In terms of computer literacy and competence, there are all levels of expertise in the population. In terms of computer comfort, however, there are only two groups: younger people, who find the technology easy to use and as simple as can be, and the rest of us, who were raised in the age of the magical knowledge system called books. As you might guess, I find myself in the latter group, and I am somewhat in awe of those in the former. I like tables of contents, chapter headings, the ability to read over what I just read by flipping back a page, the ease of finding a reference, and the warmth of holding a book on my lap or the comfort of having it in my briefcase or on my bedside table. We cannot, however, escape the fact that, as we approach the millennium, we are becoming more and more dependent on computerized information, the Internet, e-mail, and CD-ROM instructional systems. Enneking and his coworkers have produced a beautiful example of the latter.
As might be expected of someone who has lived through the grand old "book days," Enneking has taken pity on his fellow ancients by making his system very easy and, indeed, a joy to use, while offering younger students a prize that will rival any educational material that they might have in their library or computer system. The table of contents is clearly defined; a click of the mouse allows the reader to enter the appropriate chapter without a problem. The text is clearly written, in perfect Ennekingian language, which leaves little room for equivocation or interpretive error. When a picture is available, another click of the mouse brings it up not only quickly but with surprising and wonderful clarity.
This CD-ROM is intended to serve not only as a research tool that will allow students, residents, fellows, and experienced orthopaedists to learn about tumors but also as a reference base that will allow the reader (or computer user) to obtain additional information about specific terms. For example, clicking on the term chondroblastoma allows the user to review the definition; demographics; clinical presentation; natural history; radiographic, gross, and histological features; findings on imaging studies; results of treatment; and examples of cases. The reproductions of radiographs, photographs, and low and high-power histological images are of good quality and clarity. The image viewer, located on the right of the text, allows an image to be enlarged, made smaller, or superimposed as desired.
As a special, additional feature, the reader is invited to take a self-evaluation test. This test is very helpful in allowing the reader to determine how much he or she has learned. Clicking over the appropriate site immediately produces radiographic images, gross photographs of tissue, and low and high-power histological images of quality and clarity.
There are few references, but this might be considered appropriate for a text that is so definitive and so specifically reflective of the author's point of view.
The sections on tumors of all types are superb, but the sections on other topics such as growth, repair, metabolic bone disease, and arthritis are somewhat limited in their discussion of the pathophysiology and mechanisms of disease. However, this in no way detracts from the spectacular descriptions or images of gross and histological features.
Even though I am not especially comfortable with computers, I prefer this CD-ROM to Enneking's two-volume work, published in 1983, which is among my most frequently referenced texts. The CD-ROM is easy to use, informative, and not nearly as heavy as the text. (I can carry my laptop onto an airplane.) But perhaps its greatest advantage is that Enneking can (and, I suspect, will) produce new editions, with corrections and additions, at regular intervals. Another advantage is that, with a projector, more than one person can use the system; I have found it to be a fine teaching tool. I recommend this CD-ROM for all students of pathology, young and old, regardless of how much or how little they know. It is a gem.
Henry J. Mankin, M.D.
Orthopaedic Service
Massachusetts General Hospital
Boston, Massachusetts