THE USE OF BARIUM IN THE DIAGNOSIS OF ACUTE A P P E N D I C E A L DISEASE 415

o f the c e c u m or t he a s c e n d i n g co lon . I n these cases , t he t ip o f t h e c e c u m s h o w s a n i n d e n t a t i o n p r o d u c e d b y t he r e t r o c a e c a l p o s i t i o n o f t he a p p e n d i x .

The c h a n g e s o n the c e c u m are c o n s t a n t a n d r e p r o d u c i b l e o n r e p e a t e x a m i n a t i o n . T h e b a r i u m e n e m a e x a m i n a t i o n is p a r t i c u l a r l y he l p f u l in o b e s e pa t i en t s w h e r e t h e phys i ca l e x a m i n a t i o n is dif f icul t t o eva lua te .

T h e p o s t - a p p e n d e c t o m y d e f o r m i t y o f t he c e c u m

s h o u l d b e d i f f e r en t i a t ed b y the c l in ica l h i s t o r y a n d t he l a ck o r e d e m a o r d o u b l e p r e s s u r e effect.

REFERENCES BARNES, B. A., BEHRINGER, G. E., WHEELOCK, F. C. &

WILKINS, E. W. (1962). J. Am. reed., Ass., 180, 122. BOCKUS, H. L. (1964). Gastroenterology. Vol II, 2nd Ed.

Philadelphia: Saunders. CLEMENTS, N., OLSON, J. E. & POWERS, J. t t . (1965). Ann.

Surg., 161,231. COLLINS, D. C. (1965). Surgery Gynec. Obstet., 101, 437. SOTEROPOULOS, C. & GILMORE, J. (1958). Radiology, 71,246.

B O O K R E V I E W S

Myelography. By R. SHAPIRO. Second edition. Chicago: Year Book Medical Publishers. 1968. 224s.

The fact that the second edition of tbis work has appeared a relatively short time after the first is adequate testimony to its popularity, a popularity which is fully justified by the excellence of the book.

The format is fairly standard. There are chapters dealing with the history of myel0graphy, contrast media, indications, technique and radiation dosage. These are followed by a short chapter on plain X-ray examination of the spine, an excellent chapter on anatomy, and sections on the normal myelogram and possible artefacts.

The major part of the book is devoted to the abnormal myelogram. The various conditions are dealt with most comprehensively and with few apparent errors or omissions. Myelographic examination of the posterior fossa is included. The book ends with sections on complications and limita- tions, and there are chapters on intraosseous venography and discography. Recent advances since the first edition are discussed including scintillation scanning.

The book is beautifully produced, with clear, concise text and excellent illustrations. There may be different views particularly as regards technique and contrast media, but the author gives his own opinions convincingly.

The price may be beyond the means of many, but for value received it is certainly not overpriced. I think that it is probably the best book on the subject in the English language.

LEON MORRIS

Lung Calcifications in X-ray Diagnosis. By EMANUAL SALZMAN. Pp. 123 with 70 illustrations. Charles C. Thomas. Springfield, Illinois: t968. $7.50.

This book presents a most interesting and complete description of lung calcification which extends beyond its title to include calcifications and ossifications in lung, mediastinum and pleura. A very comprehensive collection of illustrative lesions is shown in a well classified manner and includes several unusual and rare examples. A wide variety of lnng calcifications include the granulomata, the pneumo- conioces and parasitic diseases. Good illustrations of many rare lesions are shown and interesting observations are made on the importance of calcification in the identification of lung tumours.

This book is up to date, with a very good example of the characteristic development of calcifying nodules in "chicken- pox" pneumonia. Calcifications in the main bronchi are well demonstrated and are shown to be a normal physiological

appearance in the elderly female. The observation that this is almost exclusively confined to the female sex has interested the reviewer for many years but no explanation for this is given.

Illustrations are very variable in quality. Most are satis- factory but many are reproduced by the LogEtron method where 'dodging' has been pushed sufficiently to distort normal contrasts and the illustration becomes quite unlike an original radiograph. The blocks are of good standard but the press-work shows some loss of definition in many illustrations, due to 'squish'.

This book is a most useful addition to the literature concerning diagnostic radiology of the chest.

G. B. LOCKE.

Principles of X-Ray Diagnosis. By DAVID H. TRAPNELL, M.A., M.D., M.R.C.P., F.F.R., D.M.R.D. Pp. 300, with illustrations. London: Butterworth & Co. (Pub- lishers) Ltd. 1967. £6 10s.

Radiological trainees frequently have difficulty in adapting themselves to the change-over from the clinical to the radiological examination of the patient.

Few text-books have attempted to deal with the funda- mental problems of radiodiagnosis and it is pleasing that an attempt has been made to rectify this position. It does not pretend to give a full account of all radiological conditions. The author gives an account of his own method of examina- tion of radiographs, stressing the importance of a systematic approach before it is possible to arrive at a diagnosis.

There are two excellent chapters on the production of X-rays and radiographs, and thereafter each anatomical system is discussed.

The book has the advantages and disadvantages of having been written by a single author. It is very easy to read, is lavishly illustrated and most of the illustrations are of a high quality. There is much that is of value in this work but unfortunately there are a number of minor errors in the text. For example, not many authorities would agree that 1 0 ~ of chronic benign gastric ulcers become malignant. In the section on the central nervous system there is a confused and muddled description of the value of arteriography in the investigation of cysts and tumours. Later in this section it is stated that cholesteatomata characteristically have ragged edges.

Despite these minor criticisms, there is much to be com- mended in this book and it will form a valuable introduction to the study of Radiology.

K. T. EVANS