Br. J. Surg. Vol. 67 (1980) 73-76

Book reviews Techniques of Vagotomy A. G . Johnson and K. W . Reynolds. 210 x 150 mm. Pp. 8 5 i viii. Illustrated. 1979. London: Edward Arnold. f5.95. VAGOTOMY in various forms is very widely used today, and the sophisticated form-proximal gastric vagotomy-is now widely advocated. A clear description is welcome. In this little ring-bound booklet the three main var,iants of vagotomy are illustrated by an excellent series of drawings with the minimum of linking text, highlighting problems and difficulties.

Brevity is admirable, but in a work of this type that should be kept in the operating theatre, it is a pity that the intraoperative tests of completeness of vagotomy introduced by Burge and Grassi are not described fully though references are given; incidentally, these are the only references in the whole text. Indications, results and complications are not discussed. It is a pity perhaps that lesser curve necrosis and the value of reperitonealization of the lesser curve are not mentioned. The authors’ own work on ensuring completeness of parietal cell denervation receives no mention and there is no mention of the use or non-use of nasogastric tubes or of the important point that proper clearance of the vagi from the oesophagus cannot be achieved with a tube in situ.

The inexperienced surgeon, to whom the book is directed, may find difficulty in interpreting ‘the dissection commences at the highest branch of the Crow’s foot on the gastric wall immediately adjacent to the lesser curve’. Fortunately the illustration is somewhat clearer.

Notwithstanding these criticisms, this booklet will be wel- comed by surgical trainees, will fit into the pocket of a white coat and will be easier to study in the operating theatre than other standard descriptions of proximal gastric vagotomy. The booklet is so clear that it could well become a standard text for operating theatre nursing staff. TERENCE KENNEDY

Operative Surgery General Editors Charles Rob and Rodney Smith. Third edition. Orthopaedicc Parts I and 11 Edited G . Bentley. 283 x 223 mm. Pp. Part I 440; Part I1 963. Illustrated. 1979. Sevenoaks: Butterworths. f90.00 the set. PROFESSOR BENTLEY undertook a difficult task when he became editor of the third edition of this now well-known two-part volume on operative orthopaedics and fractures. He can be proud of the result.

In spite of no less than 62 contributors and 127 cha ters, there is a brave attempt at uniformity of style; stanfards, however, vary. The majority of the material is very good with some sections that are quite excellent. Others I found disap- pointing. Illustrations generally were good but again rather variable. With so little text, a textbook of operative surgery of this type must depend very largely upon the excellepce of its illustrations. For example, the reader, anxious to kndw how to fix a posterior graft between the atlas and axis, will find the pictures on p. 236 less clear than those on p. 361, where a similar rocedure is described. However, in this same section, my eyegrows were raised by illustrations depicting four burr holes in the m i p u t through which it was suggested wires might be passed in order to stabilize an mipitocervical fusion! Even before the days of halo fixation, can such a procedure ever have been justified?

Any reviewer is bound to find such minor faults. He may itch to tell the reader that he knows best; for example, that the posterior ap roach to fore uarter amputation is infinitely easier than tEe anterior w h i a is advocated. These, however, are only minor irritants to the reviewer. Professor Bentley and his team have done a magnificent job in updating the last volume. They have produced a thoroughly helpful guide to orthopaedic operations, every bit in keeping with the high standard of the series as a whole.

RODNEY S W E T N A M

Developments in Clinical Nutrition Edited I . D. A. Johnson and H . A . Lee. 240 x I70 mm. Pp. 116. Illustrated. 1979. Tunbridge Wells: MCS Consultants. f3.50. THE advent of fine bore nasogastric feeding tubes has enabled a major advance to be made in the field of nutritional support. Many ill patients who were formerly fed intravenously, or not at all, can now be fed entirely by the enteral route just as effectively and more safely.

Professors Johnston and Lee have brought together in this little book a fine series of papers on this subject. The result of their skilful planning and editing is a simple and practical text describing nearly every aspect of this new and important treatment. Here the surgeon will find not only straightforward accounts of the physiology of carbohydrate, mineral and amino acid absorption but also practical instructions on the insertion of the tube, administration of the diet and how to monitor the effects of treatment. There are also basic chapters on nutrition and metabolism and up to date information on nutritional assessment.

This is the sort of book I would give to my colleagues who are looking for a quick and painless way to be brought up to date in the confusing field of clinical nutrition. In my view it is one of the best books yet produced on practical aspects of nutritional therapy.

G. L. HILL

Medical Imaging: a Basic Course L. Kreel with 24 contributors. 280 x 210 mm. Pp. 256 + viii. Illustrated. 1979. Aylesbury: H M i M Publishers. E18.00. NON-INVASIVE investigation is a growth area of the late 70s. We all want to avoid ‘exploratory laparotomy’, ‘blind gastrectomy’ and the irresistible urge to push cannulas into every available orifice and hollow tube. The ingenuity and inventiveness of those who have researched and developed computer axial tomography, ultrasonography and scintiscanning or who are working on nuclear magnetic resonance have two effects: they keep the field exciting and unsettled, and make it very difficult for the clinician to work out the place of these investigations in his practice. Part of his difficulty lies in his lack of understand- ing of the fundamentals upon which non-invasive techniques are based. I think that it is towards this gap in knowledge that the book is aimed. Its primary appeal must inevitably be to those in the field because it is written by their fellow experts. However, it is a useful reference text for anyone seeking a grounding in a new and sometimes puzzling subject. 1 would not say it is an elementary primer-far from it: however, for those who are prepared to read hard and think carefully, the pages of this book will inform. CAT predominates, but a fair coverage is given to other fields.

I do not like the groupings of illustrations at the end of each chapter. Nevertheless, Dr Kreel, an acknowledged authority in the field and the clinical originator of CAT, has created a notable volume to which all who are interested should refer.

H. A. F. DUDLEY

Ulcerative Colitis M. J. Goodman and M . Sparberg. 260 x 185 mm. Pp. 205 i xiii. Illustrated. 1979. Chichester: Wiley. €13.50. IF the UK economy were to grow as rapidly as the prevalence of inflammatory bowel disease has done recently our monetary problems would be a thing ofthe past. For as Professor Joseph Kirsner comments in the Forewhrd to this volume in the ‘Clinical Gastroenterology Monograph’ series, both ulcera- tive colitis and Crohn’s disease are far more common today than in years past. In the United States alone, over half a million people are said to have inflammatory bowel disease.