Age determination of brain contusions

In 104 individuals who had sustained traumatic brain injury, the course of traumatically induced morphological changes was investigated immunohistochemically during the first 30 weeks after the trauma. Regarding the inflammatory cell reaction in human cortical contusions, CD15-labeled granulocytes were detectable within 10 minutes following brain injury, whereas significantly increased numbers of nuclear leukocytes occurred after a postinfliction interval of at least 1.1 days (leukocyte common antigen), 2 days (CD3), or 3.7 days (UCHL-1), respectively. A positive nuclear staining for the proliferation marker MIB-1 by cerebral macrophages could be observed as early as 3 days after the injury and regularly in cases with a survival between 7 and 11 days. Injury-induced glial staining reactions could be demonstrated, at the earliest, after a postinfliction interval of 3 hours for α1-antichymotrypsin, 22 hours for vimentin, 1 day for glial fibrillary acidic protein, and 7 days for tenascin. Regarding the vascular response to brain injury, a significantly increased immunoreactivity could be detected in cortical contusions with a wound age of at least 3 hours for factor VIII, 1.6 days for tenascin, and 6.8 days for thrombomodulin, whereas the immunostaining for laminin and type IV collagen was regularly whereas the immunostaining for laminin and type IV collagen was regularly positive even in the vascular endothelium of ininjured brain tissue.     

The time course of the vascular response to human brain injury – an immunohistochemical study

In a total of 104 individuals who had sustained traumatic brain injury (TBI), the time-dependent vascular response was investigated at the injured cortical area during the first 30 weeks after the trauma. The immunohistochemical staining of the cerebral blood vessels was performed with antibodies against laminin, type IV collagen, tenascin, thrombomodulin and factor VIII associated antigen. Compared to the immunoreactivity in unaltered control tissue, a significantly increased vascular expression could be detected in cortical contusions after a postinfliction interval of at least 3 h for factor VIII, after 1.6 days for tenascin or after 6.8 days for thrombomodulin, whereas the immunostaining for laminin and type IV collagen was regularly positive even in the vascular endothelium of uninjured brain tissue. Received: 22 April 1999 / Received in revised form: 7 October 1999     

Neuronal and glial apoptosis in human traumatic brain injury

To establish reliable methods to aid the timing of brain damage after traumatic brain injury (TBI), brain tissue from 56 autopsy cases with TBI and known survival times, ranging from a few minutes to 126 days, were tested for apoptotic changes to the neuronal and glial cells. Apoptosis was established using the TdT-mediated dUTP nick end labelling (TUNEL) method of in-situ labelling and immunohistochemical reaction of caspase 3. In addition, cellular reaction and astroglial cell differentiation were investigated using histological and immunohistochemical markers. From a survival time of 120 min up to 12 days, TUNEL-positive apoptotic neuronal cells were frequently detected in the contusion zone. The earliest positive caspase 3 reaction in cortical neurons was evident after a posttraumatic interval of 80 min. Detection of apoptotic glial cells using the TUNEL technique showed that as in the case of neuronal cells, the earliest positive TUNEL reaction was obtained after 110 min. In cases of survival times of 120 min up to 4 days, apoptotic glial cells could frequently be detected. However, the first caspase 3-positive glial cells appeared 5 h after injury. Cerebral apoptosis was significantly associated with TBI cases as compared to control cases (P<0.001). The reference histological findings of neutrophilic granulocytes, CD3-positive T-lymphocytes, CD68-positive activated microglial cells/macrophages and TUNEL-positive neuronal cells increases the degree of certainty in determining the probable age of traumatic brain injury to 87.5%.     

Estimation of wound age and VCAM-1 in human skin

To estimate the age of skin wounds, the endothelial adhesion molecule VCAM-1 (CD 106) was detected in paraffin sections after autoclaving and using the ABC technique. The percentage of VCAM-1 positive blood vessels was determined after the blood vessels had been marked with PECAM-1 (CD 31). Low positive staining reactions were observed for VCAM-1 on endothelial cells of uninjured skin in 18% of the samples. In injured skin, 51% of the cases investigated showed a VCAM-1 expression. Strong positive staining reactions were observed 3 h at the earliest and 3.5 days at the latest after the time of injury. The immunohistochemical results for VCAM-1 differed significantly between the injured and uninjured skin (P < 0.01). In a few cases VCAM-1 was detected (n = 6) at low intensity in postmortem skin wounds and a moderate to strong expression of VCAM-1 is indicative of the vitality of the wound. The detection of VCAM-1 can be used for estimating the age of wounds in forensic applications if the degree of expression of further adhesion molecules, especially that of selectins, is taken into account. Received: 8 April 1998 / Received in revised form: 15 July 1998     

The course of MIB-1 expression by cerebral macrophages following human brain injury

The course of MIB-1 expression by brain macrophages adjacent to cortical contusions has been immunohistochemically investigated during the first 30 weeks after human brain injury, in order to provide data for a forensic wound age estimation. A positive nuclear staining for MIB-1 could be observed earliest after a postinfliction interval of 3 days and regularly in cases with a survival time between 7 and 14 days, whereas in uninjured brain tissue (control group) no cellular MIB-1 reactivity was visible.     

Quadriceps contusions. West Point update

A 3 year study of 117 quadriceps contusions in West Point cadets was undertaken to document the effectiveness of a three-phased therapy program to return these young athletes to full activity with a normal knee range of motion and without recurrence of injury. The treatment protocol of this study was modeled after the 1973 West Point study of Jackson and Feagin with two major changes: 1) resting the injured leg in flexion (versus extension) and 2) emphasizing early flexion exercises (versus extension). Classification of contusions was based on knee range of motion at 12 to 24 hours after the injury (mild, greater than 90 degrees; moderate, 45 degrees to 90 degrees; severe, less than 45 degrees). The average disability time was 13 days for mild, 19 days for moderate, and 21 days for severe contusions. Myositis ossificans developed in 9% of cadets and was associated with five risk factors (knee motion less than 120 degrees, injury occurring during football, previous quadriceps injury, delay in treatment greater than 3 days, and ipsilateral knee effusion.     

Immunohistochemical investigations on the course of astroglial GFAP expression following human brain injury

The course of GFAP expression by astrocytes has been immunohistochemically investigated during the first 30 weeks after human brain injury. In order to provide reliable data for a forensic wound age estimation, a quantitative morphometric analysis was performed considering the different topographic regions of the cortex as well as of the white matter. Compared to the GFAP immunoreactivity in unaltered control tissue, significantly increased numbers of GFAP positive astroglial cells could be detected adjacent to the cortical contusion from 1 day up to 4 weeks after brain injury. Received: 10 November 1998 / Received in revised form: 26 February 1999     

99Tcm-HMPAO labelled leucocytes: comparison with 111In-tropolonate labelled granulocytes

The lipophilic complex, 99Tcm-hexamethylpropyleneamine oxime (HMPAO) is an efficient leucocyte label, and labels granulocytes with more stability than mononuclear leucocytes. The recovery of 99Tcm-HMPAO granulocytes, expressed as the percentage of injected granulocyte-associated activity circulating as granulocyte-associated activity 40-45 min after injection, was 37% (S.E. 3%), similar to the recovery of 111In-labelled granulocytes isolated and labelled in plasma using tropolone. The T1/2 of 99Tcm-HMPAO labelled granulocytes in blood was 4.4 h (S.E. 0.4 h), less than that of 111In-labelled granulocytes, although when a correction was made for 99Tcm elution, it was 6.4 h. The initial biodistribution of 99Tcm-labelled leucocytes was similar to 111In-labelled granulocytes, with a rapid initial lung transit, prominent splenic activity, bone marrow activity and minimal hepatic activity, although, unlike 111In, 99Tcm activity was also seen in urine, occasionally in the gallbladder, and, from about 4 h, consistently in the colon. Bone marrow activity was particularly prominent with 99Tcm. About 6% of 99Tcm was excreted in the faeces up to 48 h after injection, and about 17% in urine up to 24 h. The time-activity curves of reticuloendothelial activity up to 24 h were broadly similar for the two labelled cell preparations, and the differences that were observed can be explained on the basis of a higher rate of 99Tcm elution. Clinical information given by the two agents was similar in 27 of 30 patients who received both. Of the three who gave different information, one received 111In-labelled granulocytes which were considered to be functionally suboptimal and two, with inflammatory bowel disease, showed different distributions of abnormal bowel activity. We conclude that with respect to granulocyte kinetics and clinical data, 99Tcm-HMPAO labelled leucocytes are comparable with 111In-tropolonate labelled granulocytes.     

Regulation of MAC-1 (CD11b/CD18) expression on circulating granulocytes in endurance runners

PURPOSE: We tested the hypothesis that degranulation of granulocytes and upregulation of the granulocyte integrin MA-1 (CD11b/CD18) are related to exercise duration and/or intensity. We also investigated whether or not the expression of MAC-1 would be influenced by body temperature or dehydration. Moreover, we tested the hypothesis that changes in leukocyte counts and changes in MAC1 expression with endurance exercise are independently regulated. METHODS: In eight amateur runners, MAC-1 (CD11b/CD18) surface expression on granulocytes was determined by fluorescent antibody cell sorting, before and after an incremental maximal treadmill test, a moderate 3-h run, and a competitive marathon race. RESULTS: Expression CD11b on granulocytes was increased by 10+/-9.6% (P < 0.05) after the maximal treadmill test and by 84+/-76% (P < 0.01) after the marathon run. There was no change in CD11b expression after the moderate 3-h run. CD18 expression was not significantly changed after any of the exercise protocols. CONCLUSION: Expression of CD11b on granulocytes is increased with intense endurance exercise, either incremental maximal treadmill testing or competitive marathon running, but not in moderate endurance training. Thus, exhaustive exercise may be one mechanism for the upregulation of integrin adhesive receptors on granulocytes. This phenomenon could be in part responsible for increased adhesion of granulocytes to endothelial cells and could facilitate tissue infiltration after endurance exercise.     

Inflammation of the cardiac conduction system in a case of hyperthyroidism

A 37-year-old female showed signs of hyperthyroidism 2 weeks before death after a partial thyroidectomy was carried out 15 years previously. An examination 3 days before death revealed a normal blood cell count, an increased level of thyroidal hormones, sinus tachycardia and a high blood pressure of 170/90 mm Hg. A hyperthyroidism was diagnosed and therapy with carbimazol (2 × 10 mg) was started but 2 days later fever and chill occurred and before death short phases of unconsciousness and dyspnoea. The autopsy findings showed an interstitial inflammation of the AV-node, the His-bundle and its branches which can correlate with typical ECG changes in hyperthyroidism. Received: 13 July 1998 / Received in revised form: 15 September 1998     

Head injury in child abuse: evaluation with MR imaging

To evaluate the usefulness of magnetic resonance (MR) imaging in the diagnosis of head injury in child abuse, the authors compared the findings at head MR imaging and computed tomography (CT) in 19 abused children. Subdural hematomas (15 cases), cortical contusions (six cases), and shearing injuries (five cases) were demonstrated to particular advantage with MR imaging. CT remained superior in the detection of subarachnoid hemorrhage. MR imaging appears to be valuable in the assessment of patients with suspected intracranial injury due to child abuse.     

Course of glial immunoreactivity for vimentin, tenascin and alpha1-antichymotrypsin after traumatic injury to human brain

In a total of 104 individuals who had sustained traumatic brain injury (TBI), the course of glial immunoreactivity was investigated at the injured cortical area during the first 30 weeks after the trauma, in order to provide data for a forensic wound age estimation. Glial cells were stained with antibodies against the intermediate filament protein vimentin, the extracellular matrix protein tenascin and the serine protease inhibitor α1-antichymotrypsin (α1-ACT). Injury-induced glial staining reactions could be observed, at the earliest, after a post-infliction interval of 3.1 h for α1-ACT, 22 h for vimentin and 7 days for tenascin. Received: 21 August 2000 / Accepted: 21 November 2000     

Unusual longitudinal stress fractures of the femoral diaphysis: report of five cases

We present five cases of a distinctive type of longitudinal stress fracture of the upper femoral shaft in which the fracture line is parallel to the outer surface of the bone, in contrast to the perpendicular orientation to the cortical surface in previously reported cases of diaphyseal stress fractures. In two cases the fracture recurred after 15 and 18 months, respectively. Received: 25 May 1998; Revision requested: 27 July 1998; Revision received: 17 August 1998; Accepted: 8 September 1998     

The development of a clinical protocol for the radiolabelling of mixed leucocytes with 99Tcm-hexamethylpropyleneamine oxime

To devise a protocol for the radiolabelling of mixed leucocytes with 99Tcm-hexamethylpropyleneamine oxime (99Tcm-HMPAO), the effect of HMPAO concentration, cell concentration, plasma concentration and anticoagulant on the uptake of the lipophilic complex was measured, together with the stability of the 99Tcm on the labelled cells. It was found that cell uptake was rapid, independent of HMPAO concentration over the range 20-80 micrograms ml-1, but dependent on cell and plasma concentration. Incubation of mixed leucocytes from 85 ml blood with 1 ml ACD-plasma and 4 ml 99Tcm-HMPAO containing 400 MBq 99Tcm for 10 min at room temperature gave optimum results and was used in 90 patients. The mean labelling efficiency, which was the amount of added 99Tcm incorporated by the cells, was 55% (+/- 13 S.D.), of which 77% were incorporated by the granulocytes, 17% by the mononuclear cells and 6% by the platelets and erythrocytes. During a 1 h incubation in plasma 9% (+/- 4% S.D.) of the 99Tcm were released from the labelled mixed leucocytes. This occurred predominantly from the mononuclear cells.     

CT复查在首诊为隐匿性肺挫伤患者中的应用价值简

目的：评价多层螺旋CT（MSCT）在隐匿性肺挫伤（OPC）患者随访复查中的临床价值。方法对35例首诊确定为OPC患者的CT随访资料及临床转归进行回顾性分析,观察CT图像上肺挫伤病变的范围、密度演变情况,患者合并感染及临床转归情况,判断CT复查在OPC患者中的应用价值。结果所有35例OPC患者均在伤后1~90 d内进行1~4次CT复查,其中13例患者出现挫伤范围的扩大,主要出现在伤后1~2 d;7例继发肺炎,主要出现在伤后7~14 d,1例发展为急性呼吸窘迫综合征（ARDS）,1例患者继发脓胸。结论首诊为OPC的患者病情可能继续发展,MSCT能较全面地判断评价OPC患者肺部病变的演变情况,应当作为OPC患者重要的随访复查手段。     

Enhanced expression of selectins in human skin wounds

The aim of the study was to characterize the vitality and age of skin wounds by the detection of selectins. A prospective study was conducted for this purpose in which 197 vital human skin wounds (time since injury ranging from 3 min to 790 days) were investigated immunohistologically. Of the samples tested, 97 were taken from autopsy material and 100 from patient material from the department of surgery at the university hospital. The selectins were detected in paraffin sections after autoclaving and using the ABC technique. The intensity was rated by a semi-quantitative evaluation using a four-stage ordinal scale. Strong positive immunohistochemical reactions were observed for the P-selectin 3 min at the earliest and 7 h at the latest after the time of injury. For the E-selectin a positive staining was evident 1 h at the earliest and 17 days at the latest from the time the skin was injured. The staining intensity decreased significantly after an interval of 12 h from the time of injury (P < 0.05). The L-selectin was regularly detected on leukocytes in thesamples of injured skin. The immunohistochemical results for the P- and E-selectins were significantly different between injured and uninjured skin (P < 0.01). The expression of the selectins is indicative of the vitality of the wound. P-selectin was detected in a few cases (n = 4) at low intensity while E-selectin could not be found in the control samples (n = 31) of postmortem skin wounds. The use of P- and E-selectins for forensic purposes can help to achieve better estimates of the age of wounds with short survival times. Received: 26 January 1998 / Received in revised form: 13 March 1998     

Immunoregulatory hormones, circulating leucocyte and lymphocyte subpopulations before and after endurance exercise of different intensities.

Sixteen subjects (male, age: 26.3 +/- 3.5 years, weight: 75.1 +/- 6.5 kg, maximal oxygen uptake: 53.6 +/- 6.7 ml.min-1.kg-1) performed endurance exercises at 100% (exhaustive), and 85% (limited) of the individual anaerobic threshold [IAT; workload (100% IAT): 3.00 +/- 0.50 W.kg-1, duration of both exercises: 87 +/- 21 min]. Before (b), immediately (0 p), 60 min (60 p), 120 min (120 p) and 24 hours (24 hp) after exercise, leucocyte subpopulations (flow cytometry) as well as epinephrine, norepinephrine, cortisol, beta-endorphin and ACTH were determined. At 0 p, 60 p and 120 p, granulocytes were significantly higher at 100% IAT than at 85% IAT, lymphocytes and monocytes did not differ. At 60 p and 120 p, granulocytes had highest, lymphocytes lowest values. CD8(+)- and CD16(+)-lymphocytes showed greater changes than CD3(+)-, CD4(+)-, CD19(+)-lymphocytes and were significantly higher at 100% IAT than at 85% IAT (0 p). Epinephrine and norepinephrine were significantly higher at 100% IAT than at 85% IAT. Cortisol, ACTH and beta-endorphin increased at 100% IAT, but not at 85% IAT (0 p). Significant correlations were calculated for cortisol (0 p) versus granulocytes (60 p, 120 p) at 100% IAT. Epinephrine did not correlate to increases of lymphocytes or lymphocyte subpopulations. In conclusion, increases of granulocytes, CD16(+)- and CD8(+)-lymphocytes are dependent on the intensity of endurance exercises and precise definition of the individual workload is important. The increase of granulocytes after exercise is partly due to increased levels of cortisol. Increased cell numbers of lymphocytes, especially CD16(+)-cells, did not correlate to increased levels of catecholamines.     

The expression of P-selectin in inflammatory and non-inflammatory lung tissue

An initial attachment of leucocytes to blood vessel walls is mediated by selectins. A feature of adhesion mediated by P-selectin is the “rolling” of leucocytes on the endothelium. The time dependent expression of p-selectin in lung tissue was investigated in five groups of cases with different causes of death: carbon-monoxide and cyanide intoxication (n = 11), drowning (n = 5), hanging (n = 9), pneumonia (n = 13) and polytrauma with blunt thorax trauma (n = 14). In paraffin-embedded archival specimens immunostaining was achieved using an adapted APAAP-immunoperoxidase technique together with a wet autoclave method. P-selectin detection was scored by a semiquantitative method evaluating the intensity and incidence of positively stained endothelial cells. The distribution pattern of endothelial P-selectin of blood vessels in cases of pneumonia and septic shock were heterogenius and weak. In one case with lung contusion (survival time 3 h) moderate infiltrates of granulocytes were found near to septal and subpleural hemorrhages. In these inflammatory areas the positive endothelial immunostaining of small vessels was often weaker than in other lung segments or compared to the intensely stained platelets in corresponding vessels. Received: 23 December 1996 / Received in revised form: 6 February 1997     

Three-dimensional cholangio-spiral CT demonstration of a post-traumatic bile leak in a child

Bilioma is a rare complication of traumatic liver injury, and the precise site of bile leak is often difficult to demonstrate with a non-invasive technique. We report a case of post-traumatic bile leak in a 15-year-old girl in whom spiral CT after intravenous cholangiography allowed excellent preoperative demonstration of the extent of the liver rupture and an exact location of the bile leak. We think that spiral-CT cholangiography could be an accurate, non-invasive technique to investigate the biliary system in cases of paediatric liver trauma. Received: 2 December 1997; Revision received: 3 April 1998; Accepted: 6 May 1998