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Brain and Mind. (Psychology in Progress Series.)

under a number of general topic headings. In the introduction, Professor John Marshall refers to the essential need for real discussion and inter-change of ideas between participants which limits the number of those attending the conference and yet there is no discussion of papers in the published proceedings. There are references at the end of each paper, there is a good author index and a list of contributors. The topic headings include: The Value of Technical Medicine for Diagnosis and Treatment of Cerebro-Vascular Disease, Neuro-Imaging Techniques, Haemorheology, Stroke in the Young; and a rather odd collection of bedfellows consisting of Cerebral Infarction, Cerebral Venous Thrombosis, and The Psychiatric Aspect of Cerebral Vascular Disease, all in one section. There is a final section of special contributions largely consisting of surgical and pharmacological innovation, attempting to improve perfusion in the ischaemic brain. Particular attention was given to calcium channel blockers, and phosphodiesterase inhibitors, which may prove to have a clinical application in due course. In the introductory session, it seems that xenon scanning techniques were the most cost-effective way of mapping local CBF values. The suggested application of CT/Xe imaging to brain death certification seems quite superfluous in view of the well established clinical criteria in use in the United Kingdom. PET is clearly likely to be the most revealing but applicable in only very few centres. The improvement of RCBF but no change of RCMR02 following ECIC bypass is in accordance with a recently published multicentre trial which for practical purposes removes the indications for that operation. In view of the recent controversy over the causation of classical migraine it is interesting that there is some PET data to support the vascular rather than the metabolic theory. Blood rheology was reviewed by David Thomas. He suggested, amongst other things, that an HCT in the lower forties is perhaps ideal but sees the need for randomised trials to try and answer the difficult questions on management. A comparison of intravenous and intraarterial DSA is made by a Dutch group who find the intravenous technique has considerable potential and have not relegated it to second place, as seems to be the trend in the UK. They do, however, imply that in the current state of the art, the services of a resident engineer are required! There are some general and specific papers of interest including one by Michael Harrison and colleagues, underlying the difficulty of drawing conclusions from laboratory work on platelet aggregation. A paper from London, Ontario, discussed the value of cardiac monitoring and echocardiography in TIA and stroke patients. In common with many other people it was found that the more frequently such patients are investigated, the more frequently cardiac abnormalities are identified as being possibly responsible for the cerebral lesion. More work needs to be done in this area before one could confidently predict that it would be a value for-money-exercise, referring large numbers of patients to already heavily over-subscribed cardiac departments for 48-72 hour cardiac monitoring and 2D echo examination. A paper from Ljungkvist and others from Malmo and Lund, pointed out the value of the relatively cheap continuous wave Doppler system for non-invasive investigation of the carotid bifurcation. They found measurement of spectral width to be the most reliable estimator of stenosis, greater than 35%. A comparison from Oslo of intravenous DSA and pulse Doppler found the Doppler to be superior and many other authors have subsequently published similar data, particularly in terms of cost effectiveness. In general, this is a book for those involved in active research in the field. Its lack of a detailed index makes it a difficult book to use, although the contents give a useful indication of the subject matter.