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Crib Death: The Sudden Infant Death Syndrome
Mayo Clin Proc, February 1990, Vol 65
behavioral paroxysmal disorders that need to be distinguished from epilepsy is particularly useful. The appropriate role of electroencephalography in diagnosing epilepsy is also reviewed. This section discusses the pharmacologic management of seizures and surgical therapy for medically refractory patients. The chapter on the appropriate use of antiepileptic drugs, monitoring of drug levels, discontinuing medication, and special considerations such as pregnancy should be appreciated by all physicians who treat patients with seizure disorders. The book concludes with an excellent presentation on the psychosocial management of patients with epilepsy that includes a discussion of education, driving, and legal rights. This book provides diverse information on epilepsy in an orderly manner. Each chapter is concise and well referenced and attempts to distinguish opinion from fact. The index and table of contents provide easy access to particular areas of interest. Many other textbooks on epilepsy concentrate on a particular aspect of the disorder; this text provides a comprehensive approach. In summary, this book will appeal to a wide range of readers who are interested in a contemporary general reference source on epilepsy. As with any review textbook, individual topics may be discussed only briefly, and the reader may have to consult the bibliography for sources of additional information. Nevertheless, this text will be worth the financial investment to physicians who treat patients with epilepsy. Gregory D. Cascino, M.D. Department of Neurology
Crib Death: The Sudden Infant Death Syndrome, 2nd ed, by Warren G. Guntheroth, 324 pp, with illus, $46, Mount Kisco, New York, Futura Publishing Company, 1989 The cause of the peculiar phenomenon of sudden, unexpected, and unexplained death in infants, now commonly referred to as sudden in-
BOOK REVIEWS
289
fant death syndrome (SIDS), remains elusive despite intensive research during the past 25 years. Positive results ofthis work, however, are the more compassionate management of those who suffer the aftermathofthis tragedy and the greater understanding that has been gained of cardiorespiratory function in the infant. In this book, Guntheroth presents a sensitive, intuitive, and comprehensive review ofthe work that has led to our current state of knowledge. The text presents a scholarly literature review that covers all the important contributions and deliberations relevant to SIDS, including 41 112 pages of references current through 1988. The book is a revision of an earlier edition published in 1982 and is an improvement in all respects except one: the preface of the first edition that provided a delightful insight into the author's background has been deleted. This second edition has been largely rewritten and reorganized, with early chapters devoted to information on a single discipline such as pathology, epidemiology, and physiology and subsequent chapters devoted to theory and synthesis under headings of management, prevention, and even politics. The categorization of information under appropriate subtitles greatly assists the reader's orientation. This is an important feature of the text because the literary style is that of a citation review, which documents the source within the text and makes for rather difficult reading. I had to reread many passages for clarification but, in the final analysis, found the material well worth the extra effort. The documentary style did not deter the author from sprinkling the text with personal commentary and recommendations. Without a doubt, Guntheroth favors home monitoring and strongly objects to certain statements made by the National Institute of Child Health and Human Development. The first chapter, entitled "Introduction and Early History of Crib Death," is simply magnificent and provides a historical perspective second to none. Similar in both editions, this chapter alone is worth the price of the book. Some repetition of subject matter is evident throughout the text; however, the information
290
BOOK REVIEWS
was intentionally repeated so that each chapter could stand alone as a reference source. Where pertinent, extrapolations and conceptualizations follow the literature citations, a format that helps the reader understand the significance of what has been said. A good example is Guntheroth's discussion of pulmonary infection and intrathoracic petechiae, which are the two most common and consistent anatomic findings in victims of SIDS and in one way or another probably hold the key to its cause. Guntheroth's personal research in this area enables him to describe expertly the various considerations that influence the formation of intrathoracic petechiae and their relationship to infection. Thought-provoking commentaries pop up like surprises along the way. For instance, the author argues against the concept that there are no nonlegal forms of SIDS. In another section, he describes in a refreshingly frank manner the risk of a family having a subsequent infant die of SIDS. As one would expect from a pediatric cardiologist, the chapter on cardiovascularcauses of SIDS is superb and explains in detail the QT and QT c relationships as they pertain to SIDS research. In the chapter entitled "Final Pathways: Apnea," one finds reference to intriguing, current information on the physiology of sleep. Most physicians, and certainly all pediatricians, should be able to relate to the author's plea that, somehow, infants must avoid exposure to day-care centers for the first 6 months of life. The current trend of early placement of infants in these centers gives them a limitless exposure to viral infections, which, among the known factors in SIDS, are the single most prevalent finding in the history and at autopsy. The chapter on clinical management is filled with tidbits of practical information. Guntheroth cautions against asking for an autopsy (and inadvertently giving the parents an opportunity to decline) until officials (the coroner or medical examiner) have decided whether there is a statutory need. In a heartfelt manner, he discusses the aftermath of SIDS as it affects parents and relatives. He could have provided a more precise explanation of the physician's approach to parents in the emergency room-an awkward situ-
Mayo CUn Proc, February 1990, Vol 65
ation for all of us-although much can be gained from his comments on grief and guilt. Should all the material in this fine book be assimilated by the readers, they could be categorized as experts on SIDS-an accomplishment that is a tribute to the author's labor. As a document, the book should endure long after a cause or causes for SIDS are discovered because it is a genuine reflection of the process by which scientific mysteries are unraveled. The unfolding ofthe world literature in this text is a luxury that should not escape the attention ofthe serious student. Roy F. House, Jr., M.D. Department of Pediatrics
Child and Adolescent Development: Clinical Implications, by Victor C. Vaughan III and Iris F. Litt, 362 pp, with illus, $45, Philadelphia, W. B. Saunders Company, 1990 Drs. Vaughan and Litt, well-known and respected pediatricians, have produced a rather unusual and extremely useful little book, which includes 11 pages of bibliography-an impressive amount of documentation. The stated emphasis of the text is the interactions among physiologic, neurodevelopmental, cognitive, and psychosocial components of growth and development. In this effort, the authors have added a different dimension to the subject-the examination of growth and development in a contemporary sociocultural context. Such treatment of the subject broadens the readership beyond physicians and students to include social workers and psychologists. The introduction is extremely lengthy-indeed, I do not know why it is labeled as such. These 130 pages cover an amazing breadth of subjects, many of which are not customarily associated with the usual approach to child growth and development. This lengthy introduction should be divided into several subtopic chapters in future editions. In addition to the standard charts, tables, and graphs that pedia-
behavioral paroxysmal disorders that need to be distinguished from epilepsy is particularly useful. The appropriate role of electroencephalography in diagnosing epilepsy is also reviewed. This section discusses the pharmacologic management of seizures and surgical therapy for medically refractory patients. The chapter on the appropriate use of antiepileptic drugs, monitoring of drug levels, discontinuing medication, and special considerations such as pregnancy should be appreciated by all physicians who treat patients with seizure disorders. The book concludes with an excellent presentation on the psychosocial management of patients with epilepsy that includes a discussion of education, driving, and legal rights. This book provides diverse information on epilepsy in an orderly manner. Each chapter is concise and well referenced and attempts to distinguish opinion from fact. The index and table of contents provide easy access to particular areas of interest. Many other textbooks on epilepsy concentrate on a particular aspect of the disorder; this text provides a comprehensive approach. In summary, this book will appeal to a wide range of readers who are interested in a contemporary general reference source on epilepsy. As with any review textbook, individual topics may be discussed only briefly, and the reader may have to consult the bibliography for sources of additional information. Nevertheless, this text will be worth the financial investment to physicians who treat patients with epilepsy. Gregory D. Cascino, M.D. Department of Neurology
Crib Death: The Sudden Infant Death Syndrome, 2nd ed, by Warren G. Guntheroth, 324 pp, with illus, $46, Mount Kisco, New York, Futura Publishing Company, 1989 The cause of the peculiar phenomenon of sudden, unexpected, and unexplained death in infants, now commonly referred to as sudden in-
BOOK REVIEWS
289
fant death syndrome (SIDS), remains elusive despite intensive research during the past 25 years. Positive results ofthis work, however, are the more compassionate management of those who suffer the aftermathofthis tragedy and the greater understanding that has been gained of cardiorespiratory function in the infant. In this book, Guntheroth presents a sensitive, intuitive, and comprehensive review ofthe work that has led to our current state of knowledge. The text presents a scholarly literature review that covers all the important contributions and deliberations relevant to SIDS, including 41 112 pages of references current through 1988. The book is a revision of an earlier edition published in 1982 and is an improvement in all respects except one: the preface of the first edition that provided a delightful insight into the author's background has been deleted. This second edition has been largely rewritten and reorganized, with early chapters devoted to information on a single discipline such as pathology, epidemiology, and physiology and subsequent chapters devoted to theory and synthesis under headings of management, prevention, and even politics. The categorization of information under appropriate subtitles greatly assists the reader's orientation. This is an important feature of the text because the literary style is that of a citation review, which documents the source within the text and makes for rather difficult reading. I had to reread many passages for clarification but, in the final analysis, found the material well worth the extra effort. The documentary style did not deter the author from sprinkling the text with personal commentary and recommendations. Without a doubt, Guntheroth favors home monitoring and strongly objects to certain statements made by the National Institute of Child Health and Human Development. The first chapter, entitled "Introduction and Early History of Crib Death," is simply magnificent and provides a historical perspective second to none. Similar in both editions, this chapter alone is worth the price of the book. Some repetition of subject matter is evident throughout the text; however, the information
290
BOOK REVIEWS
was intentionally repeated so that each chapter could stand alone as a reference source. Where pertinent, extrapolations and conceptualizations follow the literature citations, a format that helps the reader understand the significance of what has been said. A good example is Guntheroth's discussion of pulmonary infection and intrathoracic petechiae, which are the two most common and consistent anatomic findings in victims of SIDS and in one way or another probably hold the key to its cause. Guntheroth's personal research in this area enables him to describe expertly the various considerations that influence the formation of intrathoracic petechiae and their relationship to infection. Thought-provoking commentaries pop up like surprises along the way. For instance, the author argues against the concept that there are no nonlegal forms of SIDS. In another section, he describes in a refreshingly frank manner the risk of a family having a subsequent infant die of SIDS. As one would expect from a pediatric cardiologist, the chapter on cardiovascularcauses of SIDS is superb and explains in detail the QT and QT c relationships as they pertain to SIDS research. In the chapter entitled "Final Pathways: Apnea," one finds reference to intriguing, current information on the physiology of sleep. Most physicians, and certainly all pediatricians, should be able to relate to the author's plea that, somehow, infants must avoid exposure to day-care centers for the first 6 months of life. The current trend of early placement of infants in these centers gives them a limitless exposure to viral infections, which, among the known factors in SIDS, are the single most prevalent finding in the history and at autopsy. The chapter on clinical management is filled with tidbits of practical information. Guntheroth cautions against asking for an autopsy (and inadvertently giving the parents an opportunity to decline) until officials (the coroner or medical examiner) have decided whether there is a statutory need. In a heartfelt manner, he discusses the aftermath of SIDS as it affects parents and relatives. He could have provided a more precise explanation of the physician's approach to parents in the emergency room-an awkward situ-
Mayo CUn Proc, February 1990, Vol 65
ation for all of us-although much can be gained from his comments on grief and guilt. Should all the material in this fine book be assimilated by the readers, they could be categorized as experts on SIDS-an accomplishment that is a tribute to the author's labor. As a document, the book should endure long after a cause or causes for SIDS are discovered because it is a genuine reflection of the process by which scientific mysteries are unraveled. The unfolding ofthe world literature in this text is a luxury that should not escape the attention ofthe serious student. Roy F. House, Jr., M.D. Department of Pediatrics
Child and Adolescent Development: Clinical Implications, by Victor C. Vaughan III and Iris F. Litt, 362 pp, with illus, $45, Philadelphia, W. B. Saunders Company, 1990 Drs. Vaughan and Litt, well-known and respected pediatricians, have produced a rather unusual and extremely useful little book, which includes 11 pages of bibliography-an impressive amount of documentation. The stated emphasis of the text is the interactions among physiologic, neurodevelopmental, cognitive, and psychosocial components of growth and development. In this effort, the authors have added a different dimension to the subject-the examination of growth and development in a contemporary sociocultural context. Such treatment of the subject broadens the readership beyond physicians and students to include social workers and psychologists. The introduction is extremely lengthy-indeed, I do not know why it is labeled as such. These 130 pages cover an amazing breadth of subjects, many of which are not customarily associated with the usual approach to child growth and development. This lengthy introduction should be divided into several subtopic chapters in future editions. In addition to the standard charts, tables, and graphs that pedia-