Organ Preservation, Vol. 37, No. 2 of International Anesthesiology Clinics.Roysten D, ed. Philadelphia: Lippincott Williams & Wilkins, 1999. ISSN 0020-5907. 130 pages, $61.00. Although the title of the book may suggest the preservation of organs for transplantation, the authors’ objectives were to review molecular pathogenesis of organ dysfunction and scientific rationale for specific interventions and treatments of organ dysfunction associated with cardiac surgery. The book is composed of five chapters; the host defense system by cellular blood components, myocardial protection during cardiac surgery, pulmonary hypertension after cardiac surgery, the role of the intestines in postoperative morbidity, and renal preservation. The first chapter contains an in-depth description of the cellular host defense system and hemostasis contributed by neutrophils and platelets, respectively. The review of molecular interaction of inflammatory response and hemostasis is informative. It appears that the authors’ intention was to describe hemostasis as a part of inflammatory response or a host defense mechanism. However, a relatively weak description of the interaction of two systems gives an impression of one chapter with two isolated topics. The chapter on myocardial preservation describes mechanisms of myocardial stunning, determinants of coronary blood flow, and myocardial protection by chemical cardioplegia and ischemic preconditioning. Pulmonary hypertension observed during cardiac surgery and cardiac transplantation is described in the third chapter. Description of pathophysiology of pulmonary hypertension during and after cardiac surgery and cardiac transplantation is quite extensive. In addition, the rationale and mode of treatment including nitric oxide, prostacyclin, phosphodiesterase inhibitors, adenosine, adrenomedulin, and mechanical support are described. The effect of translocation of intestinal bacteria and endotoxin into the systemic circulation on the development of the systemic inflammatory response syndrome is described in the fourth chapter. In addition, the authors describe potential causes of mucosal hypoxia, various methodologies of monitoring mucosal perfusion status, and approaches to preventing postoperative gut-derived complications. The chapter on renal protection describes potential causes and interventions of postoperative renal dysfunction. The authors, however, do not comment on molecular mechanisms of renal dysfunction. Overall, this monograph describing organ dysfunctions associated with major surgery is easily readable for most clinical anesthesiologists. It is admirable that the authors tried to cover molecular mechanisms of specific organ dysfunction and relate to clinical complications and their interventions. There are two drawbacks in this book: 1) the other two major organ functions, namely central nervous system and pulmonary system, are not addressed and 2) the difficulty in combining molecular biology and clinical science results in superficial coverage of both areas. The authors, however, have achieved their objectives if they were able to deliver a scientific background of organ dysfunction to clinicians.
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