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Although the outcome of anastomotic procedures in the prevention of stroke is still controversial, there is a large amount of information relating to the pathology of ischaemia that will be interesting )o any physician involved in the management of cerebral vascular disease.

One criticism of this book is the delay in publication. As the symposium in Chicago was held in 1974, the subject matter in the book is nearly five years old. Since then microvascular surgery has advanced a long way and some of the information is of historical interest only. It is a pity to find that the book on the third symposium held nearly two years later has already been in print for some time. Although it is a delight to reach such a well produced book with excellent illustrations, one feels that a more timely publication, perhaps in a less glossy paper, would have had equal appeal to a wider readership.

However, since the microvascular approach is a relatively new challenge to the problem of stroke, every bit of information could be useful. For this reason alone, this book ought to find its way to every neurological departmental library. I also feel that every neurosurgeon involved with microvascular anastomosis should have a copy of his own.

R. P. Sengupta

Characteristics and Functions of Opioids ( D e v e l o p m e n t s in N e u r o s c i e n c e , Vol. 4) (Pro-

ceed ings o f the I n t e r n a t i o n a l N a r c o t i c R e s e a r c h C o n f e r e n c e , N o o r d w i j k e r h o u t , The

N e t h e r l a n d s , 23-27 July, 1978), by J. M. Van R e e a n d L. Te ren iu s (Eds.) , xxi ~ 520

pages , E l s e v i e r / N o r t h - H o l l a n d B i o m e d i c a l Press, A m s t e r d a m , 1978, U S $ 60.00,

Df l 135.00.

The Endorphins ( A d v a n c e s in B i o c h e m i c a l P s y c h o p h a r m a c o l o g y , Vol . 18), by E. C o s t a

a n d M. T r a b u c c h i (Eds.) , xvii + 379 pages , 104 i l lus t ra t ions , 85 tables , R a v e n Press,

N e w Y o r k , N Y , 1978, U S $ 36.40.

The opiate peptides have now supplanted the catecholamines in terms of the number of international meetings devoted to the subjects. These volumes contain collections of camera-ready papers presented at the 1978 International Narcotic Research Conference in Holland and the 1977 Endorphin Con- ference at Brescia, Italy. They both provide a valuable survey of current research in this rapidly expanding field. The Endorphins is concerned entirely with the opiate peptides and is a more compact, attractive and homogenous volume and will probably have a longer lasting value. However, Elsevier are to be congratulated for the rapid publication of the INRC volume, the contents of which reflect the wider interests of this meeting since it embraces both narcotic analgesics, their antagonists and the opioid peptides.

A vast range of subject material is covered by both books extending from psychopharmacology through neuropharmacology and neurophysiology to various biochemical aspects. However, the main emphasis is on the physiology and pharmacology of the endogenous opioid peptides. It is now clear that narcotic analgesics produce their clinical and pharmacological effects through an interaction with opiate receptors that are normally activated by the endogenous opiate peptides. What is not clear is the involvement and importance of these peptide systems in normal and pathological states although tantalising approaches to these problems are clearly identified in both books.

It now seems established that there are at least three separate opioid peptide systems as eluci- dated by chemical and biochemical analysis and by immunohistochemical mapping. The enkephalins appear to be constituents of relatively short neurones spread throughout the brain and spinal cord and are closely associated with opiate receptors. In addition enkephalin-containing neurones are also found in the peripheral nervous system, fl-Endorphin and corticotrophin is found in the brain neuro- nal system which has cell bodies in the hypothaiamus with tong axonal processes innervating a number of mid-brain and limbic areas. The role of these systems in pain mechanisms, pituitary hormone release, behaviour and learning is covered in both volumes as are the bewildering mamher of different opiate receptor types that are now beginning to be identified in the brain and peripheral nervous system.

Neither of these volumes can be considered as authoritative and newcomers to this field should

395

be warned that what is often presented as fact by many authors is in fact the basis of continuing controversy. In this respect discussion summaries would have been valuable adjuncts to both volumes. However, these are useful and convenient collections of research data and both may be recommended for those working or who are about to work in this field.

John Hughes

Noninvasive Measurement of Regional Cerebral Blood Flow in Man, b y V. D . D e s h -

m u k h a n d J. S t i r l i ng M e y e r , xiii q- 224 p a g e s , 102 i l l u s t r a t i o n s , 33 t ab l e s , SP M e d i c a l

a n d Scient i f ic B o o k s , N e w Y o r k , L o n d o n , 1978, £ 14.00.

The original isotope techniques for the measurement of cerebral blood flow in man required intra- carotid injection and hence the range of patients who could be studied was restricted. The introduction of non-invasive CBF techniques has greatly extended the range of possible studies. Over the years, a fund of theoretical and practical knowlege has accumulated, distributed diffusely in various confer- ence proceedings and enshrined in the traditions of various centres and previously no good guide existed. This book provides such a guide for the newcomer. There are four well-illustrated chapters on the relevant anatomy, physiology, pharmacology and historical aspects of the cerebral circulation. The main part of the book is devoted to a very full description of the lzaXenon inhalation technique for the measurement of CBF as used at Baylor, with a chapter devoted to the handling of lZaXenon.

After the description of the normal regional CBF distribution and its age-dependence possible clinical applications are discussed. These include coma, stroke, subarachnoid haemorrhage, headaches, migraine, cerebral oedema, intracranial and systemic hypertension, trauma, dementia, schizophrenia, epilepsy and metabolic disorders. This chapter is a little uncritical; it does not always make the distinction between the interesting and the useful findings, nor does it emphasise the practical dificulties of using any inhalational or intravenous technique with unco-operative patients. One fault of the book is that it does not provide a gentle introduction to the relevant mathematics so that the reader is abruptly assaulted by Kety's equation; only reference to the original sources will enable the reader to regain his composure.

This book will be read with profit by both clinicians and physicists interested in CBF: it will enable both to gain insight into the problems of the other. Once the question to be asked has been defined, the appropriate system can be designed, which need not be as elaborate as even the Baylor system in order to be applied to many practical problems.

J. D. Pickard

Rational Anti-Epileptic Drug Therapy, b y P. J. M . G u e l e n a n d E. V a n de r K le i jn ,

xii q- 182 pages , E l s e v i e r / N o r t h - H o l l a n d B i o m e d i c a l Press , A m s t e r d a m , 1978, U S $

19.95 (f ixed), Df l 65.00.

Many would agree that the application of blood level monitoring of anticonvulsants does offer the possibility of a more rational approach to the drug treatment of epilepsy, with its many problems of poor seizure control, polypharmacy, chronic toxicity etc. Apparently in Holland alone, some 50 laboratories are analysing 30,000 blood samples a year and over 500 laboratories are involved in similar measurements in the United States. Is all this endeavour well directed? How may we all use this infor- mation to the advantage of our patients?

Those of us, especially clinicians, whose expectations are raised by the title of this book may be disappointed with what we find. As expected, there is a good deal of basic information about the clinical pharmacology and pharmacokinetics of the major anticonvulsants with details of absorption, metabolism, distribution, excretion, drug interactions, protein binding etc. However, the clinical applications of this knowledge are inadequately covered, and in places misleading. For example, a major theme and section of this book is the authors ' concept of"relative clearance" of an anticonvulsant which they advise us to use in regulating the drug dosage in poorly controlled patients. According to this concept, if we know the drug level on a given dose, then (provided several other conditions are