Pediatric Orthopedics

Pediatric Orthopedics

$} I S Hydrocephalus (Concepts in Neurosurgery, Vol 3), edited by R. Michael Scott, 128 pp, with illus, $45, Baltimore, Williams & Wilkins, 1990 Th...

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Hydrocephalus (Concepts in Neurosurgery, Vol 3), edited by R. Michael Scott, 128 pp, with illus, $45, Baltimore, Williams & Wilkins, 1990 This text is the third volume in a series entitled Concepts in Neurosurgery produced by the Congress of Neurologic Surgeons. Numerous authors from various institutions have contributed information about the history, physiologic factors, radiologic investigation, and treatment of hydrocephalus. In addition, chapters on the management of hydrocephalus in the preterm infant, slit ventricle syndrome, shunt infections, hydrocephalus detected in utero, and normalpressure hydrocephalus are included. Obviously, the authors have considerable experience in their assigned topics, and the bibliographies at the end of each chapter are extensive. This up-to-date text has state-of-theart discussions of various subjects. The numerous photographs are of high quality, and the abundant magnetic resonance imaging scan reproductions are thoroughly explained and discussed in the text. Well-written chapters present factual information, and in cases in which questions or differing opinions occur, the alternative viewpoints are reasonably stated. The limitations of various treatment alternatives such as pharmacologic aids in the management ofhydrocephalus, serial lumbar punctures, serial ventricular punctures, and head wrapping are discussed. In addition, monitoring of intracranial pressure and radionuclide testing of shunt patency are reviewed. One of the most valuable contributions is the chapter that addresses how to prevent and treat shunt complications. Certainly, all neurosurgeons involved in the management of hydrocephalus soon realize that many problems can and do develop, even when meticulous care is exercised. Many complications mentioned in this chapter cannot be prevented; nevertheless, an understanding ofthe difficulty enables one to recognize quickly what the problem is. This Mayo Clin Proc 65:1515-1522, 1990

information will be especially valuable to inexperienced neurosurgeons who have not encountered these conditions in their patients. Occasionally, oxacillin sodium and cephalosporins are listed as effective antibiotics for prophylaxis; however, recently, vancomycin hydrochloride has been used for Staphylococcus epidermidis infections. Interestingly, the references in the chapter on shunt infections indicate the inefficacy of intraventricularly administered vancomycin, and frequently, the cited references do not confirm which antibiotic, if any, should be used, the duration of use, or even which route should be used for administration. These controversies and unresolved dilemmas frustrate even experienced neurosurgeons who are responsible for the management of hydrocephalus. Overall, this text is well done. I strongly recommend it for trainees and even for experienced neurosurgeons who need to review the management of hydrocephalus. Michael J. Ebersold, M.D. Department of Neurologic Surgery

Pediatric Orthopedics, 2nd ed (in 4 vols), by Mihran O. Tachdjian, 3,373 pp, with illus, $375, Philadelphia, W. B. Saunders Company, 1990 The 1972 edition of this book has been the most definitive pediatric orthopedic text available for almost 20 years. Therefore, the new edition is considerably overdue. This edition has been expanded from two to four volumes, but the basic format has been maintained. A detailed and highlighted table of contents facilitates rapid perusal, and the volume divisions are logically sequenced. Tables, graphs, and illustrations provide an abundance of current information with the same clarity as the initial edition. The diagrams and illustrations of operative procedures are of high quality. The exhaustive



reference lists cite sources published through 1986. Volume I details the examination of a child, and I highly recommend reading this material. Frequently, the child's normal development-in terms of both growth and function-is poorly understood, but in this text it is well illustrated and clearly discussed. Management of congenital deformities of the upper and lower extremities is thoroughly reviewed. Nonetheless, definitive texts of specific problems (for example, congenital hand, hip, or foot defects) should be consulted for more detailed descriptions, particularly when rare deformities are present. Volume II discusses the responses of bones to disease; however, the text does not provide an exhaustive list or a discussion of all congenital defects associated with bones and joints. The common anomalies are discussed, but definitive articles need to be read for information on rare lesions. Volume III covers neuromuscular diseases, physical diagnosis, and standard treatment modalities. The author notes that a detailed description of electromyographic techniques of gait analysis is beyond the scope of this text. In addition, current studies on managementofthe child with spasticity, in whom combined preoperative and postoperative gait analysis and selective posterior rhizotomy are performed, are not discussed. The section on management of spinal deformities has been considerably expanded. Because of the rapidly evolving diagnostic and treatment techniques in this area, not all are included. Basic principles and standard procedures, however, are discussed. Currently, techniques such as Dwyer instrumentation are rarely used for anterior reduction of deformities in children. Volume IV provides a thorough description of pathologic conditions of the extremities. The author's vast experience and special interest are apparent; however, he deals with the treatment of physeal injuries in a somewhat cursory manner. Little mention is made ofthe various types of lesions; their size, location, and potential for developing deformity; or the timing and types of

Mayo Cltn Proc, November 1990, Vol 65

procedures-that is, combined osteotomies, bone lengthening, and epiphysiodesis in association with physeal bar resection. Specifically, the techniques used for various types of bars are not discussed; therefore, the reader should refer to specific published articles when this problem is encountered. This four-volume edition is the result of a herculean effort by the author and is the current "classic" text for pediatric orthopedics. I commend the author and recommend the text to all orthopedists responsible for managing pediatric problems. Rudolph A. Klassen, M.D. Department of Orthopedics

Pediatric Textbook of Fluids and Electrolytes, edited by Iekuni Ichikawa, 520 pp, with illus, $69.95, Baltimore, Williams & Wilkins, 1990 Dr. Ichikawa and his contributors set some lofty goals in the preface: (1) create a textbook for both house officers and practicing pediatricians, (2) produce a reference source for the pathophysiologic basis of fluid and electrolyte disorders, and (3) compile a source of "comprehensive" approaches to treating these disorders. An additional goal is to provide pediatricians with the information needed to choose the optimal therapy for their patients. The editor and contributors succeeded remarkably well in achieving one of these goals but may have missed the others. Dr. Ichikawa notes that the book has become large. This is due in part to some overlap between and even within the sections. More importantly, however, the lengthiness is a result of the space devoted to explaining the physiologic, developmental, and pathophysiologic mechanisms involved within the subject matter ofthe chapters. This information is current, well referenced, and readable. Overlap was often appropriate to reemphasize basic tenets and occasionally necessary for clarity-for example,