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Electrogastrography, Principles and Applications
many other details, but this topic is to be the subject of further analysis. This important paper is a salutary one and should be read by all practicing gastrointestinal endoscopists. It emphasizes that this frequently used procedure carries significant hazards, the risk increasing considerably with patient age and endoscopist inexperience. Performing a procedure in which one is not adequately trained or experienced, under circumstances which are inappropriate, using drugs with which one is unfamiliar or inadequately skilled, or without proper nursing support cannot be condoned. JOHN R. BENNETT
Kingston upon Hull, United Kingdom
something that they wish to add ifa third edition of the book is published. It should be noted that in the Forward the authors mention that a Slide Atlas of Gastroenterology, Second Edition, is available based on these contents. We have not seen this slide atlas, but believe it would be extremely valuable to show the abnormalities to groups that are shown so superbly in the atlas. In conclusion, this is clearly the best atlas ofgastroenterology t h a t has been produced to date. It has absolutely no competition in t h a t area, and it is so complete and detailed it is unlikely t h a t another of equal value will be available anytime in the foreseeable future. This is one of the books t h a t should be in all areas that practice, teach, and study gastroenterology.
Denise Hunninghake, MD Stephen E. Silvis, MD Minneapolis, Minnesota
Atlas o f Clinical G a s t r o e n t e r o l o g y , S e c o n d Edition edited by J.J. Misiewicz, A. Forbes, A.B. Price, P.J. Shorvon, D.R. Triger, G.N.J. Tytgat Mosby Year Book, London, England, 1994, 223 pp., $194.00 Whether you are a beginning or an experienced gastroenterologist, if the question is, What does it look like? this is the atlas to consult. It contains 930 color photographs, 440 black and white photographs primarily of radiographic images, and more t h a n 1000 interpretive line drawings. This material has been gathered from hospitals in London and Amsterdam, as well as m a n y from other institutions, primarily in Europe. Many of the line drawings are critical to the interpretation of the photographic material, and others add to its clarity by leaving the photographic, pathologic, radiographic, endoscopic, or gross surgical specimen unencumbered by labels. One advantage is many of the examples shown are seldom seen in clinical practice. For example, page 4.25 shows a Meckel's diverticulum with an ulcer in it that is seen on x-ray on Meckel's scan, and the gross specimen is shown. For the most part this is strictly an atlas; that is, it shows the pictures to answer the question, What does i t look like? but does not give other information t h a t would require it as a companion to a more standard gastrointestinal text to have complete information. Its uniqueness is its frequent line drawings, its outstanding illustrations, and the magnitude of the illustrations. There are no references included in the text at all. It is somewhat surprising t h a t at least major reference sources are not listed at the chapters, and this may be
384 GASTROINTESTINALENDOSCOPY
Electrogastrography, Principles and Applications edited by J. Z. Chen, R. W. McCallum Raven Press, New York, 1994, 418 pp., $90.00 Electrical signals from the stomach were recorded by Dr. Walter Alverez over the upper abdomen in 1921, but the limitations of visual analysis impeded the development of the field. However, the introduction of computerized frequency analysis in the 1970s provided a means to make sense of the complex gastric electrical signals. It is premature to predict whether electrogastrography (EGG) will survive as a critical diagnostic tool. It is noninvasive, inexpensive, and technically simple to make high-quality recordings and to apply analytic methods to summarize the data. However, it has serious limitations and m a n y questions remain unanswered. For example, persons who complain of nausea often have gastric dysrhythmias, but t h a t does not prove that the dysrhythmias are the cause or explain why they are present. The editors of this book have assembled an impressive group of international investigators to provide the reader with a comprehensive review of this emerging technique. It is not possible to comprehend the clinical implications of the recordings without understanding the principles, methods, analytic methods, and language involved in the method. Chapters in the first two sections thoroughly address these issues and orient the uninformed. The last four sections of the book describe the applications of the technique to the study of motion sickness, gastric emptying and motility, nausea, vomiting and gastric dysrhythmias, and similar problems in childhood. The chapters amount to a series of short papers describing stand-alone experi-
VOLUME 42, NO. 4, 1995
merits on the topics mentioned. An ample number of recordings is included so t h a t the reader can become familiar with the patterns of normal and abnormal running spectral analyses. The result is a comprehensive, balanced, and up-to-date overview of the body of knowledge pertaining to EGG by the major workers in the field. What is lacking are critical section summaties t h a t put the information into perspective. The exception is an excellent overview of EGG in childhood. Although it is not the last word on the subject, this book will be of use to anyone who has interest in gastric physiology and clinical problems relating to gastric motor function. After reading the book, one will know how to perform, analyze, and interpret the test, but its ultimate value in managing patients will remain uncertain until a later edition is written.
Robert W. Summers, MD Iowa City, Iowa
Minimally Invasive Surgery of the Foregut edited by J. H. Peters, T. R. DeMeester Quality Medical Publishing, Inc., St. Louis, 334 pp., $115.oo So m a n y recent texts have dealt with the newly emerging field of minimally invasive surgery t h a t it is difficult to distinguish them. Although most offer a background in pathophysiology regarding each malady discussed, few elaborate on the basic science and medical therapeutic aspects of the disease processes. Rather, most concentrate on the surgical aspects of
disease management. The present text, while fimited to the foregut, attempts to present a complete picture of the pathophysiology of each disease process as well as a discussion of medical options for treatment. Further, it outlines newly emerging, minimally invasive, surgical approaches to these disease entities. The text is organized into six sections, the first dealing with the fundamentals of laparoscopic and thoracoscopic procedures, and the others addressing specific disease entities. Each section carefully and thoroughly discusses the basic science relevant to the problem. The sections addressing gastroesophageal reflux and peptic ulcer disease are particularly good. One section, t h a t dealing with endo-organ surgery, hints at future directions of minimally invasive techniques, and prepares the reader to envision what the expanded applications of minimally invasive technology might be. The contributors to this work are internationally recognized experts in the area of minimally invasive surgery and present their material in a clear and very concise fashion. The color illustrations are outstanding and carefully demonstrate the technical details of the operative methods. This book is a fine effort, combining the attributes of a medical text with those of a surgical atlas. It will be a valuable asset to those who plan to perform these procedures and to those who wish merely to understand them.
Jeffrey L. Ponsky, MD Cleveland, Ohio
CORRECTION In the July 1995 issue of the Journal, Table 3, which appeared on page 47 in the article by Barthel et al. entitled "The effect of droperidol on objective markers of patient cooperation and vital signs during esophagogastroduodenoscopy: a randomized, double-blind, placebo-controlled, prospective investigation," was printed incorrectly. The less t h a n sign (<) was replaced by twos (2) in two of the p values. The corrected table is reprinted below.
Table 3. Linear multiple regression model for EGD duration Predictor
Coefficient
p value
CONSTANT 1.684 <.001 AGE* 0.002 .127 BXS 0.067 <.001 IXS. 0.035 .009 SM -0.105 .036 InDUR = 1.684 + .002 (AGE)+ .067 (BXS)+ .035 (IXS) - .105 (SM) BXS, No. of biopsies; 1XS, no. of electronic images; SM, study medication. *As a conservativemeasure, age was left in the model despite its failure to achieve significanceas a predictor.
VOLUME 42, NO. 4, 1995
GASTROINTESTINAL ENDOSCOPY 385
Kingston upon Hull, United Kingdom
something that they wish to add ifa third edition of the book is published. It should be noted that in the Forward the authors mention that a Slide Atlas of Gastroenterology, Second Edition, is available based on these contents. We have not seen this slide atlas, but believe it would be extremely valuable to show the abnormalities to groups that are shown so superbly in the atlas. In conclusion, this is clearly the best atlas ofgastroenterology t h a t has been produced to date. It has absolutely no competition in t h a t area, and it is so complete and detailed it is unlikely t h a t another of equal value will be available anytime in the foreseeable future. This is one of the books t h a t should be in all areas that practice, teach, and study gastroenterology.
Denise Hunninghake, MD Stephen E. Silvis, MD Minneapolis, Minnesota
Atlas o f Clinical G a s t r o e n t e r o l o g y , S e c o n d Edition edited by J.J. Misiewicz, A. Forbes, A.B. Price, P.J. Shorvon, D.R. Triger, G.N.J. Tytgat Mosby Year Book, London, England, 1994, 223 pp., $194.00 Whether you are a beginning or an experienced gastroenterologist, if the question is, What does it look like? this is the atlas to consult. It contains 930 color photographs, 440 black and white photographs primarily of radiographic images, and more t h a n 1000 interpretive line drawings. This material has been gathered from hospitals in London and Amsterdam, as well as m a n y from other institutions, primarily in Europe. Many of the line drawings are critical to the interpretation of the photographic material, and others add to its clarity by leaving the photographic, pathologic, radiographic, endoscopic, or gross surgical specimen unencumbered by labels. One advantage is many of the examples shown are seldom seen in clinical practice. For example, page 4.25 shows a Meckel's diverticulum with an ulcer in it that is seen on x-ray on Meckel's scan, and the gross specimen is shown. For the most part this is strictly an atlas; that is, it shows the pictures to answer the question, What does i t look like? but does not give other information t h a t would require it as a companion to a more standard gastrointestinal text to have complete information. Its uniqueness is its frequent line drawings, its outstanding illustrations, and the magnitude of the illustrations. There are no references included in the text at all. It is somewhat surprising t h a t at least major reference sources are not listed at the chapters, and this may be
384 GASTROINTESTINALENDOSCOPY
Electrogastrography, Principles and Applications edited by J. Z. Chen, R. W. McCallum Raven Press, New York, 1994, 418 pp., $90.00 Electrical signals from the stomach were recorded by Dr. Walter Alverez over the upper abdomen in 1921, but the limitations of visual analysis impeded the development of the field. However, the introduction of computerized frequency analysis in the 1970s provided a means to make sense of the complex gastric electrical signals. It is premature to predict whether electrogastrography (EGG) will survive as a critical diagnostic tool. It is noninvasive, inexpensive, and technically simple to make high-quality recordings and to apply analytic methods to summarize the data. However, it has serious limitations and m a n y questions remain unanswered. For example, persons who complain of nausea often have gastric dysrhythmias, but t h a t does not prove that the dysrhythmias are the cause or explain why they are present. The editors of this book have assembled an impressive group of international investigators to provide the reader with a comprehensive review of this emerging technique. It is not possible to comprehend the clinical implications of the recordings without understanding the principles, methods, analytic methods, and language involved in the method. Chapters in the first two sections thoroughly address these issues and orient the uninformed. The last four sections of the book describe the applications of the technique to the study of motion sickness, gastric emptying and motility, nausea, vomiting and gastric dysrhythmias, and similar problems in childhood. The chapters amount to a series of short papers describing stand-alone experi-
VOLUME 42, NO. 4, 1995
merits on the topics mentioned. An ample number of recordings is included so t h a t the reader can become familiar with the patterns of normal and abnormal running spectral analyses. The result is a comprehensive, balanced, and up-to-date overview of the body of knowledge pertaining to EGG by the major workers in the field. What is lacking are critical section summaties t h a t put the information into perspective. The exception is an excellent overview of EGG in childhood. Although it is not the last word on the subject, this book will be of use to anyone who has interest in gastric physiology and clinical problems relating to gastric motor function. After reading the book, one will know how to perform, analyze, and interpret the test, but its ultimate value in managing patients will remain uncertain until a later edition is written.
Robert W. Summers, MD Iowa City, Iowa
Minimally Invasive Surgery of the Foregut edited by J. H. Peters, T. R. DeMeester Quality Medical Publishing, Inc., St. Louis, 334 pp., $115.oo So m a n y recent texts have dealt with the newly emerging field of minimally invasive surgery t h a t it is difficult to distinguish them. Although most offer a background in pathophysiology regarding each malady discussed, few elaborate on the basic science and medical therapeutic aspects of the disease processes. Rather, most concentrate on the surgical aspects of
disease management. The present text, while fimited to the foregut, attempts to present a complete picture of the pathophysiology of each disease process as well as a discussion of medical options for treatment. Further, it outlines newly emerging, minimally invasive, surgical approaches to these disease entities. The text is organized into six sections, the first dealing with the fundamentals of laparoscopic and thoracoscopic procedures, and the others addressing specific disease entities. Each section carefully and thoroughly discusses the basic science relevant to the problem. The sections addressing gastroesophageal reflux and peptic ulcer disease are particularly good. One section, t h a t dealing with endo-organ surgery, hints at future directions of minimally invasive techniques, and prepares the reader to envision what the expanded applications of minimally invasive technology might be. The contributors to this work are internationally recognized experts in the area of minimally invasive surgery and present their material in a clear and very concise fashion. The color illustrations are outstanding and carefully demonstrate the technical details of the operative methods. This book is a fine effort, combining the attributes of a medical text with those of a surgical atlas. It will be a valuable asset to those who plan to perform these procedures and to those who wish merely to understand them.
Jeffrey L. Ponsky, MD Cleveland, Ohio
CORRECTION In the July 1995 issue of the Journal, Table 3, which appeared on page 47 in the article by Barthel et al. entitled "The effect of droperidol on objective markers of patient cooperation and vital signs during esophagogastroduodenoscopy: a randomized, double-blind, placebo-controlled, prospective investigation," was printed incorrectly. The less t h a n sign (<) was replaced by twos (2) in two of the p values. The corrected table is reprinted below.
Table 3. Linear multiple regression model for EGD duration Predictor
Coefficient
p value
CONSTANT 1.684 <.001 AGE* 0.002 .127 BXS 0.067 <.001 IXS. 0.035 .009 SM -0.105 .036 InDUR = 1.684 + .002 (AGE)+ .067 (BXS)+ .035 (IXS) - .105 (SM) BXS, No. of biopsies; 1XS, no. of electronic images; SM, study medication. *As a conservativemeasure, age was left in the model despite its failure to achieve significanceas a predictor.
VOLUME 42, NO. 4, 1995
GASTROINTESTINAL ENDOSCOPY 385