Lung contusion-lacerations after blunt thoracic trauma in children

Chest trauma in children is an indicator of injury severity and is associated with a high mortality rate. The aim of this study was to investigate the impact of pulmonary contusion-laceration on short and long-term outcome of pediatric patients after blunt thoracic trauma. A retrospective analysis of records of 41 children aged 10 months to 17 years who were treated for pulmonary and associated injuries between 1986 and 2000 was done concerning mode of injury, types of injuries, management and outcome. In addition, a follow-up investigation was performed 4.5±1 years after injury. Of the patients 27 were involved in motor vehicle accidents (MVA group) and 14 patients suffered other types of accidents (others group). The mean injury severity score (ISS) was 30±2 (range 9–75) with no significant difference between the groups. Patients from the MVA group suffered more frequently bilateral pulmonary lesions and needed more often chest tube placement (p<0.05), 5 patients died (12%) all from the MVA group. The follow-up investigation of 34 patients showed unremarkable chest x-rays and normal lung function in all but 1 patient with bronchial asthma. In conclusion, children who recover after a pulmonary contusion-laceration trauma do not suffer from significant late respiratory problems.     

Treatment with the neurosteroid dehydroepiandrosterone promotes recovery of motor behavior after moderate contusive spinal cord injury in the mouse

The neurosteroid dehydroepiandrosterone (DHEA) has neuroprotective properties after ischemic and excitatory insults to the brain. In the developing embryo, it is produced in discrete regions of the central nervous system (CNS), where it specifically promotes axonal growth of differentiated neurons. To test if DHEA could be beneficial after spinal cord injury (SCI), we used a model of moderate contusive SCI developed and characterized in the mouse. Immediately after surgery, we applied treatment with DHEA or with vehicle only and compared treatment groups (n = 12 in each group) over a 42-day period. Locomotor recovery was assessed in an open field using a standardized 21-point scale, according to gait analysis on paw print recordings and using foot fault analyses on an inclined ladder beam. The DHEA-treated group showed improved function compared to vehicle-treated animals in these tests. More strikingly, DHEA enhanced recovery of left-right coordination and fine motor control. In an attempt to correlate functional recovery with spinal cord neuropathology in the different experimental groups, we studied the area of spared white matter at the epicenter and reactive gliosis/scar formation 42 days post-injury (DPI). DHEA significantly increased the area of white matter spared at the epicenter and reduced the area of reactive gliosis surrounding the lesion. These data demonstrate the effectiveness of DHEA in promoting functional recovery in the adult murine injured spinal cord.     

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.     

Acute subdural haematoma successfully treated by percutaneous subdural tapping in an elderly patient

Summary An elderly patient suffering acute subdural haematoma associated with cerebral contusion was treated by percutaneous subdural tapping while preparing for craniotomy. Most of the subdural haematoma, though of high density on computed tomography scanning, proved to be semiliquid. Drainage of the haematoma yielded resolution of the mass effect, and was followed by a rapid improvement of consciousness. This observation suggests the significance of trial subdural tapping for the treatment of acute traumatic subdural haematoma prior to craniotomy.     

Regional cerebral blood flow after a localized cerebral contusion in pigs

Summary Regional cerebral blood flow (rCBF) in anaesthetized pigs is investigated before and after an induced focal cerebral contusion. Mean intracranial pressure increased for a short period following the contusion and reduced perfusion pressure to 60% of control pressure. Forty five minutes later the mean intracranial pressure was still high and different from the control values. Global flow and cerebral production of CO² increased concomitantly. In the cortical region where the contusion was visible macroscopically the rCBF diminished from 36.5 to 29.1 ml/min/100g. In the rest of the grey matter the rCBF raised after the contusion with an increase away from the centre of the lesion. CBF of cortical grey matter in the region symmetrically to the contusion increased significantly more than in the traumatized hemisphere. White matter rCBF changed least in the region underlying the contusion, while an increase was observed away from the contusion and on the opposite side of the brain. The correlation between tension of CO₂ in arterial blood and regional cerebral blood flow disappeared in the region of the contusion. The correlation between global metabolism and regional cerebral blood flow disappeared after the contusion in all regions. Local flow modulating factors influencing flow in the region of macroscopically visible injury has influence abating with distance from the centre of the injury together with a possible neuronally transmitted drive on flow in the opposite hemisphere.     

Relationship between CT attenuation changes and post-traumatic CSF-CKBB-activity after severe head injury in man

Summary In order to evaluate if it is practically possible to assess the volume of contused brain tissue from the CT pictures, a comparison has been carried out between the size of the cerebral contusion(s)-as estimated from the CT scans-and the post-traumatic CSF-CK_BB activity, in a series of 29 patients with severe head injury. A clearance curve for the elimination of CK_BB from the CSF was constructed.The relation between contusion volume and CSF-CK_BB-activity was not statistically significant, while the relationships between contusion volume and outcome, and between CSF-CK_BB, as estimated at 6 hours after trauma from the clearance curve, and outcome, were.     

中药加味葶苈大枣泻肺胶囊对兔肺挫伤的治疗作用

观察中药加味葶苈大枣泻胶囊急性肺挫伤的治疗作用，方法：通过特制多功能撞中撞击兔右侧胸部，建立兔肺挫伤模型，并观察了中药对急性肺挫伤病理生理变化的影响。所用动物２４只新西兰纯种兔随朵分为模型，模型加治疗和正常对照３组，每组８只，治疗组将中药胶囊中粉粒按时经胃管注入。     

Monitoring differential CO2 excretion during differential lung ventilation in asymmetric pulmonary contusion. Clinical implications

Eighteen severely injured polytrauma patients (ISS 38±18) with severe asymmetric pulmonary contusion were ventilated with differential lung ventilation (DLV) to improve oxygenation and/or to prevent further unnecessary barotrauma to the lesser involved lung. Differential VCO₂ was studied as a parameter for indirect measurement of effective individual pulmonary perfusion. One hour after starting DLV, difference in differential VCO₂ (delta VCO₂) was 81±57ml/min. In 16 patients this had fallen significantly (p<0.001) to 32±30ml/min, 1 h before DLV was discontinued. In 2 patients, VCO₂ remained > than 200ml/min, coinciding with clinical deterioration and increasing consolidation of the pulmonary contusion. Bilobectomies were performed in both patients. The excised lobes appeared to be destroyed as the result of laceration, bleeding and subsequent haematomas. This clinical study supports laboratory studies suggesting the usefulness of monitoring differential VCO₂ to assess effective differential pulmonary perfusion during DLV.     

冰香膏及中药熏洗治疗扭伤的临床观察

目的:观察冰香膏外敷及中药熏洗治疗关节扭伤的临床疗效和安全性。方法:将就诊患者分为2组,治疗组采用冰香膏外敷及中药熏洗治疗25例;对照组口服伤泰胶囊及麝香追风膏外敷治疗25例。疗程均为6天。结果:治疗组总有效100%,显效率80%,不良反应发生率4%;对照组总有效率100%,显效率44%,不良反应发生率28%,两组显效率经R检验P<0.05,具有显著性差异,治疗组明显优于对照组。不良反应发生率经X2检验P>0.05,无显著性差异。结论:应用冰香膏敷及中药熏洗治疗关节扭伤效果显著。     

脑挫裂伤CT所见与临床表现关系的对照研究

本文报告50例脑挫裂伤的 CT 扫描与临床表现之间的相关分析。这些病例均经临床检查及腰穿作出诊断并且全部作了 CT 扫描,所有病例均经保守治疗痊愈出院。脑挫裂伤 CT 扫描与 GCS 之间的关系非常密切,即头部外伤后 GCS 越低,CT 扫描所见脑损伤程度越明显。本文结果表明目前在国际上广泛应甩的格拉斯哥昏迷评分能较客观地反映脑损伤的严重程度。