Small Stab Wound Research Articles

Kinetics of blood-brain barrier dysfunction to albumin around small cerebral stab wounds.

A small stab wound was made in the frontal lobe of the rat brain in order to study the amount of albumin extravasated at different times after the injury. Evans blue-labeled bovine albumin was injected at various times after the injury. The animal was perfused with buffered saline at predetermined times and the contents of exogenous bovine albumin and of endogeneous rat albumin in the brain were assayed by rocket immunoelectrophoresis. There was an immense extravasation of bovine albumin at the time of injury and during the first 10 min post-operatively, but a very slight extravasation during the following three post-operative hours. At the 6th postoperative hour there was an increase in the extravasation of albumin, followed by a subsequent decrease during the 16th and 24th post-operative hours. The amount of endogenous rat albumin present in the injured area of the brain did not change from 10 min to 3 h after injury. At the 6th post-operative hour there was an increase in the amount of extravasated rat albumin, reflecting the increased extravasation of macromolecules during the 6th hour after injury. The results obtained indicate that most of the albumin present in the brain during the first post-operative day is extravasated through the immediate hemorrhage at the time of injury. Thus, only a small portion of the extravasation of albumin around cerebral stab wounds can be prevented by post-operative pharmacological treatment.

External bypass operation for biliary tract obstruction.

To the Editor .—Biliary obstruction secondary to nonresectable malignancy or inflammatory and iatrogenic stricture of the biliary tract is a serious condition. Decompression is essential to relieve obstruction, to allay symptoms, and to prolong life. Many procedures for decompression of the biliary tract have been reported, including bypass operations, 1 percutaneous transhepatic drainage, 2,3 and internal prostheses. 4 I and my colleagues have been using an external biliary bypass that decompresses the biliary tree, bypasses the obstruction, and is easy to perform. At the time of laparotomy, a portion of the dilated biliary tract is exposed and opened proximal to the obstruction. A T-tube is inserted, with the long stem of the T-tube drawn to the exterior through a small stab wound. Similarly, the common duct, duodenum, or jejunum distal to the obstruction is selected and a T-tube is inserted. As with the proximal tube, the long vertical stem of

Chronic, nonocclusive, and maintenance-free central venous cannula in the rat

To provide a means of taking repeated blood samples from conscious, stress-free rats, we devised a method to chronically cannulate the inferior vena cava. The rat was anesthetized with pentobarbital sodium plus methoxyflurane. The inferior vena cava was exposed through a midline abdominal incision. Silastic tubing (0.020 in. ID, 0.037 in. OD) was pushed through a tiny hole punctured in the wall of the vein; it remained in place without leaking due to the elasticity of the vessel wall. The cannula was advanced towards the heart until its tip lay at the level of the xiphisternum at which point blood could be aspirated. A series of silk (4-0) sutures to the psoas muscle and body wall held the cannula secure without compromising blood flow. The cannula ran subcutaneously to the back of the neck where it was ligated to the underside of the skin (prolene 4-0 suture), plugged with a short metal obturator, and exteriorized through a small stab wound. The cannula was filled with heparinized saline, but it was not necessary to regularly flush it through to maintain patency. Sepsis did not occur and animals autopsied several months after cannulation showed no tissue reaction around the cannula.

ささいな小刺創に続発した弾撥指

ささいな小刺創に続発した弾撥指

Chlorpromazine treatment of blood-brain barrier dysfunction a quantitative and fluorescence microscopical study on small cerebral stab wounds in the rat

The extravasation of albumin around small cerebral stab wounds in the rat frontal cortex was studied by fluorescence microscopy after i.v. injection of Evans blue-labeled albumin and by quantitative immunoelectrophoresis after i.v. injection of bovine albumin, in both nonintoxicated and ethanol-intoxicated rats. The extravasion of albumin was enhanced in ethanol-intoxicated compared to nonintoxicated rats, as studied both by immunoelectrophoresis and by fluorescence microscopy. Administration of chloropromazine (2 mg/kg body weight i.v.) 16 h after inflicting cerebral stab wounds decreased the area around the wound showing extravasation of Evans blue-labeled albumin as studied by fluorescence microscopy both in nonintoxicated and in ethanol-intoxicated rats. Quantitative studies showed a significanct decrease in the amount of extravasated albumin around cerebral stab wounds in ehtnaol-entoxicated rats, while the extravasation in nonintoxicated rats was not significantly changed by chlorpromizine treatment.

Cellular reactions to small cerebral stab wounds in the rat frontal lobe. An ultrastructural study.

Small stab wounds were made in the frontal lobe of adult rats by the insertion of a glass capillary or a steel needle with a diameter of 50 mum. Macroscopically, there was a minute lesion filled with red blood cells. Ultrastructurally, there was a prominent edema with 200 mum from the wound during the first 3 days. There was an invasion of neutrophilic leukocytes, monocytes, and pericytes during the first postoperative week and a subsequent phagocytosis of necrotic devris during the first 2 weeks. Neurons within 150-200 mum from the wound degenerated and became phagocytized by macrophages. Astrocytes showed a transitional swelling, later followed by an accumulation of glycogen and filaments. Oligodendrocytes as well as astrocytes took part in phagocytosis. The most prominent early reaction of oligodendrocytes was the formation of multiple vacuoles and, in less injured cells, pinocytotic vesicles. Many cells with a morphology intermediate between the usual appearances of astrocytes and oligodendrocytes were seen. Some of these cells were similar to "third type of neuroglial cells." It was concluded that the healing of this type of small stab wounds occurred in a very regular way. Morpholocially, very little necrosis was seen, but there was a profound reactivity both in invading hematogeneous phagocytes, i.e., neutrophilic leukocytes and monocytes, and in neuroglial cells. Thus, the present type of trauma might be considered a useful model for studying events in healing of brain injuries.

Extravasation, spread and cellular uptake of Evans blue-labelled albumin around a reproducible small stab-wound in the rat brain.

A small stab wound was made in the frontal lobe of the rat brain in order to study both the acute damage and the restitution of the blood-brain barrier to macromolecules under well-defined experimental conditions. Intravenously administered Evans blue-labelled albumin (EBA) was used as a tracer and the brain sections were observed in a fluorescence microscope. EBA leaked into the neuropil only during the first 3 days after the trauma. The maximal leakage occurred during the first day after the injury. The tracer spread from the area surrounding the stab wound in a reproducible way, initially roughly centrifugally. Nerve and glial cells close to the wound displayed a diffuse fluorescence of their cell bodies 1 to 6 h after the injury, i.e. at times with maximal extravasation of the tracer. A more granular distribution of the tracer was seen in neurons and glial cells at both very short and long times after EBA injection. Thus, the blood-brain barrier lesion induced was reproducible and reversible as judged by the pattern of EBA leakage. Some cells immediately adjacent to the injury had a diffuse cytoplasmic distribution of the tracer complex, in contrast to cells more distant from the injury, having a more granular distribution of the tracer in their cytoplasm. However, the appearance of the fluorescence in neurons and glia was to a large extent dependent upon the time after the injury, at which the cells were exposed to the tracer complex and on the time that had elapsed from the time of injection of the tracer complex to the sacrifice of the animal. Thus, it seems likely that two factors contribute to the appearance of the neuronal EBA distribution: on one hand the location and possibly extent of cellular damage of the cell, and, on the other hand, the time and amount of EBA to which the cells were exposed.

The brain-specific S 100 protein in small cerebral stab wounds in the rat: a quantitative study.

A quantitative study of the changes in water-soluble proteins and water-soluble S 100 was made in stab-wounded rat frontal cortex as compared to unoperated controls. No great changes occurred until 30 days after the injury. At that time there was no change in the amount of water-soluble S 100 protein/g wet weight, but a large decrease in the amount of water-soluble proteins/g wet weight and thus a proportionate increase in the amount of water-soluble S 100 protein/mg of water-soluble proteins. The significance of the results is discussed.

Peritoneal lavage in blunt abdominal trauma

The detection and treatment of significant intra-abdominal injury following blunt trauma is fraught with problems. The search for signs of hemoperitoneum by paracentesis is unrellable, additional delays for observation or anglography increase morbidity and mortality, while early cellotomy may yleld negative findings in one patient in five. Peritoneal lavage provides a solution to these problems with an accurate, sensitive, rapid, and safe diagnostic test for the presence or absence of hemoperitoneum. It should be performed at the time of emergency department evaluation on all patients suffering blunt trauma with possible intra-abdominal injury. A peritoneal dialysis catheter is piaced through a small stab wound and 20 ml/kg lactated Ringer's solution infused and subsequently dralned. A 20 ml blood return correlates with significant injury in 98% of patients. A weakly positive result (less than 20 ml of blood) occurs in one third of patients with injury requiring surgery. Patients with this finding, if stable, are subjected to anglography and further observation before cellotomy is contemplated. A qualitative method for determining the amount of blood is based on turbidity of the returned lavage fluid in the infusion tubing. Printed material cannot be read through the fluid when more than 20 ml of blood is present. Complications of the procedure are a rarity. It has permitted a 50% reduction in time of preoperative evaluation, a limitation on the need for angiographic studies and a sharp reduction in unnecessary surgery.

Retrograde amnesia produced by small cortical stab wounds in the mouse.

Retrograde amnesia produced by small cortical stab wounds in the mouse.

The supersensitivity of chronically “isolated” cerebral cortex as a mechanism in focal epilepsy

1. 1. A technique is described of neuronally isolating an area of cerebral cortex through small stab wounds in the dura mater. This method, a modification of that described by Kristiansen and Courtois 1949, has largely avoided the formation of subdural adhesions and has made it possible to obtain electrocortigrams, in 100 monkeys and 3 humans, at a second operation 2 weeks to 3 1 2 years later, with little injury to the cerebral cortex or pial circulation. 2. 2. “Spontaneous” electrical activity was present in chronic completely neuronally isolated cerebral cortex provided the circulation was adequately maintained (20 monkeys and 2 human preparations) (Echlin et al. 1952; Echlin and McDonald 1954; Grafstein and Sastry 1957). This electrical activity was unstable. abnormal in appearance, often paroxysmal, and bore little resemblance to that recorded from normal cerebral cortex. 3. 3. The resting electrical activity from small blocks of chronically partially isolated cerebral cortex was similar to that usually regarded as characteristic of epileptogenie cortex (Echlin et al. 1952; Echlin 1953; Echlin and McDonald 1954). 4. 4. The nerve cells in areas of chronically “isolated” frontal or parietal cerebral cortex became supersensitive to topically applied acetylcholine (Echlin 1954; Echlin and McDonald 1954; Spiegel and Szekely 1955), eserine and electrical stimulation. The topical application of acetylcholine 0.2 to 0.5 percent widely to the cerebral cortex in such chronic preparations precipitated discharges of rhytmic wave and spike epileptiform electrical activity selectively from the “isolated” area in 90 per cent of the 80 animals and in the 1 human studied. The local use of 1 per cent acetylcholine or of 1 per cent eserine followed by 0.2 to 1 per cent ACH resulted in a spread of the epileptiform rhythmic potentials from the partially isolated zone to the motor cortex and clonic seizures and, less often, generalized electrical and clinical convulsions. 5. 5. In contrast to these findings 0.2 to 0.5 per cent acetylcholine never caused epileptiform electrical discharges when applied topically to the unanesthetized frontal or anterior parietal cortex of normal monkeys (9 preparations) or to the hemisphere homologous to one containing a chronically “isolated” block of grey matter (10 preparations). 6. 6. Evidence is provided that the “isolation factor” rather than injury or ischemia is the important factor in the causation of the supersensitivity of chronically neuronally “isolated” cerebral cortex (Echlin 1956). 7. 7. Characteristics bursting was present in electrocorticograms from the partially isolated cerebral cortex overlying and surfounding brain tumors. The bursts appeared in the EEG as slow waves. It is again suggested that EEG as slow waves. It is again suggested that at least some of the slow waves in the EEG from around brain tumors are the result of the partial isolation of cerebral neurones (Echlin et al. 1952). 8. 8. Acute surgical “isolation” of a temporal lobe spike focus in an epileptic patient caused an activation of the electrical focus. 9. 9. It has been demonstrated that chronic partially isolated human or monkey cerebral cortex has many properties, characteristics and reactions commonly regarded as characteristic of epileptogenic cortex. It therefore seems probable that chronic partial isolation of cerebral neurones by scar tissue, brain tumor, or other pathology, is an important factor — if not the basic factor—in the causation of focal epilepsy.