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tions, and artifacts simulating dis

ease are presented.


chapters on the colon deal with

bowel disease as seen with

double contrast examination. The sec
tion on inflammatory bowel disease is
superb and depicts all stages of
inflammatory bowel disease. Extrin
sic pathological conditions affecting
the colon examination are also pre
The text will be most appreciated
by the radiologist just beginning
double contrast examinations, but
those who have mastered the tech
nique will find it a reference for

Gastrointestinal Radiology and


Double Contrast Gastrointestinal Radiology


Endoscopic Correlation, by Igor Laufer,


pp, 1,080 illus, $65, Canada $78, Philadelphia,

WB Saunders Co, 1979.

Double contrast radiography of the

colon has been available to the radiologist for decades. Within the last
few years, however, there has been a
resurgence in this technique. Improvement in apparatus and barium
preparations has resulted in notably
superior radiographs. A detailed look
at the mucosal lining of gut has been
provided. A need then arose for interpretation of these surface patterns as
well as a technique to reproduce these
images consistently. The author and
his collaborators have answered this
need with Double Contrast Gastrointestinal Radiology With Endoscopic
Detailed in 17 chapters is a method
for double contrast examination of
the entire gastrointestinal tract.
Technical and interpretative information is described; radiographic reproductions are excellent. The chapter
entitled "Principles of Double Contrast Diagnosis" is particularly useful
in presenting basic concepts of interpretation that apply to double contrast examination of any region of the
gut. Pathology presented has been
limited to disease states that are
most identifiable by this technique.
The Japanese method of double
contrast examination of the stomach
has been modified by the author. This
technique, when combined with hypotonic agents, produces striking radio
graphs of the duodenum.
The small bowel examination has
always been an area of difficult radiographic analysis. A protocol for the
small bowel enema examination is
presented with examples of normal as
well as pathological states. Because of
the inaccessibility of the majority of
the small bowel to the endoscope, any

technique to improve diagnostic accu

racy is most welcomed.

Regarding endoscopy, the author

shares his personal endoscopie ex

perience. The endoscopie photographs

juxtaposed with the double contrast
radiography are most dramatic. (The
more subtle findings are highlighted
with arrows and line diagrams.)
Normal anatomy, pathological condi-



familiar with the endoscopie appear

ance of disease will find help inter
preting its radiographie counterpart.
The chapters on the postoperative
appearance of the stomach and large
bowel will certainly appeal to the
surgeon. The authors have been most
successful in compiling a text that
provides information on the perform
ance and interpretation of double
contrast examinations. Books of this
nature are presently limited. This one
will serve as the standard against
which those to come will be mea
Bruce Silver, MD
Louis A. Weiss Memorial



of Clinical Electrocardiography,
by Mervin J. Goldman, 415 pp, with illus,
paper, $12, Los Altos, Calif, Lange Medical Publications, 1979.



This tenth edition of Principles of

Clinical Electrocardiography by
Goldman is little changed from the
ninth edition. With few exceptions,
the organization, structure, content,
and illustrations are unchanged from
previous editions.
The book is easy to read; the
language is simple, concise, and
uncluttered; and the diagrams and
illustrative ECGs are generally of
good or excellent technical quality.
The text is profusely illustrated and
is complete and current, though of
necessity in a book of this type, many
topics are given brief and sketchy
treatment. Some discrepancies and
unevenness in the quality and relevancy of the material covered are
noted here and there. For example, a
few paragraphs are given to the
effects on the ECG of such drugs as
emetine hydrochloride, phenothiazines, and daunorubicin hydrochloride and such conditions as malignancy and hypothermia, yet there is no
discussion of the ECG in pulmonary

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embolism. Brief but adequate mentions are made of the fascicular

blocks and of His bundle recordings
in the evaluation and classification of
conduction disturbances, but one also
finds a discussion on the use of oral
potassium to differentiate functional
from organic T wave changesa test
of questionable value, of some poten
tial danger, and of little if any clinical


Another criticism may be the con

tinued dependency on pattern recog
nition as a means of explaining the
normal and abnormal ECG. However,
this is largely compensated for by a
later introductory chapter on spatial
vectorcardiography and by many
comments and diagrams throughout
the text illustrating the spread of the
activation process and direction of
the mean electrical axis. Still, I can
find little justification for an early
chapter on the effects of heart posi
tions on the ECG, in which detailed
descriptions are given of ECG pat
terns in the limb leads associated
with vertical, semivertical, interme
diate, semihorizontal, and horizontal
heart positions or rotations. This is
outdated terminology and a concept
that serves no useful purpose.
These comments should not detract
from much that is well done and of
value in this book, and the author is
to be commended for putting together
a concise, readable, and fairly com
plete ECG textbook aimed at the
beginner in electrocardiography.
With minor reservations this text
can be recommended to medical
students, junior house staff, and
others interested in learning basic
clinical electrocardiography.
Jean M. Pouget, MD
Veterans Administration West Side Medical Center

University of Illinois

External Fixation
External Fixation: The Current State of the

Art, Andrew F. Brooker, Jr, and Charles C.

Edwards, eds (conference, Baltimore, 1978), 419
pp, with illus, paper, $19.95, Baltimore, Williams &
Wilkins Co, 1979.

This book includes, first, a concise

review of different external fixators,
biomechanical analysis of this device,
and the biomechanics of fracture
healing. The indications, technical
considerations, and complications are
discussed. The clinical application of
the external fixator is discussed in
detail, which includes tibial fractures
(closed and open), pelvic fractures,
multiple fractures, nonunion, and
infected nonunion. The Hoffmann
apparatus is discussed also, and clinical data on its use are presented.