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PubMed1986

Contusion injuries of the optic nerve.

Indirect trauma to the optic nerve with secondary optic atrophy may result from minor trauma and has traditionally been associated with a poor visual prognosis. The case of a 32-year-old man who suffered a blow to his left supraorbital region and eyebrow in an automatic closing door is reported to draw attention to the uncommon but trivial nature of this injury which may result in profound visual loss. He suffered an initial inferonasal visual field loss which was related to vascular changes in the optic nerve head. Over the ensuing year there was deterioration in his central vision and visual field due to arachnoiditis. Current trends in the management of optic nerve contusion injuries are discussed. There is currently a move towards primary medical management with high-dose corticosteroids as in this case; surgery is reserved for those patients who fail to respond to steroids or deteriorate as the steroid dose is reduced.

Adult↗
PubMed1978

Changes in anterior chamber depth and angle-recession, late complications to ocular contusion.

Of 46 patients consecutively admitted to hospital for ocular contusion with hyphaema in 1964 and 1965, 30 patients were followed-up somewhat more than 10 years later in order to assess late complications. Angle-recession was observed in 17 (57%), while none had developed glaucoma. An average increase in depth of the anterior chamber of 0.06 mm in the affected eye was observed; this differences is highly significant with P less than 0.005. However, as these changes are small in individual patients, measurement of the increase in anterior chamber depth can only be a supplement to gonioscopy.

Adolescent↗
PubMed1987

Contusion rupture of the globe.

Severe contusion-injuries caused rupture of the globe in 20 eyes in 18 patients. 14 eyes had an open rupture (OR) and primary closure was performed in 13 eyes and one eye was enucleated. Six eyes with closed rupture (CR) had no emergency exploration. In both types of rupture, we intended to do vitrectomy within 14 days. In 12 cases vitrectomy was combined with retinal detachment surgery, lens extraction and gas injection. The upper-lateral quadrant close to the limbus was the most common site of rupture (12 eyes). In 8 eyes the length of the rupture exceeded one quadrant. The lens was extruded in 9 of 14 eyes with OR. Vision preoperatively was in all eyes only light perception. Useful vision (counting fingers or better) was obtained in 7 of 13 eyes with OR and 2 of 5 eyes with CR, excluding 2 totally blind eyes upon admission, one eye in each group. Three patients became totally blind, one patient was hit in her last eye and two patients had bilateral ruptures and these eyes could not be saved.

Adolescent↗
PubMed1982

Combined posterior contusion and penetrating injury in the pig eye. II. Histological features.

The main histological features observed after an experimental posterior contusion injury in the pig eye were haemorrhage from the choroidal vessels into the subretinal space and into the vitreous, uveal vessel dilatation, and an inflammatory reaction. These changes resolved during the first 2 weeks, and the subretinal haemorrhage was replaced by a fibrocellular membrane. The addition of a posterior penetrating injury resulted in fibrocellular proliferation at the wound site 6 days after injury and in formation of vitreoretinal traction membranes and subsequent traction retinal detachment. Posterior vitreous separation did not occur.

Animals↗
PubMed1983

Combined posterior contusion and penetrating injury in the pig eye. III. A controlled treatment trial of vitrectomy.

A controlled trial of vitrectomy following combined experimental posterior contusion and penetrating eye injury was performed on a group of pigs at 1 day, 2 weeks, and at 10 weeks after the initial injury. Severe intraoperative haemorrhage occurred in 5 eyes operated on at day after injury and in one eye operated on at 2 weeks after injury, but no haemorrhage occurred when surgery was performed 10 weeks after injury.

Animals↗
PubMed1972

Pulmonary contusion in children due to rubber bullet injuries.

Three cases of pulmonary contusion occurred in children as a result of injuries from "rubber bullets." Radiological changes were evident soon after the injury, and in one case these persisted for two months. Symptoms disappeared quickly in all three cases.

Adolescent↗
PubMed2005

Myocardial contusion injury: redefining the diagnostic algorithm.

Myocardial contusion injury (MCI) is a complication of blunt thoracic trauma, which may occur at relatively low velocities. MCI may also occur from chest compressions during cardiopulmonary resuscitation. We review the clinical pathology, diagnostic tools, and treatment for MCI.

Algorithms↗
PubMed2005

Best evidence topic report. Use of troponin for the diagnosis of myocardial contusion after blunt chest trauma.

A short cut review was carried out to establish the utility of troponin levels in diagnosing myocardial contusion following blunt chest trauma. Using the reported search, 75 papers were found, of which six presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

Biomarkers↗
PubMed1992

Delayed complications after myocardial contusion.

A 45 year old farmer was kicked in the chest by a horse. In the days following the injury episodic breathlessness developed and he was admitted to hospital with right ventricular failure and pulmonary emboli. Echocardiography showed global right ventricular dysfunction but a right ventricular mural thrombus, the likely source of the pulmonary emboli, was not seen. He gradually recovered after treatment with anticoagulant. One month later he presented with a further complication--complete atrioventricular dissociation--that required a dual chamber pacemaker implantation. This patient had few initial manifestations of right ventricular myocardial contusion and this case illustrates that such patients should be closely monitored for delayed complications.

Contusions↗
PubMed1986

Fractures, dislocations and contusions in the Borneon orang utan (Pongo pygmaeus pygmaeus)--a review of 21 cases.

The clinical features, radiographic findings and management of traumatic lesions in the orang utan are described with reference to 21 cases. Eight cases had fractures of the femur and five had humeral fractures; all the fractures were successfully treated. One case with a skull fracture (frontal parietal) died before treatment could be instigated. Five orang utans with contusions recovered with symptomatic treatment and rest.

Animals↗
PubMed1982

Evaluation of noninvasive tests of cardiac damage in suspected cardiac contusion.

Nonpenetrating trauma to the chest can result in cardiac damage that may be overlooked because of associated injuries and the lack of obvious thoracic injury. The clinical diagnosis of important cardiac damage in this setting is difficult. We evaluated noninvasive tests for detecting myocardial damage in 100 patients with severe, nonpenetrating chest trauma. The noninvasive tests included serial ECG, serial total CPK and CPK-MB enzymes, continuous Holter monitor recording to detect dysrhythmia, and technetium-99m pyrophosphate scintigraphy. Peak CPK-MB elevations occurred in 72 patients. ECG abnormalities were noted in 70 patients, and 27 patients had Lown grade 3 or greater dysrhythmias. Fifteen patients died and all had autopsies. The noninvasive abnormalities were nonspecific and did not reflect myocardial contusion that led to clinically important cardiac complications.

Adolescent↗
PubMed1995

Systemic gas embolism complicating pulmonary contusion. Diagnosis and management using transesophageal echocardiography.

Systemic air embolism has been frequently reported after penetrating thoracic trauma. In blunt thoracic trauma, systemic air embolism has been rarely diagnosed, and then only after an invasive procedure such as thoracotomy. Transesophageal echocardiography has been recently introduced for the early assessment of trauma patients and is considered a sensitive noninvasive procedure to diagnose air embolism. We report three cases of systemic air embolism in patients with pulmonary contusion secondary to a blunt thoracic trauma requiring controlled ventilation. Transesophageal echocardiography was performed for evaluation of hemodynamic instability, and it showed air bubbles in the left atrium and left ventricle during the insufflation phase, which disappeared during apnea. A decrease in airway pressure (release of PEEP, low tidal volume, high frequency jet ventilation) significantly reduced the systemic air embolism. We concluded that systemic air embolism can occur after blunt thoracic trauma, and transesophageal echocardiography enables a rapid and accurate diagnosis that may be useful for therapeutic management.

Adult↗
PubMedDate not supplied

Topically applied dimethyl sulfoxide. Its effects on inflammation and healing of a contusion.

This study investigated the effects of topically applied dimethyl sulfoxide (DMSO) to traumatized muscle of adult male rats. Eighty rats were randomly assigned to one of two groups and subsequently traumatized, treated, and sacrificed. One group was used to examine inflammation; the other, healing. Each group was further divided into an experimental group (70% DMSO and 30% distilled water) and a control group (100% distilled water); each group had five sacrifice times. Each treatment consisted of painting 1 ml of either the treatment or control solution on the contused tissue. The inflammation group received 15 additional treatments, 3 per day for the next 5 days. A three-phased, single blind, histologic examination was performed. The principle findings were: significantly fewer healing cells were present in the experimental group than in the control group during the period inflammation was examined, and no significant difference existed between the experimental and control groups during the period healing was examined.

Administration, Topical↗
PubMed2005

Varicella zoster virus acute retinal necrosis following eye contusion: case report.

BACKGROUND: Acute retinal necrosis is a sight-threatening disease caused by the group of herpesviruses. The aim of this paper is to report a case of acute retinal necrosis following ocular trauma in a patient initially treated with vaso-active drugs and corticosteroids for presumed ocular ischemic syndrome. CASE PRESENTATION: A 51-years-old otherwise healthy man, who suffered from sudden visual loss in the left eye following contusion, was commenced on vaso-active drugs and systemic corticosteroids for suspected ocular ischemic syndrome with extensive swelling of the optic disc and macular edema. Subsequently, vision in the initially uninvolved right eye decreased. Polymerase chain reaction of vitreous samples and retinal biopsy confirmed varicella zoster virus. Despite intensive treatment with intravenous antiviral medication, the patient became completely blind in both eyes. CONCLUSION: Initial treatment of acute, unexplained visual decrease with systemic corticosteroids may lead to visual loss in patients with developing acute retinal necrosis. Ocular trauma could have induced and corticosteroid treatment promoted reactivation of a latent viral infection in our patient.

Adrenal Cortex Hormones↗
PubMed2006

Chest ultrasonography in lung contusion.

STUDY OBJECTIVE: Despite the high prevalence of chest trauma and its high morbidity, lung contusion (LC) often remains undiagnosed in the emergency department (ED). The present study investigates the possible clinical applicability of chest ultrasonography for the diagnosis of LC in the ED in comparison to radiography and CT. MATERIALS AND METHODS: One hundred twenty-one patients admitted to the ED for blunt chest trauma were investigated using ultrasonography by stage III longitudinal scanning of the anterolateral chest wall to detect LC. Data were retrospectively collected in an initial series of 109 patients (group 1) and prospectively in the next 12 patients (group 2). All patients who presented with pneumothorax were excluded. After the ultrasound study, all patients were submitted to chest radiography (CXR) and CT. The sonographic patterns indicative of LC included the following: (1) the alveolointerstitial syndrome (AIS) [defined by increase in B-line artifacts]; and (2) peripheral parenchymal lesion (PPL) [defined by the presence of C-lines: hypoechoic subpleural focal images with or without pleural line gap]. RESULTS: The diagnosis of LC was established by CT scan in 37 patients. If AIS is considered, the sensitivity of ultrasound study was 94.6%, specificity was 96.1%, positive and negative predictive values were 94.6% and 96.1%, respectively, and accuracy was 95.4%. If PPL is alternatively considered, sensitivity and negative predictive values drop to 18.9% and 63.0%, respectively, but both specificity and positive predictive values increased to 100%, with an accuracy of 65.9%. Radiography had sensitivity of 27% and specificity of 100%. CONCLUSIONS: Chest ultrasonography can accurately detect LC in blunt trauma victims, in comparison to CT scan.

Adolescent↗
PubMed2005

Transplantation of neuronal and glial restricted precursors into contused spinal cord improves bladder and motor functions, decreases thermal hypersensitivity, and modifies intraspinal circuitry.

Transplanting neuronal and glial restricted precursors (NRP/GRP) into a midthoracic injury 9 d after contusion improved bladder and motor function, diminished thermal hypersensitivity, and modified lumbosacral circuitry compared with operated controls (OP-controls). Histological analysis showed that NRP/GRP survived, filled the lesion site, differentiated into neurons and glia, and migrated selectively. Volume of spinal cord spared was increased in NRP/GRP recipients, suggesting local protection. Bladder areflexia developed in both operated groups, but NRP/GRP recipients exhibited an accelerated recovery, with decreased micturition pressure and fewer episodes of detrusor hyperreflexia. Because noradrenergic receptors proliferate after spinal injury and descending noradrenergic pathways contribute to regulation of bladder control, we examined the effects of administering an alpha-1A-adrenergic antagonist, Tamsulosin, on urodynamics. This improved all cystometric parameters in both operated groups, and micturition pressure in NRP/GRP rats recovered to normal levels. Both operated groups initially showed increased sensitivity to a thermal stimulus applied to the tail; the NRP/GRP rats showed significant improvement over time. NRP/GRP grafts also produced greater recovery of hindlimb function in several tests, although both groups showed persistent and similar deficits in locomotion on a grid. Because bladder, hindlimb, and tail sensory and motor functions are organized through lumbosacral cord, we examined descending and primary afferent projections at L6-S1. The density of serotonergic, noradrenergic, and corticotrophin releasing factor-positive fibers increased in the NRP/GRP group compared with OP-controls, suggesting some sparing and/or sprouting of these modulatory pathways. Immunocytochemical staining density of dorsal root axons in the dorsal horn increased in the OP-controls but appeared normal in the NRP/GRP group. Synaptophysin immunoreactivity in the lumbosacral dorsal horn was similar among groups, consistent with restoration of synaptic density in both groups of operated animals but by different pathways. We suggest that local protection provided by NRP/GRP resulted in increased sparing/sprouting of descending pathways, which prevented sprouting by dorsal root axons, and that this modification in lumbosacral circuitry contributes to the recovery of function.

Animals↗
PubMedDate not supplied

[Surgical treatment of post-contusion orbital hematoma in the late phase].

OBJECTIVE: The object of the study was to present successfully performed decompression of the orbit in orbital hematoma. MATERIAL AND METHODS: Male, 51 years of age sustained the contusion injury of the right eye during his fall on the bath tap. It caused the development of a large orbital hematoma with protrusion, restricted movement of the eyeball, pain, diplopia, folding of the retina due to hemtoma compression to bulbus oculi and retinal hemorrhages, higher intraocular pressure and impaired visual acuity to 2/60. He was treated by medicaments for a month, but the results were not favorable. After one month from the injury, anterior-inferior transcutaneous orbitotomy was performed. During the surgical intervention, hematoma and a part of orbital fat tissue were removed. RESULTS: The globe of the eye was retracted and the exophthalmos disappeared immediately after the surgery, while the mobility of the eyeball, disappearance of retinal folds with gradual receding of hemorrhage, normal intraocular pressure, abatement of pain and diplopia as well as the restoration of visual acuity to normal ensued in a few subsequent days. CONCLUSION: This study illustrated that decompression of the orbit in orbital hematoma might be successful even in the late phase, e.g., one month following the injury. It is assumed that surgical intervention would be performed by experienced orbital surgeon.

Contusions↗
PubMed1991

The effect of severe contusion on the vessels of the femoral region. An experimental morphological study.

Forty-one rats were subjected to a single blow in the femoral region from a heavy falling object. The contusion was directed towards the palpated femoral vessels in a standard manner. Transverse sections of the femoral artery and vein with branches, including adjacent muscle, were taken at 30 min, 24 hours, 2 weeks and 1 and 3 months after the injury and evaluated by light microscopy. The injuries to the femoral vessels and their branches at 30 min and 24 hours varied from partial destruction of the internal elastic lamina only to crush injury of the media together with thrombosis. Bleeding was always present. In the most severely injured arteries the vessel wall had ruptured. The findings at 2 weeks and 1 and 3 months were more discrete. The femoral vessels had remained patent, sometimes with permanent damage to the internal elastic lamina and rearranged architecture of the elastic tissue in the media. In a few cases recanalized thrombi were seen in arterial branches. Fibrosis of the femoral muscle was found at the level of trauma. Despite a single serious blow to the femoral region, however, there was no permanent major injury to the femoral artery or vein.

Animals↗