Syndromic approach in the radiodiagnosis of maxillofacial injuries

Radiodiagnosis of maxillofacial injury (MFI) is a topical problem of modern medicine. A complex of currently available highly informative methods, which comprises spiral computed tomography, digital X-ray study, and ultrasonography, used on the basis of a syndromic diagnostic approach substantially increases the informative value of a radiodiagnostic stage, provides a clear picture of the pattern of lesions, and defines, on the findings, an adequate treatment policy.     

Quantitative analysis of brain microstructure following mild blunt and blast trauma

We induced mild blunt and blast injuries in rats using a custom-built device and utilized in-house diffusion tensor imaging (DTI) software to reconstruct 3-D fiber tracts in brains before and after injury (1, 4, and 7 days). DTI measures such as fiber count, fiber length, and fractional anisotropy (FA) were selected to characterize axonal integrity. In-house image analysis software also showed changes in parameters including the area fraction (AF) and nearest neighbor distance (NND), which corresponded to variations in the microstructure of Hematoxylin and Eosin (H&E) brain sections. Both blunt and blast injuries produced lower fiber counts, but neither injury case significantly changed the fiber length. Compared to controls, blunt injury produced a lower FA, which may correspond to an early onset of diffuse axonal injury (DAI). However, blast injury generated a higher FA compared to controls. This increase in FA has been linked previously to various phenomena including edema, neuroplasticity, and even recovery. Subsequent image analysis revealed that both blunt and blast injuries produced a significantly higher AF and significantly lower NND, which correlated to voids formed by the reduced fluid retention within injured axons. In conclusion, DTI can detect subtle pathophysiological changes in axonal fiber structure after mild blunt and blast trauma. Our injury model and DTI method provide a practical basis for studying mild traumatic brain injury (mTBI) in a controllable manner and for tracking injury progression. Knowledge gained from our approach could lead to enhanced mTBI diagnoses, biofidelic constitutive brain models, and specialized pharmaceutical treatments.     

Major Radiodiagnostic Imaging in Pregnancy and the Risk of Childhood Malignancy: A Population-Based Cohort Study in Ontario

Background

The association between fetal exposure to major radiodiagnostic testing in pregnancy—computed tomography (CT) and radionuclide imaging—and the risk of childhood cancer is not established.

Methods and Findings

We completed a population-based study of 1.8 million maternal-child pairs in the province of Ontario, from 1991 to 2008. We used Ontario''s universal health care–linked administrative databases to identify all term obstetrical deliveries and newborn records, inpatient and outpatient major radiodiagnostic services, as well as all children with a malignancy after birth. There were 5,590 mothers exposed to major radiodiagnostic testing in pregnancy (3.0 per 1,000) and 1,829,927 mothers not exposed. The rate of radiodiagnostic testing increased from 1.1 to 6.3 per 1,000 pregnancies over the study period; about 73% of tests were CT scans. After a median duration of follow-up of 8.9 years, four childhood cancers arose in the exposed group (1.13 per 10,000 person-years) and 2,539 cancers in the unexposed group (1.56 per 10,000 person-years), a crude hazard ratio of 0.69 (95% confidence interval 0.26–1.82). After adjusting for maternal age, income quintile, urban status, and maternal cancer, as well as infant sex, chromosomal or congenital anomalies, and major radiodiagnostic test exposure after birth, the risk was essentially unchanged (hazard ratio 0.68, 95% confidence interval 0.25–1.80).

Conclusions

Although major radiodiagnostic testing is now performed in about 1 in 160 pregnancies in Ontario, the absolute annual risk of childhood malignancy following exposure in utero remains about 1 in 10,000. Since the upper confidence limit of the relative risk of malignancy may be as high as 1.8 times that of an unexposed pregnancy, we cannot exclude the possibility that fetal exposure to CT or radionuclide imaging is carcinogenic. Please see later in the article for the Editors'' Summary     

Injuries to the Liver: Analysis of 20 Cases

Twenty cases of liver injury among 55 consecutive cases of abdominal injury submitted to laparotomy over a four-year period are reported. Forty-four of the cases were blunt injuries, and the cases of liver injury were in this group. Road traffic accidents accounted for 37 of the 44 cases and 17 of the 20 liver injuries. Except in two cases injury to the liver was associated with injury to other organs. Severe chest injury was found in 40% of the cases and serious skeletal injury in 45%. The overall mortality in blunt injury to the liver was 20% (4 cases) and was directly attributable to the liver injury in only one case.Liver injuries are classified as minor or major according to the depth of the wound and the associated destruction of liver tissue. Liver resection is advocated for major injuries. Right hepatic lobectomy was performed on five occasions and three of the patients survived. Death in the other two was due to associated injuries. The remarkable regenerative capacity of the liver is emphasized.     

A high-frequency lung injury mechanism in blunt thoracic impact

When a mechanical load is applied very rapidly to the thoracic wall, part of the internal damage is suspected to be due to a "high-frequency" injury mechanism, that is, a phenomenon in which waves are involved. This paper addresses a specific high-frequency mechanism for lung injury in which a stress wave is generated through rapid acceleration of the body wall. Displacement-related injuries, which are rather "low-frequency" phenomena, are not considered. The present work was done in the context of assessing behind armor blunt trauma (injury to thoracic organs occurring when a bullet is stopped by a body armor) through mathematical modeling. One aspect of the thorax response to high-speed blunt impact and an associated injury mechanism are investigated based on an idealized model of thorax and a set of computations presented in previous papers. The injury mechanism considered elucidates a possible mathematical relationship between the acceleration at the surface of the thoracic wall and the occurrence of lung injury.     

Dynamic histology of the antral epithelium in the mouse stomach: IV. Ultrastructure and renewal of gland cells

The renewal of gland cells was investigated by three-dimensional reconstruction of typical mucous units of the pyloric antrum using electron microscopy and 3H-thymidine radioautography in 3 to 4 month-old CD1 mice. Based on analysis of 42 units, the average gland measured 31 micron in length and was composed of 37 (mucous) gland cells with eight enteroendocrine cells scattered among them. The gland neck cells located close to the isthmus showed the cytoplasmic and nuclear features characteristic of differentiating cells. The mid-gland cells occupying the central portion of the gland appeared to be at a more advanced stage of development and completing differentiation. The gland base cells comprising the blunt end of the gland were fully mature. To quantify the renewal process, the percent of gland cell nuclei carrying label was determined at several times following 3H-thymidine administration. The rate of proliferation was found to be greatest in the gland neck, lower in the mid-gland, and even lower within the gland base. Furthermore, the isthmus contributed to gland-cell renewal by providing an estimated 12.4 cells per day. Labeled cells migrated toward the blunt end of the gland. The migration rate became progressively slower with their descent, and many cells were lost along the migration pathway, mainly in the gland neck. The loss took place without being preceded by gradual cell degeneration, but occurred as a result of rapid extrusion to the lumen or, less frequently by pyknosis, which could be followed by phagocytosis. It is concluded that the rapid rate of mitosis within the isthmus and gland neck generates a pressure causing downward migration of the cells toward the blunt end of the gland. The rate of migration, however, gradually diminishes as cells descend into the gland, presumably owing both to decreasing proliferation rate and to cell loss. Thus, while cells migrate down toward the gland base, many are lost before reaching it. This sequence is described as "the cascade pattern" of renewal.     

Gated 99mTC-MIBI SPECT in assessment of left ventricle global contractility

The complex radiodiagnostic study (synchronized 99mTc-MIBI SPECT and equilibrum ventriculography) has been made in 30 pts. The opportunity of use synchronized tomoscintigraphy for an estimation of a global left ventricle ejection fraction was shown.     

Etiology of shock in blunt trauma.

Patients who have suffered blunt trauma and present in shock of uncertain cause represent a problem frequently encountered by emergency physicians. A retrospective review of the charts of 879 patients who had suffered blunt trauma and presented to a regional trauma unit over a 44-month period revealed that 154 of the patients had presented to either a hospital or the trauma unit in shock. The most common causes of shock when a single source of hemorrhage was identified were, in order of decreasing frequency, intraperitoneal hemorrhage, pelvic or other musculoskeletal fractures, thoracic hemorrhage, severe head injury and spinal cord injury. Severe head injuries accounted for only 8% of the single-source cases and contributed to shock in only seven of the remaining cases.     

Evaluation of postmortem serum and cerebrospinal fluid growth hormone levels in relation to the cause of death in forensic autopsy

Previous studies have shown that postmortem serum levels of adrenocorticotropic hormone (ACTH) were significantly lower in cases of asphyxia and poisoning than in other groups, whereas ACTH levels in cerebrospinal fluid (CSF) were significantly lower for hypothermia and hyperthermia. This study comparatively analyzed growth hormone (GH) levels in serum and CSF in relation to cause of death in routine forensic work. Autopsy cases (n?=?116), including cases of blunt injury, sharp instrument injury, fire fatality, asphyxia, drowning, hypothermia, and acute myocardial infarction/ischemia (AMI), were examined. GH concentrations were measured using an immunoradiometric assay technique. GH levels in serum were significantly higher in cases of blunt injury, sharp instrument injury, hypothermia, and AMI than in the other groups. GH levels in CSF were significantly higher in fire fatality cases with a high COHb level than in the other groups. In a previous study ACTH immunopositivity in the adenohypophysis was significantly higher in cases of blunt injury, fire fatality, and AMI whereas GH immunopositivity was not significantly different among the groups, although positivity was higher in cases of fire fatality with a low COHb level. These observations suggest that postmortem serum/CSF GH and ACTH levels in acute deaths change differently, depending on the cause of death, because of varied stress reactions of the hypothalamic-pituitary-adrenal (HPA) axis.     

Experience in the operation of an x-ray diagnostic complex with a remote-controlled stand

Functional potentialities of serial stands of the RUM-20 radiodiagnostic units were critically analyzed. The clinical use of remote-controlled stands of Rentgen-100T type was shown to hold promise.     

Blunt Liver Injury with Intact Ribs under Impacts on the Abdomen: A Biomechanical Investigation

Abdominal trauma accounts for nearly 20% of all severe traffic injuries and can often result from intentional physical violence, from which blunt liver injury is regarded as the most common result and is associated with a high mortality rate. Liver injury may be caused by a direct impact with a certain velocity and energy on the abdomen, which may result in a lacerated liver by penetration of fractured ribs. However, liver ruptures without rib cage fractures were found in autopsies in a series of cases. All the victims sustained punches on the abdomen by fist. Many studies have been dedicated to determining the mechanism underlying hepatic injury following abdominal trauma, but most have been empirical. The actual process and biomechanism of liver injury induced by blunt impact on the abdomen, especially with intact ribs remained, are still inexhaustive. In order to investigate this, finite element methods and numerical simulation technology were used. A finite element human torso model was developed from high resolution CT data. The model consists of geometrically-detailed liver and rib cage models and simplified models of soft tissues, thoracic and abdominal organs. Then, the torso model was used in simulations in which the right hypochondrium was punched by a fist from the frontal, lateral, and rear directions, and in each direction with several impact velocities. Overall, the results showed that liver rupture was primarily caused by a direct strike of the ribs induced by blunt impact to the abdomen. Among three impact directions, a lateral impact was most likely to cause liver injury with a minimum punch speed of 5 m/s (the momentum was about 2.447 kg.m/s). Liver injuries could occur in isolation and were not accompanied by rib fractures due to different material characteristics and injury tolerance.     

Effectiveness of helmets in skiers and snowboarders: case-control and case crossover study

Objective To determine the effect of helmets on the risk of head and neck injuries in skiers and snowboarders.Design Matched case-control and case crossover study.Setting 19 ski areas in Quebec, Canada, November 2001 to April 2002.Participants 1082 skiers and snowboarders (cases) with head and neck injuries reported by the ski patrol and 3295 skiers and snowboarders (controls) with non-head or non-neck injuries matched to cases at each hill.Main outcome measures Estimates of matched odds ratios for the effect of helmet use on the risk of any head or neck injury and for people requiring evacuation by ambulance.Results The adjusted odds ratio for helmet use in participants with any head injury was 0.71 (95% confidence interval 0.55 to 0.92), indicating a 29% reduction in the risk of head injury. For participants who required evacuation by ambulance for head injuries, the adjusted odds ratio for helmet use was 0.44 (0.24 to 0.81). Similar results occurred with the case crossover design (odds ratio 0.43, 0.09 to 1.83). The adjusted odds ratio for helmet use for participants with any neck injury was 0.62 (0.33 to 1.19) and for participants who required evacuation by ambulance for neck injuries it was 1.29 (0.41 to 4.04).Conclusions Helmets protect skiers and snowboarders against head injuries. We cannot rule out the possibility of an increased risk of neck injury with helmet use, but the estimates on which this assumption is based are imprecise.     

Can more efficient use be made of x ray examinations in the accident and emergency department?

Increasing workloads in our radiology department prompted a study of casualty officers'' use of x ray examinations, of which there were 5463 in the period. While casualty officers were in post referrals for x ray examination did not become more selective, but skills in interpreting films improved. Overall, 4.9% of trauma radiographs were misinterpreted, but this fell from 7.1% to 2.9% during tenure of post. One in four errors was clinically important. Clinical guidelines for selective radiography produced a significant and sustained reduction in the number of x ray examinations requested by the department. Analysis of one common injury indicated that the quality of patient care was not adversely affected. The number of x ray examinations carried out in the accident and emergency department can be reduced by using guidelines, and this does not compromise the quality of patient care. Appreciable savings may be made in patients'' waiting times and radiodiagnostic expenditure.     

Influence of the crash pulse shape on the peak loading and the injury tolerance levels of the neck in in vitro low-speed side-collisions

The aim of the present in vitro study was to investigate the effect of the crash pulse shape on the peak loading and the injury tolerance levels of the human neck. In a custom-made acceleration apparatus 12 human cadaveric cervical spine specimens, equipped with a dummy head, were subjected to a series of incremental side accelerations. While the duration of the acceleration pulse of the sled was kept constant at 120 ms, its shape was varied: Six specimens were loaded with a slowly increasing pulse, i.e. a low loading rate, the other six specimens with a fast increasing pulse, i.e. a high loading rate. The loading of the neck was quantified in terms of the peak linear and angular acceleration of the head, the peak shear force and bending moment of the lower neck and the peak translation between head and sled. The shape of the acceleration curve of the sled only seemed to influence the peak translation between head and sled but none of the other four parameters. The neck injury tolerance level for the angular acceleration of the head and for the bending moment of the lower neck was almost identical for both, the high and the low loading rate. In contrast, the injury tolerance level for the linear acceleration of the head and for the shear force of the lower neck was slightly higher for the low loading rate as compared to the high loading rate. For the translation between head and sled this difference was even statistically significant. Thus, if the shape of the crash pulse is not known, solely the peak bending moment of the lower neck and the peak angular acceleration of the head seem to be suitable predictors for the neck injury risk but not the peak shear force of the lower neck, the peak linear acceleration of the head and the translation between head and thorax.     

Lower urinary tract injuries following blunt trauma: a review of contemporary management

Lower urinary tract trauma, although relatively uncommon in blunt trauma, can lead to significant morbidity when diagnosed late or left untreated; urologists may only encounter a handful of these injuries in their career. This article reviews the literature and reports on the management of these injuries, highlighting the issues facing clinicians in this subspecialty. Also presented is a structured review detailing the mechanisms, classification, diagnosis, management, and complications of blunt trauma to the bladder and urethra. The prognosis for bladder rupture is excellent when treated. Significant intraperitoneal rupture or involvement of the bladder neck mandates surgical repair, whereas smaller extraperitoneal lacerations may be managed with catheterization alone. With the push for management of trauma patients in larger centers, urologists in these hospitals are seeing increasing numbers of lower urinary tract injuries. Prospective analysis may be achieved in these centers to address the current lack of Level 1 evidence.     

Thiopental Anesthesia and Tannic Acid Diagnostic Enemas

The administration to albino rats of tannic acid as a retention enema (in doses of 0.2 g./kg. body weight and over) prolonged the duration of anesthesia induced by thiopental given immediately before, or 72 hours after, the tannic acid. This dose of tannic acid corresponds, on the basis of body weight, to a radiodiagnostic enema of 2 1. of 0.25% tannic acid in barium sulfate suspension given to a child weighing 25 kg. By excluding certain hypothermic effects of tannic acid, it was concluded that thiopental potentiation was probably due to impairment by the tannic acid of the liver''s ability to detoxify the barbiturate. The results suggest that a drug which is detoxified in the liver should be administered three to five days after a tannic acid-barium sulfate radiodiagnostic enema only with considerable caution.     

2. Newer aids in the diagnosis of blunt abdominal trauma.

The assessment of a case of blunt abdominal trauma can be complicated by many factors, and the resultant inaccurate or delayed diagnoses have contributed to the unacceptable mortality for this type of injury. Recently several useful diagnostic techniques have been developed that, if applied intelligently, may be instrumental in decreasing the high mortality among patients who present with ambiguous abdominal signs after sustaining blunt trauma. Although hematologic investigation and routine radiography have facilitated detection of intraperitoneal injury, peritoneal lavage has become the single most helpful aid. Scanning procedures are sometimes useful in recognizing splenic and hepatic defects especially; these may be confirmed or clarified by angiography. Although ultrasonography may be no more valuable than scintigraphy in outlining splenic and hepatic abnormalities, it is an important technique, especially in the diagnosis of retroperitoneal masses of traumatic origin. Laparoscopy also may be helpful in investigation if surgeons become more familiar with the procedure.     

骨骼肌钝挫伤恢复过程中HIF-1α、AMPKα2表达的改变

目的：观测大鼠骨骼肌钝挫伤（SMBI）恢复进程中腺苷酸活化蛋白激酶α2（AMPKα2）、缺氧诱导因子-1α（HIF-1α）的表达变化,探讨SMBI恢复可能生物学机制。方法：雄性Wistar大鼠48只,随机选取6只作为正常对照组;另42只大鼠重物砸伤后肢小腿建立钝挫伤模型后分7组（n=6）,造模后各组分别在伤后12 h、2 d、5 d、7 d、10 d、15 d、30 d取材,检测小腿三头肌HIF-1α、AMPKα2表达的变化。结果：损伤后12 h HIF-1α、AMPKα2表达均明显升高,在伤后15 d开始回落接近正常;HIF-1α、AMPKα2表达的峰值出现在伤后2 d内,伤后5 d后表达量开始下降;除HIF-1α mRNA在伤后2 d组表达出现峰值外,其余时间点二者mRNA与蛋白表达时程变化基本一致。结论：SMBI后,HIF-1α、AMPKα2可能通过参与调解缺氧适应、肌细胞再生、能量代偿起到促进伤后恢复的作用。     

Evaluation of different projectiles in matched experimental eye impact simulations

Eye trauma results in 30,000 cases of blindness each year in the United States and is the second leading cause of monocular visual impairment. Eye injury is caused by a wide variety of projectile impacts and loading scenarios with common sources of trauma being motor vehicle crashes, military operations, and sporting impacts. For the current study, 79 experimental eye impact tests in literature were computationally modeled to analyze global and localized responses of the eye to a variety of blunt projectile impacts. Simulations were run with eight different projectiles (airsoft pellets, baseball, air gun pellets commonly known as BBs, blunt impactor, paintball, aluminum, foam, and plastic rods) to characterize effects of the projectile size, mass, geometry, material properties, and velocity on eye response. This study presents a matched comparison of experimental test results and computational model outputs including stress, energy, and pressure used to evaluate risk of eye injury. In general, the computational results agreed with the experimental results. A receiver operating characteristic curve analysis was used to establish the stress and pressure thresholds that best discriminated for globe rupture in the matched experimental tests. Globe rupture is predicted by the computational simulations when the corneoscleral stress exceeds 17.21 MPa or the vitreous pressure exceeds 1.01 MPa. Peak stresses were located at the apex of the cornea, the limbus, or the equator depending on the type of projectile impacting the eye. A multivariate correlation analysis revealed that area-normalized kinetic energy was the best single predictor of peak stress and pressure. Additional incorporation of a relative size parameter that relates the projectile area to the area of the eye reduced stress response variability and may be of importance in eye injury prediction. The modeling efforts shed light on the injury response of the eye when subjected to a variety of blunt projectile impacts and further validate the eye model's ability to predict globe rupture. Results of this study are relevant to the design and regulation of safety systems and equipment to protect against eye injury.     

Blunt abdominal trauma in pregnancy.

Two cases are presented in which the effects of blunt trauma to a pregnant woman''s abdomen were apparently minor but resulted in fetal death. Blunt trauma may result in serious injury to the fetus or the placenta. Three-point restraint systems should be worn by pregnant women travelling in automobiles to minimize the risks to mother and fetus. Awareness of the potential for injury in these circumstances is essential to reduce the risks to the fetus.