Posted by: arisfil | March 30, 2008

Small gun ?

Small gun  

a small gun…that is what we have for brain edema… 


I was reading the literature about traumatic brain injury and I was feeling terrible as the treatment of post-traumatic brain edema lies after years in mannitol, hyperventilation and hydration with or without hypertonous fluids. We have to admit that we have a lot to find and we are back. We have a lot of mysteries to resolve. I cannot admit that we have an osmotic diuretic in the first line of treating brain edema in the years of molecular biology, advanced immunology and decoded human genome! These practices were pioneered years before when medical research was bereaved of advanced scientific methods.

Mannitol devastates the osmotic regulation and its effect lasts for a few days but still it is in the front line. Multiple injured patients with life threatening brain and abdominal injuries may be in shock and this is an everyday reality in emergency rooms as elder people with cardiac history are. These patients are in shock and we are forced to use a substance like mannitol for their brain edema while it may worsen the situation. Its all we got after all!

Don’t you think that we should put our best to find something novel, clever, and effective concerning the treatment of post traumatic edema? Don’t you think that we are back when we are compared with the miracles and advances of immunology and molecular biology ? Aquaporins are a new family of water channels aged about 20 years and the literature is promising… Are we close to changing the level to neurosurgery ? Who knows…maybe in some years we would be in another difficult situation…Which aquaporin inhibitor of 50 is the appropriate ?




  1. Dear Aristo,
    You are amazing. I think you carry the challenge with a neurosurgical heart and a philosophic mind. You are translating our own feelings into simple words. Keep going, I m seeing you a star in the future sky.
    Mohamed Mohi Eldin,
    Professor of Neurosurgery,
    Cairo University.

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