[From nobody Fri Jan  5 14:49:50 2007
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Subject: Res:ccml High dose mannitol, CRASH-2, cross post from trauma.org
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From: Claudia Teles &lt;claudiateles@danet.com.br&gt;
To: Ben Reynolds &lt;aneurysm_42@yahoo.com&gt;
Cc: ccm-l@ccm-l.org, kmattox@aol.com, tpb9k@virginia.edu, rubens1956@gmail.com,
	haggeas@uol.com, joaoluizferreiracosta@gmail.com, odinbs@terra.com.br
Date: Fri, 5 Jan 2007 11:05:45 -0200
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&lt;FONT=20face=3D&quot;Sans=20Serif=20padr=E3o,Verdana,Arial,Helvetica,sans-seri=
f&quot;=20size=3D2&gt;&lt;DIV&gt;Dear=20listmembers,&lt;/DIV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/DIV&gt;&lt;DIV&gt;As=20a=
=20brazilian=20intensivist,&amp;nbsp;I=20must=20say=20something=20here.&lt;/DIV&gt;=
&lt;DIV&gt;I=20knew&amp;nbsp;=20superficially=20Dr=20Julio=20Cruz=20in=20life=20-=
=20mostly=20from=20lectures,=20and=20occasional=20talks=20in=20scientific=
=20meetings=20-=20but=20in=20the=20very=20few=20moments=20I=20met=20him,=
=20he=20left=20to=20me=20the=20clear=20impression=20of=20a=20true=20and=
=20serious&amp;nbsp;scientist.=20Mostly,=20I&amp;nbsp;recognize=20his=20value=20t=
hrough=20the=20contribution=20he=20gave=20to=20the=20medical=20formation=
=20of=20some&amp;nbsp;outstanding=20neurointensivists=20&amp;nbsp;in=20Brazil=20-=
=20especially=20in=20the=20area=20of=20neurotrauma,=20serious=20people=20=
and=20attained=20to=20scientific=20truth.&amp;nbsp;He=20is=20now=20dead=20and=
=20cannot=20defend=20himself=20.=20He=20was=20a=20bright=20man.=20In=20th=
e=20end=20of=20his=20existance,=20he=20suffered=20from=20depression,=20an=
d=20underwent=20isolation=20from=20his=20colleagues,=20but=20that=20does=
=20not=20demeanor=20his=20outstanding=20contribution=20to=20neurointensiv=
e=20care=20at=20all=20.&lt;/DIV&gt;&lt;DIV&gt;Many=20brazilian=20neurosurgeons=20and=
=20neurointensivists=20learned=20and=20were=20trained&amp;nbsp;by=20him.=20Un=
fortunately,=20I=20was=20not=20one=20of=20them,=20but&amp;nbsp;=20I=20expect=
=20the=20necessary=20ethical=20behaviour=20from=20the=20Cochrane=20Group=
=20and=20from&amp;nbsp;the=20Brazilian&amp;nbsp;National=20Commission=20for=20Res=
earch=20Ethics&amp;nbsp;in=20order=20to=20investigate=20in=20depth=20the=20su=
bject,=20or=20even=20conduct=20an=20adequate=20controlled=20study,=20to=
=20check=20if=20the=20data=20are=20reproducible,&amp;nbsp;before=20putting&amp;nb=
sp;=20Dr=20Julio=B4s=20honesty=20into=20question.&lt;/DIV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/DIV&gt;&lt;=
DIV&gt;&amp;nbsp;&lt;/DIV&gt;&lt;DIV&gt;And,=20Ben=20and=20other=20common=20members=20of=20t=
rauma=20list,&amp;nbsp;&amp;nbsp;I=20cannot=20access=20right=20now&amp;nbsp;my&amp;nbsp;g=
mail=20address=20subscribed=20to=20the=20trauma=20list&amp;nbsp;to=20send=20t=
his=20message=20to=20that=20listserv,&amp;nbsp;so,=20can=20you=20kindly&amp;nbsp;=
=20forward&amp;nbsp;this=20to=20the=20trauma.org=20too?=20&lt;/DIV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/=
DIV&gt;&lt;DIV&gt;Thanks=20in=20advance.&lt;/DIV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/DIV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/DIV&gt;&lt;D=
IV&gt;Claudia=20Teles,=20MD&lt;/DIV&gt;&lt;DIV&gt;Rio=20de=20Janeiro,=20Brazil&lt;/DIV&gt;&lt;DIV=
&gt;&amp;nbsp;&lt;/DIV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/DIV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/DIV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/DIV&gt;&lt;DIV&gt;&amp;nbs=
p;&lt;/DIV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/DIV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/DIV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/DIV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/D=
IV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/DIV&gt;&lt;DIV&gt;&amp;nbsp;&lt;/DIV&gt;&lt;DIV&gt;&lt;BR&gt;&amp;nbsp;&lt;/DIV&gt;&lt;FONT=20color=
=3D#990099&gt;-----ccm-l-bounces@ccm-l.org=20escreveu:=20-----&lt;BR&gt;&lt;BR&gt;&lt;/FONT=
&gt;&lt;blockquote=20style=3D&quot;PADDING-RIGHT:=200px;=20PADDING-LEFT:=205px;=20MA=
RGIN-LEFT:=205px;=20BORDER-LEFT:=20#000000=202px=20solid;=20MARGIN-RIGHT:=
=200px&quot;&gt;Para:=20ccm-l@ccm-l.org&lt;BR&gt;De:=20Ben=20Reynolds=20&amp;lt;aneurysm_42=
@yahoo.com&amp;gt;&lt;BR&gt;Enviado=20por:=20ccm-l-bounces@ccm-l.org&lt;BR&gt;Data:=2004/=
01/2007=2017:09&lt;BR&gt;Assunto:=20ccml=20High=20dose=20mannitol,=20CRASH-2,=
=20cross=20post=20from=20trauma.org&lt;BR&gt;&lt;BR&gt;&lt;FONT=20face=3Dmonospace=20siz=
e=3D2&gt;&lt;BR&gt;&lt;BR&gt;Below*=20was=20posted=20today=20on=20the=20trauma.org=20lis=
t=20and=20is&lt;BR&gt;quite=20pertinent=20to=20the=20neurointensivists=20who=20=
inhabit&lt;BR&gt;this=20list.&lt;BR&gt;The=20following=20link=20takes=20you=20to=20th=
e=20Cochrane=20Injury&lt;BR&gt;Group=20response:=20&amp;nbsp;&lt;BR&gt;&lt;A=20href=3D&quot;http:=
//www.crash2.lshtm.ac.uk/Mannitol.htm&quot;=20target=3Dblank=20=20&gt;http://www.=
crash2.lshtm.ac.uk/Mannitol.htm&lt;/A&gt;&lt;BR&gt;&lt;BR&gt;Ben=20Reynolds,=20PA-C&lt;BR&gt;Pitt=
sburgh,=20PA&lt;BR&gt;&lt;BR&gt;*=20Dear=20all,&lt;BR&gt;&lt;BR&gt;Prof=20Ian=20Roberts,=20who=20=
chairs=20the=20Cochrane=20Injuries&lt;BR&gt;Group,=20has=20asked=20me&lt;BR&gt;to=20p=
ass=20on=20the=20information=20below,=20which=20has=20led=20to=20the&lt;BR&gt;w=
ithdrawal=20of=20&lt;BR&gt;the&lt;BR&gt;Cochrane=20review=20on=20high=20dose=20mannit=
ol.=20Details=20are&lt;BR&gt;available=20on=20the&lt;BR&gt;CRASH2=20website.&lt;BR&gt;My=20=
interpretation=20is=20that=20this=20is=20a=20sad=20story=20and=20that&lt;BR&gt;=
we=20will=20probably&lt;BR&gt;never=20know=20the=20truth.=20However=20it=20does=
=20seem=20that=20the&lt;BR&gt;data=20in=20the=20three&lt;BR&gt;published=20papers=20c=
annot=20be=20verified,=20greatly=20reducing&lt;BR&gt;the=20body=20of&lt;BR&gt;evidenc=
e=20for=20high=20dose=20mannitol=20therapy.&lt;BR&gt;&lt;BR&gt;Tim.=20Coats.&lt;BR&gt;Profe=
ssor=20of=20Emergency=20Medicine.&lt;BR&gt;Leicester=20University&lt;BR&gt;&lt;BR&gt;Dear=
=20Tim=20&lt;BR&gt;The=20Cochrane=20Injuries=20Group=20conducted=20an=20investi=
gation&lt;BR&gt;into=20some=20head&lt;BR&gt;injury=20trials=20by=20Cruz=20et=20al=20-=
=20the=20details=20should=20be=20of&lt;BR&gt;interest=20to=20the&lt;BR&gt;trauma=20co=
mmunity.=20&lt;BR&gt;We=20have=20put=20the=20key=20correspondence=20on=20the=20=
trial&lt;BR&gt;website=20to=20make=20it&lt;BR&gt;available=20to=20our=20collaborators=
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ma.org=20know=20about=20it=20as=20well.=20&lt;BR&gt;Between=202001=20and=202004=
,=20three=20reports=20were=20published=20by&lt;BR&gt;Dr=20Julio=20Cruz=20&lt;BR&gt;an=
d&lt;BR&gt;colleagues=20presenting=20the=20results=20of=20three=20clinical&lt;BR&gt;t=
rials=20comparing&lt;BR&gt;high=20dose=20and=20conventional=20dose=20mannitol=
=20in=20the&lt;BR&gt;treatment=20of=20head&lt;BR&gt;injury.=20They=20appeared=20to=20=
show=20that=20high=20dose=20mannitol&lt;BR&gt;was=20dramatically&lt;BR&gt;effective=
=20in=20reducing=20death=20and=20disability=20after=20head&lt;BR&gt;injury.=20&lt;=
BR&gt;Cruz=20C,=20Minoja=20G,=20Okuchi=20K.=20Improving=20clinical&lt;BR&gt;outcom=
es=20from=20acute&lt;BR&gt;subdural=20hematomas=20with=20emergency=20preoperati=
ve&lt;BR&gt;administration=20of=20high&lt;BR&gt;doses=20of=20mannitol:=20a=20randomiz=
ed=20trial.=20Neurosurgery&lt;BR&gt;2001;49(4):864-71.&lt;BR&gt;Cruz=20C,=20Minoja=20=
G,=20Okuchi=20K.=20Major=20clinical=20and&lt;BR&gt;physiological=20benefits=20&lt;=
BR&gt;of&lt;BR&gt;early=20high=20doses=20of=20mannitol=20for=20intraparenchymal&lt;BR=
&gt;temporal=20lobe&lt;BR&gt;hemorrhages=20with=20abnormal=20pupilary=20widening.&lt;=
BR&gt;Neurosurgery&lt;BR&gt;2002;51(3):628-38.&lt;BR&gt;Cruz=20J,=20Minoja=20G,=20Okuchi=
=20K,=20Facco=20E.=20Successful=20use=20of&lt;BR&gt;the=20new=20&lt;BR&gt;high-dose&lt;B=
R&gt;mannitol=20treatment=20in=20patients=20with=20Glasgow=20Coma&lt;BR&gt;Scores=
=20of=203=20and&lt;BR&gt;bilateral=20abnormal=20pupillary=20widening:=20a=20ran=
domized&lt;BR&gt;trial.=20Journal=20of&lt;BR&gt;Neurosurgery=202004;100(3):376-83.&lt;BR=
&gt;The=20trials=20were=20included=20in=20a=20systematic=20review=20of=20the=
&lt;BR&gt;effectiveness=20of&lt;BR&gt;mannitol=20in=20head=20injury=20and=20published=
=20in=20the=20Cochrane&lt;BR&gt;Library=20in=20July&lt;BR&gt;2005.=20The=20review=20c=
oncluded=20that=20&quot;high=20dose=20mannitol&lt;BR&gt;appears=20to=20be&lt;BR&gt;prefera=
ble=20to=20conventional=20dose=20mannitol=20in=20the=20acute&lt;BR&gt;managemen=
t=20of&lt;BR&gt;comatose=20patients=20with=20severe=20head=20injury.&quot;=20&lt;BR&gt;The=
=20Cochrane=20Injuries=20Group=20later=20discovered=20that&lt;BR&gt;there=20wer=
e=20concerns&lt;BR&gt;about=20these=20trials=20and=20an=20investigation=20was=
=20made=20the&lt;BR&gt;results=20of=20which&lt;BR&gt;are=20available=20on=20the=20CRA=
SH-2=20website&lt;BR&gt;(www.crash2.lshtm.ac.uk&lt;BR&gt;&amp;lt;/exchweb/bin/redir.asp?U=
RL=3Dhttp://www.crash2.lshtm.ac.uk&amp;gt;&lt;BR&gt;).=20We=20know&lt;BR&gt;that=20mannit=
ol=20is=20widely=20used=20in=20the=20management=20of&lt;BR&gt;patients=20with=
=20head&lt;BR&gt;trauma=20and=20felt=20that=20you=20should=20be=20made=20aware=
=20of=20the&lt;BR&gt;Injuries=20Group&lt;BR&gt;investigation=20as=20soon=20as=20possi=
ble.=20Please=20pass=20this&lt;BR&gt;message=20on=20to=20your&lt;BR&gt;colleagues=20i=
n=20trauma=20care.=20&lt;BR&gt;Ian=20&lt;BR&gt;&amp;nbsp;&lt;BR&gt;-=20-=20-=20-=20-=20-=20-=20=
-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=
=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-&lt;BR&gt;Este=20e-mail=
=20foi=20verificado=20pelo=20Sistema=20de=20Anti-Virus=20da=20Diagnostico=
s=20da=20America.&lt;BR&gt;-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20=
-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=
=20-=20-=20-=20-=20-=20-=20-=20-&lt;BR&gt;Antes=20de=20imprimir=20pense=20na=20=
sua=20responsabilidade=20com=20o=20Meio=20Ambiente.&lt;BR&gt;-=20-=20-=20-=20-=
=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=
=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-&lt;BR&gt;&lt;=
BR&gt;&lt;/FONT&gt;&lt;/blockquote&gt;&lt;br&gt;&lt;/FONT&gt;=3D=0D=0A&lt;table&gt;&lt;tr&gt;&lt;td=20bgcolor=3D#ff=
ffff&gt;&lt;font=20color=3D#000000&gt;&lt;pre&gt;=20=20=0A-=20-=20-=20-=20-=20-=20-=20-=
=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=
=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=0AEste=20e-mail=
=20foi=20verificado=20pelo=20Sistema=20de=20Anti-Virus=20da=20Diagnostico=
s=20da=20America.=0A-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=
=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=
=20-=20-=20-=20-=20-=20-=20-=20-=0AAntes=20de=20imprimir=20pense=20na=20s=
ua=20responsabilidade=20com=20o=20Meio=20Ambiente.=0A-=20-=20-=20-=20-=20=
-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=
=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=20-=0A=20=0A=
&lt;/pre&gt;&lt;/font&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
]