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Differential Diagnosis in Conventional Gastrointestinal Radiology

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Differential Diagnosis in Conventional Gastrointestinal Radiology. Burgener FA, Kormano M. (Pp 233; illustrated; DM115.00.) Stuttgart: Georg Thieme Verlag, 1997. ISBN 0-86577-676-8.

This book is the second edition of a monograph in theDifferential Diagnosis in Conventional Radiology series by Burgener and Kormano aimed at radiologists, physicians and surgeons interested in gastroenterology. There are chapters on the abnormal gas pattern, abdominal calcifications, displacement of abdominal organs, dilatation and motility disorders, narrowing, and filling defects. There is also a chapter on ulcers, diverticula and fistulae, and one on biliary tract abnormalities.

There is lot of interesting material in this book that should prove helpful to those who wish to expand their knowledge of basic gastrointestinal radiology. In general, the book is well illustrated but there are exceptions, particularly in the chapter on ulcers, diverticula and fistulae. I would like to have seen an example of the typical appearances of an oesophageal web shown on lateral and anteroposterior projections.

There are, however, a number of shortcomings, particularly lack of attention to detail when describing or discussing some of the more uncommon disorders. In some cases the views expressed are out of date and I was left with the impression that neither of the authors have extensive experience in gastrointestinal radiology. On the first page it is suggested that the upright view of the abdomen is routinely used to show free intraperitoneal air, whereas the upright chest radiograph is now widely used for this purpose. The upright chest radiograph provides the best chance of showing small amounts of free intraperitoneal air because the horizontal x ray beam is tangential to the dome of the diaphragm. The current practice in a number of leading paediatric centres of using air instead of barium to reduce intussusception in infants is not mentioned, although hydrostatic reduction is discussed. When discussing neonatal necrotising enterocolitis, it is stated that gas in the portal vein indicates a probable fatal outcome. The presence of extensive pneumotosis intestinalis and portal venous gas indicates severe disease but does not necessarily predict an irreversible course. Gastrocolic fistulae resulting from benign ulceration are occasionally shown during a barium meal examination and I am reluctant to accept the views expressed that at the present time gastrocolic fistulae are mostly complications of malignancy, best shown by barium enema. There is a statement that entero-enteric fistulae are rare in ulcerative colitis (0.5%). Ulcerative colitis does not involve the small intestine and I am not aware that entero-enteric fistulae ever occur in this disorder.

These criticisms only relate to some sections and overall this book contains a wealth of information that is concisely presented. It is ideal for those who wish to find out about the many diverse disorders that can be diagnosed using conventional radiological techniques.

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