BOOK REVIEWS

Fundamental Techniques in Plastic Surgery. By IAN A. McGREGOR. T h i r d edi t ion .

Pp . 292. ( E d i n b u r g h a n d L o n d o n : E. & S. L iv ings tone . 1965.) 35s.

The third edition of Mr McGregor 's well" known book follows the pattern of the previous editions but has been enhanced in teaching value by various notes and comments, particularly upon the hmmatoma as one disastrous hazard.

The inclusion of perineal surgery is indeed fundamental and his observations are most valuable. It is perhaps the inclusion of Nor th American techniques for treating facial fractures which

calls for comment. We recall that the omission of reference to maxiUo-facial work engendered criticism by us as a defect of the first edition. This was remedied in the second by introducing the favoured British technique. The new edition presents this work more adequately and clearly and it will be the more universally valuable in being inter-continental rather than merely insular in appeal and application. A sound knowledge of alternative methods is always valuable : however much a favourite technique may be preferred by the individual there is only disadvantage in bigotry.

Mr McGregor is to be congratulated upon this breadth of outlook and his industry in producing this edition. We recommend it to all surgeons who have occasion to treat injuries or deformities resulting from ablative surgery. It can hardly be possible to obtain a more concise and reasonably .comprehensive introduction to plastic surgery at the remarkable price, in present times, of 35s. net, postage IS. 4 d.

G. H. M.

Histoeompatibility Testing. R e p o r t o f a C o n f e r e n c e a n d W o r k s h o p s p o n s o r e d b y t he

D iv i s ion o f M e d i c a l Sciences , N a t i o n a l A c a d e m y of Sciences , N a t i o n a l Resea rch

Counc i l , 7 t h to i 2 t h J u n e 1964. Pub l i c a t i on 1229. Pp . 192. ( W a s h i n g t o n , D .C . : N a t i o n a l A c a d e m y o f S c i e n c e s - - N a t i o n a l R e s e a r c h Counc i l . 1965. ) $6.oo.

The problems of surgical technique and patient management in tissue homotransplantation ~have been largely solved. The barrier of the immune response, which is responsible for graft rejection, has yielded little in recent years. While new methods ofimmuno-suppression are developed, the effectiveness of existing methods would be greatly increased, if a donor, minimaUy hlsto- incompatible with the recipient, could be selected.

In the report of the Conference and Workshop held in Washington in June 1964, several approaches to the question of donor selection are presented and discussed by many of the leading workers in this field. Part I of the report contains six papers on leucocyte typing, mostly using antisera from multipara, or from patients who have had multiple blood transfusions. Agglutination, absorption of antisera, complement fixation, and leucocyte-cytotoxicity were all used to classify leucocytes. Special mention should perhaps be made of the paper by Van Rood and Van Leeuwen, :for its scope and basic information, while Terasaki et al. presented an elegant micro-assay of cytotoxicity. Papers on the Normal Lymphocyte Transfer test and the Mixed Leucocyte Reaction are also included. Running through most of the papers is a note of dispassionate appraisal, and it is clear that the techniques used demand a critical attention to detail, if quantitation and reproducibility are to be achieved. Difficulties in obtaining a reliable and practical method of donor selection have been highlighted by Hamburger et al. (Lancet, 1965, i , 985) and Nelson et al. (Lancet, 1965, I, I359), who report lack of correlation between results of N.L.T. tests and leucocyte agglutination tests. There have also been instances where graft survival t ime has differed from that expected on the basis of histocompatibility testing.

The value of the tests ultimately depends on the degree to which leucocyte antigens represent transplantation antigens. There is general agreement that erythrocyte antigens play at most a minor ;role in transplantation. Histocompatibility testing in its present forms appears to be suited more to eliminating thoroughly incompatible donors than selecting ideal ones.

Part I I is a report of a Workshop held in Duke University Medical Center. In this section, the techniques employed in the various histocompatibility tests are given in painstaking detail and very comprehensively, except where centrifugal force is occasionally indicated by r.p.m, only, instead .of " g."

The book itself is weU produced. The points on the graph on page 63 are all of one type instead Lof two as in the caption. In the figures on pages 87 and 9o, a greater contrast in shading would have been less exacting on the eye.

This conference report makes stimulating reading, and the co-operation that it represents between groups engaged in tissue typing augurs well for improvements in methods of donor selection. The workshop section must at least minimise the errors and frustrations of anyone .embarking on histocompatibility testing.

B . N .

447