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PubMedDate not supplied

[Surgical tactics in contusions of the cerebral hemispheres].

The author conducted complex examination of 540 patients who were operated on for brain contusion. Comparison of the clinical and instrumental findings with the pathomorphological changes in the brain (disclosed during operation or autopsy) revealed the structural features of contusion foci of convex and pole-basal localization which were factors underlying the three-dimensional enlargement of the affected brain lobe in cases of increasing perifocal edema. The results of surgical management were analysed according to the character of the contusion foci, the extent of traumatic softening of the white matter in the zone of the contusion, and the volume of surgical debridement of the foci. It is concluded that decompression of the brain can be accomplished by removing massive convex and pole-basal contusion foci penetrating the deep layers of the cerebral hemispheres; the volume of surgical debridement of contusion foci is determined by their macrostructure and the size of the zone of white matter softening.

Adolescent↗
PubMed1985

[Volume dynamics of contusion foci of the cerebrum].

Of 740 patients with severe contusions of the brain a group of patients with expansion of the contusion foci was differentiated. In 31.8% of the patients, the contusion foci were localized in the polar-basal portions of the frontal and/or temporal lobes and in 2.5% of patients on the convex surface of the large hemispheres and penetrated into the white matter. Clinical variants of the course of expansion processes of contusion foci are described. The craniographic, echoencephalographic and angiographic characteristics of the damaged brain are also presented. Expansion of contusion foci of the large hemispheres is documented pathomorphologically. A correlation was found between the manifestations of expansion of the contusion foci and their structural characteristics.

Adolescent↗
PubMed1993

New skeletal muscle model for the longitudinal study of alterations in microcirculation following contusion and cryotherapy.

This preliminary report describes the use of a rat model developed to study in vivo the effect of anesthesia, contusion, and cryotherapy on skeletal muscle microcirculation by use of an implanted chamber. The diameters of arterioles and venules within the chamber were determined by photomicroscopy in the contusion study and by compound videomicroscopy in the anesthesia study; microvascular perfusion was determined by laser Doppler fluxmetry (LDF). Combined ketamine and xylazine anesthesia significantly reduced (P < 0.05) arteriolar and venular diameters by 32.4% and 37.8%, respectively, and average LDF measurements by 36.1%. Contusion significantly increased arteriolar diameters over baseline values (P < 0.05); cryotherapy did not alter arteriolar diameters but increased venular diameters (P < 0.05). It is hypothesized that this increase in venular diameter may, by increasing the surface area available for reabsorption, explain one mechanism by which cryotherapy decreases the edema of contusion. Use of this model should help to advance the understanding of microcirculatory dynamics following contusion and cryotherapy.

Anesthesia↗
PubMed2001

Behavioral and histological outcomes following graded spinal cord contusion injury in the C57Bl/6 mouse.

A computer-controlled electromagnetic spinal cord injury device (ESCID) has been adapted to develop a mouse model of spinal cord contusion injury. In the present study, we have extended this model in C57Bl/6 mice with behavioral and histopathological outcome assessment. Three groups of mice received a laminectomy at the T(9) vertebral level followed by a contusion injury from a predetermined starting load of 1500 dynes. Contusion was produced by rapid displacement of the spinal cord to a peak distance of 0.3, 0.5, or 0.8 mm, with the entire injury and retraction procedure completed over a 23-ms epoch. Control groups received laminectomy alone or complete transection. Functional recovery was examined for 9 weeks after injury using the BBB locomotor rating scale, grid walking, and footprint analysis. Distinct patterns of locomotor recovery were evident across the five groups. Measurements of spared white matter at the epicenter, lesion length, and cross-sectional area of fibronectin-immunopositive scar tissue were also significantly different between injury groups. The severity of injury corresponded with the biomechanical measures recorded at the time of impact as well as with behavioral and histological parameters. The results demonstrate that graded contusion injuries can be produced reliably in mice using the ESCID. The data provide a thorough and quantitative analysis of the effects of contusion injury on long-term behavioral and histological outcome measures in this strain and species.

Animals↗
PubMed1989

A plea for sensible management of myocardial contusion.

The purpose of this study was to define the relative risk of life-threatening sequelae in patients at risk for myocardial contusion. During a 3-year period, 280 patients sustaining blunt chest trauma were admitted to the surgical intensive care unit to exclude myocardial contusion. Patients were evaluated by electrocardiogram and creatine phosphokinase (CPK) MB enzyme levels every 8 hours for a minimum of 48 hours. Myocardial contusion was identified in 35 patients (13 percent); the diagnosis was established by transient electrocardiographic changes (30), CPK-MB more than 3 percent (9) or both criteria (4). Two patients (1 percent) died from cardiac decompensation 4 and 12 hours postinjury, and seven (3 percent) required early (12 hours postinjury) intensive care unit treatment of arrhythmias or myocardial failure. None of the remaining 271 patients developed cardiac symptoms. This clinical experience underscores the low incidence of cardiac sequelae among patients at risk for myocardial contusion. Complications were always manifest within 12 hours of injury. The clinical diagnosis of myocardial contusion can be excluded pragmatically in the asymptomatic patient with a normal electrocardiogram and CPK-MB levels during the initial 24-hour postinjury period.

Adolescent↗
PubMed1991

Effect of lung contusion on pulmonary hemodynamics.

Our purpose was to examine changes in pulmonary hemodynamics for patients with pulmonary contusion. Pulmonary vascular resistance index (PVRI) and shunt fraction were calculated from standard measurements in 25 traumatized patients. The percent of lung volume injured, measured as air-space filling disease (ASF), was quantitated from computed tomograms using a previously described technique. The amount of reactive pulmonary vasoconstriction per unit of injury (PVRI/ASF) identified 3 groups of patients: 5 were reactors (PVRI/ASF greater than 15), 10 were weak-reactors (PVRI/ASF = 5 to 15), and 10 were nonreactors (PVRI/ASF less than 5). In the reactor group PVRI increased as the size of contusion (ASF) increased (r = 0.99). In weak-reactors PVRI also increased with the size of contusion (r = 0.93), but the slope was less pronounced. In both groups shunt fraction did not rise above 0.31. In the nonreactors, PVRI remained normal while shunt fraction increased with the extent of injury (r = 0.95). These results indicate that pulmonary vasoconstriction often occurs after pulmonary contusion. The vasoconstriction most probably represents a compensatory mechanism to limit perfusion of traumatized parenchyma, thereby minimizing increases in shunt fraction. Some patients (nonreactors) not demonstrating this response have unchecked increases in shunt fraction. This insight into the hemodynamic sequelae of pulmonary contusions may enhance our ability to provide optimal care for patients suffering from this injury.

Adolescent↗
PubMed1989

Post-traumatic pulmonary contusion in children.

We reviewed 35 consecutive cases of post-traumatic pulmonary contusion in children that occurred during a 12-year period. Of these, 19 children (54%) were more than 5 years old, 30 (86%) were involved in motor vehicle accidents, and 29 (83%) had multiple trauma. External thoracic wall contusion, fracture of the bony thorax, tachypnea, hemoptysis, and abnormal breath sounds were frequently absent on presentation. Associated intrathoracic lesions of pleural effusion, pneumothorax, and hemothorax occurred in 20 children (57%) and were particularly prevalent in those with fracture of the bony thorax (93%); the radiographic appearance of these lesions was delayed up to 48 hours in 40% of cases. In 34 children (97%), radiographic evidence of pulmonary contusion was present on admission and did not progress radiographically during hospitalization. No child experienced respiratory deterioration subsequent to presentation or required mechanical ventilation for respiratory insufficiency. Pulmonary contusion in children is usually a consequence of significant-impact injury associated with multiple trauma and has a good prognosis. Despite a paucity of abnormal physical findings, children who sustain high-impact trauma should receive radiographic evaluation of the chest to assess for possible intrathoracic injury. When pulmonary contusion is accompanied by fracture of the bony thorax, serial radiographic evaluation of the chest should be performed during the initial 48 hours of hospitalization.

Adolescent↗
PubMed2002

Should we follow ATLS guidelines for the management of traumatic pulmonary contusion: the role of non-invasive ventilatory support.

OBJECTIVE: To assess the management of patients with blunt traumatic pulmonary contusion admitted to our hospital. To identify the role of early blood gas analysis, non-invasive ventilation and to assess the validity of the current Advanced Trauma Life Support manual statement that "Patients with significant hypoxia, i.e. PaO(2)<65 mm Hg or 8.6 kPa on room air, SaO(2)<90%, should be intubated and ventilated within the first hour after injury". SETTING: A 24 bed Intensive Care Unit in a major Trauma Centre situated in South Western Sydney, Australia. METHODS: Retrospective review of adults with blunt traumatic pulmonary contusion identified from the trauma registry. RESULTS: A total of 75 patients with an age range of 16-81 years were identified over a 2-year period. Arterial blood gas measurement was available for 32 patients during the immediate resuscitative period (<1 h from admission). All patients received supplemental oxygen and a PaO(2)/FiO(2) ratio was calculated. Seven patients had significant pulmonary contusion, indicated by an initial PaO(2)/FiO(2) ratio of <300, and were treated successfully with non-invasive ventilatory support. A further five patients without arterial blood gas (ABG) analysis on admission but with PaO(2)/FiO(2) ratio of <300 in the ICU were also managed with non-invasive ventilatory support. Multi-modal analgesia was commonly used. CONCLUSIONS: All major trauma patients admitted to our hospital received supplemental oxygen. Interpretation of ABG breathing room air was not used as an indicator for intubation. Most decisions to intubate early were based on clinical need. Patients with significant pulmonary contusion required intubation for reasons other than respiratory failure. Patients with significant pulmonary contusion were managed safely with non-invasive ventilatory support. Further investigation will determine the role of non-invasive ventilatory support in the management of these patients.

Adolescent↗
PubMed1986

[Computed tomography of lung contusion. An experimental study].

A new experimental model has been developed to determine whether computed tomography has any advantages for the investigation of lung contusions. In 27 dogs, chest wall deformation was produced at speeds varying from 17.3 m/sec to 45.7 m/sec, leading to lung contusion. After the injury, 27 out of 27 (100%) CT examinations demonstrated the contusions, but only nine out of 24 (37.5%) were seen on conventional radiographs. In contrast to conventional radiography, which either failed to show the presence of a contusion, or which under-estimated the extent by more than one cm, in more than half the cases CT agreed with the pathological findings in more than 90%. No lung contusions were found at autopsy which had not been demonstrated by CT.

Animals↗
PubMed1998

Alteration in rate modulation of reflexes to lumbar motoneurons after midthoracic spinal cord injury in the rat. I. Contusion injury.

This study investigated the regulation of reflex excitability in normal and midthoracic contusion-injured animals. Recent observations revealed that rate depression, a rate-modulatory process that decreases reflex excitability, was significantly decreased following experimental midthoracic contusion injury. The present experiments were performed to extend those studies and to determine if posttetanic potentiation (PTP), a rate-modulatory process that increases reflex excitability, also was altered in lumbar monosynaptic reflexes (MSRs) following midthoracic contusion injury. In normal animals, a mean PTP of 160% of the pretetanus control was observed at 30 sec following tetanus of the tibial MSR. The decay of the PTP in normal animals followed a rapid initial, then a more gradual pattern, before returning to pretetanus values by 5 min posttetanus. Following midthoracic contusion injury, the maximal (unpotentiated) MSRs were significantly increased in amplitude, whereas the percent potentiation of the PTP of the tibial MSRs was significantly decreased. PTP decay in postcontusion animals was significantly more gradual than observed in normal animals and followed a single decay process. Further analysis of rate depression of tibial MSRs in normal animals revealed that the attenuation pattern produced by stimulation within the lower range of test frequencies was different from that produced by stimulation at the higher test frequencies. Following contusion, rate depression of tibial MSRs was significantly reduced at all test frequencies. These physiological changes in the stretch reflex neural pathway are discussed relative to the development of spasticity.

Animals↗
PubMed1975

Cardiac contusion: a capricious syndrome.

Cardiac contusions are being recognized with frequency. Among 507 patients with non-penetrating chest injuries, 210 had serial electrocardiograms sufficient to evaluate the heart. Forty-five of these 210 patients (21%) had cardiac contusions. These 45 patients and 3 others who were confirmed to have cardiac contusions at necropsy, comprise the 48 patients in this series. Life-indangering cardiac complications occurred in 14 (29%) of the 48 patients, and 4 patients died. The development of cardiac complications following cardiac contusions appears to have a significant relationship to the presence of shock, hypoxia and to factors related to the severity of multiple injuries. These observations have therapeutic implications in management of patients with cardiac contusions through prevention of hypovolemia and hypoxia and avoidance of fluid overload as well as treatment of specific cardiac complications.

Accidents, Traffic↗
PubMed1990

Suspected myocardial contusion. Triage and indications for monitoring.

Although many different tests are used to diagnose myocardial contusion, the clinical implications of the diagnosis are unclear. This makes it difficult to decide which patients require admission to a monitored bed. During 16 months, 3010 patients with blunt trauma were reviewed for evidence of sequelae attributable to myocardial contusion. None of 2204 admissions to unmonitored beds had evidence of serious arrhythmias or heart failure. No patient who died after admission had myocardial contusion at autopsy. Of the 644 admissions to monitored beds, 95 had workups for suspected contusion. Heart failure not obvious on admission did not occur and there were only four arrhythmias that required treatment. Conduction abnormalities on admission electrocardiogram predicted serious arrhythmias. Echocardiography and creatine phosphokinase isoenzyme levels, although frequently positive, did not predict morbidity. Clinically significant myocardial contusions are rare. Patients who will develop life-threatening complications from blunt cardiac injury can be identified in an emergency room setting.

Adolescent↗
PubMed1986

Emergency surgery in patients with post-traumatic myocardial contusion.

Little information concerning the prognostic and functional significance of post-traumatic myocardial contusion appears to exist. During a 10-month period, 19 patients with major blunt thoracic trauma were diagnosed as having myocardial contusion using clinical findings, serial ECG and CPK-MB isoenzyme determinations, and biventricular radionuclide angiocardiography (RA). All patients had associated thoracic and extrathoracic injuries. ECG and RA were useful and complementary tests, detecting abnormalities in 90% and 47% of patients, respectively. Only one patient had an abnormally elevated CPK-MB. All patients required operative treatment for associated injuries, 15 (79%) on the day of admission. Eleven patients required perioperative cardiac inotropic support and one needed IABP. No late complications were attributable to the cardiac contusions per se; no patients died. Emergency surgery for associated injuries in patients with myocardial contusion can be safely performed using hemodynamic monitoring to guide cardiac inotropic support measures. Myocardial contusion does not constitute an absolute contraindication to necessary operations in polytraumatized patients.

Adolescent↗
PubMed1999

Prostanoids: early mediators in the secondary injury that develops after unilateral pulmonary contusion.

BACKGROUND: We have previously shown a sequence of events after unilateral pulmonary contusion that suggests the release of blood-borne prostanoid mediators and that culminates in refractory bilateral pulmonary failure. PURPOSE: To determine the role of platelet-derived thromboxane and endothelial-derived prostacyclin in the primary and secondary injury after unilateral blunt chest trauma, and to determine whether pretreatment with the cyclooxygenase inhibitor indomethacin alters the progression of secondary injury. METHODS: Anesthetized, ventilated (FIO2 = 0.50) pigs received a unilateral, blunt injury to the right thorax (n = 20) or sham injury (n = 5) and were monitored for 24 hours. Either indomethacin (5 mg/kg i.v.; n = 10) or its saline vehicle (n = 10) were administered 15 minutes before injury. Serial bronchoalveolar lavages of each lung were analyzed for protein and neutrophil (polymorphonuclear neutrophil (PMN)) content. RESULTS: Contusion caused profound hypoxemia; PaO2 partially recovered within 1 hour of injury to 50% of baseline. Thereafter, worsening hypoxemia required positive end-expiratory pressure. With indomethacin compared with vehicle, PaO2 was higher at any given level of positive end-expiratory pressure (p < 0.05). There was an early increase in serial bronchoalveolar lavage protein on the injured side (peak at 2 hours), with a delayed pulmonary capillary leak on the contralateral side (peak at 6 hours), which correlated with increasing PMN infiltration; this was reduced by 40 to 60% with indomethacin (p < 0.05). Thromboxane peaked within 1 hour after contusion at 800% baseline, then fell off rapidly. This peak preceded the maximal increase in permeability and was completely blocked by indomethacin. Prostacyclin slowly rose to 300% baseline by 3 hours and remained elevated; this change was blocked by indomethacin for 18 hours. CONCLUSIONS: Contusion of the right thorax induced a delayed pulmonary capillary leak in the left lung, which reflects a progressive secondary inflammatory response. Elevations in thromboxane and prostacyclin preceded progressive bilateral PMN infiltration. Indomethacin blocked thromboxane and prostacyclin and attenuated, but did not prevent, the progression to pulmonary failure. Overall, these data suggest that prostanoids are released soon after unilateral contusion and initiate an inflammatory response in both lungs that is sustained by PMN infiltration.

6-Ketoprostaglandin F1 alpha↗
PubMed2000

Failure of voluntary activation of the quadriceps femoris muscle after patellar contusion.

STUDY DESIGN: Descriptive study of phenomenon. OBJECTIVES: To determine the extent of failure of voluntary activation of the quadriceps femoris muscle in patients early after patellar contusion. BACKGROUND: Pain and effusion are related to the presence of quadriceps inhibition. We hypothesized that patients with patellar contusions would be unable to fully recruit their quadriceps muscles and that the activation deficit would be associated with self-report measures of function. METHODS AND MEASURES: Sixteen patients who had sustained a unilateral patellar contusion fewer than 4 months prior to testing participated in the study (7 men, 9 women; mean age = 30.0 +/- 11.6). Subjects completed a self-report questionnaire to assess knee function and performed an isometric burst superimposition test on the involved and uninvolved quadriceps at 60 degrees of knee flexion. The subjects were assigned to 2 groups according to the presence (n = 5) or absence (n = 11) of quadriceps inhibition. RESULTS: Sixty-nine percent of the subjects tested were able to fully activate their quadriceps. Both groups had a decreased knee extensor force on the involved side compared to the uninvolved, but the group with inhibition had a lower side-to-side percentage of knee extensor force (mean = 65.5% +/- 18.9) than those without inhibition (mean = 85.5% +/- 16.4). CONCLUSION: Early after patellar contusion, approximately one-third of the patients demonstrated quadriceps inhibition. According to our working hypothesis, the majority of the patients tested should have demonstrated inhibition. Quadriceps inhibition was not associated with the activities of daily living, sports activity, or global rating scales in this study. Decreased volitional quadriceps force production (the hallmark of inhibition) was the only variable that discriminated patients with patellar contusion who had inhibition from those who did not.

Adult↗
PubMed2002

Functional recovery after complete contusion injury to the spinal cord and transplantation of human neuroteratocarcinoma neurons in rats.

OBJECT: Human neuroteratocarcinoma (hNT)-derived neurons are differentiated postmitotic neurons derived from a human teratocarcinoma cell line following treatment with retinoic acid. In preclinical transplantation studies investigators have demonstrated both their safety as a source of neurons for transplantation and efficacy in treating stroke-related behavioral deficits. The objective of this study was to examine whether hNT neurons transplanted in an area of complete spinal cord contusion would improve electrophysiological measures of spinal cord function. METHODS: Complete spinal cord contusion injury, defined as the complete loss of motor evoked potentials (MEPs), was produced in 30 rats at T-8. Ten rats with contused spinal cords underwent transplantation with hNT neurons within the site of contusion immediately after injury (immediate transplant group). Ten rats underwent hNT neuron transplantation following a 2-week evaluation for loss of MEPs (delayed transplant group). Ten other rats with contusion injury served as a spinal cord injury control group, and 10 rats underwent only a T-8 laminectomy and served as non-injured controls. All rats survived 8 weeks after transplantation. In the delayed transplant group significant functional recovery was observed, as demonstrated by return of MEPs and a modest improvement of motor function. Immunohistochemical analysis showed the survival, integration, and long fiber outgrowth of the grafted hNT neurons. CONCLUSIONS: These findings suggest that the transplantation of the hNT neurons may be an effective means of reestablishing electrical connectivity of the injured spinal cord.

Animals↗
PubMed2002

[Diagnosis of heart contusions].

PURPOSE OF THE STUDY: Heart contusion is a severe injury for the diagnosis of which there still doesn't exist a uniform procedure. The aim of the work was to compare individual methods and provide opinion on the justification of their use. MATERIAL: In the period of 1998-2000 at the authors' departments 103 patient were hospitalised with a severe contusion of the chest. These patients were admitted at the department within 24 hours after the injury. METHODS: The diagnosis was based on the examination of the ratio of CKMB/CK serum levels, cTnl serum level, ECG examination and echocardiography. RESULTS: Heart contusion was diagnosed in 18 patients of the group of 103. The most precise diagnostic method proved to be the determination of the serum level of troponin I (success rate 86%) and echocardiographic examination (succes rate 67%). CONCLUSIONS: Examination of cTnl serum level and echocardiography are the best methods for the determination of the diagnosis of heart contusion. Simultaneous application of these two methods is the most reliable diagnostic procedure. Examination of CK and CKMB serum levels produces often falsely positive results and it is not a contribution to the determination of the diagnosis of heat contusion.

Contusions↗
PubMedDate not supplied

Pulmonary contusion: CT vs plain radiograms.

In experimentally induced pulmonary contusions, CT (n = 27) and chest X-ray (n = 24) findings were compared with the findings at autopsy. Twenty-seven of 27 (100%) pulmonary contusions were visible by CT immediately after trauma compared with 9 of 24 (37.5%) in the chest X-ray. After 30 min follow-up, 18 of 24 (75%) lesions were seen on the plain film. Five of 24 (21%) contusions escaped detection on conventional radiographs. Computed tomography underestimated lesion size in 5 of 60 (8%) measurements, conventional radiographs in 21 of 36 (58%) measurements. Pathological examination never revealed a pulmonary contusion that was not demonstrated by CT. Therefore, pulmonary contusion seems unlikely in a trauma patient with normal pulmonary CT.

Animals↗