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Cardiac surgery and the brain. Edited by Peter L. Smith and K. M. Taylor London Edward Arnold 1993 284 pp illustrated. $110

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their patients and families about the risks of cardiac surgery.
Finally, each chapter raises clinically important questions that
are potentially answerable by the researcher interested in
human neuroprotection.
Reviews
Cardiac Surgery and the Brain
Edited by Peter L. Smith and K. M . Taylor
London. Edward Arnold, 1993
284 pp3 illustrated, $1 10.00
Wade S. Smith, M D , PhD
San Francisco, CA
For nearly 40 years extracorporeal circulation has been used
to bypass the human heart during cardiac surgery. As surgical, anesthetic, and perfusion techniques have improved,
mortality has dropped dramatically, raising neurological morbidity to paramount concern. In Cardiac Surgevy and the
Brain, Drs Smith and Taylor edit a comprehensive review
of this complicated literature in a readable, well-organized,
multiauthored book.
The book is divided into three sections. The first section
surveys the clinical impact of cardiac surgery on the brain. It
begins by introducing the technique of cardiopulmonary bypass (CPB) and the various phenomena unique to this intervention, including progressive vasoconstriction, flow-no reflow, and blood cell activation. Five chapters review the
incidence and prognosis of neurological sequelae including
stroke, psychosis, decline in intellect, encephalopathy, and
peripheral nervous system damage. The issue of prophylactic
and concomitant carotid endarterectomy is reviewed in detail. Two chapters provide in-depth review of the numerous
cognitive outcome studies spanning the last 30 years, which
demonstrate a consistent decline in neuropsychiatric test
scores following CPB. An additional chapter addresses the
neuropsychiatric and behavioral development of pediatric patients who receive headheart-lung transplants. The potenrial neurological damage from heart transplantation and toxicity from immunosuppressive agents is reviewed. Finally, the
technique of deep hypothermia with circulatory arrest is discussed and compared with continuous low-flow bypass with
emphasis on potential neurotoxicity of these procedures.
The second section surveys various techniques used to assess cerebral function during cardiac surgery. It begins with
a review of cerebral blood flow and its measurement, a discussion of the controversy around carbon dioxide management strategies, the coupling of cerebral oxygen consumption and blood flow, and the neuroprotective effects of
hypothermia. Data using transcranial Doppler, magnetic resonance imaging, and retinal fluorescein angiography are presented in subsequent chapters, which support the contention
that multiple embolizations to the cerebral vasculature occurs
during CPB.
The last section reviews various neuroprotective strategies
tested in humans undergoing CPB. These include the use
of platelet aggregation inhibitors (prostacyclin and synthetic
analogues), anesthetics (barbiturates and propofol), and the
use of excitatory amino acid antagonists. The book concludes
with a discussion of blood gas Sanagement strategies, arterial
filtration, and type of oxygenator.
This book is potentially useful for a wide range of practitioners including cardiothoracic surgeons and anesthesiologists. Consulting neurologists will find excellent discussions
about the range, incidence, and prognosis of neurological
syndromes unique to patients undergoing cardiac surgery.
Similarly, cardiologists, internists, and pediatricians who refer
patients may find this text informative so as to best educate
Advances i n Neurology, Vol. 64:Neurological
Complications of Pregnancy
Edited by Owin Devinsky, Edward Feldmann,
and Brian Hainline
New York, Raven, 1994
272 p p p illustrated, $90.00
This book is part of the successful series on advances in
neurology published by Raven Press. Like several other
books in this series, the present volume is based on the proceedings of a symposium-this one held in New York in
1992. Unlike many of its companion volumes, however, a
general overview is provided rather than an account of recent advances in a particular field.
The emphasis of this book is on the diagnosis and treatment of neurological disorders in pregnancy. A wide range of
neurological topics is discussed in 17 chapters; the remaining
three chapters are concerned with psychiatric disorders, cocaine and alcohol use, and legal issues. Most chapters consist
of useful and comprehensive reviews of the literature. A few
of the chapters, however, provide a general account of various neurological topics with only passing reference to pregnancy, rather than a more focused account that emphasizes
issues assuming particular importance during pregnancy. Indeed, in a number of instances, a neurological disorder is
discussed in some depth before the reader is informed that
it has rarely, if ever, been reported in association with pregnancy.
Nonetheless, there is little doubt that this book will serve
as a valuable source of information for practitioners responsible for the care of pregnant women with neurological disorders, and it certainly merits a place in all institutional medical
libraries. Individual physicians may hesitate before purchasing this book, however, because of its cost and because it is
relatively uncommon to encounter women with neurological
disorders that pose difficult management problems related
specifically to pregnancy.
Michael J . Aminoff; MD, FRCP
San Francisco, C A
Brain Tumors: A Comprehensive Text
Edited by Robert A. Morantz and John W . Walsh
New York, Marcel Dekker, 1994
864 pp, illustrated, $195.00
This is a well-produced and nicely illustrated volume that
focuses on primary brain tumors with a decidedly surgical
emphasis. However, many chapters, including those dealing
with epidemiology, radiology, radiation therapy, and chemotherapy will interest medical neurooncologists as well as neu-
Copyright 0 1994 by the American Neurological Association
119
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london, arnold, edward, illustrated, smit, brain, 110, 284, 1993, taylor, edited, surgery, peter, cardiaca
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