Mannitol and Glycerine Combination.

[Guy Jackson]

Dr John,

Mannitol, yes, standard therapy in the initial management of intracranial
haematoma (i.e. pre-theatre) and secondary rise in ICP.

Glycerol ???????

A quick Medline search using the key words 'mannitol', 'glycerol', and
'craniocerebral trauma' revealed five reviews only; the most recent dating
from 1979. This smells of a therapy that has been abandoned. Like you I
would want to see some good evidence for adding glycerol to the mix. I can
understand the principle of fluidising red cell membranes, but I would like
to see outcome studies.

Here in the UK I can write to the Medical Director of the company, and
he/she has to supply me with the papers. The company representatives would
also happily supply me with the evidence. Perhaps you should ask the same of
them there.

Let me guess. A combination product is being offered to you at an inflated
price. Such a drug must justify its cost over the standard product. Thus my
answer to the reps in the absence of such evidence is: That will be £3000
per patient please to run the trial, plus the fees demanded by the ethics
committee for commercial research, etc., etc., etc.

Sorry to be so negative, but the burden of proof in on the drug company.
Turn it back on them.

Guy Jackson
London, UK.

----- Original Message ----- 
From: "jacob john" <jacobjns at yahoo.com>
To: <trauma-list at trauma.org>
Sent: Friday, December 08, 2006 8:50 AM
Subject: Mannitol and Glycerine Combination.



Dear Sir/Madam,

Many pharmaceuticals are promoting the use of a
combination of mannitol and glycerine to treat
cerebral oedema.

Is that combination pharmacologically acceptable?

What scientific evidence?

Regards

Dr.Jacob John MBBS,MS,M.Ch

Neurosurgeon,

Bishop Benziger Hospital,Kollam,Kerala,India.

jacobjns at gmail.com

jacobjns at yahoo.com



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