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PubMed1997

[A case of traumatic cardiac contusion accompanied by the rupture of pericardium].

We experienced a case of traumatic cardiac contusion accompanied by the rupture of the pericardium after multiple blunt trauma sustained in a traffic accident. A 26-year-old woman who had suffered from blunt chest and abdominal trauma was admitted to our hospital, being unconscious with multiple severe injuries including pelvic fracture, bilateral hemothorax, and multiple fractures in the extremities. The patient was in a shock status. We performed the transcatheter arterial embolization of the internal iliac arteries to control the bleeding, when aortography showed that the contrast media extravasated toward the left thoracic cavity. Immediately, an operation for blunt chest trauma was performed. Blood was flooding out of the ruptured pericardium because of the contusion of myocardium. The postoperative course was uneventful. Blunt chest trauma is usually accompanied by multisystem injury. Therefore, it is imperative to determine the priority of treatment based on preoperative examination in patients having multiple injuries.

Abdominal Injuries↗
PubMedDate not supplied

[Remarks on the pathogenesis of brain contusions occurring by a counterimpact mechanism in the acute period of their development].

Clinical course, CT, EEG and EP data as well as a cerebral blood flow and central hemodynamics parameters of 1727 patients with brain contusions were analyzed. It has been concluded that features of cerebral countercoup injuries do not match with definition of cerebral contusion. Countercoup injuries should be considered as secondary traumatic lesions with hemangiopathic and ischemic components. Their progress or regress depends on changes of CBF and integrity of vascular walls of regional vessels.

Acute Disease↗
PubMed1991

Anton's syndrome in a patient with posttraumatic optic neuropathy and bifrontal contusions.

We describe a patient who manifested Anton's syndrome after sustaining head trauma that resulted in optic nerve damage and bifrontal contusions. Denial of monocular blindness, generalized anosognosia, and confabulation were prominent neurobehavioral features. Anton's syndrome is most commonly encountered in patients with bilateral occipital cortex lesions. Patients previously described who demonstrated Anton's syndrome secondary to a peripheral lesion have had an associated delirium or profound dementia. Our case demonstrates that Anton's syndrome may occur in association with blindness from a peripheral lesion, even in the absence of a delirium or significant dementia. We suggest that the bifrontal dysfunction may have been a critical factor in the production of Anton's syndrome. Implications for the role of frontal lobe dysfunction in the genesis of anosognosia and confabulation are discussed.

Adult↗
PubMed1978

Flail chest syndrome and pulmonary contusion.

Controlled mechanical ventilation has been the mainstay of treatment in the flail chest syndrome for more than 20 years, retrospective studies have recently suggested that the technique is unnecessary, and they infer that spontaneous ventilation or intermittent mandatory ventilation are equally effective. The common theme of these investigations is that mechanical ventilation is required only to relieve hypoxemia associated with the underlying contusion. In two cases of flail chest, spontaneous respiratory efforts resulted in complete disruption of the fracture sites and thus prolonged the duration of mechanical ventilation that was required. In severe cases of flail chest syndrome, there is still a need for controlled mechanical ventilation to splint the rib fractures in a position which facilitates union of the fragments.

Adult↗
PubMed1986

Diagnosis of traumatic cardiac contusion.

Cardiac contusion following blunt chest trauma remains a diagnostic problem because of a lack of sensitive diagnostic tests. This study evaluated thallous chloride Tl 201 single-photon-emission computed tomography in a series of 48 patients following blunt chest trauma. Of the 48 patients, 23 had normal scans. None of these patients proved to have serious arrhythmias during three days of continuous monitoring. Of 25 patients with abnormal or ambiguous studies, five (20%) developed serious arrhythmias requiring therapy. Single-photon-emission computed tomography scanning thus was sensitive in indicating that group of patients at risk of serious arrhythmias, and may therefore prove to be a useful screening test to determine the need for hospitalization and arrhythmia monitoring following blunt chest trauma.

Accidents, Traffic↗
PubMed1996

Effects of Schwann cell transplantation in a contusion model of rat spinal cord injury.

Cultured Schwann cells were transplanted at various delays into a spinal cord contusion injury performed at low thoracic level in adult female rats. The Schwann cells were purified from the dorsal root ganglia of adult syngeneic animals. the transplants were well tolerated, and the transplanted Schwann cells invaded the injured spinal cord. As quantified using video image analysis, the survival and growth of the transplanted cells were poor when the grafting procedure was performed 3-4 days after injury and very good when performed immediately or 10 days after injury, in which cases post-traumatic micro- and macrocavitation were strongly reduced. In animals grafted immediately after injury but not in animals grafted after 10 days, post-traumatic astrogliosis was much reduced. The Schwann cells transplanted area was invaded by numerous regenerating axons, the vast majority of which were, based on the neurotransmitter (CGRP and SP) profile, originating from dorsal root ganglion. No regeneration of the corticospinal tract as assessed after anterograde tracing or of descending aminergic fibers could be demonstrated.

Animals↗
PubMed1998

Selective chemokine mRNA accumulation in the rat spinal cord after contusion injury.

Following traumatic injury to the spinal cord, hematogenous inflammatory cells including neutrophils, monocytes, and lymphocytes infiltrate the lesion in a distinct temporal sequence. To examine potential mechanisms for their recruitment, we measured chemokine mRNAs in the contused rat spinal cord, using specific and sensitive reverse transcriptase polymerase chain reaction (RT-PCR) dot-blot hybridization assays. The neutrophil chemoattractant GRO-alpha was 30-fold higher than control values at 6 hr postinjury and decayed rapidly thereafter. LIX, a highly related alpha-chemokine, also was elevated early postinjury. Monocyte chemoattractant peptide (MCP)-1 and MCP-5 mRNAs, potent chemoattractants for monocytes, were significantly elevated at the lesion epicenter at 12 and 24 hr postinjury and declined thereafter. Interferon-gamma-inducible protein, 10 kDa (IP-10), chemoattractant towards activated T-lymphocytes, was significantly elevated at 6 and 12 hr postinjury. The dendritic cell chemoattractant MIP-3alpha also was increased, perhaps contributing to the development of T-cell autoreactivity to neural components after spinal cord injury (SCI) in rats. Other beta-chemokines, including MIP-1alpha and RANTES (regulated on expression normal T-cell expressed and secreted), were minimally affected by SCI. Expression of chemokines, therefore, directly precedes the influx of target neutrophils, monocytes, and T-cells into the spinal cord postinjury, as noted previously. Thus, selective chemokine expression may be integral to inflammatory processes within the injured spinal cord as a mechanism of recruitment for circulating leukocytes.

Animals↗
PubMed1996

Increased basic fibroblast growth factor expression following contusive spinal cord injury.

Neurotrophic factors appear to be crucial for the survival and potential regeneration of injured neurons. We have previously demonstrated that contusive spinal cord injury (SCI) increases the levels of mRNA for basic fibroblast growth factor (FGF2). To determine whether FGF2 protein levels also increase, Western blot analysis was performed on extracts of spinal cord tissue after a standardized SCI and compared to laminectomy controls. In spinal cord extracts, a monoclonal antibody to FGF2 recognized various molecular forms of FGF2 (18-24 kDa) and some characteristic proteolytic fragments. Extracts of spinal cords 1 day after SCI showed a slight increase in the levels of these polypeptides. By 4 days, a significant increase (two-fold) was detected in the levels of the 18-kDa and higher molecular weight forms as well as the proteolytic fragments. Immunohistochemical analyses on spinal cord tissue sections confirmed an increased cellular (glial) FGF2 as well as interstitial immunoreactivity surrounding neurons and along blood vessels. Heparinpurified spinal cord extracts from tissue 4 days after SCI showed increased biological activity as indicated by their ability to (i) increase [3H]thymidine incorporation in cultures of Balb/c 3T3 cells and (ii) induce phosphorylation of suc-associated neurotrophic factor-induced tyrosine-phosphorylated target, a FGF2 target protein. These data suggest that SCI induces increased FGF2 expression and support the hypothesis that FGF2 may play a role in the partial recovery of function seen following SCI.

Animals↗
PubMed1996

A quantitative spatial analysis of the blood-spinal cord barrier. I. Permeability changes after experimental spinal contusion injury.

Blood-spinal cord barrier (BSB) permeability was measured using quantitative autoradiography following contusion injury to the rat spinal cord. Permeability was assessed by calculating blood-to-tissue transfer constants (Ki values) for the vascular tracer [14C]-alpha-aminoisobutyric acid (AIB) in injured (3, 7, 14, and 28 days postinjury), laminectomy control, and uninjured control animals. Permeability was quantitated using four separate imaging techniques in gray and white matter throughout the rostro-caudal extents of the forming lesion. Away from the epicenter, gray matter permeability was further differentiated within discrete spinal lamina using computerized templates. Regardless of the type of analysis used, increased AIB permeability (Ki values) was noted at all survival times in all tissue regions with respect to both uninjured and laminectomy control groups. The data indicate a large increase in individual Ki values throughout the dorsoventral axis of the spinal cord at 3 days postinjury (approximately 6-9 ml/kg/min). By 7 days, Ki values were quantitatively smaller (approximately 4-5 ml/kg/min) in all regions compared with 3-day tissues. Despite further attenuation of AIB uptake in the gray matter at 14 and 28 days postinjury, circumferential white matter tracts showed a secondary increase in permeability compared to 7-day tissue. Permeability in the white matter at 14-28 days postinjury (approximately 5-6 ml/kg/min) was comparable to that at 3 days postinjury (6-7 ml/kg/min). Measurements of the axial distribution of AIB permeability indicate increased BSB permeability over several segments rostral and caudal to the lesion epicenter (approximately 3 cm in both directions). Secondary elevations of AIB transfer in the spinal white matter between 14 and 28 days were colocalized with zones of immunohistochemically defined microglial clusters. The known plasticity of this cell type in response to changes in the extracellular microenvironment suggests that the spinal white matter at later survival times (14-28 days postinjury) is an area of dynamic vascular and/or axonal reconstruction. The implications of increased permeability to both tissue injury and neural regeneration are discussed.

Aminoisobutyric Acids↗
PubMedDate not supplied

The value of SPECT-thallium scanning in screening for myocardial contusion.

In this prospective study of 40 patients sustaining blunt chest trauma, the value of single-photon-emission computed tomography (SPECT)-thallium scanning in the prediction of morbidity due to cardiac contusion was examined. Twelve patients developed cardiac complications--arrhythmias, ventricular conduction defects, and pericarditis. The sensitivity of SPECT-thallium scans was 55.6%, and the specificity was 32.1%, with an accuracy of 37.8%. Accuracy of the initial electrocardiogram (ECG) was 85%, with a sensitivity of 91.7% and a specificity of 82.1%. Patients with a normal ECG on admission rarely developed cardiac complications. It is concluded that SPECT-thallium is not a useful screening tool in this patient population.

Adolescent↗
PubMed2006

[Polytrauma with severe lung contusion. Early use of extracorporeal membrane oxygenation].

Extracorporeal membrane oxygenation (ECMO) is a technique for sustaining body oxygenation in case of respiratory failure. Since ECMO technology has undergone improvements resulting in better hemo-compatibility and reduced side effects, venovenous ECMO is a mostly accepted treatment of adult respiratory distress syndrome (ARDS). One should discuss the early initiation of ECMO therapy for post-traumatic respiratory failure. We report about a 23-year-old male and a 15-year-old female patient, who suffered polytrauma and received early treatment with ECMO because of severe lung contusion.

Accidental Falls↗
PubMed1996

Temporally changing patterns of hippocampal cerebral glucose utilization following sensorimotor cortical contusion in rats.

Unilateral sensorimotor cortical contusion significantly decreased ipsilateral hippocampal cerebral metabolic rates of glucose utilization (CMRglu) compared to sham controls at 2 and 16 days post injury. In contrast, hippocampal CMRglu was transiently increased at 6 days post injury. Both the increased and decreased CMRglu were predominantly localized to the hippocampal CA3 subfield ipsilateral to injury and were significantly different from sham controls in the dorsal but not ventral hippocampal formation.

Animals↗
PubMed1984

Myocardial contusion associated with fracture of the sternum: important features of the seat belt syndrome.

Recent legislation has led to increasing numbers of car occupants wearing seat belts and presumably the number of injuries attributable to seat belts will also increase. The commonest such injury is a fracture of the sternum, and blunt myocardial damage is a logical sequel although often unsuspected and therefore unsought. Confirmation is difficult and ECG changes are usually absent or not specific. In three consecutive patients admitted with a fractured sternum we found raised blood levels of CK-MB (creatine kinase-myocardial band) and believe these indicate myocardial contusion. We therefore feel that an isolated fracture of the sternum should be considered a more serious injury than is initially apparent, as these patients are at risk of developing cardiac complications.

Accidents, Traffic↗
PubMed1989

Late sequelae of lung contusion.

Twenty-four patients with severe lung contusion and multiple rib fractures were studied at a mean 4.9 years (range 2-9 years) after injury. All patients had been in good health before the accident. After the accident 15 (63 per cent) patients had respiratory symptoms such as dyspnoea at rest or moderate exercise (4), pain (8), cough or increased expectoration (11) and frequent bronchopulmonary infections (5). Three patients had changed their job because of respiratory disturbance. The average vital capacity, forced expiratory volume in 1 s, maximal voluntary ventilation and CO transfer factor were reduced respectively to 87, 88, 82 and 83 per cent of predicted values (P less than 0.01), while total lung capacity, residual volume and helium mixing time showed no definite changes (P greater than 0.05). Arterial blood gases at rest and at maximum exercise showed slight changes only. Maximal working capacity and ECG, as well as the ventilatory cost of moderate exercise were normal, where as the CO2 recovery time after moderate exercise was slightly increased (P less than 0.05). Overall there was a tendency towards poorer function in patients treated with artificial ventilation. Chest radiographs were normal in 10 patients (42 per cent), and moderate changes were seen in 14 patients. Diaphragmatic movements were essentially normal in all patients. Severe injury to the chest causes frequent respiratory symptoms. However, objective tests were only moderately reduced when compared with normal values. There was no unequivocal association between the subjective symptoms and the pulmonary function.

Adult↗
PubMed1978

An electron-microscopic analysis of axonal alterations following blunt contusion of the spinal cord of the rhesus monkey (Macaca mulatta).

Following contusion (500 g-cm) at upper thoracic levels, sections from the spinal cords of 13 rhesus monkeys were examined with the electron microscope. Survival times ranged from 4 hr to 10 weeks. Samples were taken from the lesion site, from areas 3 and 10 mm rostral and caudal to the lesion center, and from the lumbosacral cord. Four hours postoperatively, several small axons located close to the grey matter at the lesion site exhibit abnormal accumulations of organelles including mitochondria, dense bodies, vesicular structures, and multivesicular bodies. By 12 hr postoperatively many axons at the lesion site appear to be swollen with organelles and exhibit thinning of their myelin sheath. Some organelle-rich profiles lack a myelin sheath altogether. At this time dark axons are present, and myelin sheaths which appear to be empty or to contain small amounts of flocculent material. By 18 hr the first signs of axonal changes appear in the tissue taken 3 mm from the center of the lesion, both swollen and pyknotic axons being present. The axonal pathology spreads from the central part of the cord to the periphery at the impact site, and from the impact site rostrally and caudally, beginning at 18 hr and continuing for the duration of the study. Small fibers degenerate first and large fibers later. The axonal changes observed appear to be comparable to those reported for the central and peripheral nervous systems in other species.

Animals↗
PubMed1995

Biphasic edema development after experimental brain contusion in rat.

The time course of edema development following experimental brain contusion was studied by measuring cortex specific gravity 1 and 12 h after the trauma, and thereafter once daily until 7 days after the trauma. A biphasic development of edema was observed; the specific gravity decreased to a minimum on day 2 (P < 0.001), increased to an almost normal level on day 4 and thereafter decreased again to a second minimum 6 days after the trauma (P < 0.01). Delayed edema formation has been recognized in clinical settings, but has not been described in experimental studies. This study, with a prolonged daily follow-up, clearly demonstrates that a secondary phase of edema is an experimentally reproducible entity. The model will enable study of the pathogenetic mechanisms.

Animals↗
PubMed1995

Electrophysiological improvement after co-implantation of carbon filaments and fetal tissue in the contused rat spinal cord.

The electrophysiological integrity of the adult rat spinal cord was assessed at the lumbar, lower cervical and cortical levels after the animals sustained a severe contusion injury at the mid-thoracic level (T8) and received either carbon filament cultured with fetal spinal cord tissue implants, fetal tissue implants, or carbon filament implants alone. Somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) were recorded from all animal groups at the end of the 8-week survival period. The results of this study demonstrate that the spinal cord injured animals that received carbon filament cultured with fetal spinal cord tissue implants had the highest degree of electrophysiological recovery, indicating that this combination plays an important role in promoting recovery after injury.

Animals↗