470 CLINICAL RADIOLOGY

B O O K R E V I E W S

Efficiency and Limits of Radiologic Examination of the Pancreas. Ed. Hermarm Anacker. Published by Georg Thieme, Stuttgart, 1975. Pp. 276, 353 figures, 74 tables. Price 68 DM (approximately £12.75).

This book contains the papers read at the Symposium Radiologicum Pancreatitis held in Munich in 1973. As is to be expected in a collection of this sort, the 43 contributions are of widely varying quality. Unfortunately, the text is littered with spelling and typographical errors (estimated at more than 500). Also the verbatim style is in parts difficult to understand. Nevertheless, for those interested in the subject there is much to reward a careful search of the text and most of the illustrations are worth looking at.

The contents give an indication of the present state of radiological examination of the pancreas and several con- tributors describe their experience of each method. Notable amongst recent advances is endoscopic retrograde pan- creatography and cholangiography. Hypotonic duodeno- graphy also features prominently with contributions by the proponents of the intubation and tubeless methods. In this context there is an interesting comparison between the effects and side effects of hyoscine-n-butylbromide, propantheline bromide and glucagon by D. Novak. The replacement of percutaneous splenoportography by selective visceral angio- graphy is also made clear. As expected arteriography attracts considerable attention and the use of superselective techniques and of pharmacoangiography are described.

This is essentially a book for the enthusiast. Those who want to learn about the radiology of the pancreas will get more value from some other texts. Rather than read the whole book however, the busy radiologist would be well advised to first read the ten page r6sum6 at the back by three contributors, C. Hernandez, Paris, J. R6sch, Portland and H. Anacker, Munich, and from this pick out selected papers for detailed study. It is always pleasing to read an opinion which one has long held. J. R6sch states 'I have however one comment on the statistical data presented in some papers. We cannot get an objective view of the efficiency of a method if we compare two or three procedures done with different degrees of experience, where one method is per- formed and evaluated with the highest standards and others only on the basis of limited experience. Such statistics have only local valitity and cannot be generalised.' How right he is.

One is left with the conclusion that present rnethods of examination have reached their maximum sophistication and

that each individual patient requires a combination of methods to achieve the best chance of diagnosis. There also comes a time when laparotomy becomes preferable to continuation of a long sequence of investigations, and the sensible radiologist mast be able to judge when this time has come. H. Anacker makes an interesting attempt to compile a 'use and sequence sheet' of the individual investigations for the respective diseases of the pancreas. It is of course easier to decide which investigation to do when the diagnosis is known already. In the usual clinical situation however, it may be more diffficult. Nevertheless, in these times of limited resources the correctly applied sequential examination of patients is important. In order to achieve this it is necessary for the radiologist to have an influence on the choice of investigations.

K. C. SIMPKINS

Radionudide Scanning in Cyanotic Heart Disease. By GARY F. GATES. Charles C. Thomas. Springfield, Illinois. Pp. 100. Price $15.00.

The author's twin interests of nuclear medicine and paedia- tric radiology are a firm foundation for this enthusiastic little monograph. He has applied the well-known pulmonary perfusion scanning techniques to the study of suspected right to left shunts in morbus couruleus. Straightforward data processing techniques enable the shunt ratio and individual lung perfuslon ratios to be calculated and the author is persuasive about their accuracy in the clinical context. His experience of some 100 cases is documented and there are good comparative illustrations of angioeardio- graphy and scans. The latter technique is a relatively non- invasive study of function and does not set out to show anatomical detail. The author's thesis is that there is a growing need for such a technique both before and after cardiac surgery. For example it may save serial angioeardio- graphy with its attendant hazards in the assessment of the function of Blalock and Waterston operations for Fallot's tetralogy. The book should stimulate wider interest in the application of these techniques. The bilbiography and index are very helpful, but it was disappointing to find the discus- sion of radiation hazard so scant and so late in the book (p. 88). If the book were published in soft cover it might be cheaper and might also reach a wider ownership.

E. RHYS-DAVIES