicuously absent. The

discussions are for the most part excellent, but the chap-

ters that include contributions from physicians have a slight

edge over those that do not.

It is strange that such a high-quality text is not accom-

panied by better diagrams. Although there are several good

anatomical diagrams, there are few that illustrate normal

physiology or the pathophysiology of disease, and those that

are provided do not show the use of drugs and where they

act. In contrast, for virtually every condition, there is a

flow chart indicating what to do when a test is positive or

negative, when a patient has a particular clinical feature

that might modify therapy, or when a patient does or does

not have a response to treatment. But these diagrams are

difficult to use. Moreover, their rigid format does not ac-

commodate an understanding that the enormous variabil-

ity among the patients one encounters in everyday practice

greatly militates against such an approach in all but the

simplest stepwise problem, such as the treatment of asth-

ma, which is clearly illustrated by the simplicity of the flow

chart for asthma.

The introductory chapters are disappointing. To open

with a chapter on the economics of drug therapy surely

gives the wrong emphasis, even in an increasingly cost-

conscious health care system. The chapter on pharmaco-

kinetics and pharmacodynamics sets a high bar to vault,

and other chapters are too short to allow their authors a

long enough run up to succeed. An introduction of only

90 pages (less than 4 percent of the text) is not enough,

although to be fair, some general aspects of drug therapy

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1536 ·May 18, 2000

The New England Journal of Medicine

are discussed in other chapters (for instance, there is a de-

scription of how to alter drug dosages in the section on

renal disorders). I found few mistakes in the book and none

of importance, except for the curious dose ranges for an-

giotensin-converting–enzyme inhibitors listed in the chap-

ter on heart failure, with daily doses as high as 400 mg

given for drugs such as enalapril.

This book is a good reference for clinical pharmacists

who can create their own diagrams. But to get the most

out of the text, they will need to know their basics pretty

well and be prepared to flesh out certain points by con-

sulting the review literature.

JEFFREY K. ARONSON, D.PHIL., F.R.C.P.

Radcliffe Infirmary

Oxford OX2 6HE, United Kingdom

NOTICES

Notices submitted for publication should contain a mailing address and

phone number of a contact person or department. We regret we are

unable to publish all notices received. Notices also appear on the

Journal's Web site (http://www.nejm.org/general/text/notices.htm).

The listings can be viewed in their entirety or searched by

location, month, or key word.

PROTECTION FROM RESEARCH RISKS

A "National Human Subjects Protections Workshop," entitled "Sensitiv-

ity in Research Involving Individuals with Cognitive Impairment, Genetics,

and Tissue Banks," will be held in Chicago, June 8 and 9.

Contact April Trenholme, Office of Research Affairs, Rush–Presbyteri-

an–St. Luke's Medical Ctr., 1653 W. Congress Pkwy., Chicago, IL 60612;

or e-mail april_c_trenholme@rush.edu; or call (312) 942-5498; or fax

(312) 942-2874.

CALL FOR APPLICATIONS

The American Philosophical Society is accepting applications for its "Da-

land Fellowships in Clinical Investigation," which support research in sev-

eral branches of clinical medicine, including internal medicine, neurology,

pediatrics, psychiatry, and surgery. Candidates should have held an M.D.

or M.D./Ph.D. for less than six years. Deadline for submission is Sept. 1.

Contact DFCI, APS, 104 S. Fifth St., Philadelphia, PA 19106; or see

http://www.amphilsoc.org.

CURRENT CONCEPTS IN EMERGENCY CARE

The "21st Meeting" will be held in Maui, Hawaii, Dec. 3–8.

Contact Lee Ann Williams, Kailani World Travel, 4192 Meridian Ave.,

Box 9751, Bellingham, WA 98227; or see http://www.ieme.com; or call

(800) 544-9269 (natl.) or (360) 671-1800 (Wash.); or fax (360) 647-

6008.

CALL FOR ABSTRACTS

Abstracts are being accepted for the "8th Biennial Symposium on Statis-

tical Methods," entitled "Issues Associated with Complicated Designs and

Data Structures," to be held in Atlanta, Jan. 23 and 24. Abstracts must be

postmarked no later than Sept. 30.

Contact Chris Johnson, 4770 Buford Hwy., NE (MS-K21), Atlanta, GA

30341; or e-mail cjohnson3@cdc.gov; or call (770) 488-5185; or fax (770)

488-5967; or see http://www.cdc.gov/sag.

AMERICAN CLINICAL NEUROPHYSIOLOGY SOCIETY

The "Annual Meeting" will be held in Montreal, Sept. 22 and 23.

Contact ACNS, P.O. Box 30, Bloomfield, CT 06002; or fax (860) 286-

0787; or e-mail acns@ssmgt.com.

THE INTERNET AND THE PUBLIC'S HEALTH

The conference, subtitled "Impact on Individuals, Communities, and

the World," will be held in Cambridge, Mass., May 30 and 31.

Contact IS2K ; http://www.is2k.harvard.edu; or call (617) 204-4234;

or e-mail is 2k@harvard.edu.

PRACTICAL ANATOMY

The following workshops will be held in St. Louis: "Endoscopic Release

of the Carpal Tunnel" (June 3 and Oct. 21); "Cervical Spine Decompres-

sion and Stabilization" (Aug. 18–20); "Clinical Neuroanatomy, Neurolo-

gy, and Neurosurgery" (Sept. 8–17); "Cranial Microsurgery — Anatomy

and Approaches" (Sept. 18–21); "Extensor Tendon Injuries for the Hand"

(Sept. 26); "Surgical Approaches to the Skull Base" (Sept. 22–24 and

April 19–21); "Sellar and Parasellar Pituitary Tumors" (Oct. 16–18); and

"Clinical Management of the Client with LBP" (Oct. 27 and 28).

Contact Sandy Turck, PA Workshop of St. Louis, Saint Louis Univ.,

3839 Lindell Blvd., St. Louis, MO 63108; or call (314) 535-4000; or fax

(314) 535-8214; or see http://pawslab.slu.edu.

AMERICAN SOCIETY FOR THERAPEUTIC RADIOLOGY AND ONCOLOGY

The "42nd Annual Meeting" will be held in Boston, Oct. 22–25.

Contact ASTRO, 12500 Fair Lakes Circle, Fairfax, VA 22033-3882; or

call (800) 962-7876 (natl.) or (703) 502-1550 (Va.); or fax (703) 502-

7852.

FETAL ORIGINS OF ADULT DISEASE

The "1st World Congress" will be held in Bombay, India, Feb. 2–4.

Contact Alifiya S. Motiwala, Ctr. for Study of Social Change, Plot 6,

Block F, Opp. Govt. Colony Bldg., No. 326, Bandra (East), Mumbai-400

051, India; or see http://www.sneha-india.org; or call (91) 22 6516439;

or e-mail mrcssc@vsnl.com; or fax (91) 22 6516438.

AMERICAN ACADEMY OF DERMATOLOGY

The Committee on International Affairs of the AAD is developing

a clearinghouse of opportunities for dermatologists to volunteer in clin-

ics in developing countries for durations of a few weeks to a month.

Information regarding any such opportunities can be forwarded to the

AAD.

Contact Deborah Kroncke, AAD, P.O. Box 4014, Schaumburg, IL

60168-4014; or e-mail dkroncke@aad.org; or fax (847) 330-1123.

UNIVERSITY OF MICHIGAN

A course, entitled "Practical Training in Vascular Interventions," will be

offered in Ann Arbor, Mich., Oct. 16–20.

Contact Joyce Robertson, Office of CME, UM, P.O. Box 1157, Ann Ar-

bor, MI 48106-1157; or call (800) 800-0666 (natl.) or (734) 763-1400

(Mich.); or e-mail ocme@umich.edu; or fax (734) 936-1641.

UNIVERSITY OF WISCONSIN–MADISON

The following courses will be offered in Madison, Wis.: "Focus on

Rheumatology" and "Headache" (Sept. 21); "Low Back Pain" (Sept. 22);

and "Update in the Control of Nosocomial Infections" (Nov. 16 and 17).

Contact Sarah Aslakson, CME, UWM, 2715 Marshall Court, Madison,

WI 53705; or e-mail aslakson@facstaff.wisc.edu; or call (608) 263-2856;

or fax (608) 262-8421.

HEART ATTACK AND BRAIN ATTACK IN THE NEW MILLENNIUM

The symposium, subtitled "Prevention and Treatment," will be held in

Honolulu, May 25 and 26.

Contact Straub Fdn., 1100 Ward Ave., Honolulu, HI 96814; or call

(808) 524-6755; or see http://www.straub-foundation.org; or fax (808)

521-0123.

CANCER

The "American and European Associations for Cancer Education Joint

Meeting" will be held in Washington, D.C., Nov. 2–5.

Contact Virginia Krawiec, American Assoc. for Cancer Educ., P.O. Box

601, Snellville, GA 30078-0601; or call (404) 329-7612; or fax (404) 321-

4669; or e-mail gkrawiec@cancer.org.

The New England Journal of Medicine

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... Hypertension severity is classified accordingly ( Table 2); adults with a diastolic blood pressure of less than 90 mm Hg and systolic blood pressure value of 140 mm Hg or over are classified as having isolated systolic hypertension. This condition is believed to be caused by age-related pathophysiological changes in arterial vasculature (23); prehypertension is the classification given when blood pressure is elevated above the optimal range, but is not considered 1% Table 2. Classification of blood pressure for adults (24). Stage four of hypertension may be categorized as systolic blood pressure levels in excess of 210 mm Hg and diastolic pressures above 120 mm Hg. 8 ...

53705; or e-mail aslakson@facstaff.wisc.edu; or call (608) 263-2856; or fax

Contact Sarah Aslakson
Uwm Cme

Contact Sarah Aslakson, CME, UWM, 2715 Marshall Court, Madison, WI 53705; or e-mail aslakson@facstaff.wisc.edu; or call (608) 263-2856; or fax (608) 262-8421.

The New England Journal of Medicine Downloaded from nejm.org on October 4, 2016. For personal use only. No other uses without permission. Copyright © 2000 Massachusetts Medical Society. All rights reserved.

Ann Arbor , MI 48106-1157; or call (800) 800-0666 (natl.) or (734) 763-1400 (Mich.); or e-mail ocme@umich.edu; or fax (734) 936-1641. UNIVERSITY OF WISCONSIN–MADISON The following courses will be offered in Madison

Contact Joyce Robertson
Cme Office Of
P O Box

Contact Joyce Robertson, Office of CME, UM, P.O. Box 1157, Ann Arbor, MI 48106-1157; or call (800) 800-0666 (natl.) or (734) 763-1400 (Mich.); or e-mail ocme@umich.edu; or fax (734) 936-1641. UNIVERSITY OF WISCONSIN–MADISON The following courses will be offered in Madison, Wis.: " Focus on Rheumatology " and " Headache " (Sept. 21); " Low Back Pain " (Sept. 22);

MO 63108; or call (314) 535-4000; or fax (314) 535-8214; or see http

Lindell Blvd
St
Louis

Lindell Blvd., St. Louis, MO 63108; or call (314) 535-4000; or fax (314) 535-8214; or see http://pawslab.slu.edu.

Endoscopic Release of the Carpal Tunnel Cervical Spine Decompression and Stabilization Extensor Tendon Injuries for the Hand); " Surgical Approaches to the Skull Base Sellar and Parasellar Pituitary Tumors

Louis St
Neuroanatomy
Neurosurgery Neurology

ANATOMY The following workshops will be held in St. Louis: " Endoscopic Release of the Carpal Tunnel " (June 3 and Oct. 21); " Cervical Spine Decompression and Stabilization " (Aug. 18–20); " Clinical Neuroanatomy, Neurology, and Neurosurgery " (Sept. 8–17); " Cranial Microsurgery — Anatomy and Approaches " (Sept. 18–21); " Extensor Tendon Injuries for the Hand " (Sept. 26); " Surgical Approaches to the Skull Base " (Sept. 22–24 and April 19–21); " Sellar and Parasellar Pituitary Tumors " (Oct. 16–18); and " Clinical Management of the Client with LBP " (Oct. 27 and 28).

Source: https://www.researchgate.net/publication/245998492_Book_Review_Pharmacotherapy_A_pathophysiologic_approach_Edited_by_Joseph_T_DiPiro_Robert_L_Talbert_Gary_C_Yee_Gary_R_Matzke_Barbara_G_Wells_and_L_Michael_Posey_2440_pp_illustrated_Stamford_Conn_Applet

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