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Ischemic Stroke: from Basic Mechanisms to New Drug Development.

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    Ischemic Stroke: from Basic Mechanisms to New Drug Development. Edited by C Y Hsu. (Pp l66, Sw fr 159). Published by S Kargar AG, Switzerland, 1998. ISBN3-8055-6560-7.

    This volume in the Monographs in Clinical Neuroscience series provides a timely overview of recent advances in stroke therapy. The list of contributors includes many prominent names from current experimental stroke research, and the contents of the book generally live up to the expectations that such a list generates. Aspects of experimental neuroprotection that were covered in individual chapters include glutamate receptor mediated ischaemic neuronal death, oxidant mechanisms, nitric oxide, inflammatory mechanisms, temperature modulation of ischaemic injury, apoptosis, and neurotrophic factors. The chapters vary somewhat in character. For example, the chapters on glutamate neurotoxicity and inflammatory mechanisms provide an overview of the recent literature, whereas that on oxidant mechanisms provides focuses more on the use of transgenic and knockout animals to study free radical injury in ischaemia. Both types of chapter provide useful information, but the former variety seemed to me to sit better with my perception of the aims of the book.

    The second part of the book contains three chapters. The first of these considers the current status of new drug development for stroke, with brief sections on both clinical trials of thrombolytic and neuroprotective therapy. It also contains a useful analysis of how protocols for clinical trials might be advanced, with consideration of clinical outcome assessment, the need for early enrollment, sample size issues, and the utility of surrogate end points. The second of these two chapters focuses on new MRI techniques in acute stroke. The final chapter provides a useful overview of future directions in stroke research.

    The book provides an admirable review of current knowledge regarding experimental stroke research, and outlines the problems and some solutions in the clinical application of such knowledge. I think that this book will find a wide readership in both clinical and experimental stroke research, and will be useful reading for clinicians involved in stroke management. If I had a concern, it would be that the discussion of progress in clinical therapy seems more optimistic than justified. However, it might be argued that one of the prime function of monographs such as this is to arouse and sustain enthusiasm.