"synopsis" may belong to another edition of this title.
Acute Stroke Treatment, with contributors from four continents, rides the wave of enthusiasm that followed those two encouraging studies. Thrombolysis after ischemic stroke is the theme around which most of the chapters revolve. The longest and perhaps most helpful chapter, by Brott, is devoted to the reopening of occluded brain arteries. However, Brott's review of the relevant clinical trials, including trials of streptokinase with or without aspirin, is conventional and narrative. Readers would have been better informed by a systematic, integrated analysis of the evidence, such as is now available in the data base of the Cochrane Collaboration, which is updated quarterly. What is also missing is the recognition that it is premature to introduce thrombolysis as a blanket treatment for all ischemic strokes. Many centers still lack the diagnostic skill and facilities to identify patients who stand to lose from thrombolysis (by intracerebral bleeding) rather than gain from it. In addition, current knowledge of the benefits and risks of this therapy in individual patients, according to cause and type of stroke, is far from complete.
This book's contributors address brain ischemia from many other angles as well. There is a sound chapter about clinical syndromes, three chapters dealing with biochemical changes (predictably overlapping in content), and three chapters about diagnostic techniques (divided rather awkwardly). The contribution concerning cardiac tests strays into an incomplete review of anticoagulant treatment and even into stroke-induced tachycardia in mice and humans. Some investigations are mentioned only in the chapter on intensive care treatment of ischemic stroke. That approach explores the borderlands of evidence-based medicine; unwary readers will be surprised to learn that in some centers, treatment may be so intensive that acoustic evoked potentials are necessary to assess brain-stem function. Two good but forlorn contributions review the management of intracerebral and subarachnoid hemorrhages. The chapter by Brass, on methods of clinical trials, offers good instruction, although it reviews the rather sterile topic of bias introduced by the exclusion of patients from the randomization process. In addition, pragmatists may find his discussion too lenient on surrogate end points and impairment scales.
The production time of this book was admirably short, allowing citation of references from late 1996 and even 1997. Only the International Stroke Trial could not be incorporated into Koudstaal's closing chapter, which focuses on prevention of early recurrences of stroke. Inevitably, speed is achieved at the expense of cohesion. Perhaps editorial whips should be cracking more loudly, now that books about stroke are turned out faster than ordinary mortals can read them. Fortunately, Acute Stroke Treatment includes a thorough index to guide the novice who prefers a monograph to the original reports.
Reviewed by J. van Gijn, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
"About this title" may belong to another edition of this title.
Shipping:
FREE
Within U.S.A.
Book Description Condition: New. Brand New Original US Edition.We Ship to PO BOX Address also. EXPEDITED shipping option also available for faster delivery.This item may ship from the US or other locations in India depending on your location and availability. Seller Inventory # ABTR-29191
Book Description Condition: New. Brand New Original US Edition. Customer service! Satisfaction Guaranteed. This item may ship from the US or our Overseas warehouse depending on your location and stock availability. We Ship to PO BOX Location also. Seller Inventory # ABRR-29191
Book Description Condition: Brand New. New. US edition. Expediting shipping for all USA and Europe orders excluding PO Box. Excellent Customer Service. Seller Inventory # ABEOCT23-365059
Book Description Condition: New. pp. 304. Seller Inventory # 261789891
Book Description Condition: New. Brand New Original US Edition.We Ship to PO BOX Address also. EXPEDITED shipping option also available for faster delivery.This item may ship from the US or other locations in India depending on your location and availability. Seller Inventory # ABTR-287068
Book Description Condition: New. pp. 304. Seller Inventory # 7139356
Book Description Condition: New. Brand New Original US Edition. Customer service! Satisfaction Guaranteed. This item may ship from the US or our Overseas warehouse depending on your location and stock availability. We Ship to PO BOX Location also. Seller Inventory # ABRR-287068