Cerebral blood-flow.

CEREBRAL BLOOD FLOW Edited by M. Brock, C. Fieschi, D. H. Ingvar, N. A. Lassen, and K. Schurmann. (Pp. xx + 291; 113 figures; DM 58). Springer: Berlin. 1970. Measurement of the cerebral blood flow using isotope techniques is a field in which European centres have held the lead since their introduction by Lassen and Ingvar and by Harper exactly 10 years ago. Conferences at which the initiated argue out methodological controversies have been held with increasing frequency in recent years and are attended by steadily increasing numbers of participants. It must be admitted that the clinical yield from all this activity has remained somewhat meagre and the techniques are still confined to the relatively few clinics which have built up the necessary teams to carry out these studies. However, at the Mainz symposium in April 1969, of which this is the report, a real attempt was made to emphasize the clinical application and 60 of the 100 papers in this volume are based on data obtained from man. The papers are grouped into seven chapters at the end of each of which there is a useful summary and comment by the chairman of that section of the meeting; and at the end Dr. Seymour Kety and Dr. Niels Lassen each present a rather longer comment, on methodology and on clinical application respectively. The chapters include ones on cerebrovascular disease, on carotid surgery, on tumours and intracranial pressure, on trauma, coma and dementia and on anaesthesia and hyperventilation therapy. The book is well produced, just the right amount of illustration, and not too many references. Many of the papers are very short, presenting summarized data and conclusions without the tedium of methods or reviews of the literature. Although the conference was primarily for an exchange of information between experts, the book provides a good introduction to the field, directing the newcomer's attention to the many possible fields of application of these techniques. If clinical management is not yet greatly influenced by the cerebral blood flow findings, it seems likely from the information presented here that that situation will not obtain for long. It is clear that brain damage of many kinds causes focal circulatory changes, both in flow at rest and in the reactivity of the blood vessels to changing circumstances-such as intracranial pressure, PaO2, PaCo2, blood pressure, and the like. Knowledge of the state of the cerebral circulation in various clinical situations may well lead the clinician to seek for means of improving situations about which hitherto he has only had retrospective information from the pathologist.