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PubMed1990

Regional cerebral blood flow after a localized cerebral contusion in pigs.

Regional cerebral blood flow (rCBF) in anaesthetized pigs is investigated before and after an induced focal cerebral contusion. Mean intracranial pressure increased for a short period following the contusion and reduced perfusion pressure to 60% of control pressure. Forty five minutes later the mean intracranial pressure was still high and different from the control values. Global flow and cerebral production of CO2 increased concomitantly. In the cortical region where the contusion was visible macroscopically the rCBF diminished from 36.5 to 29.1 ml/min/100 g. In the rest of the grey matter the rCBF raised after the contusion with an increase away from the centre of the lesion. CBF of cortical grey matter in the region symmetrically to the contusion increased significantly more than in the traumatized hemisphere. White matter rCBF changed least in the region underlying the contusion, while an increase was observed away from the contusion and on the opposite side of the brain. The correlation between tension of CO2 in arterial blood and regional cerebral blood flow disappeared in the region of the contusion. The correlation between global metabolism and regional cerebral blood flow disappeared after the contusion in all regions. Local flow modulating factors influencing flow in the region of macroscopically visible injury has influence abating with distance from the centre of the injury together with a possible neuronally transmitted drive on flow in the opposite hemisphere.

Animals↗
PubMedDate not supplied

Comparison of bone contusion seen by MRI in partial and complete tears of the anterior cruciate ligament.

OBJECTIVE: Bone contusions are frequently found in association with complete tears of the anterior cruciate ligament (ACL) and can be a helpful secondary sign in diagnosis. We compare the frequency, location, and significance of bone contusions in complete and partial ACL tears. MATERIALS AND METHODS: Twenty-nine patients with complete and 42 patients with incomplete tears of the ACL were examined by MRI for the presence of accompanying bone contusions within 1 month of injury. RESULTS: Bone contusions were found in 72% of the complete ACL tears but in only 12% of the partial tears. Of the partial ACL tears with accompanying contusions, 80% were high grade injuries that eventually went on to complete rupture within 6 months. Only 16% of the partial ACL injuries without bone contusion progressed to complete rupture at 1-2 year follow-up. There was no difference between the bone contusions of partial and complete tears in terms of general appearance and location. They were predominantly in the lateral compartment (90%) and had a specific predilection for the mid portion of the lateral femoral condyle and the posterior portion of the lateral tibial plateau, often occurring in tandem. CONCLUSION: Bone contusions occur with much less frequency in partial ACL tears than in complete tears but their presence in partial rupture favors a high grade tear that is likely to become complete.

Adolescent↗
PubMed1984

Technetium-fibrinogen lung scanning in canine lung contusion.

To detect experimentally induced acute lung contusion in anesthetized dogs, serial radionuclide images of the lung were recorded following intravenous infusion of 99mTc-labelled human fibrinogen (Tc-HF). The accumulation of Tc-HF in canine lungs was serially quantitated for up to 20 hours after lung contusion. A contusion (#1) was produced in one lung, Tc-HF was injected IV after 15 minutes, and 75 minutes later a contralateral lung contusion (#2) was produced in a series of 14 dogs. At autopsy the excised lungs were scanned, sectioned, and counted for radioactivity. Radiolabelled fibrinogen accumulated within 2-4 minutes of contusion #2 and remained stable over the next 20 hours in 14 dogs; contusion #1 was barely visible in four dogs. Lung Tc-HF activity in the central region of contusion #2 remained sixfold higher than in normal lung tissue. These data suggest that following lung contusion, fibrinogen deposition occurs rapidly and remains stable over a 20-hour interval of observation.

Animals↗
PubMed1990

Oedema fluid formation within contused brain tissue as a cause of medically uncontrollable elevation of intracranial pressure: the role of surgical therapy.

In patients with focal cerebral contusions, medical therapies have generally been advocated unless haemorrhages significantly contributing to the elevated intracranial pressure (ICP) exist. We report here several lines of clinical evidence which indicate that (1) enormous amount of extracellular oedema fluid is formed within contused brain tissue, (2) the formation of extracellular oedema fluid within contused brain tissue alone can be a cause of medically uncontrollable elevation of ICP and (3) surgical excision of the contused brain tissue provides excellent control of the elevated ICP in such patients. The excision of contused brain tissue appears to be the only therapy currently available to alleviate the formation of extracellular oedema fluid in cerebral contusions. We believe that, if ICP is elevated primarily by extracellular oedema due to cerebral contusions and the elevated ICP is medically uncontrollable, surgical excision of contused brain tissue should be carried out without delay regardless of the size of associated haemorrhages.

Body Fluids↗
PubMed1994

Bilateral frontal cortical contusion in rats: behavioral and anatomic consequences.

The purpose of this study was to develop a bilateral model of frontal cortical contusion in the rat that would demonstrate reproducible deficits typically found after frontal lobe injury in humans. We used a pneumatically controlled cortical impactor to create bilateral contusions of the medial prefrontal cortex (PFC) in adult male Sprague-Dawley rats. Cognitive, neurologic, physiologic, and histopathologic measures were used to evaluate changes caused by the injury. The cognitive task employed the Morris water maze (MWM). Contused rats performed worse than sham-operated controls on measures of time taken to find a submerged platform, distance to the platform, and swim strategy. Neurologic measures revealed impairments of tongue mobility and transient deficits of forelimb placing. Body weights of the contused rats were chronically reduced with respect to controls, indicating that cortical contusion produces disruption in homeostasis. All rats given bilateral PFC contusions developed marked necrotic cavities at the site of impact. The borders surrounding the cavities were heavily lined with astrocytes and ameboid microglia. There was subcortical gliosis in the medial caudate that extended throughout the rostral-caudal length of the caudate-putamen and into the mediodorsal (MD) and ventrolateral (VL) nuclei of the thalamus. The thalamus was also the site of distal transneuronal degeneration. In both the MD and the VL, there was significant neuronal loss in the contused rats as compared with sham-operated controls. This method of bilateral cortical contusion demonstrates clear, reproducible results that would be required for the development of future pharmacologic therapies designed to promote functional recovery.

Animals↗
PubMed1989

[Changes in local cerebral glucose utilization, DC potential and extracellular potassium in various degree of experimental cerebral contusion].

UNLABELLED: Pathophysiology of the traumatized brain, especially that of cerebral contusion, is very complex and has not been well understood. In recent years, changes in extracellular ion concentration have been known in various pathological conditions such as cerebral concussion, spinal contusion, ischemia, hypoglycemia, epilepsy and spreading depression as one of the triggers to lead to secondary brain damage. To know the metabolic and ionic changes following cerebral contusion, the authors made various degree of cerebral contusion by fluid percussion method, and observed successive changes in EEG, DC potential, extracellular potassium concentration and local cerebral glucose utilization (LCGU). MATERIALS AND METHODS: Using 42 male Wistar rats, mild (0.2 kg/cm2), moderate (0.4 kg/cm2) and severe contusion (0.6 kg/cm2) were made in the left lower parietal region of the rats. EEG, DC potential and extracellular potassium concentration (using potassium sensitive glass microelectrode) were monitored for four to five hours after making the contusions. LCGU (by 14C-2-deoxyglucose method) was studied at the time of the negative shift of DC potential. RESULTS: The negative shift of DC potential with EEG suppression was observed at 30 min. to 3 hours after injury. The severer the injury was, the earlier and the more frequent negative shifts appeared. LCGU showed no significant changes in the mild injury group. In the moderate injury group, frequent negative shifts of DC potential associated with EEG suppression were observed. A 20% increase of glucose utilization in the cortex of the lesion side was observed whereas 50% decreases in the subcortical structures were found. In the severe injury group, EEG was suppressed immediately after contusion and had never recovered. DC potential fluctuated and was unstable. The increase of LCGU was noted not only in the cortex of the lesion side but also in some of the subcortical structures (hippocampus, caudate nucleus, dentate nucleus and thalamus). The extracellular potassium concentration rose to 30 mM, being correlated closely with DC potential. DISCUSSION: Increase of LCGU associated with EEG suppression, negative shift of DC potential and elevation in extracellular potassium concentration was thought to be due to spreading depression. It was postulated that spreading depression following cerebral contusion causes energy failure and can lead to secondary brain damage.

Animals↗
PubMed1990

Cardiac contusion in pediatric patients with blunt thoracic trauma.

To investigate the prevalence of myocardial contusion associated with blunt chest trauma in the pediatric age group, all patients admitted to our institution during a 6-month period with blunt thoracic trauma severe enough to produce a pulmonary contusion or rib fracture were prospectively evaluated. Cardiac evaluation was undertaken, including a multiple-gated acquisition (MUGA) cardiac scan, serial electrocardiograms (ECG), and serum creatine phosphokinase (CPK) and CPK isoenzymes. Seven patients, ranging in age from 2 1/2 to 18 years, with rib fractures or pulmonary contusion by chest roentgenograph were identified. One patient was injured as a passenger in a motor vehicle accident, five were struck by automobiles as pedestrians, and one sustained traumatic asphyxia when a car, supported by a jack, fell on his chest. All had at least one other major organ system injured. All patients had pulmonary contusions as determined by chest radiograph, and two had associated rib fractures. In 43% (three of seven) of patients, a significant cardiac contusion was identified, defined by abnormal right or left ventricular wall motion and a decreased ejection fraction on MUGA scan, and confirmed by an increase in cardiac enzymes and isoenzymes. However, in contrast with adults, no patients had ECG abnormalities. This limited series suggests that cardiac contusion may occur frequently in pediatric patients who have suffered from blunt thoracic trauma significant enough to result in pulmonary contusion. An MUGA scan provides a rapid, noninvasive assessment of cardiac damage in this setting. Further studies will be required to determine the clinical significance and long-term consequences of traumatic myocardial damage in the pediatric population.

Accidents, Traffic↗
PubMed1979

Pathophysiology of pulmonary contusion in dogs.

We produced a localized right lower lobe (RLL) contusion in 14 anesthetized ventilated dogs, 7 of which were treated with positive end-expiratory pressure (PEEP group). We measured gas exchange, pulmonary mechanics, and regional function before and 5 h after the contusion. Arterial PO2 decreased by 20 Torr and venous admixture doubled in both groups during air breathing. The shunt fraction (Qs/Qt) was minimally increased, despite a large lobar Qs/Qt (0.43) in the contused RLL. These results were explained by reduced ventilation per unit volume (VA/V), and ventilation-to-perfusion ratios of the contused RLL measured with 133Xe technique. We conclude that pulmonary contusion causes a leak of blood and plasma, flooding 25% of the air spaces of the RLL at FRC, reducing the compliance of adjacent air spaces, and resulting in a reduced VA/V and a large RLL Qs/Qt. These results are consistent with the observed reduction in regional volume and perfusion in the contused RLL, and suggest that Qs/Qt was not increased because blood flow was markedly reduced to flooded air spaces. PEEP reduced the hypoxemia, but increased the contusion.

Animals↗
PubMed1989

Myocardial contusion in the stable patient: what level of care is appropriate?

To evaluate the significance of myocardial contusion, we evaluated 243 stable patients hospitalized for blunt chest trauma between 1982 and 1986. The groups were identified according to results of radionuclide angiography, mean injury severity score (ISS), and outcome. Group I (n = 71; mean ISS = 12.7) patients were those without myocardial contusion by radionuclide angiography. Two patients with cardiac complications were in this group. The patients with myocardial contusion were divided into two groups. Group II (n = 69; ISS = 19.5) patients had myocardial contusion as an isolated injury, and group III (n = 103; ISS = 30.9) patients had myocardial contusion and injury to at least one other organ system. Three patients from group II had cardiac complications. Eleven patients from group III had cardiac complications. There were no significant differences between the cardiac complication rate in the three groups, and each complication was present when the patient arrived in the emergency department. The predicted mortality rate based on ISS was 10% to 20% for patients with myocardial contusion, whereas the observed mortality rate for the groups (II and III) overall was 0.58%. We conclude that in the stable trauma patient myocardial contusion (1) does not by itself increase the risk of complication, (2) does not necessitate intensive care unit monitoring, (3) should be devalued when computing ISS scores, (4) may account for lengthy and often unnecessary hospitalization, and (5) in patients at risk for complications may be identified by ECG abnormalities on arrival to the emergency department.

Adolescent↗
PubMed1988

MR imaging of brain contusions: a comparative study with CT.

Ninety-eight brain contusions in 17 patients served as a data base for a comparative study of MR and CT for defining brain contusions. MR was the more sensitive technique, detecting 98% of the brain contusions compared with only 56% by CT. CT was slightly better for showing hemorrhagic components, documenting 77% of hemorrhages compared with 71% for MR. The appearance of the contusions on MR was variable, depending on the T1- and T2-weighting of the images and the constituents of the contusions, such as edema, hemorrhage, and encephalomalacia. On MR, hemorrhagic components appeared as high signal on T1-weighted images and as either low or high signal on T2-weighted images, depending on the age of the hemorrhage. The approximate ages of hemorrhagic contusions were often suggested by their appearance on T1- and T2-weighted images. CT is very effective for evaluating acute head trauma, but MR is recommended for documenting brain contusions during the subacute and chronic stages of head injuries.

Adolescent↗
PubMed1976

[Coxarthrosis due to contusion].

Can a contusion cause coxarthrosis in the absence of both fracture and dislocation? Yes. To demonstrate this the authors report 6 cases that fulfil the following conditions: (1) Simple but violent contusion affecting the greater trochanter or the knee (dashboard accident) or a forced movement, such as in doing the splits; (2) immediate or slightly delayed pain, generally of short duration (a few weeks); (3) absence of coxarthrogenic malformations and absence of pre-existing signs of a pathological hip condition; (4) progressive coxarthrosis on the side of the contusion; (5) chronological relation between the development of the coxarthrosis images and the date of the contusion; (6) subjects less than 35 years of age, in order to eliminate cases with latent primary pre-coxarthrosis. The average age of the six patients at the start of the coxarthrosis was 24.7 years (range: 13 to 33 years); there were four men and two women. In five of the six cases a violent contusion in the trochanter region was involved as a result of a fall on a hard surface or a traffic accident. In one case a forced movement on landing from a jump was involved. Evolution in three periods is usual: the hip is painful either immediately or after a few weeks (particularly on rising after a period in bed for multiple injuries). This post-traumatic pain lasts from ten days to one month, rarely longer. It is followed by a period free of pain that may last from five months to ten years (average: five years). Subsequently there is pain every day and the onset of the limp associated with coxarthrosis. Radiographically the reduction of the joint space and/or the osteophytosis appears after three months to two years (average: one year). However, there may not be any pain associated with these lesions for a long time. The authors propose that the first five conditions enumerated above represent the essential medico-legal conditions of coxarthrosis by contusion. The restriction as regards age (No 6) was introduced only to show clearly the existence of post-contusive coxarthrosis. However, even if one or more of the medico-legal conditions are not fulfilled the imputability may still be valid. Some such cases are discussed.

Adolescent↗
PubMed1978

[Neurological and EEG-follow-up studies in head-injured adults: criteria for the clinical diagnosis concussion and contusion (author's transl)].

A stystematic neurological and electroencephalographical follow-up study in 344 head injured adults gave the following results: 1. 52% of all the hospitalized (mostly primarily amnesic) patients had a cerebral contusion. A contusion was assumed in cases with focal neurological signs (13%), amnesias of more than 8 hours (16%) and/or EEG-abnormalities lasting for more than 24 hours (49%). 2. Traumatic EEG-abnormalities were general slowing (43%) and foci (32%). In 40% of the cases with general slowing the slowing (greater than or equal to 1.5/sec) was within the alpha-frequency band and could only retrospectively be assed. 3. The EEG was invariably abnormal in cases with an amnesia exceeding 8 hours. If the amnesia exceeded 1 hour abnormalities were found in 73%. 4. Among the patients with contusion 6.5% had no amnesia, 48% less than 30 minutes and only 30% an amnesia for more than 8 hours. In 75% of the patients with concussion amnesia lasted less than one hour. 5. Skull fractures were mostly combined with contusion (74%). 6. Impaired drive, reduced ability to concentrate, memory deficits, headache and dizziness were significantly more frequent 6 months after contusion than after concussion. 7. 21% of the patients with traumatic dizziness (44%) had a labyrinthine contusion. 8. Among the contusions diagnosed with the aid of EEG recordings 58% would have been missed after exclusive neurological examination and 82% after application of the classical criteria used by surgeons and general practitioners.

Adolescent↗
PubMedDate not supplied

[Determination of the degree of severity of cerebral contusions].

Three degrees of severity of the brain contusion are generally distinguished today for working out the most rational and purposeful treatment. It is quite difficult to judge the severity of the contusion from the neurological picture alone because neurological manifestations of the brain contusions are very diverse and dynamic in character. The authors analysed 630 case records of patients with contusion of the brain and disclosed signs most characteristic of each degree of contusion. In appraising the severity of the contusion, the authors recommend resorting to the laboratory and instrumental diagnostic methods accepted currently in neurosurgical practice in addition to the neurological examination. The complex method of appraising the patients' condition makes the determination of the degree of severity of the brain contusion more trustworthy and objective.

Brain Concussion↗
PubMed1984

Ureteral contusion with gunshot wounds.

The entity of ureteral contusion with a gunshot wound has not been well described in the literature. The blast effect of the bullet, even one of low velocity, can cause contusion of the ureter manifested by hematuria, no extravasation on the IVP, and a normal appearing ureter or some bruising of the ureteral wall and periureteral tissues. The ureteral contusion may resolve or may progress to delayed necrosis of the ureteral wall with urine leakage. Twelve cases of ureteral contusion with gunshot wounds are reported. The ureter was found contused at exploration in two patients; one had excision of the contused area with end-to-end anastomosis and the other had a nephrostomy and ureteral splint. The ureter appeared normal in ten patients and no immediate treatment was performed to the ureter; eight had no postoperative evidence of urine leakage and two developed a urinary fistula.

Adult↗
PubMed1979

Effects of contusion and flail chest on pulmonary perfusion and oxygen exchange.

Localized pulmonary contusions were produced in the right lower lobes (RLL) of 12 anesthetized ventilated dogs, 6 of which had a flail segment in the chest wall over the RLL. Pulmonary oxygen exchange during ventilation with air and oxygen, and the lobar distribution of pulmonary perfusion by radioactive microsphere techniques were measured before and 3 h after contusion, and again after thoracotomy. These were compared to 12 noncontused dogs, 6 of which had a flail segment. Contusion produced an average decrease of 20 Torr in Pao2 during air breathing and an average increase in Qs/Qt of less than 5%, surprisingly small given the doubled weight and average 44% shunt calculated in the contused lobe after thoracotomy. No significant effect of flail or thoracotomy was found, indicating that the presence of an intact chest wall and lung-chest wall interdependence was not a major factor preventing a larger increase in intact whole-animal shunt of contused dogs. Rather, the small effect of this severe lobar injury on whole-animal shunt was due to a 30% decrease in RLL relative perfusion. This reduction was demonstrated to be localized to a smaller hemorrhagic subsection of the contused lobe.

Animals↗
PubMed1992

Altered patterns of reflex excitability subsequent to contusion injury of the rat spinal cord.

1. The present study investigated regulation of reflex excitability after experimental contusion injury of the spinal cord. 2. Four measures of H-reflex excitability were evaluated in normal rats and at 6, 28, and 60 days after contusion injury at the T8 level: 1) reflex thresholds, 2) slope of the reflex recruitment curves, 3) maximal plantar H-reflex/maximal plantar M-response (Hmax/Mmax) ratios, and 4) rate-sensitive depression (i.e., the decrease in reflex magnitude relative to repetition rate). 3. Tested as a function of the afferent volley magnitude, the thresholds for reflex initiation fell progressively subsequent to contusion injury. No change was observed at 6 days postinjury, and the decrease at 28 days was not significant. However, by 60 days postinjury, the threshold had decreased by 23% of the maximal afferent volley, and this decrease was significant, [analysis of variance (ANOVA, P < or = 0.01)]. 4. Hmax/Mmax ratios elicited in postcontusion animals at 0.3 Hz were not significantly different from those recorded in normal animals. 5. The slopes of the recruitment curves were markedly reduced subsequent to contusion injury. The decrease was greatest at 6 days postinjury. Although some recovery toward normal occurred at 28 and 60 days postinjury, the slopes of recruitment curves in postcontusion animals remained significantly decreased. 6. H-reflexes elicited at 1-5 Hz were less sensitive to rate depression in postcontusion animals than in normal animals at the same respective frequencies. The decrease was progressive in onset, becoming significant by 28 days postinjury, and of an enduring nature, i.e., still significantly different from normal in the reflexes tested 60 days postinjury. 7. Rate sensitivity of the tibial nerve monosynaptic reflex (MSR) was also compared in normal and postcontusion animals. Rate sensitivity of the tibial MSRs was significantly reduced at 28 and 60 days post-contusion, compared with normal animals. 8. These data indicate that significant changes in lumbar reflex excitability result from midthoracic contusion injury of the spinal cord. These changes include reflex threshold, slope of recruitment, and rate-sensitive depression. Although recruitment slope was most altered in the shortest postinjury interval tested, followed by some recovery, the other changes were progressive in onset and enduring in duration.

Animals↗
PubMed1984

Right ventricular contusion: experimental pathophysiology and treatment in an open-chest canine preparation.

To investigate the pathophysiology and treatment of right ventricular (RV) contusion we assessed biventricular function via volume expansion in eight open-chest, anesthetized, ventilated dogs. Measurements were obtained before and after RV contusion with a captive bolt pistol and during dobutamine infusion. RV contusion depressed both RV and left ventricular (LV) performance as assessed by classical ventricular function curves (p less than 0.05). Dobutamine reduced filling pressure (p less than 0.05) and increased cardiac output (CO) (p less than 0.01) when infused post contusion. Because, on inspection, the LV was not contused, the apparent depression in LV function is most likely due to reduced diastolic compliance secondary to ventricular interdependence. In support of this possibility, in four dogs, LV performance significantly improved (p less than 0.05) when the pericardium was opened. We conclude that RV contusion can depress the relationship between CO and filling pressures in both ventricles and that dobutamine is superior to volume in treating the resultant low cardiac output state.

Animals↗
PubMed1991

Implantation of neuronal suspensions into contusive injury sites in the adult rat spinal cord.

Implants of various types of neuronal and nonneuronal tissue have shown promise for the amelioration of certain disorders of the adult mammalian brain. Implants may also have therapeutic potential for some lesions of the spinal cord. To examine the feasibility of implantation for clinically relevant spinal cord injuries, we have implanted cells into injury sites produced by a well-characterized and standardized rat model of contusive injury. To reduce the possibility of the implantation procedure itself causing damage to the spinal cord, the tissue was dissociated and a suspension of cells introduced into the cord via a small bore needle. To test the implantation procedure, dissociated adult rat dorsal root ganglia were used because of the ease with which these neurons could be distinguished after implantation. The extent to which functional deficits were produced or exacerbated by the implantation procedure was assessed by behavioral tests of groups of rats that had been implanted (implant controls), contused (injury only) or contused and implanted (injury-implant). Survival of the implanted neurons was assessed by quantitative morphological analysis of histological sections taken through the injury/implant sites at different times following injury. In addition, the histopathology of the contusive injury sites was compared for rats that had or had not received immediate or delayed implants. Results indicated that cell suspensions could be implanted into the spinal cord without causing a functional deficit in an otherwise uninjured animal or exacerbating a standardized incomplete contusive injury. Implanted neurons survived for at least 4 weeks in all contusion sites whether implantation was performed immediately following injury or after a delay of 1 week.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗