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PubMed1983

Cardiac contusion: a new diagnostic approach utilizing two-dimensional echocardiography.

In the past, myocardial contusions after blunt thoracic trauma have been frequently overlooked or missed unless hemodynamic instability or dramatic electrocardiographic findings were observed. We now know that this entity is more common than once believed. However, our understanding of cardiac contusions remains unclear and obscure because of the inability to diagnose the condition accurately. Chest roentgenograms, electrocardiograms, and radionuclide imaging have had less than optimal success. We believe that the serial determination of creatine phosphokinase-myocardial band isoenzymes and subsequent two-dimensional echocardiographic sector scanning are the most sensitive indicators of structural and functional cardiac injury presently available.

Adolescent↗
PubMed1978

[On the proof of late sequelae of bulbal and orbital contusion (author's transl)].

Contusion cataracts may develop long time after injury, without visible lens changes in the interval. The lens opacities appear like those known in senile cataracts if the eye was injured after the 45th year of age. Demonstration of other traumatic changes becomes then very important for the evaluation of the role of the accident as a cataract cause. As late sequelae of eye (and orbit) contusion, enophthalmos and supersensitivity of the pupil to adrenergic drugs can be found. Ultrasound exophthalmometry proved to be more accurate for checking the former than Hertel's optical exophthalmometry alone. The pupil was studied by the reaction following local instillation of one drop of 1% adrenaline solution (comparison with other eye). The results found in 2 patients are described.

Adult↗
PubMed1982

Controversies in the management of pulmonary contusion.

Most polytraumatized patients with lung contusion also have injury to the chest wall. Both are serious but the lung contusion is most important in contributing to respiratory failure. A small and localized injury to the lung leads to generalized edema in surrounding lung and even in the opposite lung. The permeability of capillaries is affected and there is an outpouring of the fluid through a leaking pulmonary membrane. Diagnosis is easy when the condition is straightforward and severe, but may be complicated in a confused or unconscious patient with or without head, abdominal and orthopedic injuries producing shock. Pulmonary aspiration and pneumonia may cloud the issue. Aggressive chest physiotherapy combined with the reduction of pain by local intercostal blockade or epidural anesthesia may obviate the need for mechanical ventilation.

Contusions↗
PubMed1978

A model for evaluating the ocular contusion injury potential of propelled objects.

The existing data on experimental ocular contusion were analyzed in terms of a simple mathematical model which predicts the maximum contact force between the eye and the impacting projectile. It was shown that this force was related to the injury producing mechanism, eyeball expansion, which was widely advocated in the literature. The effect of loading rate was also accounted for in the model. A dimensional analysis allowed previous experimental data to be used to generate tolerance curves for ocular injury. The agreement between the prediction of the model and previous subjective opinions of a panel of ophthalmologists was considered to be satisfactory. When the model was used to predict the hazard potential of projectile toys which presently exist in the market place, it was found that the contusive injury producing capability of these products covered the full range from safe to hazardous.

Biophysical Phenomena↗
PubMed1982

Contusive trauma of the popliteal artery.

The writers have reviewed thirteen cases of contusive trauma of the popliteal artery which came under their observation. The incidence of such lesions in arterial trauma is 22 per cent. The limb was saved in 76 per cent; but the result was only functionally good in only 46 per cent. The fundamental factors for successful revascularization are early diagnosis and precise technique. The operation of choice is a by-pass using the saphenous vein from the contralateral limb; this "jumps" right over the focus of arterial contusion.

Adolescent↗
PubMed1980

[Contusion of the lung and intrapulmonary hematoma (author's transl)].

After a survey of possible lesions caused by obtuse traumata of the osseus thorax, the lung, the heart and the vascular system the radiological changes following the appearance of intrapulmonary hematoma after contusion of the lung are discussed by means of two case histories. The possibility of sucking off the blood coagula by bronchoskopy with the aid of Friedel's catheter in the case of big hematomas is suggested. A definition of contusion of the lung compared with the shocklung is attempted.

Adult↗
PubMed1995

[Treatment of suppurative contused wounds in the region of the metacarpophalangeal joints].

The results of treatment of 46 patients with purulent contused wounds in the region of the metacarpophalangeal joints are analysed. Damage to the articular capsule with development of arthritis occurred in 10 and damage to the capsule with osteoarthritis of the metacarpophalangeal joint in 18 patients. In 18 patients the joint was not involved in the pathological process. The treatment of such injuries consists in surgical debridement of the wound and obligatory inspection of the capsule of the underlying joint. If the articular capsule is damaged, drainage of the joint with installation of a drainage-irrigation system is performed and a primary suture is applied to the wound. If osteodestructive changes are found, sequestrectomy and drainage of the joint and wound is undertaken and a destruction apparatus is applied. It is emphasized that only timely surgical debridement of the purulent contused wound with inspection of the articular capsule guarantees successful treatment of this pathological condition.

Adult↗
PubMed1993

[Post-traumatic coxarthrosis. Medicolegal conditions of the likelihood of fractures, luxations or contusions].

Trauma is the cause of 5 to 10% of all cases of osteoarthritis of the hip. One third of patients with a dislocation or fracture-dislocation of the hip or an acetabular fracture develop osteoarthritis of the hip within one to 20 years. Symptoms may be minor or absent during the interval. In addition to severe injuries, simple contusions resulting for instance from a blow to the greater trochanter or knee or from forced abduction of the hip (e.g., splits) can also result in osteoarthritis of the hip. We developed a set of five imputability criteria, of which three are essential: 1) documentation of the exact nature of the trauma; 2) absence of osteoarthritis in the uninjured hip; 3) consistency between the estimated duration of osteoarthritis and the date of the injury. Causality assessment problems which arise when a trauma worsens or accelerates preexisting osteoarthritis are discussed on the basis of clinical and roentgenographic findings. Mechanical and biochemical factors involved in the pathophysiology of contusion-related osteoarthritis of the hip are briefly reviewed.

Adolescent↗
PubMed1994

[A case of infrarenal left inferior vena cava with macrohematuria after contusion in the lumber region].

A 33-year-old woman was admitted with macrohematuria after contusion in the left lumber region. The excretory urogram showed no abnormal findings, but color doppler and RI-angiography revealed infrarenal left-sided inferior vena cava (left IVC). The pressure in the dilated left renal vein was higher than that in the right one. Renal contusion in addition to the congestion of the left renal vein due to left IVC was thought to be the cause of hematuria in this case. Hematuria disappeared after retrograde instillation of 0.2% AgNO3 water solution into the left renal pelvis. Left IVC rarely presents clinical symptoms, and is usually found by chance on CT scan or ultrasonography during examinations for upper abdominal organs. Our case is the 69th one of left IVC in Japan, and belongs to Type 2' according to our classification of left IVC.

Adult↗
PubMed1993

[An experimental study of ocular contusion in rabbits: the changes in electroretinography].

In rabbits, the amplitude of a-waves and b-waves in the ERG declined following ocular contusion; however, the oscillatory potentials did not change markedly. In the anisodine therapeutic group, the amplitude of a-waves recovered higher than did that in the control group at the 2nd and 4th week post-traumatic, while all a-waves recovered at the 6th week in both groups. The amplitude of b-waves was restored to normal in 72 hours for all eyes. Since the a-wave was sensitive to contusion, it monitored the severity of damage and objectively evaluated the therapeutic effect of treatment.

Animals↗
PubMed1993

[Contusion of the eyeball. Changes in trauma types and their treatment].

All journals of patients admitted to the Eye Department, Ullevål hospital with the diagnosis ocular contusion were examined during three periods in the course of the 24 years from 1968 to 1991. The distribution of age, sex and number of patients in the different periods remained almost unchanged. The hospitalization period decreased from six days in the first period to two days in the last period, but this did not increase the incidence of complications. The number of working traumas was reduced, and traumas by violence remained unchanged. There was a large percentage increase in sport traumas, caused mainly by a ball, and these now account for more than 1/3 of all contusions. The prognosis was good in most patients.

Accidents, Occupational↗
PubMed1993

Myocardial contusion: new concepts in diagnosis and management.

Myocardial contusion is diagnosed with one or a combination of four diagnostic procedures: electrocardiography, echocardiography, creatine kinase MB fractions and/or radionuclide procedures. This article presents a critical review of 18 recent studies addressing the utility, sensitivity and specificity of these tests. Careful review suggests that clinically significant myocardial contusions as a result of blunt trauma are rare and may be detected simply and inexpensively using electrocardiography and careful physical examination. Serum myocardial enzymes and radionuclide studies are nonspecific and are not predictive of cardiac complications. Echocardiography is useful in the management of myocardial decompensation but not as a primary screening tool in blunt cardiac injury. Cost comparisons, resource allocation and implications for critical care practice are discussed.

Adolescent↗
PubMed1993

[Pulmonary embolism as a late complication of heart contusion].

A 57 year-old woman was hospitalized because of a sternal fracture inflicted during a car accident. During the following two weeks she became breathless and was readmitted after having syncope, induced by exertion. A perfusion scan of the lungs showed pulmonary emboli in both the lower lobes. After anti-coagulation treatment her symptoms faded, but the ultrasonographic signs of pulmonary hypertension persisted for nearly four months. The probable mechanism behind the pulmonary embolism was transmural contusion of the right ventricle, leading to a mural thrombus which eventually became detached. The authors review the literature and discuss problems connected to the diagnostic criteria for cardiac contusion, as well as delayed complications, of which pulmonary embolism is a potentially lethal condition.

Accidents, Traffic↗
PubMed1993

Combined severe myocardial and pulmonary contusion: early diagnosis with transesophageal echocardiography and management with high-frequency jet ventilation: case report.

We report the case of a 27-year-old patient with blunt thoracic trauma in whom transesophageal echocardiography enabled an early diagnosis of severe myocardial contusion. Conventional mechanical ventilation dramatically enhanced cardiogenic shock because of myocardial contusion, requiring increasing doses of catecholamine. High-frequency jet ventilation produced an immediate improvement in hemodynamic status, permitting a decrease in catecholamine administration.

Adult↗
PubMed1995

[Contusion of the lungs in childhood].

The authors evaluated in a retrospective study a group of 45 patients with contusion of the lungs (age 1 to 15 years) who were treated at the Faculty Hospital in Motol in 1989-1993. In 38 children contusion of the lungs was part of multiple injuries with signs of failure of vital functions. These children were admitted after the injury to the in-patient department of the Anaesthesiological and Resuscitation Clinic. Seven children without alterations of vital functions were treated at the Department of Paediatric Surgery. The diagnosis was based on the case-history, clinical examination, X-ray examination and laboratory signs of lung injuries. An isolated pneumothorax was found in 17.8% of the injured children, haemothorax in 8.9% and in 24.5% pneumothorax and haemothorax. Severe craniocerebral injuries were diagnosed in 71% of patients, 37.8% children had concomitant injuries of the abdominal organs and retroperitoneum and 42% had fractures of the long bones. 46.6% of the children had rib fractures. The condition of 35 injured children called for endotracheal intubation (on average for 17 days) and artificial ventilation (on average for 14.4 days). 98% of the injured children were given antibiotics, in 84% steroids were administered, in 18 of the injured children (40%) drainage of the thoracic cavity was essential. Six patients (13.3%) drainage of the thoracic cavity was essential. Six patients (13.3%) died--the cause of death were severe injuries of the CNS.

Adolescent↗
PubMed1996

Pulmonary contusion: a collective review.

Pulmonary contusion is the most common injury identified in blunt chest trauma. Despite improvements in diagnostic imaging and critical care, the associated mortality has not appreciably changed over the last three decades. Parenchymal injury ultimately manifests as alveolar collapse and lung consolidation. Early detection and intervention toward minimizing injury progression provides the greatest chance for survival. Avoiding fluid overload, oxygen therapy, and a low threshold for mechanical ventilation are useful therapeutic guidelines. Complications include pneumonia and adult respiratory distress syndrome, which may occur in up to one half of all cases. Pulmonary contusion is a serious injury that may complicate patient management as well as pose a vital threat.

Contusions↗
PubMed1996

[Contralateral lung contusion].

A 47-year-old man was admitted to the emergency room in November 1994 with left-sided chest pain. Two days before admission, he had fallen two meters and hit the left side of his chest. A chest roentgenogram showed patchy infiltrative shadows and a pleural effusion confined to the right lung field. Bloody fluid was obtained from the right B3b by bronchoalveolar lavage. Specimens obtained from the right lung by transbronchial lung biopsy revealed deposition of hemosiderin and precipitation of fibrin, which were consistent with lung contusion. The abnormal shadows on the chest roentgenogram disappeared spontaneously within one week. Review of the literature suggests that contra coup pulmonary contusion is rare, and that the mechanism might involve injury of small vessels by high-speed vibration of the contralateral part of the mediastinum.

Accidents, Occupational↗