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PubMed2005

Effects of epidural hypothermic saline infusion on locomotor outcome and tissue preservation after moderate thoracic spinal cord contusion in rats.

OBJECT: Regionally delivered hypothermia has advantages over systemic hypothermia for clinical application following spinal cord injury (SCI). The effects of local hypothermia on tissue sparing, neuronal preservation, and locomotor outcome were studied in a moderate thoracic spinal cord contusion model. METHODS: Rats were randomized to four treatment groups and data were collected and analyzed in a blinded fashion. Chilled saline was perfused into the epidural space 30 minutes postcontusion to achieve the following epidural temperatures: 24 +/- 2.3 degrees C (16 rats), 30 +/- 2.4 degrees C (13 rats), and 35 +/- 0.9 degrees C (13 rats). Hypothermia was continued for 3 hours when a 45-minute period of rewarming was instituted. In a fourth group a moderate contusion only was induced in 14 animals. Rectal (core) and T9-10 (epidural) temperatures were measured continuously. Locomotor testing, using the Basso-Beattie-Bresnahan (Ba-Be-Br) scale, was performed for 6 weeks, and rats were videotaped for subsequent analysis. The lesion/preserved tissue ratio was calculated throughout the entire lesion cavity and the total lesion, spinal cord, and spared tissue volumes were determined. The rostral and caudal extent of gray matter loss was also measured. At 6 weeks locomotor recovery was similar in all groups (mean Ba-Be-Br Scale scores 14.88 +/- 3.71, 14.83 +/- 2.81, 14.50 +/- 2.24, and 14.07 +/- 2.39 [p = 0.77] for all four groups, respectively). No significant differences in spared tissue volumes were found when control and treatment groups were compared, but gray matter preservation was reduced in the infusion-treated groups. CONCLUSIONS: Regional cooling applied 30 minutes after a moderate contusive SCI was not beneficial in terms of tissue sparing, neuronal preservation, or locomotor outcome. This method of cooling may reduce blood flow in the injured spinal cord and exacerbate secondary injury.

Analysis of Variance↗
PubMed2000

[Diagnosis of heart contusion in associated chest trauma].

The efficacy of different methods of heart contusion diagnosis in patients with concomitant chest trauma was studied. Criteria of heart contusion diagnosis by electrocardiography, integral body rheography, ultrasonic diagnosis, heart enzymes analysis were covered. Comparative analysis revealed that there was no modern method with 100% diagnostic value. Only complex use of these methods permits to make objective diagnosis of heart contusion. This approach allowed to decrease diagnostic mistakes rate in patients with concomitant chest trauma by 18%.

Clinical Enzyme Tests↗
PubMed2000

[Diagnosis of heart contusions in patients with multiple trauma of the chest].

A complex investigation of effectiveness of different methods of detection of heart contusion in patients with combined traumas of the chest allowed detailed elucidation of the criteria of diagnostics of heart contusions by means of electrocardiography, integral rheography of the body, ultrasonography, enzyme diagnostics. A comparative analysis has shown that none of the available now methods can be taken as absolute. The complex use of these methods only can make the maximum objective diagnosis of heart contusion. This approach allowed the authors to make the amount of diagnostic errors 18% less in patients with a combined trauma of the chest and thus to improve the results of treatment.

Clinical Enzyme Tests↗
PubMed2001

[Lung contusion--an indication for resection?].

Pulmonary contusion is the most common injury in blunt chest trauma. Parenchymal injury and systemic inflammatory response lead to respiratory insufficiency and secondary pneumonia. Early detection and intervention to minimize progression of lung consolidation with a low threshold for mechanical ventilation optimize treatment results. Between 1990 and 2000 55 thoracotomies or thoracoscopies for chest trauma were performed. In 26 patients pulmonary contusion with hematothorax (n = 13), endobronchial bleeding (n = 9), bronchopleural fistula (n = 6), bronchusruptur (n = 2) or other contusion related injuries (n = 6) was responsible for the thoracotomies. We performed 12 lobectomies, 1 pneumonectomy, 11 parenchymal suture and 2 decortications. Preoperatively a bronchoscopy for the localisation of the bleeding and disclosure of central airway injury is mandatory. The benefit of bronchoscopy guided blocking of the bronchus for endobronchial bleeding is unclear. Video assisted procedures are not useful for massive bleeding or anatomical resections.

Contusions↗
PubMedDate not supplied

[Problems of treatment of contusions and dislocations of the brain].

The clinical course and prognosis in the event of a severe cerebrocrainial trauma depend, above all, on the extent of the contusion and smashing of the brain sustained. The pathogenetic factor of prime importance determining the severity of the contusion is the development of the local and general cerebral edema. Rapidly accuring edema and turgescence of the brain, rising intracranial pressure lead to the dislocation of the brain attended by a clinical picture of a grave secondary lesion of the brain stem. To eliminate or prevent the emergence of the dislocation syndrome an operative removal of the primary contusion focus and concussory treatment of the brain in combination with the pathogenetic conservative therapy, aimed at preventing further progressive edema of the brain, are indicated in some of such patients.

Brain Edema↗
PubMed2002

[Angiographic changes in optic disc and its surrounding choroid after contusion of optic nerve].

PURPOSE: To study the angiographic changes in the optic disc and its surrounding choroidoretina after optic nerve contusion with fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA). METHODS: Thirty patients (30 eyes) with various degree of optic nerve damage caused by ocular contusion were examined with FFA and ICGA. (The choroidal rupture were excluded in this study). RESULTS: All patients present some abnormal angiography except one case. The main findings in FFA were hypofluorescein on quadrantal or entire disc in the early phase and leakage or persistent nonperfusion in the late phase. Meanwhile, the choroid surrounding disc was clearly delayed in its choroidal filling time. The retinal pigment epithelium (RPE) damage was observed over the localized abnormally perfused choroid. However, the RPE above the circular area around the disc which was hypofluorescein in ICGA showed no RPE damage in 9 cases. There are 2 cases combined with branche retinal vein occlusion and 19 (63%) cases showed ischemic changes exactly on the location of so-called "water separating zone". The visual acuity was not more than 0.1 in 80% of the patients in this study. CONCLUSIONS: There is severe optic nerve lesion in the strong ocular contusion, in which the choroidal and retinal arterial circulation has also been seriously damaged. The FFA and ICGA should be conducted in time in order to judge the injury correctly and allow the clinician to better manage the cases.

Adolescent↗
PubMed1991

[Does lung contusion and general injury severity have an effect on the lung following intramedullary femoral nailing? An animal model].

We evaluated changes in lung function after closed intramedullary femoral nailing (IMN) in sheep. The effects of isolated IMN were compared with those of nailing after lung contusion and hemorrhagic shock. In adult female merino sheep a chronic lung lymph fistula was prepared according to the method described by Staub. At day 1, group 1 received right-sided lung contusion and hemorrhagic shock to a mean blood pressure of 50 mmHg for 2 h. Group 2 was the control group. At day 3 both groups were submitted to IMN, followed by a 2-h observation period. IMN caused a transient significant increase in pulmonary artery pressure and central venous triglycerides in both groups. Chemiluminescence of isolated polymorphonuclear leukocytes (PMNL) decreased in group 1 from 2.699 +/- 0.344 to 2.460 +/- 0.187 x 10(6) cpm/25000 PMNL and increased in group 2 from 2.757 +/- 0.127 to 3.824 +/- 0.439 x 10(6) cpm/25000 PMNL. Lymph flow in group 1 increased 1.5-fold while microvascular pressure decreased. In group 2 lymph flow increased less, while MVP increased. The filtration coefficient in group 1 was 5 times (7.533 +/- 0.044) that in the control group (1.45 +/- 0.133). Calculations of permeability indicated a 2-fold increase (0.044 group 1 vs 0.026 group 2). In the presence of previous lung contusion and hemorrhagic shock there is definite lung damage from IMN. This is probably mediated by stimulation of PMNL.

Animals↗
PubMed1991

A prospective evaluation of myocardial contusion: correlation of significant arrhythmias and cardiac output with CPK-MB measurements.

Over a nine-month period, patients with chest trauma were prospectively evaluated for myocardial contusion. Ninety-two patients with evidence of anterior chest trauma were entered into the study and had 1) an ECG on admission and daily for three days; 2) monitoring of the myocardial band fraction of creatine phosphokinase (CPK-MB) on admission and every eight hours for 24 hours; 3) continuous electrocardiographic Holter monitoring for three to five days; and 4) noninvasive pulsed-Doppler cardiac output measurements daily for three days. Twenty-three patients developed 25 significant arrhythmias (SARRs): 1 atrial fibrillation, 1 AV dissociation, 5 supraventricular tachycardias, and 18 paroxysmal ventricular tachycardias. Cardiac outputs were significantly higher in those patients without SARRs. The CPK-MB levels correlated with the SARRs but were neither sensitive nor specific. No patients required specific therapy and none developed adverse sequelae of the SARRs. We conclude that 1) CPK-MB monitoring should not be routinely used for screening and diagnosis; 2) continuous arrhythmia monitoring deserves further clinical investigation but not routine application; 3) stable patients at risk for myocardial contusion should be monitored for 24 hours; and 4) the Abbreviated Injury Score for "minor" myocardial contusion should be deleted for purposes of ISS tabulation.

Adolescent↗
PubMed1987

[Contusion of the heart].

Whereas heart contusion can be identified by autopsy as a traumatic damage to the heart, clinical diagnosis during life is mostly made by exclusion only and subsequently, the more so since there is no absolutely reliable parameter that permits diagnosis ad hoc. Complications often develop only hours or days after the accident. Heart contusion can be masked by haemorrhagic-traumatic shock and accompanying injuries and delay its diagnosis. Traumatic damage to the myocardium can equal a myocardial infarction. Hence, it is imperative that persons injured in an accident who are suspected of having suffered a contusion of the heart, are placed in an intensive-care ward to recognise complications well in time and to institute therapeutic measures without delay. As is the case with acute myocardial infarction, anaesthesia and surgery can be performed only in case of a vital indication.

Arrhythmias, Cardiac↗
PubMed1987

[Diffuse pulmonary contusion].

Seventy-two cases of diffuse pulmonary contusion, 50 of which concerned multiple injury patients, are retrospectively described. The pleuro-parietal and associated lesions, the clinical, radiological and laboratory findings and the extent of the damage are analyzed. Treatment of shock (50 cases), mechanical ventilation (51 cases), thoracotomy (7 cases) and surgery of associated lesions are studied. Morbidity and mortality (34.7%) are detailed. The nosology of pulmonary contusion is discussed in relation to several factors, including shock, perfusions and associated lesions. The principles of treatment are restated. The most important complication is pulmonary superinfection. Diffuse pulmonary contusion is a serious condition. Associated lesions and their treatment contribute to its outcome.

Adult↗
PubMed1988

Graded experimental myocardial contusion: impact on cardiac rhythm, coronary artery flow, ventricular function, and myocardial oxygen consumption.

Current management of myocardial contusion is based on experience with ischemic heart disease, but the mechanism responsible for cardiac dysfunction may be quite different. The purpose of this study was to characterize the pathophysiology of myocardial contusion in a controlled animal model. Sprague-Dawley rat hearts were prepared on a standard Langendorff apparatus, and myocardial function (DP, + dP/dT, - dP/dT) measured via a left ventricular balloon. Bipolar atrial and ventricular leads were placed to define conduction changes. Coronary sinus effluent was sampled for pO2, pH, creatine phosphokinase (CPK), and lactic dehydrogenase (LDH). The hearts were freeze-clamped to measure phosphocreatine (PC) and adenosine triphosphate (ATP). Myocardial contusion was produced by a single blow with a weighted pendulum. Hearts were divided into control (n = 5), moderate impact--Group I (n = 5), and major impact--Group II (n = 5). Group I sustained a 25% decrease in function after an impact of 78 +/- 5 mJoules/gm, and Group II a 50% deficit after 87 +/- 7 mJoules/gm. Impact resulted in complete electrical arrest, followed by sequential ventricular, atrial, and AV nodal recovery; recovery time correlated directly with degree of injury. Coronary flow at 2 min postinjury was decreased (p less than 0.05) in Group I (12.8 +/- 0.8 ml/min) and Group II (11.5 +/- 1.3) compared to control (17.2 +/- 0.5), and returned to baseline levels at 20 min. LDH and CPK levels were twice as high in Group II as in Group I. The PC/ATP ratio in Group II increased from 1.63 at baseline to 2.54 (p less than 0.05) at 25 min, confirming ischemic reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

[Contusions of the abdomen in children].

Marked progress in the treatment of abdominal contusions in children over the last few years is due to the development of conservative surgery to the spleen and even possible abstention from operation following splenic injuries. The reliability of paraclinical exploratory procedures has increased, and ultrasound and CT scan imaging have reduced the need for peritoneal puncture-lavage. However, and unresolved problem concerns associated visceral lesions, and although treatment of isolated splenic injuries is fairly well detailed that of hepatic lesions raises difficulties because of lack of data on exact location of lesions and the anatomical damage produced. Injuries provoked and treatment instituted are described in relation to children admitted for severe abdominal contusions between 1970 and 1985. Since 1984, 52 children have undergone initial ultrasound imaging and only 6 (8%) peritoneal puncture-lavage procedures were necessary. Ultrasound is of value for diagnosis of a hemoperitoneum but of very limited use for defining sites of lesions, a more refined diagnosis being established by computed tomography. Finally, routine simplified emergency intravenous urography is performed in any child with severe abdominal contusion with even microscopic hematuria to detect possible subadventitial rupture of renal artery.

Abdominal Injuries↗
PubMed1987

[Diagnosis of contusion of the heart].

Experiences with diagnostics of contusion of the heart in 96 patients were analyzed. A complex of methods has been proposed for express-diagnostics of contusion of the heart which allowed the contusion to be reliably differentiated from other manifestations of the trauma disease. Topographic anatomic peculiarities of the injury were established more exactly as well as a degree of the trauma and the adequate treatment could be started in due time. The outcomes of the trauma became better, lethality was reduced.

Adolescent↗
PubMed1987

Experimental post-contusive osteoarthritis of the knee: quantitative microscopic study of the patella and the femoral condyles.

A contusive procedure has been developed for the induction of a predictable and reproducible degenerative joint disease in knees of rabbits. Significant degeneration was observed in patella, condyles, and trochlea. These lesions included fibrillation, ulceration and erosion, clones of chondrocytes, and osteophyte formation. The incidence and distribution of lesions with time following contusion were also investigated. Lesions were observed as early as 1 day post-contusion and increased in number and severity. A global scoring system has been devised to permit comparisons of lesion incidence and severity, specially to test drug efficacy in this model of osteoarthritis.

Animals↗
PubMed1986

The contused kidney, an angiographic picture.

Problems in the interpretation of an angiogram of a contused kidney are reported. The angiogram showed signs of avascularity and tumor vessels and a malignancy was considered. However, on operation the kidney appeared to be contused but otherwise normal. One should be aware of the possibility of pitfalls arising in early angiograms of contused kidneys.

Adult↗
PubMed1977

[Inversion of intraheptic portal flow in contusions of the liver: a new concept of traumatic arterioportal fistulas (author's transl)].

Inversion of the intrahepatic flow is a phenomenon commonly observed during the initial days of a liver contusion. Its symptomatology combines one direct sign: segmentary, peripheral arterioportal reflux; and two indirect signs: arteriolar hypervascularization and a functional amputation of portal flow on selective arteriography of the superior mesenteric artery in the same territory. The direct sign may be absent, and may not be visualized in the absence of a selective injection. Both indirect signs are always present and enable the diagnosis. In most cases it is a question of a transient phenomenon secondary to a inflammatory reaction released by the contusion of the liver parenchyma; it may be the only sign of liver trauma. It may be a sign of a benign contusion and is not alone an indication for surgery. This concerns a hemodynamic phenomenon which must be clearly differentiated from arterioportal fistulas with which it is often confused.

Adult↗
PubMed1983

Myocardial contusion in chest trauma.

Because myocardial dysfunction may result from severe trauma, the author assessed, prospectively, left and right ventricular function in 25 patients who had sustained severe trauma, including blunt chest injury, by electrocardiographically gated blood pool radionuclide angiography. Focal abnormalities of ventricular wall motion were defined in 17 patients: right ventricular in 12, left ventricular in 2 and biventricular in 3. Traumatic tricuspid insufficiency demonstrated in two patients was subsequently verified by contrast angiography. Other means of detecting myocardial contusion (enzymatic, electrocardiographic and scintigraphic) proved to be insensitive when compared with radionuclide angiography. Two of the five deaths were attributed to refractory arrhythmias. Surgical or autopsy evidence of traumatic myocardial injury was obtained in five instances when radionuclide angiography indicated contusion. Of the 13 patients available for follow-up, 11 showed complete or partial resolution of the ventricular wall abnormality and in 2 there was no change. Comprehensive cardiopulmonary monitoring revealed an inverse relation between the right ventricular ejection fraction and pulmonary vascular resistance as well as between the pulmonary vascular resistance and left ventricular ejection fraction and left ventricular end-diastolic volume. Further, as the right ventricular end-diastolic volume was increased in trauma, left ventricular function and compliance were reduced. In blunt chest trauma, right ventricular contusion occurs more frequently than has been recognized previously and positive radionuclide angiography constitutes prima facie evidence of direct myocardial injury. Moreover, left ventricular function remains preload-dependent, but may be depressed by elevated pulmonary vascular resistance, impeding the blood flow from the right to left ventricle, and decreased left ventricular compliance, or both.

Accidents, Traffic↗
PubMed1978

Myocardial contusion: effect of intra-aortic balloon counterpulsation on cardiac output.

Intra-aortic balloon counterpulsation (IABCP) improves impaired left ventricular (LV) performance associated with myocardial ischemia. We have evaluated the effect of IABCP on cardiac output (CO) after blunt trauma to the heart where LV performance is impaired by myocardial contusion but coronary blood flow is normal. Contusion of 20 to 40% of the LV in 13 dogs decreased CO by 41% +/- 6.4. A 30-minute period of IABCP was followed by 30 minutes without IABCP with three assist periods in each animal unless death occurred. Immediate IABCP after injury in six dogs increased CO 14% +/- 3.8 (p less than 0.01). Treatment was delayed for 30 minutes in seven dogs, and CO further decreased 0.7% +/- 3.2; initiation of IABCP then increased CO 9.2% +/- 6.5 (p less than 0.05). When CO was decreased less than 25% or greater than 50% after injury, IABCP had no effect on CO. In midrange when CO decreased 25 to 50%, IABCP increased CO 12.5% +/- 3.2 (p less than 0.001 initially, 9.3% +/- 1.3 (p less than 0.005) with second assist, and third assist 5.6% +/- 2(NS). It is concluded that IABCP improves LV performance following myocardial contusion, especially when applied early after injury.

Animals↗