Traumatic intracerebral lesions without extracerebral haematoma in 218 patients

Summary 218 of the 852 patients in the HIT-2 study of head injury had intracerebral lesions only. They were analysed to get more information on the optimal treatment of these severely injured patients. The initial CT scans were reviewed to exclude patients with extracerebral lesions, and to make a radiological diagnosis of contusion, contusion under a depressed fracture, diffuse axonal injury, or intracerebral haematoma. Deterioration after admission to hospital was seen in 71% of patients. Patients with contusions, and contusions from depressed fractures in particular showed a worse outcome than expected, while patients with diffuse injury had a tendency to improve rather than to deteriorate. Patients with intracerebral haematoma seemed to improve if the mass was evacuated. Nimodipine had an impact only in patients with contusions. Our findings mandate surgical evacuation of contusions and intracerebral haematomas in patients with lesions larger than 20 ml who also have radiological signs of a mass effect. Regardless of an apparently good clinical state in the early phase, intracerebral lesions larger than 50 ml seemed to benefit from surgery as compared to nonsurgical treatment.The findings indicated that a further refinement of diagnostic criteria may enable individually tailored head injury treatment to interfere with most important pathogenic mechanisms. More accurate diagnoses will improve head injury treatment and outcome, and are a prerequisite for making successful pharmaceutical trials of head injury in the future.     

Acute traumatic mutism

A patient who had suffered acute trauma to the head is reported. The patient was observed immediately upon admission to the hospital, and he was noted from the outset to have wakeful speechlessness. The evolution and resolution of neurological deficits were also observed. A review of the literature and a discussion of the possible causes of acute traumatic mutism are presented.     

创伤性连枷胸的临床特征与救治

目的　探讨创伤致连枷胸的损伤特征及救治。方法　回顾性分析 1997年 1月～2 0 0 2年 12月我科收治的 5 3例连枷胸患者的临床特点及诊治体会。行气管切开 12例 ,肋骨牵引 8例 ,手术内固定 18例 ,呼吸机治疗 10例 ,非固定治疗 5例。结果　治愈 49例 ( 92 .4% ) ,45例肺功能恢复正常 ;死亡 4例 ( 8.6% )。结论　在创伤性连枷胸患者中 ,肺挫伤和反常呼吸运动是引起呼吸和循环功能障碍的重要原因。保持呼吸道通畅 ,恢复胸壁的稳定性 ,治疗肺挫伤 ,积极救治复合伤是治疗的关键措施。     

The electrocardiographic and clinical diagnosis of myocardial contusion

The clinical features and treatment of 34 patients with myocardial contusion is presented. The value of specific clinical features for diagnosis is discussed. Guidlines for therapy are presented.     

促甲状腺素释放激素(TRH)类似物YM14673对大鼠脑损伤并发脑水肿的作用

用雄性Wistar大鼠,采用Feeney等的落体撞击法造成左顶颅脑挫伤。动物随机分组,给于TRH类似物YM14673(0.1 mg·kg^-1或1.0 mg.kg^-1,ip)或等体积生理盐水。治疗组可明显地减轻脑水肿。     

Timing of cortical contusion

Summary One hundred and sixteen cases with known intervals between the time of brain injury and the time of death were systematically examined for selected histologic alterations in an attempt to facilitate the timing of histomorphologic alterations in cortical contusions following closed brain injury. The following criteria were considered: erythrocytes, polymorphonuclear leukocytes, scavenger cells, hemosiderophages, lymphocytes, hematoidin, degenerating neurons, neuronophagy, axonal swelling, protoplasmic astrocytes, piloid astrocytes, siderin-containing astrocytes, edema, increase of vessels, fibroblasts/fibrocytes, and collagenous fibers. The post-traumatic interval ranged between 0 min and 58 years.Following routine staining, the paraffin sections were evaluated, and the presence of the selected histomorphologic criteria was determined (i.e., the time at which the criteria were demonstrable for the first and the last time during the post-traumatic interval in cases with different times of post-traumatic survival). The relative frequency of those cases with positive findings was calculated for each criterium in each observation period. The limits of confidence for the respective relative frequency was estimated with a statistical reliability of 95% according to Clopper and Pearson (1934) in the cases with demonstrated individual histomorphologic criteria. The distribution-free tolerance intervals with which each histomorphologic criterium is to be expected with 95% reliability within the observation period were established. The statistical data were compared with some of the data presented in the literature.     

胸部闭合性肺实质损伤的X线诊断：附200例分析

本文报告肺实质损伤２００例，将其Ｘ线表现主要归纳为：（１）肺内表现，创伤性湿肺，肺挫伤，肺撕裂伤，肺内血肿四种类型。（２）肺外表现，单纯性气胸，单纯性血胸，血气胸，皮下气肿或纵隔气肿四种类型，并就其Ｘ线表现及病理基础做了简要分析，指出对于肺实质损伤患者，进行动态胸部Ｘ线摄片检查的必要性。     

脑挫伤早期细胞凋亡相关基因表达的实验性研究

目的 探讨脑挫伤早期细胞凋亡相关Bcl-2,Fas/Fas-L的表达变化规模及神经细胞凋亡的调控机制。方法 运用光镜观察脑挫伤后脑组织的形态学变化，同时应用免疫组织化学方法检测脑挫伤早期不同时程Bcl-2,Fas/Fas-L的表达变化规律。结果 伤后8h在脑挫伤周围可见典型的凋亡神经细胞；伤后30min损伤灶周围神经细胞出现Bcl-2,Fas/Fas-L阳性表达，以后呈逐渐上升趋势且表达范围亦逐渐扩大，其中Bcl-2蛋白表达在伤后4h达高峰，随后呈下降的趋势，至伤后10－12h其表达程度与伤后1h相比无明显差异。结论 神经细胞凋亡参与脑挫伤后病理形态学改变，神经细胞凋亡的形成可能与促凋亡调控基因和抑凋亡调控基因的表达不平衡有关。     

挫伤性前房积血74例临床分析

前房积血发病率为眼外伤住院的14．45％。20岁以下占62．165，多为非职业性外伤。有24．32％继发青光眼，前房积血总致盲率为22．97％，其中41．18％是继发育青光眼。角膜血染致盲率100％，治疗着重止血、促进吸收、预防继发出血和眼压升高。     

Blunt chest trauma

Summary Blunt chest trauma is the leading cause of thoracic injuries in Germany, penetrating chest injuries are rare. Hereby, single or multiple rib fractures, hemato-pneumothorax and pulmonary contusion represent the most common injuries. The early managment of thoracic injuries consists of detection and sufficient therapy of acute life threatening situations like tension pneumothorax, acute respiratory insufficiency or severe intrathoracic bleeding. Most of the isolated thoracic injuries are adequately treated by conservative means, sufficient analgesia, drainage of intrapleural air or blood, physiotherapy and clearance of bronchial secretions provided; operative intervention is rarely indicated. In multiple injured patients however, severe blunt chest trauma and especially pulmonary contusion negatively affects outcome with a significant increase of morbidity and mortality. Hence, patients with this combination of pulmonary injuries, such as lung contusion and associated severe injuries, carry a particular high risk of respiratory failure, ARDS and MOF with a considerable mortality. Therefore, early exact diagnosis of all thoracic injuries is essential and can be achieved by thoracic computed tomography, which becomes more and more popular in this setting. Early intubation and PEEP-ventilation, alternate prone and supine positioning of multiple injured patients with lung contusion and differentiated concepts of volume- and catecholamine therapy represent the basic therapeutic principles. Additionally, the entire early trauma management of multiple injured patients must focus on the presence of pulmonary contusion. Every additional burden on their pulmonary microvascular system like microembolisation during femoral nailing, the trauma burden of extended surgery or mediator release in septic states may cause rapid decompensation and organ failure and therefore, has to be avoided.