-

BOOK REVIEW

Ti1le:

Childhood
Tuberculosis:

Modern Imaging
and Clinical

Concepts

Principal authors:
Professor Bryan
Cremin and Dr

Douglas Jamieson

Publisher:
Springer-Verlag,

London, 1995

Pages:
122

This beautifully presented book
containing 141 figures is pleasing to
handle and to read. The headings of
the eight chapters give a very fair
indication of the content of the book.
In an abbreviated form these read:
• Historical and pathological
background
• Biology of the organism and the
host pathogen response
• Pulmonary tuberculosis
• Central nervous system tuberculosis
• Abdominal tuberculosis
• Skeletal tuberculosis
• Clinical spectrum and diagnosis,
and
• Drug treatment and resistance

The book is extremely relevant to
almost all disciplines of medical prac-
tice but is directed at the practising
radiologist. The principal author has a
long-standing interest in the radiology
of tuberculosis in childhood and has
built up a vast "hands on" experience.
This fact is clearly discernible in the
book.

The four chapters which form the
radiological focus of the book are
based on system involvement by the
disease. Each chapter starts with a de-
scriptive outline of the various forms
of radiological investigation of that
particular system. The approach is
practical, with clearcut opinions. Ex-
tremely useful information is given in
the actual performance of certain ex-
aminations, such as the high kilo-volt-
age filtered chest radiographs.

The accompanying pictures are
mostly easy to interpret or are clearly
labelled, and follow the text closely.The
protean radiological manifestations of
primary pulmonary tuberculosis are
emphasised. This is especially evident
in patients with immune deficient
states. The authors stress the impor-
tance of reviewing the full series of
chest radiographs as this often influ-
ences one in considering the likelihood
of the disease being tuberculosis. The
hallmark of the disease is lymphaden-
opathy which occurs in 63-95% of
x-rays, especially in the younger child.
They again emphasise that a normal
chest radiograph does not exclude pul-
monary tuberculosis. The radiological
picture of disseminated pulmonary dis-
ease is usually not that of diffuse equal-
sized small nodules. There is often a lin-
ear component to the opacities, and
confluent opacification.

In the chapter on cerebral tubercu-
losis,the authors emphasize the differ-
ence between the two forms of necro-
sis which occur in tuberculomata: the
gummatous type, and the purely cel-
lular form which includes caseous
necrosis. They describe the Computer
Tomographic and Magnetic Resonance
images of these various granulomata.

20 SA JOURNAL OF RADIOLOGY. February 1998

The authors often refer to the rim
enhancement which occurs in nodes
after intravenous contrast administration.
They also emphasize that tuberculous
osteo-arthritic disease is often an indo-
lent, painless process, and hyperaemic
loss of bone visualization is frequently
an early manifestation. Linear tomog-
raphy may often show lytic bone areas
not appreciated on plain films.

These chapters on systemic tuber-
culosis end with a list of other condi-
tions which could simulate the radio-
logical changes seen in tuberculosis.
Practical tips are given in differentiat-
ing between these conditions. The ap-
proach is realistic and clearly based on
actual experience.

The four remaining chapters are
each written by an expert in that field.
The statistics are awesome. Eight to ten
million new cases and three to five hun-
dred thousand deaths from tuberculo-
sis occur each year. Children are espe-
cially susceptible to disseminated dis-
ease, and the incidence in sub-Saharan
Africa is particularly high.

The pathological change which oc-
curs in the disease is clearly explained,
and the biological and host-pathogen
relationship of Myobacterium tuberculo-
sis is vividly detailed with clear, well il-
lustrated diagrams. It is generally ac-
cepted that the bacillus can remain dor-
mant in a macrophage or in a granuloma
for years or decades. The genetic basis
of resistance and susceptibility to the
bacillus is briefly explained. The possi-
bility of developing a protective vaccine
is discussed.

Professor Kibel gives a brief but
clear outline of the clinical spectrum
and diagnosis of the disease, and Pro-
fessorDonald emphasisesthe indications,

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8001< REVIEW

frompage20

uses, actions and side effects of the
drugs used to treat the condition.

This reviewer read through the
book three times and gained a little
more on each occasion. He enjoyed the
experience and congratulates all the
authors for an important contribution
to the understanding and diagnosis of
a most important condition.
Reviewer:
Prof Hillel Goodman,
Groote Schuur Hospital

Allan Cormack
clinical use of isotopes. He particularly
acknowledged the contributions of Pro-
fessor RW James of the UCT Physics
Department, and Dr Muir Grieve, a
Groote Schuur Hospital Radiothera-
pist, in encouraging him to make his
discovery.

He was awarded the Nobel Prize
for Physiology and Medicine together
with Sir Godfrey Hounsfield in 1979.
He is only one of three South Africans
to have won a scientific Nobel Prize
(with Max Theiler and Aaron Klug).

He later worked at Cambridge,
Harvard and subsequently Tufts Uni-
versity, where he became Chairman of
the Department of Physics.

The first CT scanner was placed
into clinical service in London in 1971,
and his insight has since gone on to
revolutionise our profession.

He died on 9 May this year at his
home in Winchester, Massachusetts at
the age of 74.

Acknowledgements
UCT Monday Paper, May 18-25, 1998, Vol. 17: No
13; Obituary, Emeritus Professor of Physics, Robin
Cherry, Sunday Times

Allan Cormack shares the distinction
of having founded the mathematical
principles of the image reconstruction
techniques used in Computerised
Tomography and Magnetic Resonance,
together with Sir Godfrey Hounsfield.
He also had close ties to the University
of Cape Town Physics and Radiology
Departments, where he made his
important mathematical deductions in
1957.

Born in Johannesburg, he matricu-
lated at Rondebosch Boys High, and
received his MSc in Physics at UCT in
1945.

His original work on resolving the
problems of axial imaging was based
on a phantom made of an aluminium
cylinder surrounded by a wooden cyl-
inder, together with the use of radio-
isotopes to confirm his mathematical
suspicions. He published these findings
in 1963 and 1964, establishing the core
logic of axial tomography, which
Hounsfield took to commercial com-
pletion. At the time of his momentous
discovery he was working in the Ra-
diology Department supervising the

Title:

Clinics in
Diagnostic

Imaging
Author:

Wilfred Peh
Publisher:

Miller Freeman
Price:

USO 15

Pages:
255

ISBN 981 04 01337

This book consists of 30 case
presentations with radiological images
and a discussion with each case. The
cases cover all important areas of
imaging from head and neck to
gynaecology. The images are of good
quality. The discussions are excellent
with current references. This book will
be very useful for registrars preparing
for the final fellowship examination.

The University of Pretoria is planning a Congress for
10-12 February 2000.

Topic: "Chest Radiology- Adult and Paediatric" Congress Chairman: Prof SF Prinsloo
Venue: CSIR, Pretoria Tel: (012) 354-2406
Please make a note of this in your diary if you are Fax: (012) 329-6763
interested Department of Radiology,Faculty of
Further details will he forthcoming Medicine, University of Pretoria,
Congress Co-ordinator: Dr LL Sirkin PO Box 667,Pretoria,OOOl

Advance
notification of
Chest Radiology
Congress

22 SA JOURNAL OF RADIOLOGY· February 1998