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Computed tomography of the abdomen
September
capacitance vessels) are clearly presented, and should be extremely valuable. Chapters on blood flow and eating, motility, and the gastrointestinal hormones follow. Other chapters cover tissue oxygenation and flow, cardiovascular reflexes, neonatal circulation, and colonic circulation. The theory of countercurrent exchange in the small intestine is thoroughly presented, but the book fails to present the data that call into question the validity of this theory, e.g., the lack of the necessary close anatomic arrangement between villous arterioles and venules in many species, including humans, to permit countercurrent exchange. The chapters in the section on intestinal transcapillary fluid exchange clearly review a difficult, important, but until very recently, neglected field. These chapters constitute “must” reading for physiologists in this area. Among the various tissues, the small bowel is unique in the interaction between transcapillary and lymphatic fluid fluxes in that intestinal capillaries alternate between periods of net filtration and absorption. This section reviews the role of lymph formation, capillary permeability, and microvascular pressure in these processes. The section on mathematical models includes current concepts concerning the intestinal circulation and intestinal function. A mathematical model of local microvascular control of intestinal oxygenation is presented, and its behavior under different conditions is scrutinized. As the editors state in their preface, such models provide a means for integrating diverse experimental findings. They force the investigator to state his assumptions explicitly and to express in precise form the relationships he believes exist among the variables. The pathophysiology section includes chapters on shock, intestinal obstruction, portal hypertension, nonocelusive intestinal ischemia, diabetes mellitus, and arterial hypertension. These chapters should be of interest to gastroenterologists and gastrointestinal or vascular surgeons. The final section on pharmacology reviews the effects of vasopressin on the splanchnic circulation, the pharmacology of intestinal blood flow and oxygen uptake, and the effect of drugs on transcapillary fluid exchange. In summary, this is a very well-written, up-to-date review of the current state of our knowledge of intestinal circulation and its role in intestinal physiology and pathophysiology. It is an invaluable text for investigators in intestinal physiology and pathophysiology and should prove valuable to gastroenterologists, surgeons, and students wishing to review in detail aspects of the intestinal circulation. PAUL H. GUTH, M.D.
Los
HOOK
1985
Angeles, California
Diagnostic Ultrasound in Gastroenterology. Instrumentation, Clinical Problems and Atlas. By L. Bolondi, L. Gandolfi, and G. Labo. 533 pp., $49.95. ButterworthtPiccin Publishers, Stoneham, Massachusetts, 1984. Predominantly an atlas of abdominal ultrasonography, there are many exceptional examples of normal and abnormal anatomy, with emphasis on the more common pathologic conditions. The images overall are quite good and
REVIEWS
699
well labeled but many have a disturbing grid overlying anatomic structures. In addition to the major authors’ contributions, there are chapters by Ohto, Fukuda, and DiMagno-well-known investigators in the application of ultrasound to abdominal disease. Ultrasonographic appearances of the liver, biliary tree, pancreas, gut, abdominal vessels, intraperitoneal cavity, and retroperitoneal space are displayed in separate chapters. A separate chapter on ultrasound-guided needle placement and biopsy is included. The text accompanying each condition is a brief summary of literature. Although the text is easily readable, it is far too brief to be considered a complete review for each subject, and, indeed, this does not seem to be the intent of the authors. A special chapter by DiMagno on endoscopic ultrasonography represents a truly up-to-date addition. The illustrations using this new technique are of superb quality and demonstrate the best that endoscopic ultrasonography has to offer. It is too early to say whether this technique will have widespread applicability-mainly because it is invasive, whereas standard ultrasonography is not. This text is applicable to those who are primarily concerned with abdominal sonographic imaging. It would serve the beginning sonographer as an excellent overview of abdominal sonography; for the more experienced sonographer, it will serve as a reference atlas. It is unlikely to be utilized by a nonsonographer gastroenterologist who might infrequently be interested in viewing another example of a patient’s abdominal disease. HENRY 1. GOLDBERG, M.D. PETER CALLEN. M.D.
San Francisco,
California
Computed Tomography of the Abdomen. Edited by J. R. Haaga and R. J. Alfidi. 105 illustrations, 467 pp., $70.00. The C. V. Mosby Company, St. Louis, Missouri, 1985. This book is a reproduction of 12 chapters already published in the authors’ 1983 two-volume work, Computed Tomography of the Whole Body. It is a multicontributor book, organized into 12 chapters according to organ systems, followed by a chapter with four sections concerning current technology, including nuclear magnetic resonance (NMR). The computed tomographic features of the abdomen, retroperitoneum, and pelvis are reviewed comprehensively, fulfilling its goal of being a reference text on computed tomography (CT) of the abdomen for radiologists and all physicians who deal with diseases involving these regions. The first 12 chapters are well organized; sections describing normal anatomy and computed tomography techniques are presented initially, followed by a description of benign and malignant abnormalities. The illustrations are generally of high quality and the text and tables are extremely readable. The last chapter breaks the general organization of the text. The section on vascular problems could easily have been integrated into the chapter on great vessels, and it is not clear why there is a section on acute renal inflammatory disease separate from the chapter on renal disease. The sections on nuclear magnetic resonance fit poorly into
700
BOOK REVIEWS
the book. They appear to have been appended as an afterthought and include numerous nonabdominal images. Overall, the book is a more than adequate compilation of abdominal computed tomography and it is presented in a readable, reasonably sized volume. It is expensive for a
GASTROENTEROLOGY
Vol. 89, No. 3
reproduction of an earlier work, but should be of value to radiologists and physicians wanting a specialized reference on the subject. ALBERT A. MOSS, M.D.
Seattle, Washington
capacitance vessels) are clearly presented, and should be extremely valuable. Chapters on blood flow and eating, motility, and the gastrointestinal hormones follow. Other chapters cover tissue oxygenation and flow, cardiovascular reflexes, neonatal circulation, and colonic circulation. The theory of countercurrent exchange in the small intestine is thoroughly presented, but the book fails to present the data that call into question the validity of this theory, e.g., the lack of the necessary close anatomic arrangement between villous arterioles and venules in many species, including humans, to permit countercurrent exchange. The chapters in the section on intestinal transcapillary fluid exchange clearly review a difficult, important, but until very recently, neglected field. These chapters constitute “must” reading for physiologists in this area. Among the various tissues, the small bowel is unique in the interaction between transcapillary and lymphatic fluid fluxes in that intestinal capillaries alternate between periods of net filtration and absorption. This section reviews the role of lymph formation, capillary permeability, and microvascular pressure in these processes. The section on mathematical models includes current concepts concerning the intestinal circulation and intestinal function. A mathematical model of local microvascular control of intestinal oxygenation is presented, and its behavior under different conditions is scrutinized. As the editors state in their preface, such models provide a means for integrating diverse experimental findings. They force the investigator to state his assumptions explicitly and to express in precise form the relationships he believes exist among the variables. The pathophysiology section includes chapters on shock, intestinal obstruction, portal hypertension, nonocelusive intestinal ischemia, diabetes mellitus, and arterial hypertension. These chapters should be of interest to gastroenterologists and gastrointestinal or vascular surgeons. The final section on pharmacology reviews the effects of vasopressin on the splanchnic circulation, the pharmacology of intestinal blood flow and oxygen uptake, and the effect of drugs on transcapillary fluid exchange. In summary, this is a very well-written, up-to-date review of the current state of our knowledge of intestinal circulation and its role in intestinal physiology and pathophysiology. It is an invaluable text for investigators in intestinal physiology and pathophysiology and should prove valuable to gastroenterologists, surgeons, and students wishing to review in detail aspects of the intestinal circulation. PAUL H. GUTH, M.D.
Los
HOOK
1985
Angeles, California
Diagnostic Ultrasound in Gastroenterology. Instrumentation, Clinical Problems and Atlas. By L. Bolondi, L. Gandolfi, and G. Labo. 533 pp., $49.95. ButterworthtPiccin Publishers, Stoneham, Massachusetts, 1984. Predominantly an atlas of abdominal ultrasonography, there are many exceptional examples of normal and abnormal anatomy, with emphasis on the more common pathologic conditions. The images overall are quite good and
REVIEWS
699
well labeled but many have a disturbing grid overlying anatomic structures. In addition to the major authors’ contributions, there are chapters by Ohto, Fukuda, and DiMagno-well-known investigators in the application of ultrasound to abdominal disease. Ultrasonographic appearances of the liver, biliary tree, pancreas, gut, abdominal vessels, intraperitoneal cavity, and retroperitoneal space are displayed in separate chapters. A separate chapter on ultrasound-guided needle placement and biopsy is included. The text accompanying each condition is a brief summary of literature. Although the text is easily readable, it is far too brief to be considered a complete review for each subject, and, indeed, this does not seem to be the intent of the authors. A special chapter by DiMagno on endoscopic ultrasonography represents a truly up-to-date addition. The illustrations using this new technique are of superb quality and demonstrate the best that endoscopic ultrasonography has to offer. It is too early to say whether this technique will have widespread applicability-mainly because it is invasive, whereas standard ultrasonography is not. This text is applicable to those who are primarily concerned with abdominal sonographic imaging. It would serve the beginning sonographer as an excellent overview of abdominal sonography; for the more experienced sonographer, it will serve as a reference atlas. It is unlikely to be utilized by a nonsonographer gastroenterologist who might infrequently be interested in viewing another example of a patient’s abdominal disease. HENRY 1. GOLDBERG, M.D. PETER CALLEN. M.D.
San Francisco,
California
Computed Tomography of the Abdomen. Edited by J. R. Haaga and R. J. Alfidi. 105 illustrations, 467 pp., $70.00. The C. V. Mosby Company, St. Louis, Missouri, 1985. This book is a reproduction of 12 chapters already published in the authors’ 1983 two-volume work, Computed Tomography of the Whole Body. It is a multicontributor book, organized into 12 chapters according to organ systems, followed by a chapter with four sections concerning current technology, including nuclear magnetic resonance (NMR). The computed tomographic features of the abdomen, retroperitoneum, and pelvis are reviewed comprehensively, fulfilling its goal of being a reference text on computed tomography (CT) of the abdomen for radiologists and all physicians who deal with diseases involving these regions. The first 12 chapters are well organized; sections describing normal anatomy and computed tomography techniques are presented initially, followed by a description of benign and malignant abnormalities. The illustrations are generally of high quality and the text and tables are extremely readable. The last chapter breaks the general organization of the text. The section on vascular problems could easily have been integrated into the chapter on great vessels, and it is not clear why there is a section on acute renal inflammatory disease separate from the chapter on renal disease. The sections on nuclear magnetic resonance fit poorly into
700
BOOK REVIEWS
the book. They appear to have been appended as an afterthought and include numerous nonabdominal images. Overall, the book is a more than adequate compilation of abdominal computed tomography and it is presented in a readable, reasonably sized volume. It is expensive for a
GASTROENTEROLOGY
Vol. 89, No. 3
reproduction of an earlier work, but should be of value to radiologists and physicians wanting a specialized reference on the subject. ALBERT A. MOSS, M.D.
Seattle, Washington