796

Diagram of the jejunal-biopsy tube and additional outer tubingwith terminal perforations.

tubing. The terminal centimetre of the outer tube has a

number of holes 1 mm. in diameter. This perforated end isslipped over the capsule tubing until it rests against the base ofthe capsule. 5 cm. from the proximal end the inner capsuletubing is threaded out through a small hole in the wall of thepolyvinyl tube. This enables water or dye to be injected downthe main tube and out at the base of the capsule. The capsulehead is not dislodged nor is the capsule prematurely fired.The child needs only light sedation. The stiffer outer tubing

allows the capsule to be passed into the stomach with theminimum of difficulty and without coiling of the tube in thestomach during insertion. If fluoroscopy is available the tubeand capsule can often be eased through the pylorus and theninto the jejunum.

If fluoroscopy is not available a measured length of tubingcan be passed into the stomach with the child held on theright side. Fluids may be given through the outer tube andaspiration of bile from this tube will immediately establishwhether the capsule has passed into the duodenum. A further

length of tubing can then be advanced to push the capsuleinto the jejunum. Before the child is X-rayed, 10 ml. of radio-opaque dye are injected down the outer tubing to show theexact position of the capsule in relation to the duodenojejunalflexure and jejunum. This is important, for where a child hasa high duodenojejunal flexure there may be difficulty indistinguishing a loop of tubing, even if radio-opaque, in thestomach from a correctly sited tube in the jejunum. The exactposition of the capsule is also significant if the biopsy specimenis used for disaccharidase assay, because the level of enzymeactivity depends on the site from which the specimen is taken."With this technique the time required has been reduced in

many cases to 30 minutes from the time of inserting the tube tocorrect positioning of the capsule in the jejunum. In only onemalnourished 6-month-old child was any difficulty encoun-tered with this modified tube.’ The child had a pronouncedflexion of the duodenum, but by pushing the inner tube throughthe outer polyvinyl tube the capsule was advanced, withinminutes, to the correct position.Over forty biopsy specimens have been taken successfully

with this technique and there have been no ill-effects.

W. P. T. JAMESM.B., B.SC. Lond., M.R.C.P.

Medical Research CouncilTropical Metabolism Research Unit,

University of the West Indies,Mona, Kingston 7, Jamaica

31. Newcomber, A. D., McGill, D. B. Gastroenterology, 1966, 51, 481.

Reviews of Books

An Immunological Approach to CancerH. N. GREEN, M.A., M.sc., M.D., professor of experimentalpathology and cancer research, University of Leeds, and directorof cancer research, University of Sheffield; HONOR M. ANTHONY,M.B., lecturer, department of experimental pathology and cancerresearch, University of Leeds; R. W. BALDWIN, B.sc., PH.D.,M.C.PATH., director, British Empire Cancer Campaign labora-tories, University of Nottingham; J. W. WESTROP, B.sc., researchworker, cancer research unit, University of Sheffield. London:Butterworth. 1967. Pp. 321. 95s.

As more information on the carcinogenic process comes tolight, there is an increasing (and understandable) tendency forresearch workers to avoid formulating hypotheses to

" explain "the various aspects of neoplasia. The late Prof. H. N. Greendid not subscribe to this view, and in 1954 he published a far-reaching paper, entitled An Immunological Concept of Cancer, 1which provoked much interest and discussion. Numerousadvances have been made since that time, and this reappraisalof Green’s original theory will be widely welcomed. It will alsocause argument, for many aspects of the original hypothesisremain controversial. This book provides a valuable source ofreference to the work of Green and his school and, polemicsaside, contains much material of absorbing interest.

A Primer of High Blood PressureERIK AsK-UPMARK. Stockholm: Svenska Bokforlaget. 1967.

Pp. 129. Sw. kr. 27.75.

Dr. Ask-Upmark has had a lifelong interest in high blood-pressure. In this well-produced book he reviews, succinctlybut comprehensively, the definition, aetiology, pathology,clinical features, prognosis, and treatment of hypertension. Hehas not allowed his publishers to correct his sometimes unidio-matic English, but his style is nevertheless direct and easy toread. There are a few minor errors, and a few rather question-able opinions. For example, blood-transfusion is recommendedas preoperative preparation in cases of pha:ochromocytoma,with the additional option of adrenergic &bgr;-receptor blockade,but the author makes no mention of ot-receptor blockadewhich is now the cornerstone of preoperative preparation.Many would consider that he is unduly hard on methyldopa.However, many of his " clinical impressions " are sound, andthe book is full of common-sense clinical experience. A medical

1. Br. med. J. 1954, ii, 1374.

student or a young graduate should find this book a usefulintroduction to a complex subject.

The Plastic Surgery AtlasProf. Mudr. FRANTISEK BuRiAN. London: Butterworth.Prague: Czechoslovak Medical Press. 1967. Pp. 933. E21 perset of three vols.

Professor Burian died in October, 1965, a few days aftercompleting that part of his manuscript which authors para-doxically leave to the last-the introduction. This atlas is arecord of a professional career spanning more than half acentury. It is truly an atlas: the text has been limited toshort introductions to each section and sufficient captionmaterial to explain the figures. Virtually every facet of plasticsurgery has been illustrated by a representative case. Two-colour line drawings are interspersed among black-and-whitephotographs, which vary considerably in quality. The line

drawings, however, have a beautiful simplicity and clarityof line, and adequately explain each procedure. The overallproduction is excellent. This volume is an achievement, butit should not be regarded as an up-to-date textbook; plasticsurgery is continually changing, and illustrative material fromthe files of fifty years are often dated to the modern eye. Thetime has passed when any one man from his own experiencecan write a book which will provide an authoritative surveyof the whole of plastic surgery. Burian’s atlas is thus neithera beginner’s guide nor the expert’s reference; but, to the readerwith sufficient background, there is much that is fascinatingin the various methods which have been tried in the past andmuch to be learned about the development of modem tech-niques. Above all, the atlas is an autobiographical testamentto the life work of a great pioneer.

New Editions

Textbook of Endocrinology.-4th ed. Edited by Robert H. Williams.London, Philadelphia, Toronto: W. B. Saunders. 1968. Pp. 1258.£10 4so24.

The Electrical Activity of the Nervous System: A Textbook forStudents.-3rd ed. By Mary A. B. Brazier. London : Pitman Medical.1968. Pp. 317. 45s.

Medical Treatment: A Textbook of Therapy in Four Volumes.-3rd ed. Vol. I: Cardiovascular and Respiratory Diseases (includmgTuberculosis). London : J. & A. Churchill. 1968. Pp. 280. 40s.

Current Therapy 1968: Latest Approved Methods of Treatment forthe Practicing Physician. Edited by Howard F. Conn. London,Philadelphia, Toronto: W. B. Saunders. 1968. Pp. 898. E5 19s.;$14.