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Wed Apr 23 05:14:38 BST 2008

No, NO, NO, NO NO

In a message dated 4/22/2008 11:06:45 P.M. Central Daylight Time,  
ivanhronek at yahoo.com writes:

Be a  better friend, newshound, and know-it-all with Yahoo! Mobile. Try it 
now.  
I got an approval from Sandy Miller to post this here, anyone feels  strongly 
about it ?

At the PGA (Postgraduate Assembly of the  NYSSA)last December, the 
question came up in a discussion during a panel  (I missed the main 
talk because of another meeting).

This is for  those who deal with acute spinal cord injured patients. 
The question asked  was: given a patient who is both head and spinal 
cord injured,would you  use megadose steroids? To my surprise--and 
shock--the panelist answered  yes. I didn't get a chance to make a 
comment myself because time was  up.

Now, I had thought that it was generally understood by now that the  
evidence for any good effect of steroids in SCI is at best  
questionable, and that the evidence for harm from steroids in acute  
brain injury is unequivocable. Hence my shock. Certainly, if you have  
to be most concerned with any injury, one to the brain should be at  
the top of the list.

So, my question for the list: does anyone  still use megadose steroids 
for spinal cord injured pts? If so, why? If  not, why not? If you have 
a pt with SCI who also has a head injury, would  you use them then? If 
so, why?

Shameful self-promotion: I have an  article on this in the current 
issue of Jopurnal of Neurosurgical  Anesthesiology, and just finished 
our chapter on Trauma and Burns for the  next issue of Barash, so I 
have gone over the literature pretty  thoroughly. I'll post some 
references if you like; I'm running out of time  now.

Sanford M. Miller, MD

Ivan Hronek MD 
SFMC, Los  Angeles
cell: 310  487-3288
http://health.groups.yahoo.com/group/Anesthideas/
Your most  unhappy customers are your greatest source of learning. Bill Gates.
P  Please don't print this e-mail unless you really need  to.

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Steroids in spinal cord injury ?