losartan-potassium and Craniocerebral-Trauma

Traumatic brain injuries remain an area of great challenge to both neurosurgeons and neuroanaesthesiologists. The management of these injuries starts at the scene of the accident. However, strategies for preventing secondary brain injury and its sequelae are continuing to evolve. These strategies include the use of pharmacological and nonpharmacological techniques. Preventing hypoxia and the use of hypertonic saline have been shown to have favourable results on the outcome of these injuries. The use of isoflurane has been shown to have a neuronprotective effect. Propofol is thought to be the future drug of choice because of its neuroprotective properties, although these still need to be further proven through research. In this review an understanding of the pathophysiology of traumatic brain injury will be outlined in order to understand the effects of pharmacological and nonpharmacological agents on secondary brain injury.

Topics: Adolescent; Adult; Brain Injuries; Cell Death; Central Nervous System Depressants; Craniocerebral Trauma; Cyclosporine; Dexmedetomidine; Erythropoietin; Humans; Hypothermia, Induced; Hypoxia-Ischemia, Brain; Intracranial Hypotension; Isoflurane; Middle Aged; Neuroprotective Agents; Nitrous Oxide; Perioperative Care; Propofol; Resuscitation; Saline Solution, Hypertonic; Xenon; Young Adult

Jehovah's Witness followers do not accept blood derived transfusions and available methods for avoiding transfusion have been used with degrees of success, demonstrating that the probability of death after trauma in these patients may not be significantly different from religious groups. In this report, we describe the case of a child victim of a multiple trauma with severe anemia due to blood loss, whose family would not authorize blood transfusion because of their Jehovah's Witness faith. We discuss the current indications for restricting transfusion, as well as highlighting new tools that contribute to the success of minimizing blood loss, thus avoiding transfusion.

Topics: Accidents, Traffic; Anemia; Anti-Bacterial Agents; Case Management; Child; Colloids; Combined Modality Therapy; Craniocerebral Trauma; Crystalloid Solutions; Culture; Debridement; Dopamine; Erythropoietin; Ferric Compounds; Fluid Therapy; Folic Acid; Hemorrhage; Humans; Isotonic Solutions; Jehovah's Witnesses; Male; Multiple Trauma; Plasma Substitutes; Vitamin K

Until now, erythropoietin (EPO) was thought to be produced exclusively in fetal liver and adult kidney and to regulate mammalian erythropoiesis. However, we recently showed that steady state levels of EPO mRNA could be induced up to 100-fold in primary mouse astrocytes cultured under hypoxic conditions, and also reported the presence of mRNA for EPO and its receptor in the brain of mouse, monkey and human. In extending these studies on humans we now show that immunoreactive EPO is present in ventricular cerebrospinal fluid (CSF) of 5 patients with traumatic brain injuries: EPO was found in 15 out of 15 CSF samples. There was no correlation between the serum EPO concentration and the concentration in the CSF. However, EPO concentrations in CSF correlated with the degree of blood-brain-barrier dysfunction. This suggests that EPO does not cross the intact blood-brain-barrier, implying that EPO is produced in the brain itself, most probably by astrocytes in an oxygen-dependent manner. In view that neuronal cells carry the EPO receptor, we propose that EPO acts in a paracrine fashion in the central nervous system and might function as a protective factor against hypoxia-induced damage of neurons.

Topics: Adult; Animals; Blood-Brain Barrier; Brain; Craniocerebral Trauma; Erythropoietin; Female; Humans; Male; Mice; Middle Aged; RNA, Messenger