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PubMed2004

Endothelins and the role of endothelin antagonists in the management of posttraumatic vasospasm.

Increasing evidence implicates endothelin in the pathophysiological development of cerebral vasospasm. This review summarizes background topics such as the structures and biosynthesis of endothelins, the types of endothelin and their receptors, as well as their biological effects. Basic science and clinical observations supportive of the role of endothelins in the spasm associated with stroke and subarachnoid hemorrhage are presented. Similar basic science and clinical observations are presented regarding the role of endothelins in impaired cerebral hemodynamics following traumatic brain injury, cryogenic cortical lesion injury and fluid percussion brain injury. The role of age in the contribution of endothelin to impaired cerebral hemodynamics following fluid percussion brain injury is discussed. Finally, potential mechanisms for endothelin contributions to vasospasm following fluid percussion brain injury such as impaired K+ channel function are described.

Animals↗
PubMed1999

Local mitochondrial function following traumatic brain injury in rats.

The effect of lateral fluid percussion injury on mitochondrial function in the rat brain was investigated by quantitative imaging of changes in the regional activity of succinate dehydrogenase (SDH), a mitochondrial enzyme of the tricarboxylic acid cycle for adenosine triphosphate production. Regional SDH was measured in the frontal, parietal, temporal, and occipital cortices, CA1 and CA2-3 of the hippocampus, thalamus, corpus callosum, caudate/putamen, and cerebellum 1 hour and 72 hours after low, medium, and high pressure injury. No regional difference between the hemispheres in the activity of SDH was observed in the sham group. The hippocampus showed high SDH activity. The CA2-3 regions showed the highest activity among the regions examined. The corpus callosum, which is white matter, showed the lowest. One hour after low pressure fluid percussion injury, only the frontal lobe showed significantly lower SDH activity than the sham control in the ipsilateral hemisphere, whereas after 72 hours SDH activity was significantly lower in the frontal, parietal, and temporal lobes. SDH activity was significantly lower in the frontal, parietal, and temporal lobes in the medium and high pressure injury groups than in the sham control 1 hour after injury, and SDH activity in the CA1 and CA2-3 of the hippocampus was significantly decreased 72 hours after injury. No decrease in SDH activity was observed in any region of the contralateral hemisphere either 1 hour or 72 hours after injury. Mitochondrial dysfunction of the ipsilateral cortex and hippocampus following fluid percussion injury is correlated with the severity of injury and advances with time after injury. The results suggest that progression of mitochondrial dysfunction is associated with secondary bioenergetic deterioration.

Animals↗
PubMed1979

Assessment of fracture healing by vibration.

The wave signal from percussion of a bone (i.e. percussion-note) has been used to evaluate the extent of bony consolidation after fracture. Forty-one cases with a fresh tibial fracture and eight cases of delayed union of the tibia were investigated. The medial malleolus of the tibia was struck with a tapper and the vibration signal was picked up at the medial region of the tibial tuberosity. The changes in the signal waveform of the percussion-note with time were investigated. As healing proceeds, the signal waveform of the fractured bone approaches that of intact bone. In cases of delayed union, the character of the wave does not improve sufficiently with time. The authors are convinced that this is a promising new method for the early diagnosis of delayed union.

Adolescent↗
PubMed2001

[The importance of feeling the pulse].

The physician Bordeu (1722-1776) is best known as a character in Diderot's Reve de d'Alembert. Yet his medical writings are worth studying for their synthesis of ancient and modern medicine. In particular, his "Recherches sur le pouls par rapport aux crises," published in 1756, is a valuable source for investigating subtle changes in the methods of and reasons for pulse taking. Bordeu proposed to read more from the pulse than the usual patient's temperament. He thought that the blood stream manifested bodily activities, indicated where diseases occurred, and predicted when and where crises took place, which could relieve morbid matters. The study of "Recherches sur le pouls" shows how he adapted traditional and current theories to his specific goals. In accord with the sensationists, he wanted to increase the use of touch to advance medical knowledge. Bordeu chose the pulse while Auenbrugger (1728-1809) turned his attention to percussion. Both physicians were striving for means to bring into focus a picture from inside the patient's body to the physician's mind. Bordeu's vitalist perspective used pulse feeling to reach functions; Auenbrugger's mechanistic bent applied percussion to reveal organs. Both correctly insisted that their method detected unsuspected pathologies; percussion is still widely used, while pulse feeling is often neglected.

France↗
PubMed1993

Cerebral blood flow decreased by adrenergic stimulation of cerebral vessels in anesthetized newborn pigs with traumatic brain injury.

Changes in cerebral blood flow (CBF), pial arteriolar diameter, and arterial blood pressure, gases, and pH were examined before and for 3 hours after fluid-percussion brain injury in alpha-chloralose-anesthetized piglets. The brain injury was induced by a percussion of 2.28 +/- 0.06 atm applied for 23.7 +/- 0.5 msec to the right parietal cortex. Regional CBF was measured with radiolabeled microspheres, and changes in pial arteriolar diameter were monitored in the left parietal cortex using closed cranial windows. Immediately following brain injury, mean blood pressure transiently (for approximately 10 minutes) either increased or decreased and then exhibited a prolonged decrease in all of the animals. The brains showed changes consistent with traumatic brain injury such as subarachnoid hemorrhage, contusions, or reactive axonal swelling; none showed histological evidence of a global alternative pathogenetic mechanism such as hypoxic ischemic damage. While CBF of uninjured control animals did not change over a 3-hour observation period, after brain injury blood flow decreased 30% +/- 1% below the baseline level within 10 minutes and remained there for 2 to 3 hours posttrauma. After adrenergic blockade, CBF did not decrease at any time during the 3-hour period in either the uninjured control or the injured animals. Concomitant with the decreased blood flow after brain injury, pial arteriolar diameter decreased 14% below the preinjury level. However, in piglets treated with adrenoceptor antagonists, uninjured control and brain-injured animals did not show a decrease in pial arteriolar diameter. The present results support the hypothesis that increased sympathetic outflow to the cephalic vasculature following the fluid-percussion brain injury causes cerebral vasoconstriction decreasing pial arteriolar diameter and regional CBF.

Adrenergic alpha-Antagonists↗
PubMed2000

[The development and application of a minitype multifunctional bio-impactor].

This study was aimed to develop a device that can be used for gas percussion, rigid impact, cell injury and simple estimation of the condition of injury. The device has been developed with the use of aerodynamical principle, measuring technique for feeble signal, and integration of machine-electricity. The gas percussion, rigid impact, and cell injury can be produced by altering impact tip. It was examined in the experimental researches of eye, brain, lung and cell injury; the parameters of causing injury could be controlled and on-line tested by the computer. The neurological states of pre- and post-injury were evaluated with the device. The results of animal experiments showed that mild, moderate and severe injury models were produced by gas pressure respectively. The pressure was 400, 600, 700 kPa for rats brain gas percussion injury, 600, 800, 1000 kPa for rabbits' retinal contusion, 300, 450, 600 kPa for rats' lung rigid impact injury, and 100, 150, 200 kPa for cultured cells' injury. In conclusion, the device is simple and easy to use for making controllable injury models, in which different parts and levels of injuries on different minitype animals can be reproduced.

Animals↗
PubMed2005

[Association between Bacteroides forsythus in the infected root canals and clinical symptoms of chronic apical periodontitis].

OBJECTIVE: To investigate the distribution of Bacteroides forsythus in root canals with chronic apical periodontitis and to determine its associations with clinical symptoms. METHODS: Thirty-eight tooth root canals from 31 subjects were studied with a 16S rDNA-directed polymerase chain reaction (PCR). These teeth were classified into symptomatic and asymptomatic groups according to the clinical symptoms and signs, including spontaneous pain, percussion pain, sinus tract and swelling, respectively. RESULTS: Ten of the 38 root canal samples were positive for B. forsythus. The prevalence of B. forsythus was 26.3% for 38 root canals, 45.5% for spontaneous pain group, 39.1% for percussion pain group, 29.4% for sinus tract group, 42.9% for swelling group, respectively. Significant positive associations were observed between B. forsythus in infected root canals and the spontaneous pain, percussion pain, and swelling of apical periodontitis, respectively (OR=infinity, 9, 12; P<0.05). There was no significant association between B. forsythus and sinus tract of apical periodontitis (OR=1.33). CONCLUSION: B. forsythus colonized in the infected root canals. It is the putative pathogen of apical periodontitis.

Adolescent↗
PubMed1989

[Reflex reaction in the abductor pollicis brevis muscle after mechanical and electrical stimulation in patients with central hemiparesis and Parkinsonism. Electromyographic study].

The reflex responses in the abductor pollicis brevis muscle were examined in 22 patients with mild central hemiparesis and in nine patients with Parkinson's disease. In the group of patients with central hemiparesis there were 15 subjects with a spastic and seven subjects with a flaccid type of affection. The reflex responses in the abductor pollicis brevis muscle were evoked during isometric contraction. The recorded muscular potentials were unidirectionally rectified and averaged. The reflex responses were then identified as excitatory and inhibitory modulations of basal activity of the muscle after the evoking stimulus. The reflexes were evoked by percussion with a hammer on the lateral area of the base of the distal digit of the thumb, by electrical stimulation of the median nerve on the wrist and by electric stimulation of the cushion of the thumb and the superficial radial nerve on both sides. On the side of the spastic or flaccid central hemiparesis the long-latency parts of the reflex responses after percussion on the distal digit of the thumb and after electrical stimulation of the median nerve were either not elicitable or had a lower amplitude than on the non-paretic extremity. In three subjects on the affected side also the of long-latency part of the reflex response was prolonged after percussion of the distal digit of the thumb. The short-latency parts of the reflex response on the side of the spastic hemiparesis were more expressed, contrary to the finding on the side with the flaccid hemiparesis where suppressed.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebrovascular Disorders↗
PubMed1978

[A clinical study with apexcardiogram, kinetocardiogram and carotid pulse tracing in aortic insufficiency (author's transl)].

The apexcardiogram, kinetocardiogram and carotid pulse tracing were studied in 24 normal subjects and 20 patients with aortic insufficiency. The electrocardiogram and phonocardiogram were recorded simultaneously as the time reference. The study of the carotid pulse tracing and systolic time intervals was made using the injection of methoxane and inhalation of amyl nitrite. In aortic insufficiency, the apexcardiogram of the infinite decay time tended to demonstrate a lift of end-systolic shoulder according to the severity of the disease, while, kinetocardiograms at K-45 showed a prominent systolic outward movement. The correlation ratio of these findings between normal and aortic insufficiency was 0.59 in the apexcardiogram and 0.72 in the kinetocardiogram. The findings were also correlated with CTR with a correlation coefficient of 0.41 and 0.62 in aortic insufficiency only or 0.63 and 0.81 including normal cases. The apexcardiogram of the short time constant represented no characteristic changes. Therefore, it might be concluded that the kinetocardiogram is more useful than the apexcardiogram in determining the existence and severity of aortic insufficiency. Effects of acute hemodynamics changes: the effects of increasing total peripheral resistance on the externally recorded carotid pulse were determined by the injection of methoxamine. This drug showed changes characterized by a rise in the ratio of the height of the tidal wave to that of the percussion wave. In contrast, amyl nitrite decreased total peripheral resistance and produced a significant decline in the ratio of the height of the tidal wave to that of the percussion wave. In conclusions, the carotid waves contain two systolic maximums, the percussion wave and tidal wave, the former related, at least in part, to peak blood volume and the latter to aortic pressure. Comparing with systolic time intervals in aortic insufficiency and that of normal cases, the patients with aortic insufficiency had statistically significant increase in the ejection time index and pre-ejection time, especially after the injection of methoxamine.

Adolescent↗
PubMed1994

[Electron microscopic and immunohistochemical studies of acute stages of severe brain injury in rats].

Few morphological studies on fluid-percussion experimental models using mechanically produced severe brain injury have been reported. This study was initiated to evaluate light and electron microscopic and immunohistochemical findings in severe brain injury models using rats. The experimental rats and the methods used were as described for a fluid-percussion model. Fluid-percussion models of traumatic brain injury produce injury rapidly by injecting fluid volumes into the epidural space of the temporal lobe. We used 5 rats which sustained various degrees of injury by high (7.0 atm), medium (5.6 atm) and low (3.5 atm) magnitudes of impact and sham control. The rats were sacrificed and perfused transcardially with buffer solution followed by 2.5% glutaraldehyde at intervals of 24 hours, 3 days, and 7 days, and there were normal and sham control groups. In this immunohistochemical study, monoclonal antibody to 70 kilodalton neurofilament subunit has been used in a standard Avidin-Biotin Complex Kit (DAKO). Microscopic findings of the animals revealed subarachnoid hemorrhage, lateral IIIrd ventricular hemorrhage, and rarefaction and petechial hemorrhage of the local contusional lesion. In the medium level injury, there was a marked petechial hemorrhage in the corpus callosum and subependymal area. In the high level injury, there was marked edema in the white matter of the ipsi and contralateral cerebral hemisphere, and multiple petechial hemorrhage in the brain stem and cerebellum. Microscopic findings in the corpus callosum, subependyma and brain stem in the vicinity of petechial hemorrhage revealed a large number of axonal swellings, but in these specimens only a few typical axonal retraction balls were seen using Bodian and immunohistochemical stains.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Inflammatory leukocytic recruitment and diffuse neuronal degeneration are separate pathological processes resulting from traumatic brain injury.

The present study characterized whether inflammatory leukocytic infiltration is temporally and regionally correlated with neuronal degeneration and/or blood brain barrier (BBB) breakdown resulting from traumatic brain injury. Adult rats were sacrificed at 5 min, 2, 4, 12, 24, and 72 hr after lateral fluid percussion brain injury. BBB breakdown, neuronal degeneration and leukocyte infiltration were assessed using immunocytochemistry, silver impregnation and toluidine blue and eosin staining. BBB breakdown and neuronal degeneration occurred concomitantly in injured cortex, hippocampus, and along the dorsolateral quadrant of the diencephalon. However, neuronal degeneration within deep diencephalic structures transpired in the absence of IgG extravasation. Neutrophils were observed only in regions exhibiting BBB damage and were first apparent in injured cortex and hippocampus between 2-12 hr posttrauma lining the vasculature and filling subarachnoid/subdural spaces. Neutrophils then migrated from damaged vasculature into traumatized cortical and hippocampal parenchyma by 24 hr after lateral fluid percussion injury. Macrophages were also observed within cortical parenchyma at 24 hr and completely filled the cortical lesion site by 72 hr after injury. Macrophages were not as abundant throughout hippocampal parenchyma and were found only in hippocampal regions exhibiting focal hemorrhage at 72 hr. Finally, neutrophils did not migrate to deep diencephalic structures that showed no BBB damage despite extensive neuronal degeneration. Indeed, lateral fluid percussion elicits inflammatory leukocytic recruitment only in regions experiencing concomitant BBB damage and neuronal degeneration. In summary, inflammatory leukocytic recruitment and diffuse neuronal degeneration are separate pathological processes resulting from traumatic brain injury.

Animals↗
PubMed1996

Acoustic assessment of fracture healing. Capabilities and limitations of "a lost art".

The ability of bone to conduct sound was applied clinically over 50 years ago to identify the presence of fresh fractures, although the technique has become a relatively "a lost art" as more sophisticated X-ray and other imaging techniques have been developed. The objective of this report is to challenge clinical orthopaedic surgeons unfamiliar with the technique to explore this simple beside method in the clinical management of fractures. A portable computer-based vibrational analysis device was employed and experiments conducted to objectively evaluate the capabilities of auscultatory percussion techniques. Auscultatory percussion can, with certain limitations, detect the presence of fractures, assess qualitatively the progress of healing, detect delayed or nonunions, and indicate when sufficiently firm continuity has occurred to permit early mobilization or loadbearing. Vibrational assessment is, however, subject to systematic and random errors, and thus cannot always discriminate between the stages of healing in a fractured bone; in addition, various artifacts can lead to significant uncertainty in the diagnosis. Nevertheless, auscultatory percussion is a useful tool in clinical fracture management, and particularly where roentgenographic facilities are inadequate or not available. Computerized vibrational analysis can be used in place of classical percussion/stethoscope methods by those with poor tonal capabilities,or when more objective record keeping is desired.

Auscultation↗
PubMed1992

Ludwig Traube. The man and his space.

The detection of dullness to percussion in the left hemithorax raises the possibility of pleural effusion, consolidation, or atelectasis. Percussion of Traube's space, a semilunar tympanitic area overlying the gas bubble in the stomach, is a valuable maneuver in this regard: obliteration of Traube's space favors a pleural effusion. Knowledge of the remarkable life of Traube, and the ability to demonstrate the utility of his sign on rounds, provides an opportunity in a technologic age to remind the medical student of the romance of bedside medicine.

Germany↗
PubMed2005

Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old.

BACKGROUND: Acute bronchiolitis is the leading causes of medical emergencies during winter in children younger than two years of age. Chest physiotherapy is thought to assist infants in the clearance of secretions and decrease ventilatory effort. OBJECTIVES: To determine the efficacy and safety of chest physiotherapy in infants aged less than 24 months old with acute bronchiolitis. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2004) which contains the Acute Respiratory Infection Group's specialised register; MEDLINE (January 1966 to June 2004); EMBASE (1990 to June 2004); PASCAL; SCISEARCH; LILACS; and Cumulative Index to the Nursing & Allied Health Literature (CINAHL) (1982 to May 2004). SELECTION CRITERIA: Randomised controlled trails (RCTs) in paediatric patients younger than twenty four months old in which chest physiotherapy was compared against no intervention or against another type of physiotherapy. DATA COLLECTION AND ANALYSIS: Two independent reviewers extracted the data. Primary outcome was a severity clinical score. Secondary outcomes were length of hospital stay, duration of oxygen supplementation, and the use of bronchodilators and steroids. MAIN RESULTS: Three clinical trials met the inclusion criteria. All evaluated vibration and percussion techniques in postural drainage positions compared to no intervention. The study population were hospitalised infants with a clinical diagnosis of acute bronchiolitis, although one study included only infants who required nasogastric tube feeding or intravenous fluids. None of the other included trails observed any differences in the severity of the clinical score at day five or during each of the five days of the trial or until discharge, length of hospital stay, or oxygen requirements between chest physiotherapy group and control. AUTHORS' CONCLUSIONS: Based on the results of three RCTs, chest physiotherapy using vibration and percussion techniques does not reduce length of hospital stay, oxygen requirements, or improve the severity clinical score in infants with acute bronchiolitis that are not under mechanical ventilation, and who do not have any other co-morbidity. Chest physiotherapy using forced expiratory technique needs to be evaluated by clinical research.

Acute Disease↗
PubMed2001

[Development of modern physical diagnosis and its application in cardiothoracic surgery].

The year 2000 marked the 300th anniversary of the birth of Gerard Van Swieten (1700-1772). He reformed medicine in Vienna, putting new emphasis on diagnosis based on clinical observation in combination with anatomical-pathological findings. This led to the introduction by Leopold Auenbrugger (1722-1809) of percussion in the examination of thoracic organs. However, further work by Joseph Skoda (1805-1881) was required to finally establish this method as a diagnostic tool for pathologies in the thorax. The surgeon Franz Schuh (1804-1865) carried out further basic research in respiratory physiology that cleared the way for the use of percussion and auscultation in thoracic surgery. He is also remembered for introducing experimental surgery in Austria, thus making surgery a science. This article aims to recall these men and their fundamental work behind early paracentesis of the thorax, and especially the first successful pericardiotomy by Schuh 160 years ago, which is also considered a milestone in cardiac surgery.

Auscultation↗
PubMed1994

Mechanical chest stimulation as a physiotherapy aid.

In patients with lung disorders there is often a build up of mucus inside the lungs which in healthy people is normally removed by the action of cilia on the lung tissue surfaces. In the diseased lung, however, this clearance mechanism may be ineffective and so patients are offered physiotherapy in order to assist the mucus removal process. The consequences of not properly removing the mucus are impaired lung function and a much higher risk of contracting lung infections and suffering consequent permanent scarring of the lung tissues. If unchecked the latter leads ultimately to failure of the lungs and to the patient's death. The most common forms of chest physiotherapy used are percussion coupled with postural drainage and an active cycle of breathing. This requires the patient to lie head downwards on an inclined surface, so that gravity might assist the mucus removal process, whilst the physiotherapist strikes the patient's chest with the hands. The procedure is interspaced by periods of 'huffing and coughing' by the patient to remove the loosened sputum from the body. An alternative to the manual percussion described above is to use machinery to provide the stimulus to the chest. If such a procedure were found to be satisfactory then it would enable more patients to manage their own physiotherapy, may make the required duration of the physiotherapy sessions shorter, and would free much of the professional physiotherapists' time to enable them to assume more of a physiotherapy management role.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1999

Periodontal and pulpal condition of the central incisors after midline osteotomy of the maxilla.

PURPOSE: The purpose of this study was to evaluate the periodontal and pulpal condition of the central incisors after Le Fort I and midline osteotomies for transverse expansion of the maxilla. PATIENTS AND METHODS: The series included 12 women and eight men, with an average age at operation of 28.4 years (range, 17 to 48 years). Each patient, examined retrospectively, underwent transverse expansion of the maxilla by combined Le Fort I and midline osteotomies. The minimum follow-up was 12 months (range, 12 to 85 months, with an average of 38 months). The central incisors were tested for percussion sound, mobility, and pulpal response to electric stimulation, and then compared with the lateral incisors. The pocket depths and the height of the alveolar bone were measured, and the root surface was evaluated for resorption on radiographs. RESULTS: Percussion and mobility tests indicated normal values for all teeth. Four (11%) of the central incisors did not respond to electrical stimulation. There was no difference in pocket depth between the mesial and distal sulci of the central incisors. In one tooth, resorption was detectable on the medial surface of the root. Minor root surface injury was seen in two roots, although these injuries were not progressive. The alveolar bone level of the central incisors was located slightly more superiorly on the mesial than on the distal side. CONCLUSIONS: Although there may be some minor complications to the periodontal and pulpal tissues after combined Le Fort I and midline osteotomies, the harmful effects seem to be of negligible clinical significance.

Adolescent↗
PubMed2000

Dose-response curve and optimal dosing regimen of cyclosporin A after traumatic brain injury in rats.

Acute neuropathology following experimental traumatic brain injury results in the rapid necrosis of cortical tissue at the site of injury. This primary injury is exacerbated in the ensuing hours and days via the progression of secondary injury mechanism(s) leading to significant neurological dysfunction. Recent evidence from our laboratory demonstrates that the immunosuppressant cyclosporin A significantly ameliorates cortical damage following traumatic brain injury. The present study extends the previous findings utilizing a unilateral controlled cortical impact model of traumatic brain injury in order to establish a dose-response curve and optimal dosing regimen of cyclosporin A. Following injury to adult rats, cyclosporin A was administrated at various dosages and the therapy was initiated at different times post-injury. In addition to examining the effect of cyclosporin A on the acute disruption of the blood-brain barrier following controlled cortical impact, we also assessed the efficacy of cyclosporin A to reduce tissue damage utilizing the fluid percussion model of traumatic brain injury. The findings demonstrate that the neuroprotection afforded by cyclosporin A is dose-dependent and that a therapeutic window exists up to 24h post-injury. Furthermore, the optimal cyclosporin dosage and regimen markedly reduces disruption of the blood-brain barrier acutely following a cortical contusion injury, and similarly affords significant neuroprotection following fluid percussion injury. These findings clearly suggest that the mechanisms responsible for tissue necrosis following traumatic brain injury are amenable to pharmacological intervention.

Animals↗