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Concise Dictionary of Modern Medicine by Joseph C. Segen, 765 pp, $29.95, ISBN 0-8385-1535-5, paper, New York, NY, McGraw-Hill, 2006. JAMA. 2006;296:101-102. Most lexicographers compile or edit dictionaries; Joseph C. Segen, MD, writes them. A pathologist with a passion for informatics and an indefatigable collector of stray nuggets and arcane factlets, Dr Segen has produced another cornucopia of medical infobites cast in his trademark staccato style. His latest dictionary defines not only formal terminology but also jargon, neologisms, casual speech, and brand names pertaining to both the basic sciences and clinical medicine, with special attention to current topics in molecular biology, public health, medical education, legal medicine, alternative medicine, and professional practice issues. Like earlier works by this author, the book deals with countless topics that can't be found in other reference sources: black patch delirium, contragestion, good death, hungry bones syndrome, lazy pituitary, Martha Stewart disease, Old Sparky, one-eyed vertebra, Panama Red, rave, scut work, Seinfeld syncope, tape booger, wrecking ball effect. And unlike dictionaries that limit themselves to a standard core of formal terminology, this one affords hours of entertaining and instructive leisure reading. The author's individual touch and wry humor appear everywhere. He defines cosmetic surgery as "Plastic surgery designed to sculpt an Adonis or Venus from lumps of mortal clay" and surgical scrubs as "the universal uniform of those daring men and women of action, the surgeons." One feature of Meniere's disease, he tells us, is "profound hearing loss in one or more ears." The dictionary presents succinct surveys of expected topics such as angiotensin II receptor antagonist, cocaine, cystic fibrosis, deep vein thrombosis, hypereosinophilic syndrome, infective endocarditis, intussusception, necrotizing enterocolitis, paroxysmal cold hemoglobinuria, pulmonary alveolar proteinosis, wart, and Wegener's granulomatosis. Tables enhance the text on some subjects, including AIDS, depression, end-of-life care, infanticide (diagnosis of), inflammatory bowel disease, lasers in medicine, postgastrectomy syndrome, serum protein electrophoresis, systemic lupus erythematosus, and tick. Many entries are cyclopedic in format, presenting information under several headings. Others exhibit the terse idiom and frantic tempo of lecture notes or memos scribbled during rounds. These are often sketchy, with erratic punctuation and syntactic license verging on gibberish: "foot ... The distal part of the lower extremity on which a person stands and uses to walk ... "; "nightmare ... often seen in normal childhood unless they interfere with sleep, development or psychosocial development." It's hard to be too harsh with an author who admits that he failed the International English Language Testing System examination the first time he took it in preparation for employment by the National Health Service after relocation in the United Kingdom, but jumbles like these crop up on virtually every page. This slapdash mode of composition carries over into other phases of the book, which suffers from an abundance of typographic errors, misspellings, cyberhash, and cross-references that lead nowhere. A few entries appear to have been salvaged from an aging database that hasn't been properly updated. Pneumocystis jiroveci is still called P carinii. The entry for erectile dysfunction describes older treatments but doesn't mention phosphodiesterase type 5 inhibitors. West Nile fever is characterized as strictly an Old World disease. Some of Segen's shorter definitions fall short of the precision and accuracy expected in a technical dictionary. To mainline is not simply "to inject a drug," nor is the single word "coitus" an appropriate semantic equivalent for fornication. The PDR (Physicians' Desk Reference) certainly does not list "all A 2500 US therapeutics requiring a physician prescription." Inspissation means thickening or condensation, not "plugging of a tubular lumen." And one expects a pathologist's dictionary to correctly state that cardiac cirrhosis is a disorder of the liver, not the heart. The reader learns with alarm that "virtually all notes regarding term usage, preferred names, and source material ... were obtained via the Internet." Perhaps that inexhaustible wellspring of rubbish inspired the lexicographer to define Lugol solution as acetic acid solution, non-gonococcal urethritis as "an STD defined as the presence of abundant PMNs in urine," and parenteral as "[r]eferring to a non-topical route of administration." After describing Terminologia Anatomica as the "official body and grand poobah of anatomic nomenclature created by ... a chucklefest of brainy long-faced coves with serious intent," Segen goes on to observe that "to stubbornly cling to the belief that anatomic terminology can be written in anything but English is to risk being labelled obsolete and irrelevant." Possibly that stance accounts for his deviant Latin, not only in anatomy (adnexae, amygdalus, cordae tendinae) but also in nosology (lichen sclerosis, lymphopathia venereum, pyoderma gangrenosa) and taxonomy (Gingko, N meningococcus, Ureaplasma urealytica). Nit-picking aside, this work, which is intended to supplement standard medical dictionaries rather than to replace them, contains an enormous amount of useful, accurate, and entertaining material. Its unique scope and accessibility make it a valuable addition to any physician's library, and no medical educator, writer, or editor should be without it. Disclosure: The reviewer has received fees for consulting and editorial services for Lippincott Williams & Wilkins, publishers of the Stedman's series of medical reference works. John H. Dirckx, MD, Reviewer Dayton, Ohio Book and Media Reviews Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA. Journal of American Medical Association 20060705