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The efficacy of Vonum cutan ointment was tested in a clinical trial on 56 patients with distortions and contusions of the upper and lower extremities over a period of 1 week. Prompt relief from pain and a rapid reduction in swelling resulted from topical treatment with Vonum cutan ointment. No serious side effects were observed.
The effects of a single contusion without surface disruption and without fracture of the patella were studied in 40 rabbits. Macroscopic observation as well as light and electromicroscopy revealed lesions comparable to those observed in patients with chondromalacia of the patella and arthrosis. Three successive stages can be distinguished: a degeneration of the chondrocytes, a temporary proliferative reaction and an extension of the degenerative lesions resulting in an arthrosis. This is therefore a new model of chondromalacia and experimental arthrosis which is comparable in every respect to what is observed in human traumatology.
The author refers to a group of 13 adult patients, who suffered trauma to the upper or lower extremities. Longstanding pain for weeks and months, but no positive x-ray or laboratory-findings were able to explain the complaints. Only by bone scan a constant elevated uptake was demonstrable. The author used the name "bone contusion" for this phenomenon. The scan was the most sensitive procedure to document sequels of trauma. It is recommended to use bone scan in longstanding symptomatology with negative x-ray findings after trauma and in patients who developed avascular necrosis. This may proof a relation between trauma and avascular necrosis.
An experimental model was developed in dogs that quantifies the amount of pulmonary trauma produced. The severity of thoracic trauma is related to mortality and to a presence or absence of bilateral pulmonary injury. Bilateral injury represents severe trauma, consistently alters blood gases and is associated with significant mortality when untreated. Both methylprednisolone and glycerol exerted beneficial effects on mortality from bilateral pulmonary contusion, and glycerol altered the blood gas pattern towards normal. Glycerol has been utilized extensively clinically to reverse the adverse effects of cerebral edema. It may prove to be of similar value when pulmonary injury is an important factor.
Two unusual cases of rhegmatogenous retinal detachment following contusion to the eyeball showed retinal tears at the posterior fundus close to the optic disc and the large retinal blood vessels. In both cases, the tears were not detected immediately after the injury due to a coexisting vitreous hemorrhage. Both patients were successfully treated by pars plana vitrectomy, air-fluid exchange, and endolaser photocoagulation. During vitrectomies, an adhesion of the vitreous to the flap or the operculum of the tear was observed, with detachment of the remainder of the posterior vitreous from the retina. Vitrectomy allowed a more complete resolution of posterior tractional forces than scleral buckling, and eliminated the vitreous hemorrhage.
BACKGROUND: Prior functional studies on myocardial contusion (MC) have emphasized left ventricular performance even though the right ventricle (RV) is more likely to be injured after blunt trauma. Furthermore, associated injuries requiring resuscitation and surgery are frequently present. Our aim was to evaluate the impact of MC on RV function after MC and subsequent resuscitation from hemorrhagic shock. METHODS: RV performance was evaluated with a modified pulmonary artery catheter that determines RV volumes and ejection fraction (RVEF), as well as filling pressures and cardiac output in an anesthetized swine model. RESULTS: MC caused a 28% fall in mean arterial pressure and a 33% decrease in cardiac output. RVEF was 82%, and RV stroke work was 49% of baseline after injury. Resuscitation of hemorrhagic shock to baseline preload or greater failed to restore mean arterial pressure or cardiac output (depressed 23% and 22%, respectively). RV end-diastolic volume returned to baseline and central venous pressure was increased. RV dysfunction was depicted by a sustained depression of RV stroke work and RVEF. CONCLUSIONS: Impaired RV compliance and contractility, which was evident throughout this study, may hamper resuscitative efforts after multiple blunt trauma. RV monitoring may be useful in this setting.
We present the first case of myocardial contusion secondary to blunt chest trauma with injury in two different areas, with and without coronary lesions. The akinesis of the anterolateral wall was secondary to the obstruction of the left anterior descending coronary artery and the severe hypokinesis of the posterior wall, without lesion of the right coronary artery, was probably related with the compression between the sternum and vertebral column.
The main management's characteristics of the pulmonary contusion in the trauma patients are explained. From possible alveolocapillary membrane's injuries, with consideration of worsening evolution (ARDS, nosocomial infection, MOF), main points of discussion are circulation and mechanical ventilation. For the most severely injured, invasive monitoring is necessary, including the oxygenation parameters we now can dispose of. Quantification of extravascular lung water is an original and valuable tool to determine the time course and amount of pulmonary oedema. There is no ideal mode of ventilation but the basic ventilatory patterns must be adjusted; a target is the reduction of time requirement for ventilatory support.
The function of the retina and optic nerve was studied in 79 patients with contusions of the eyeball of various severity. A complex electrophysiological method was used, consisting of recording of visual evoked potentials and of the general and macular electroretinograms, assessment of the threshold electrical sensitivity and lability. Changes were detected in all the layers of the retina and optic nerve, the degree of these changes augmenting with the severity of injury. Changes in the functional parameters of the paired intact eyes, similar in the trend, were observed.
The authors describe an approximately 3.5 x 4 cm size cranial bone-defect, which was observed on the plane skull X-ray of a 27 months old child in the left sided frontal region following head injury. The defect decreased in size spontaneously one year later, and disappeared completely three years after the trauma. Similar observations about the spontaneously healing traumatic cranial bone-defect were not found in the Hungarian medical literature, and only scant publications could be revealed in the international scientific literature. The authors suggests that the spontaneously healing skull bone-defect develops following vascular lesions associated with the contusion. They suppose that these bone defects develop more often as they are revealed. Regarding that this condition most frequently does not produce neurological signs and symptoms, it might explain that the lesion is discovered rarely. The outcome of the disease is favourable and the differential diagnosis is important to the correct treatment.
The authors report a nontraditional effective method of treating patients with contusion semiluxation of the lens. It consists in fixation of the lens at the expense of formation of posterior synechiae because of an inflammatory process induced by laser exposure of pigmented epithelium of the iris and ciliary body. Complex clinical evaluation of the organ of vision in 132 patients, including the remote period (after 3-10 years), showed good stabilization of visual functions and of the geometrical position of the incompletely dislocated lens after its laser fixation.
PURPOSE: Analysis of the clinical and therapeutic results of giant retinal tears after ocular blunt trauma. PATIENTS AND METHODS: We performed a retrospective review of nine patients with giant retinal tears associated to retinal detachment after ocular blunt trauma. The traumatic giant retinal tear was a peripheral break of 90 degrees or greater. Seven patients had myopia. Primary management of retinal detachment included, scleral buckling and external drainage of subretinal fluid, in 2 cases. Vitrectomy with fluid-silicone oil exchange was used in 7 cases and perfluorodecalin in 3 cases. RESULTS: Our results indicate that myopia was the principal risk factor of blunt trauma retinal tears, which appear even when the contusion was not too violent or indirect. Successful results were not obtained with episcleral surgery alone (2 cases). With primar vitrectomy, the success rate was 57%. The overall success rate was 66.6% with an average acuity of 2/10. CONCLUSION: High myopia is the principal risk factor of giant retinal tear after blunt ocular trauma. The prognosis of this retinal detachment depends on the grade of proliferative vitreoretinopathy.
The author discusses clinical variants of grave contusions of the eyeball involving the iridolenticular diaphragm and characterized by dislocation of the iris, lens, and vitreous body and subsequent development of secondary glaucoma. This condition is proposed to be singled out as the postcontusion dislocation intraocular syndrome. Sixty-four patients were treated. Variants of surgical repair are proposed, aimed at elimination of the dislocation and maximal repair of the anatomical ratios, including removal of the lens, vitrectomy, and iridoplasty with a circular pupil suture, depending on the severity of posttraumatic changes. Such treatment helped remove the retention disorders and prevent the irreversible changes; high ocular function was preserved in 41.7% patients and a good cosmetic effect attained in the rest cases. Remote results were followed up for up to 10 years. In only 8.3% patients they may be considered unsatisfactory.
Study of local cerebral blood flow and PO2 in 19 patients with contusion of the brain after they had undergone surgery with removal of intracranial hematoma showed that posthypohyperemia developed in the previously compressed area of the brain which led to the formation of multiple hemorrhages along the vessels and consequent decrease in local blood flow later. It was assumed that the level of hyperemia in stability of general arterial pressure reflects the degree of tissue acidosis which grows with an increase in intracranial pressure. Early operative intervention for correcting the brain compression is most effective in such conditions.
BACKGROUND: Pulmonary contusion (PC) is a common sequelae of blunt trauma in adults and children; previous reports suggest that children have more favorable outcomes because of differences in mechanisms of injury, associated injury, and physiologic response. Our objective was to determine whether children who sustain PC have different outcomes compared with similarly injured adults. STUDY DESIGN: Our Level I Trauma Registry was reviewed for a 4-year period and identified 251 consecutive patients who sustained PC. Their charts were reviewed retrospectively for demographics, injury mechanism, injury severity scores, associated injuries, and outcomes (measured by the need for intubation, ventilation days, pneumonia, acute respiratory distress syndrome, and death). Data are expressed as the mean +/- SEM. The Student's t-test was used to compare the groups. A p value less than 0.05 was considered significant. RESULTS: Of the study patients, 41 (16%) were children (ages 2-16, mean 10 years) and 210 (84%) were adults (ages 17-80, mean 34 years). The most common injury mechanisms in children were motor vehicle accidents (56%) and auto-pedestrian accidents (39%), but in adults, motor vehicle accidents (80%, p = 0.02) predominated. Injury severity score was not significantly different between groups (children, 26 +/- 2 and adults 25 +/- 1). Similarly, the incidence of associated injuries was not different between children and adults: head 78% versus 62%, abdomen 59% versus 43%, and skeletal fractures 41% versus 29%, respectively. Neither need for intubation, ventilator days, pneumonia, acute respiratory distress syndrome, or death differed significantly between groups. CONCLUSIONS: Although children and adults differ in regard to injury mechanism, their overall injury severity, associated injuries, and outcomes are quite similar. Thus, contrary to previous reports, children do not have a more favorable outcome after PC.
Functional loss after spinal cord injury (SCI) is caused, in part, by demyelination of axons surviving the trauma. Neurotrophins have been shown to induce oligodendrogliagenesis in vitro, but stimulation of oligodendrocyte proliferation and myelination by these factors in vivo has not been examined. We sought to determine whether neurotrophins can induce the formation of new oligodendrocytes and myelination of regenerating axons after SCI in adult rats. In this study, fibroblasts producing neurotrophin-3 (NT-3), brain-derived neurotrophic factor (BDNF), ciliary neurotrophic factor, nerve growth factor, basic fibroblast growth factor, or beta-galactosidase (control grafts) were transplanted subacutely into the contused adult rat spinal cord. At 10 weeks after injury, all transplants contained axons. NT-3 and BDNF grafts, however, contained significantly more axons than control or other growth factor-producing grafts. In addition, significantly more myelin basic protein-positive profiles were detected in NT-3 and BDNF transplants, suggesting enhanced myelination of ingrowing axons within these neurotrophin-producing grafts. To determine whether augmented myelinogenesis was associated with increased proliferation of oligodendrocyte lineage cells, bromodeoxyuridine (BrdU) was used to label dividing cells. NT-3 and BDNF grafts contained significantly more BrdU-positive oligodendrocytes than controls. The association of these new oligodendrocytes with ingrowing myelinated axons suggests that NT-3- and BDNF-induced myelinogenesis resulted, at least in part, from expansion of oligodendrocyte lineage cells, most likely the endogenous oligodendrocyte progenitors. These findings may have significant implications for chronic demyelinating diseases or CNS injuries.
We present a review of the literature and results of a survey involving 50 closed scrotal traumas. Based on this analysis, we propose an anatomoclinical classification of scrotal contusions based on what we consider to be the most appropriate therapeutic management.
Focal microinjection of 2, 3-dihyro-6-nitro-7-sulfamoyl-benzo(f)quinoxaline (NBQX), an antagonist of the AMPA/kainate subclass of glutamate receptors, reduces neurological deficits and tissue loss after spinal cord injury. Dose-dependent sparing of white matter is seen at 1 month after injury that is correlated to the dose-related reduction in chronic functional deficits. To determine whether NBQX exerts an acute effect on white matter pathology, female, adult Spague Dawley rats were subjected to a standardized weight drop contusion at T-8 (10 gm x 2.5 cm) and NBQX (15 nmol) or vehicle (VEH) solution focally injected into the injury site 15 min later. At 4 and 24 hr, tissue from the injury epicenter was processed for light and electron microscopy, and the histopathology of ventromedial white matter was compared. The axonal injury index, a quantitative representation of axoplasmic and myelinic pathologies, was significantly lower in the NBQX group at 4 hr (2.7 +/- 0.24, mean +/- SE) and 24 hr (1.4 +/- 0.19) than in VEH controls (3.8 +/- 0.33 and 2.1 +/- 0.20, respectively). Counts of glial cell nuclei indicated a loss of at least 60% at 4 and 24 hr after injury in the VEH group compared with uninjured controls. NBQX treatment reduced this glial loss by half. Immunohistochemistry revealed that the spared glia were primarily oligodendrocytes. Thus, the chronic effects of NBQX in reducing white matter loss after spinal cord injury appear to be attributable to the reduction of acute pathology and may be mediated through the protection of glia, particularly oligodendrocytes.