David J. Tibbs; ed. 576 pages. Boston: Butterworth-Heinemann; 1992. $350.00.

Circulatory problems can be chronic, and patients with these conditions can be frustrated and discouraged by their circumstances. This is further compounded by the unfortunate fact that residency training programs have been lax in including venous diseases in their curriculum. As a direct consequence of this, few physicians are comfortable treating these illnesses, although they may form a considerable part of a clinical practice.

I am pleased to report that this text helps to fill a gap in the medical literature. Venous and lymphatic problems constitute a significant portion of my clinical practice. Few reference texts have dealt with these subjects with the scope and depth of Dr. Tibb's text. This comprehensive textbook deals with most issues that one would need to cover thoroughly almost any topic in venous diseases. Each chapter is replete with meticulously detailed clinical information, and the author uses many individual case studies based on his own years of clinical experience to illustrate significant points. These case presentations are reinforced with pictures, venograms, hand-drawings, and commentary that enhance understanding of difficult topics. The chapters on ulceration, edema, and deep venous thrombosis are informative and rewarding to read. The author's chapters on sclerotherapy and vein stripping provide a well-done, detailed account of how to do these procedures. It is particularly noteworthy that David Tibbs wrote most of this text himself.

The author has written in the foreword that "the book is not intended to be read from cover to cover but rather to be dipped into." I agree with him. Reading the text from cover to cover proved laborious at times. However, it is only fair to point out that the author's careful and detailed descriptions have lead to a remarkably fine reference text. Unfortunately, the cost and the title may limit its use to a narrow audience. The title of the text does not adequately reflect the depth, detail, and scope of the material covered.

It is my recommendation that medical libraries make Varicose Veins and Related Disorders available to physicians as a reference text. I suspect it will become useful as future instruction material for students of venous disease.