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The Clinical Pharmacology of Cerebral Ischemia.

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    The Clinical Pharmacology of Cerebral Ischemia.Edited by gert j ter horst and jakob korf. (Pp 305; price $99.50). New Jersey: Humana Press, 1996. ISBNO-89603-378-3.

    Stroke is well known to be the third largest cause of death in the western World but its treatment is largely conservative. The recognition that the area surrounding an infarct (the penumbra) is still viable during the early stages of ischaemia along with our increasing understanding of the pathophysiology of cerebal ischaemia has led to the establishment of a whole host of clinical trials using various “clot-busters” as well as agents designed for neuroprotection—for example, calcium antagonists, excitatory amino acid antagonists, free radical scavengers etc. Physicians and scientists interested in stroke found themselves at first awkward, but now increasingly comfortable, bedfellows. This timely book— a collection of reviews— seeks to cover the newest of the subspecialties drawing on the expertise of around 30 investigators from three continents. The editors of the book have undertaken a brave task. Almost by definition their subject is moving quickly. Books, no matter how well intentioned or researched, are by virtue of their medium slow creatures; there are few references later than 1995. The book fails to cite much of the recent literature which has moved the argument of stroke units needing “further study” to requiring them in every hospital. The lead time of publication is also responsible for the absence of discussion of the International Stroke Trial (IST), a large randomised trial comparing the use of aspirin and heparin in stroke, which recently reported its preliminary results. Not all clinicians will agree with the book’s failure to endorse the use of MRA in selected patients. The discussion on the future of genetics in cerebral ischaemia is brief and somewhat out of keeping with the pharmaceutical industry’s enormous spending on trying to identify those with genetic predisposition to vascular diseases. At one point we wondered whether “mo” was a new gene till we realised it was an abbreviation for “month”! Notwithstanding, these are minor irritations which we hope the authors will forgive us for mentioning; we would be failing in our duty if we did not cite them. The editors should be congratulated for producing an outstandingly well referenced treatise on what is likely to become an increasing large subspecialty. Reviewers should recommend a book if they themselves would have it on their shelves— we do and we would. But would we pay the price asked for by the publishers?