Nonpenetrating Injury Research Articles

Cervical esophageal rupture after blunt neck trauma: Surgical primary repair and long-term follow-up

Summary Cervical esophageal rupture secondary to non-penetrating injury is exceedingly rare in pediatric patients. Less than 10 cases have been reported in the world literature. We report a case of a 9-year-old boy that suffered an esophageal perforation following cervical blunt trauma. The diagnosis was delayed 48 h but surgical primary repair was effective and recovery was uneventful. Early diagnosis and operative management options are discussed.

A model of posttraumatic epilepsy induced by lateral fluid-percussion brain injury in rats

Although traumatic brain injury is a major cause of symptomatic epilepsy, the mechanism by which it leads to recurrent seizures is unknown. An animal model of posttraumatic epilepsy that reliably reproduces the clinical sequelae of human traumatic brain injury is essential to identify the molecular and cellular substrates of posttraumatic epileptogenesis, and perform preclinical screening of new antiepileptogenic compounds. We studied the electrophysiologic, behavioral, and structural features of posttraumatic epilepsy induced by severe, non-penetrating lateral fluid-percussion brain injury in rats. Data from two independent experiments indicated that 43% to 50% of injured animals developed epilepsy, with a latency period between 7 weeks to 1 year. Mean seizure frequency was 0.3±0.2 seizures per day and mean seizure duration was 113±46 s. Behavioral seizure severity increased over time in the majority of animals. Secondarily-generalized seizures comprised an average of 66±37% of all seizures. Mossy fiber sprouting was increased in the ipsilateral hippocampus of animals with posttraumatic epilepsy compared with those subjected to traumatic brain injury without epilepsy. Stereologic cell counts indicated a loss of dentate hilar neurons ipsilaterally following traumatic brain injury. Our data suggest that posttraumatic epilepsy occurs with a frequency of 40% to 50% after severe non-penetrating fluid-percussion brain injury in rats, and that the lateral fluid percussion model can serve as a clinically-relevant tool for pathophysiologic and preclinical studies.

Anterior Approach to Traumatic Mid Aortic Arch Transection

The majority of nonpenetrating traumatic injuries to the thoracic aorta are fatal. Survivors of aortic transection tend to have injuries occurring at the isthmus. We report a rare, blunt traumatic complete transection of the mid aortic arch between the innominate and left common carotid arteries diagnosed by multidetector computed tomography of the chest. The repair was approached anteriorly and required aortic arch replacement.

Nonpenetrating injuries of the abdomen. By Robert H. Kennedy, B.A., M.D., F.A.C.S., Consulting Surgeon, Beekman-Downtown, Bellevue and University Hospitals. 8¼ × 5¾ in. Pp. 121. 1960. Springfield Ill.: Charles C. Thomas. (Oxford: Blackwell Scientific Publications.) 38s

Journal Article Nonpenetrating injuries of the abdomen. By Robert H. Kennedy, B.A., M.D., F.A.C.S., Consulting Surgeon, Beekman-Downtown, Bellevue and University Hospitals. 8¼ × 5¾ in. Pp. 121. 1960. Springfield Ill.: Charles C. Thomas. (Oxford: Blackwell Scientific Publications.) 38s Get access Nonpenetrating Injuries of the Abdomen. By Robert H Kennedy, B.A., M.D., F.A.C.S., Consulting Surgeon, Beekman-Downtown, Bellevue and University Hospitals. 8¼ × 5¾ in. Pp. 121. 1960. Springfield Ill.: Charles C. Thomas. (Oxford: Blackwell Scientific Publications.) 38s. British Journal of Surgery, Volume 48, Issue 209, November 1960, Page 350, https://doi.org/10.1002/bjs.18004820939 Published: 06 December 2005

Traumatic thrombosis of the internal carotid artery following a non-penetrating injury and leading to infarction of the brain

Traumatic thrombosis of the internal carotid artery following a non-penetrating injury and leading to infarction of the brain

Post-traumatic thrombosis of the internal carotid and vertebral arteries after non-penetrating injuries of the neck.

Post-traumatic thrombosis of the internal carotid and vertebral arteries after non-penetrating injuries of the neck.

Isolated double gastric rupture as a result of blunt abdominal trauma

Isolated double gastric rupture as a result of blunt abdominal trauma

Tracheoesophageal Fistula with Severe Mediastinitis Following Blunt Chest Trauma

Tracheoesophageal fistula (TEF) following nonpenetrating injury is a very rare traumatic condition but serious complication that needs an immediate surgical intervention after making an accurate diagnosis. A case of TEF with severe mediastinitis that is rarely accompanied with TEF is reported. An 18-year-old man who had a traffic accident was admitted to the intensive care unit. After 2 days following admission and intubation, bile juice was suctioned from the trachea. TEF was suspected and promptly confirmed by contrast esophagogram. The patient was taken to surgery and underwent a right posterolateral thoracotomy. The tracheal defect was repaired by primary suture with reinforcement of the pedicled intercostal muscle flap and esophageal exclusion and diversion with drainage was performed because of severe mediastinitis. A second-stage esophageal reconstruction with a right colon conduit was performed when he was completely stabilized in the aspects of infection, nutrition and respiration. His postoperative course was uneventful.

Amantadine for traumatic brain injury: does it improve cognition and reduce agitation?

To review the available literature pertaining to amantadine as therapy for improving cognition and reducing agitation following a non-penetrating traumatic brain injury (TBI). Clinical literature was accessed through MEDLINE (from 1966 to February 2004) and bibliographic searches. Key search terms included 'amantadine', 'traumatic brain injury', 'cognition', and 'agitation'. Amantadine is primarily used for treatment and prophylaxis of influenza A. Its ability to improve mentation and motor function in patients with head injury remains questionable. An evaluation of five clinical trials, two case reports, and one case series is conducted focusing on the use of amantadine following TBI. Patients in clinical trials were assessed using a variety of neuropsychological tools aimed at, among other things, assessing cognition and agitation. Although individual patient results varied, the majority of patients studied showed improved neuropsychological test scores. Similar observations are noted in the case reports and case series. Improvement in cognition and reduced agitation seems to occur with post-injury amantadine therapy. Amantadine is a reasonable option for improving cognition and reducing agitation following a TBI but confirmatory evidence of the efficacy the drug is necessary.

Trauma associated with acute myocardial infarction in a multi-state hospitalized population

Introduction Trauma has been suggested, in case series, as one of the nonatherosclerotic mechanisms leading to acute myocardial infarction (AMI), the leading cause of death in the US. AMI following non-penetrating injury has been shown to carry significant morbidity and mortality. Objective To determine whether hospitalized injuries in a large multi state population are associated with increased risk of AMI during the initial hospital stay. Methods Statewide injury hospital discharge data were collected from 19 states in 1997. Affected body regions of interest included thoracic, abdominal or pelvic, spine or back and blunt cardiac injury (BCI). The outcome of interest was AMI which was identified based on ICD-9-CM discharge diagnoses for the same visit. Unadjusted and adjusted multivariate logistic regression analyses were performed. Results Independent of confounding factors and coronary arteriography (CA) status, BCI was associated with 2.6-fold increased risk for AMI in persons 46 years or older. When the diagnosis of AMI was confirmed by CA, BCI was associated with 8-fold risk elevation among patients 46 years and older and a 31-fold elevation among patients 45 years and younger. Abdominal or pelvic trauma, irrespective of confounding factors and CA status, was associated with a 65% increase in the risk of AMI among patients 45 years and younger and 93% increase in the risk of among patients 46 years and older. When the diagnosis of AMI was confirmed by CA, abdominal or pelvic trauma was associated with 6-fold risk elevation among patients 46 years and older. Conclusion Direct trauma to the heart, as characterized by a diagnosis of BCI, was observed to carry the greatest risk for AMI. Abdominal or pelvic trauma also increased the risk for AMI. Longitudinal studies are warranted to better understand the relationship between trauma and AMI.

CASE REPORT Sympathetic Ophthalmia after a Hyphema due to Nonpenetrating Trauma

Purpose: To report a case of sympathetic ophthalmia occurring after nonpenetrating ocular trauma. Methods: Interventional case report. Results: An 18-year-old white male presented with sympathetic ophthalmia four weeks after a hyphema from a nonpenetrating bungee cord injury. Vision was 20/20; there were keratic precipitates, anterior chamber cells, vitritis, and discrete yellow deep choroidal lesions consistent with Dalen-Fuch's nodules OU. The uveitis was treated with topical, oral, and periocular corticosteroids and the oral immunosuppressives cyclosporine and mycophenolate mofetil. Vision remained 20/20 OU for the first year of follow-up; vision OD then deteriorated to 20/50 over the next year with the formation of a posterior subcapsular cataract OD. Conclusion: Sympathetic ophthalmia may result from nonpenetrating ocular trauma. Ophthalmologists should be aware of this as prompt intervention is warranted.

Nonsteroidal Anti-inflammatory Drugs and Acetaminophen in the Treatment of an Acute Muscle Injury

Background Nonsteroidal anti-inflammatory drugs are frequently used to treat muscle injuries in athletes. It is not known whether the anti-inflammatory effects of these drugs are important or whether their effectiveness is a result of their central anal-gesic effect. Hypothesis The effects of nonsteroidal anti-inflammatory drugs are no different than the effects of an analgesic (acetaminophen) without anti-inflammatory action in an experimental, acute muscle contusion model. Study Design Controlled animal study. Methods A standardized, unilateral, nonpenetrating injury was created to the tibialis anterior muscle of 96 adult male mice. Four treatment groups were used: group 1, placebo treatment; group 2, treatment with rofecoxib, a nonsteroidal anti-inflammatory drug with cyclooxygenase-2 selectivity, and treatment after the injury; group 3, rofecoxib treatment starting 24 hours before the injury; and group 4, acetaminophen treatment after the injury. The muscle and the contralateral normal muscle were evaluated at 2, 5, and 7 days after injury by grading of gait, wet weight as a measure of edema, and histologic evaluation. Results Group 1 had significantly more gait disturbances at day 2 than all other groups (P < .05). No differences were found at days 5 and 7. Wet weights showed an increase at day 2 in group 1 (P < .01). Again, no differences were found at days 5 and 7. Histology revealed similar inflammatory changes at day 2 in all groups, with regeneration of muscle fibers at days 5 and 7. Conclusions The results indicate that rofecoxib as a nonsteroidal anti-inflammatory drug and acetaminophen as a non-nonsteroidal anti-inflammatory drug analgesic have similar effects. The lack of differences in wet weights and histology suggests that the anti-inflammatory effects of rofecoxib are not an important feature of its action. Clinical Relevance The routine use of nonsteroidal anti-inflammatory drugs in muscle injuries may need to be critically evaluated because low-cost and low-risk analgesics may be just as effective.

Traumatic Brain Injury in the Rat Using the Fluid‐Percussion Model

Traumatic brain injury is a leading cause of death and disability, particularly among young adults. During closed head trauma, the injury process is initiated by the impact of the brain against the inner table of the calvarium. Subsequently, there is prompt initiation of a complex biochemical, cellular, and physiological injury cascade that may take days to complete. From a functional standpoint, this culminates in neurologic dysfunction and, if severe, death. This unit describes an impact-induced brain trauma model in rats which replicates nonpenetrating head injury. It does not model either penetrating or ischemic brain injuries.

Assessment of inflammatory response and sequestration of blood iron transferrin complexes in a rat model of lung injury resulting from exposure to low-frequency shock waves.

Impact of air blast overpressure waves (OPW), or shock wave, with the body wall or body armor produces two types of energy waves: high-frequency low-amplitude stress waves and long-duration low-frequency share waves. These types of energy waves are characterized by different mechanisms of primary tissue injury that mostly affect lung. Systemic inflammation and resultant acute respiratory distress syndrome are known major secondary causative agents of delayed multiple organ failure and subsequent death after OPW exposure. However, association of each pattern of the blast OPW-produced energy waves with postexposure inflammatory events has not yet been delineated. The objectives of the present research were a) establishment of a rat model for assessment of the inflammatory response following lung injury produced by exposure to medium-amplitude (approximately 120 kPa) low-frequency (260+/-5 Hz) OPWs; and b) assessment of the dynamics of alteration in polymorphonuclear leukocyte counts and expression of CD11b adhesion molecules on the surface of polymorphonuclear leukocytes and status of iron-transferrin complexes in peripheral blood after OPW exposure. This study focused on the OPW effects at different time periods, using a sequential approach to postexposure events. Lung injury in rat was induced by OPW generated in a laboratory shock tube. Animals were exposed to OPW (at peak overpressure of 118+/-7 kPa) that produced "moderate" lung injury. Military research institute. Twenty-seven CVF Sprague-Dawley rats were subjected to OPW exposures, and 17 sham-treated animals were used as control. Lung tissue and blood samples were collected at 1, 3, 6, 12, and 24 hrs following OPW exposures and compared with samples collected from nonexposed animals. OPW-induced lung injury caused a 2.7-fold increase in the number of circulatory polymorphonuclear leukocytes as early as 1 hr postexposure, which is indicative of mobilization of the pool of marginated polymorphonuclear leukocytes into the free circulation. Polymorphonuclear leukocyte counts increased through the following 3- and 6-hr periods, when they were, respectively, 5-fold and 3.5-fold higher than in controls. These effects were accompanied by a pronounced expression of CD11b in polymorphonuclear leukocytes and tissue sequestration of blood iron-transferrin complexes during the entire 24-hr period of observations. The increase in circulatory polymorphonuclear leukocytes was accompanied by a decrease in iron-transferrin complex concentrations that apparently reflected implication of blood plasma iron in the inflammatory cell response to OPW-induced injury. The observed dynamics in polymorphonuclear leukocyte alterations in peripheral blood after OPW exposure were similar to those found recently in clinical observations of nonpenetrating injury and in animal models of infectious insults. Therefore, our data suggest that the main pattern of proinflammatory alterations in the rat model of lung injury induced by exposure to long-duration shock wave is similar to patterns that are characteristic of major trauma. The data further suggest that the expression of polymorphonuclear leukocyte CD11b and the response of iron-transferrin complex can be considered as potential surrogate markers in blood for systemic alterations following OPW-induced injury and, therefore, warrant further investigation in a human pilot study.

Neuroprotective role of aminoguanidine in behavioral changes after blast injury.

The present study investigated the neuroprotective role of aminoguanidine, a known inducible nitric oxide synthase inhibitor, in both behavioral and morphologic changes in rats subjected to nonpenetrative blast injury. Male Sprague-Dawley rats were randomly divided into groups to receive either normal saline or aminoguanidine (AG) before or after exposure to two blast dosages of either 2.8 or 20 kPa. The neurobehavioral alterations were determined by subjecting the animals to rotametric, grip-strength, passive avoidance, total and ambulatory locomotor activities, and acoustic startle response tests. Exposure to blast at 20 kPa resulted in a significant performance decrement on rotametric and grip-strength tests in rats treated with normal saline. In contrast, animals receiving AG either prophylactically before or after the blast seemed unaffected by the same blast. This finding also correlates well with histologic examination that showed a reduction in degenerating cortical neurons in AG-treated rats compared with those receiving saline injection. It is thus suggested that AG could play a neuroprotective role in rats subjected to blast exposure.

Methylprednisolone in acute spinal cord injuries.

Methylprednisolone is the only neuroprotective therapy advocated in acute non-penetrating spinal cord injury. Trials indicate improved neurological outcome following early administration of a high dose regime. The National Spinal Injuries Unit (NSIU) has promoted this regime by a simple laminated poster sent to all Irish A&E departments. To assess the use of methylprednisolone in patients with spinal cord injuries. A retrospective audit of patient data for all patients admitted with traumatic neurological impairment over a 12-month period. One hundred ninety-six patients were admitted during the study period, 28 (14%) received intravenous methylprednisolone of which six had clear records documenting compliance. One patient received both dexamethasone and methylprednisolone in high doses and three had incorrect bolus dosages administered. Six patients received methylprednisolone infusion longer than the protocol, while five patients were given infusions shorter than recommended. Three patients were admitted to the unit that could have received the steroid regime at the point of transfer. There was poor documentation of prescription orders and timing of administration. Only six patients had clear documentation allowing confirmation of adherence to the protocol of the National Acute Spinal Cord Injury Study (NASCIS) III trial.

Neuroplasticity following non-penetrating traumatic brain injury

The primary objective of this review is to examine the methodology and evidence for neuroplasticity operating in recovery from traumatic brain injury (TBI), as compared with previous findings in patients sustaining perinatal and infantile focal vascular lesions. The evidence to date indicates that the traditional view of enhanced reorganization of function after early focal brain lesions might apply to early focal brain lesions, but does not conform with studies of early severe diffuse brain injury. In contrast to early focal vascular lesions, young age confers no advantage in the outcome of severe diffuse brain injury. Disruption of myelination could potentially alter connectivity, a suggestion which could be confirmed through diffusion tensor imaging (DTI). Initial reports of DTI in TBI patients support the possibility that this technique can demonstrate alterations in white matter connections which are not seen on conventional magnetic resonance imaging (MRI) and might change over time or with interventions. Preliminary functional MRI studies of TBI patients indicate alterations in the pattern of brain activation, suggesting recruitment of more extensive cortical regions to perform tasks which stress computational resources. Functional MRI, coupled with DTI and possibly other imaging modalities holds the promise of elucidating mechanisms of neuroplasticity and repair following TBI.

NON-STEROIDAL ANTI-INFLAMATORY DRUGS (NSAIDS) AND ACETAMINOPHEN IN THE TREATMENT OF AN ACUTE MUSCLE INJURY

Muscle injuries are common in athletes. Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used to treat them. It is not known whether the anti-inflammatory effects of these drugs are important or whether their effectiveness is a result of their central analgesic effect. PURPOSE: evaluate and compare the effects of non-steroidal anti-inflammatory medication (NSAID), an analgesic (acetaminophen) and placebo in an experimental, acute muscle contusion model. METHODS: A standardized, unilateral, non-penetrating injury was created to the tibialis anterior muscle of 96 adult, male mice. Four treatment groups were used: Group 1 placebo treatment, Group 2 rofecoxib, an NSAID, treatment following the injury, Group 3 rofecoxib treatment starting 24 hrs prior to the injury, Group 4 acetaminophen treatment following the injury. The muscle and the contralateral normal muscle were evaluated at 2, 5 and 7 days post-injury with grading of gait, wet weight and histology. RESULTS: Group 1 had significant more gait disturbances at day 2 than all other groups (P < 0.05). No differences were found at day 5 and 7. Wet weights showed an increase at day 2 in Group 1 (P < 0.01). Again no differences were at day 5 and 7. Histology revealed similar inflammatory changes at day 2 in all groups with regeneration of muscle fibers at day 5 and 7. CONCLUSION: The results of in this muscle injury study indicate that rofecoxib as an NSAID and acetaminophen as a non-NSAID analgesic have similar effects. The lack of differences in wet weights and histology suggest that the anti-inflammatory effects of rofecoxib are not an important feature of its action. Similarly, administration of the NSAID prior to the injury does not appear to enhance its effectiveness.

Early seizures following non-penetrating traumatic brain injury in adults: risk factors and clinical significance

Background : In the literature dissenting data are obtained about risk factors for early post-traumatic seizures and their impact on outcome. This study was conducted to obtain more information about the clinical significance of early seizures and their possible impact on the treatment of traumatic brain injury. Methods and results : A consecutive series of 1868 adult patients with head injury were analysed retrospectively. Demographic data of the patients, characteristics of the injury, and findings on CT scan were recorded. Risk factors for early post-traumatic seizures were identified using univariate statistics. A multivariate logistic regression was performed to look for interaction of different variables. The impact of early post-traumatic seizures on outcome was examined in an analogous way. Chronic alcohol abuse, subdural haematoma and brain contusion were identified as independent risk factors for early post-traumatic seizures. A significant association of early post-traumatic seizures with an unfavourable outcome was observed, but this effect was small compared to other variables. Conclusions : Early post-traumatic seizures appear to be an acute reaction of the brain to cortical damage with little independent impact on the management of head injury.

The role of steroids in acute spinal cord injury: an evidence-based analysis.

Literature review. The purpose of this article is to review the available literature and formulate evidence-based recommendations for the use of methylprednisone in the setting of acute spinal cord injury (SCI). Since the early 1990s, methylprednisolone has become widely prescribed for the treatment of acute SCI. Arguably, it has become a standard of care. Through an electronic database search strategy and by cross-reference with published literature, appropriate clinical studies were identified. They were reviewed in chronologic order with respect to study design, outcome measures, results, and conclusions. Nine studies were identified that attempted to evaluate the role of steroids in nonpenetrating (blunt) spinal cord injury. Five of these were Class I clinical trials, and four were Class II studies. All of the studies failed to demonstrate improvement because of steroid administration in any of the a priori hypotheses testing. Although post hoc analyses were interesting, they failed to demonstrate consistent significant treatment effects. From an evidence-based approach, methylprednisolone cannot be recommended for routine use in acute nonpenetrating SCI. Prolonged administration of high-dose steroids (48 hours) may be harmful to the patient. Until more evidence is forthcoming, methylprednisolone should be considered to have investigational (unproven) status only.