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Ulusal Travma Ve Acil Cerrahi Dergisi =... Mar 2023This study aimed to examine whether two different doses of dexamethasone (DXM), which is a corticosteroid, and amifostine (AMI), which reduces cumulative tissue toxicity...
BACKGROUND
This study aimed to examine whether two different doses of dexamethasone (DXM), which is a corticosteroid, and amifostine (AMI), which reduces cumulative tissue toxicity induced by cisplatin in advanced-stage cancer patients, have ameliorative effects on pathologic changes associated with cardiac contusion (CC) induced in rats.
METHODS
Forty-two Wistar albino rats were equally divided into six groups (n=7): C, CC, CC+AMI 400, CC+AMI 200, CC+AMI+DXM, and CC+DXM. Tomography images and electrocardiographic analyzes were performed, mean arterial pressure was measured from the carotid artery, and blood and tissue samples were obtained for histopathological and biochemical analyses after trauma-induced CC.
RESULTS
While the total oxidant status and disulfide parameters in the cardiac tissue and serum were significantly higher (p<0.05), the total antioxidant status, total thiol, and native thiol parameters were significantly lower (p<0.01) in rats with trauma-induced CC. The most frequently observed finding in the electrocardiography analyze was ST elevation.
CONCLUSION
According to evaluation based on histological, biochemical, and electrocardiographic examinations, we believe that only 400 mg/kg dose of AMI or DXM can be effective in the treatment of myocardial contusion in rats. Evaluation based on histological findings.
Topics: Rats; Animals; Rats, Wistar; Thoracic Injuries; Amifostine; Wounds, Nonpenetrating; Heart Injuries; Myocardial Contusions
PubMed: 36880625
DOI: 10.14744/tjtes.2023.84308 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Aug 2022Acute cardiac contusion induced by trauma is known with its high mortality and morbidity. The role of oxidative stress and inflammation in its pathophysiology has led to...
BACKGROUND
Acute cardiac contusion induced by trauma is known with its high mortality and morbidity. The role of oxidative stress and inflammation in its pathophysiology has led to the investigation of antioxidant and anti-inflammatory substances in non-sur-gical treatment. In this study, the effects of rutin which has these two features on acute cardiac contusion were investigated.
METHODS
Thirty male albino Wistar rats were divided into three equal groups as healthy (HG), contusion (CG), and rutin + con-tusion (rutin + CG). A heart contusion was created dropping 200 g weight from 1-m height onto anterior thorax of CG (n=10) and Rutin + CG (n=10) group animals by anesthetizing with intraperitoneal administration of 60 mg/kg ketamine and xylazine inhalation at appropriate intervals. Thirty minutes after contusion was applied, rutin at the dose of 50 mg/kg was administered orally to the stomach by gavage to the rutin + CG group animals. The rutin was used once a day for 2 days. Rats were killed at the end of 48 h. Heart tissues were removed and examined biochemically and histopathologically. Troponin I (TP I) and creatine kinase-MB (CK-MB) were measured in blood samples taken from the tail veins just before the rats were killed.
RESULTS
TP I, CK-MB, malondialdehyde, total oxidant status, and nuclear factor-kappa B levels increased in the CG when compared to the HG, and Rutin application prevented this increase, total glutathione (eGSH) and total antioxidant status levels decreased, and rutin application prevented this decrease. Histopathological findings also supported these findings.
CONCLUSION
Rutin had a protective effect on heart tissue.
Topics: Animals; Antioxidants; Contusions; Male; Myocardial Contusions; Oxidative Stress; Rats; Rats, Wistar; Rutin
PubMed: 35920429
DOI: 10.14744/tjtes.2021.97760 -
Heart (British Cardiac Society) Jul 2020We assessed the diagnostic and prognostic implications of early cardiac magnetic resonance (CMR), CMR-based deformation imaging and conventional risk factors in patients... (Observational Study)
Observational Study
OBJECTIVE
We assessed the diagnostic and prognostic implications of early cardiac magnetic resonance (CMR), CMR-based deformation imaging and conventional risk factors in patients with troponin-positive acute chest pain and non-obstructed coronary arteries.
METHODS
In total, 255 patients presenting between 2009 and 2019 with troponin-positive acute chest pain and non-obstructed coronary arteries who underwent CMR in ≤7 days were followed for a clinical endpoint of all-cause mortality. Cine movies, T2-weighted and late gadolinium-enhanced images were evaluated to establish a diagnosis of the underlying heart disease. Further CMR analysis, including left ventricular strain, was carried out.
RESULTS
CMR (performed at a mean of 2.7 days) provided the diagnosis in 86% of patients (54% myocarditis, 22% myocardial infarction (MI) and 10% Takotsubo syndrome and myocardial contusion (n=1)). The 4-year mortality for a diagnosis of MI, myocarditis, Takotsubo and normal CMR patients was 10.2%, 1.6%, 27.3% and 0%, respectively. We found a strong association between CMR diagnosis and mortality (log-rank: 24, p<0.0001). Takotsubo and MI as the diagnosis, age, hypertension, diabetes, female sex, ejection fraction, stroke volume index and most of the investigated strain parameters were univariate predictors of mortality; however, in the multivariate analysis, only hypertension and circumferential mechanical dispersion measured by strain analysis were independent predictors of mortality.
CONCLUSIONS
CMR performed in the early phase establishes the proper diagnosis in patients with troponin-positive acute chest pain and non-obstructed coronary arteries and provides additional prognostic factors. This may indicate that CMR could play an additional role in risk stratification in this patient population.
Topics: Adult; Aged; Angina Pectoris; Biomarkers; Coronary Artery Disease; Databases, Factual; Diagnosis, Differential; Female; Humans; Longitudinal Studies; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Myocardial Contusions; Myocardial Infarction; Myocarditis; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Takotsubo Cardiomyopathy; Time Factors; Troponin; Young Adult
PubMed: 32447308
DOI: 10.1136/heartjnl-2019-316295 -
Annals of Medicine Dec 2024To determine the incidence rates (IRs) of catastrophic injuries and exertional medical events in lacrosse athletes.
OBJECTIVE
To determine the incidence rates (IRs) of catastrophic injuries and exertional medical events in lacrosse athletes.
METHODS
Catastrophic injuries and exertional medical events in lacrosse in the US among youth or amateur, high school and college athletes were analysed from the National Center for Catastrophic Sport Injury Research (NCCSIR) database from 1982/83 to 2019/20. Frequencies, IRs per 100,000 athlete-seasons (AS) with 95% confidence intervals (CIs), and incidence rate ratios (IRRs) with 95% CIs were calculated. Participation data were gathered from the National Federation of State High School Associations (NFHS), National Collegiate Athletic Association (NCAA) and USA Lacrosse.
RESULTS
Sixty-nine catastrophic events (16 youth or amateur, 36 high school and 17 college; 84% male) occurred in US lacrosse from 7/1/1982 to 6/30/2020. Thirty-six percent of all incidents were fatal. The overall IR was 0.5 per 100,000 AS (95% CI: 0.4-0.7). There were 15 cases of non-traumatic sudden cardiac arrests (SCAs) and 15 incidents of commotio cordis. Fatality rates from SCA and commotio cordis decreased 95% (IRR = 0.05; 95% CI: 0, 0.2) from 1982/83-2006/07 to 2007/08-2019/20. Incidence rates were higher for collegiate versus high school 1982/83-2019/20 (IRR = 3.2; 95% CI: 1.8, 5.7) and collegiate versus youth 2005/06-2019/20 (IRR = 8.0; 95% CI: 3.0, 21.4) level. Contact with a stick or ball (41%) and contact with another player (20%) were the primary mechanisms of injury.
CONCLUSIONS
The incidence of catastrophic events during lacrosse was higher among collegiate than high school or youth athletes. SCA from an underlying cardiac condition or from commotio cordis was the most common catastrophic event. Fatality rates from catastrophic injuries have declined significantly over the study period, perhaps driven by protective measures adopted by lacrosse governing bodies.
Topics: Humans; Male; Adolescent; United States; Female; Athletic Injuries; Commotio Cordis; Schools; Racquet Sports; Athletes; Incidence
PubMed: 38335556
DOI: 10.1080/07853890.2024.2311223 -
BMC Anesthesiology Jul 2023One of the worst types of severe chest injuries seen by clinicians is flail chest. This study aims to measure the overall mortality rate among flail chest patients and... (Observational Study)
Observational Study
BACKGROUND
One of the worst types of severe chest injuries seen by clinicians is flail chest. This study aims to measure the overall mortality rate among flail chest patients and then to correlate mortality with several demographic, pathologic, and management factors.
METHODOLOGY
A retrospective observational study tracked a total of 376 flail chest patients admitted to the emergency intensive care unit (EICU) and surgical intensive care unit (SICU) at Zagazig University over 120 months. The main outcome measurement was overall mortality. The secondary outcomes were the association of age and sex, concomitant head injury, lung and cardiac contusions, the onset of mechanical ventilation (MV) and chest tubes insertion, the length of mechanical ventilation and ICU stay in days, injury severity score (ISS), associated surgeries, pneumonia, sepsis, the implication of standard fluid therapy and steroid therapy, and the systemic and regional analgesia, with the overall mortality rates.
RESULTS
The mortality rate was 19.9% overall. The shorter onset of MV and chest tube insertion, and the longer ICU, and hospital length of stay were noted in the mortality group compared with the survived group (P-value less than 0.05). Concomitant head injuries, associated surgeries, pneumonia, pneumothorax, sepsis, lung and myocardial contusion, standard fluid therapy, and steroid therapy were significantly correlated with mortality (P-value less than 0.05). MV had no statistically significant effect on mortality. Regional analgesia (58.8%) had a significantly higher survival rate than intravenous fentanyl infusion (41.2%). In multivariate analysis, sepsis, concomitant head injury, and high ISS were independent predictors for mortality [OR (95% CI) = 568.98 (19.49-16613.52), 6.86 (2.86-16.49), and 1.19 (1.09-1.30), respectively].
CONCLUSION
The current report recorded mortality of 19.9% between flail chest injury patients. Sepsis, concomitant head injury, and higher ISS are the independent risk factors for mortality when associated with flail chest injury. Considering restricted fluid management strategy and regional analgesia may help better outcome for flail chest injury patients.
Topics: Humans; Flail Chest; Developing Countries; Tertiary Care Centers; Thoracic Injuries; Pneumonia; Morbidity; Craniocerebral Trauma; Sepsis; Steroids; Retrospective Studies; Length of Stay
PubMed: 37403012
DOI: 10.1186/s12871-023-02185-y -
BMC Cardiovascular Disorders Feb 2023Blunt cardiac injury (BCI) has a variety of symptoms that may be a potentially life-threatening injury that can lead to death. Depending on the diagnosis of BCI,...
BACKGROUND
Blunt cardiac injury (BCI) has a variety of symptoms that may be a potentially life-threatening injury that can lead to death. Depending on the diagnosis of BCI, treatment direction and length of stay may vary. In addition, the utility of other diagnostic tests for cardiac disease as diagnostic tools for BCI remain unclear. The purpose of this study was to investigate the competence of N-terminal pro-B-type natriuretic peptide (NT pro-BNP) and cardiac index (C.I) as adjunctive diagnostic tools for BCI.
METHODS
From January 2018 to March 2020, severe trauma patients with sternum fracture who were admitted to the traumatic intensive care unit (TICU) were included this study. Patients with sternum fracture, 18 years of age or older, and with an injury severity score > 16 who required intensive care were included. Invasive measurement for the analysis of the pulse contour for C.I monitoring and intravenous blood sampling for NT pro-BNP measurement were performed. Sampling and 12-lead electrocardiogram were performed at different time points as follows: immediately after TICU admission and at 24 h and 48 h after trauma.
RESULTS
Among 103; 33 patients with factors that could affect NT pro-BNP were excluded; therefore, 63 patients were included in this study. According to the American Association for the Surgery of Trauma Cardiac Injury Scale, 33 patients were diagnosed with non-BCI, and 30 patients constituted with BCI. The median ages of the patients were 58 (52-69), and 60 (45-69) years in the non-BCI and BCI groups, respectively (p = 0.77). The median NT pro-BNP values were higher in the BCI group on admission, hospital day (HD) 2, and HD 3, however, no statistical difference was observed (125 (49-245) vs. 130 (47-428) pg/mL, p = 0.08, 124 (68-224) vs. 187 (55-519) pg/mL, p = 0.09, and 121(59-225) vs. 133 (56-600) pg/mL, p = 0.17, respectively). On the contrary, significantly lower values were observed in the median C.I measurement on admission and HD 3 in the BCI group (3.2 (2.8-3.5) vs. 2.6 (2.3-3.5) L/min/m, p < 0.01 and 3.2 (3.1-3.9) vs. 2.9 (2.4-3.2) L/min/m, p < 0.01, respectively); however, no significant difference was observed on HD 2 (3.4 (3.0-3.7) vs. 2.6 (2.4-3.4) L/min/m, p = 0.17), Furthermore, The median lactate levels in the BCI group upon admission, HD 2, and HD 3 were significantly higher than those in the non-BCI group (1.8 (1.1-2.6) vs. 3.1 (2.1-4.4) mmol/L, p < 0.01; 1.3 (0.8-2.3) vs. 3.0 (2.2-4.7) mmol/L, p < 0.01; and 1.5 (0.9-1.5) vs. 2.2 (1.3-3.7) mmol/L, p < 0.01, respectively).
CONCLUSION
Consecutive values of NT pro-BNP and C.I show no correlation with ECG-based BCI diagnosis. However, lactate level measurement may help in the early recognition of BCI as an adjunctive tool. It should be noted that this is a hypothesis-generating study for BCI diagnosis. Further studies should be conducted in larger populations with a prospective approach.
Topics: Adolescent; Adult; Aged; Humans; Middle Aged; Young Adult; Biomarkers; Critical Care; Intensive Care Units; Lactates; Myocardial Contusions; Natriuretic Peptide, Brain; Peptide Fragments
PubMed: 36765285
DOI: 10.1186/s12872-022-02990-2 -
Heart Rhythm Apr 2020
Topics: Commotio Cordis; Death, Sudden, Cardiac; History, 19th Century; Humans; Italy; Thoracic Injuries
PubMed: 31981737
DOI: 10.1016/j.hrthm.2020.01.020 -
Cureus Dec 2022Here, we report a case of a 54-year-old man who presented with complications of a left ventricle apical aneurysm, which was the result of a myocardial infarction (MI)....
Here, we report a case of a 54-year-old man who presented with complications of a left ventricle apical aneurysm, which was the result of a myocardial infarction (MI). Interestingly, he sustained the MI following a cardiac contusion whilst playing rugby 32 years ago. He had another MI 10 years later, despite the presence of normal coronary angiography following the initial event, and presented with two episodes of sustained ventricular tachycardia over six months. The patient proceeded to surgical resection of the aneurysm and went on to make a good recovery.
PubMed: 36628051
DOI: 10.7759/cureus.32348 -
Canadian Respiratory Journal 2020Prognostic determinants in thoracic trauma are of major public health interest. We intended to describe patterns of thoracic trauma, demographic factors, clinical...
Prognostic determinants in thoracic trauma are of major public health interest. We intended to describe patterns of thoracic trauma, demographic factors, clinical course, and predictors of outcome in selected tertiary care hospitals in Sri Lanka. A multicentre prospective cohort study was conducted in five leading teaching hospitals from June to September 2017. Patients with thoracic trauma were followed up during the hospital stay. A logistic regression analysis was conducted using in-hospital morbidity as the dichotomous outcome variable. One hundred seventy-one patients were included in the study yielding 1450 (median = 8.5) person-days of observation. Of them, 71.9% ( = 123) were males. The mean age was 45.8 ± 17.9 years. Majority (39.2%, = 67) were recruited from the National Hospital of Sri Lanka. Automobile accidents were the commonest (62.6%, = 107), followed by falls (26.9%, = 46), assaults (8.8%, = 15), and animal attacks (1.8%, = 3). The ratio of blunt to penetrating trauma was 5.6 : 1. Injury patterns were rib fractures (80.7%, = 138), haemothorax (44.4%, = 76), pneumothorax (44.4%, = 76), lung contusion (22.8%, = 39), flail segment (15.8%, = 27), tracheobronchial trauma (7.0%, = 12), diaphragmatic injury (2.3%, = 4), vascular injury (2.3%, = 4), cardiac contusions (1.1%, = 2), and oesophageal injury (0.6%, = 1). Ninety nine (57.9%) had extrathoracic injuries. Majority (63.2%, = 108) underwent operative management including intercostal tube insertion (60.8%, = 104), wound exploration (6.4%, = 11), thoracotomy (4.1%, = 7), rib reconstruction (4.1%, = 7), and video-assisted thoracoscopic surgery (2.9%, = 5). Pneumonia (10.5%, = 8), bronchopleural fistulae (2.3%, = 4), tracheaoesophageal fistulae (1.8%, = 3), empyema (1.2%, = 2), and myocardial infarction (1.2%, = 2) were the commonest postoperative complications. The mean hospital stay was 15.6 ± 18.0 days. The in-hospital mortality was 11 (6.4%). The binary logistic regression analysis with five predictors (age, gender, mechanism of injury (automobile/fall/assault), type of trauma (blunt/penetrating), and the presence of extrathoracic injuries) was statistically significant to predict in-hospital morbidity ( (6, = 168) = 13.1; =0.041), explaining between 7.5% (Cox and Snell ) and 14.5% (Nagelkerke ) of variance. The automobile accidents (OR: 2.3, 95% CI = 0.2-26.2) and being males (OR: 2.3, 95% CI = 0.6-9.0) were the strongest predictors of morbidity.
Topics: Cohort Studies; Female; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Postoperative Complications; Prospective Studies; Sri Lanka; Surgical Procedures, Operative; Tertiary Care Centers; Thoracic Injuries; Trauma Severity Indices; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 32655722
DOI: 10.1155/2020/1219439 -
The Kurume Medical Journal Apr 2023Myocardial contusion is the most common cardiac injury from blunt chest trauma (BCT), whereas isolated valve injury is uncommon. We report a case of acute mitral...
Myocardial contusion is the most common cardiac injury from blunt chest trauma (BCT), whereas isolated valve injury is uncommon. We report a case of acute mitral regurgitation (MR) due to isolated valve injury after BCT. A 60-year-old man received an impact on his left chest by a car wheel three weeks prior to visiting our hospital. At the time a diagnosis of contusion of the chest wall without rib and sternal fractures was made. Thereafter, the patient had progressive worsening of heart failure symptoms. Eventually he developed dyspnea on slight exertion but echocardiographic evaluation was not performed at the time of diagnosis or during the three weeks prior to admission. At admission a holosystolic murmur was heard. Transthoracic echocardiography revealed prolapse of the posterior mitral leaflet due to torn chordae tendineae with severe MR and normal left ventricular wall motion. At surgery, torn chordae tendineae and a leaflet tear of the posterior leaflet were detected, and mitral valve repair was achieved without residual MR. Pathological examination of the torn chordae showed no findings of endocarditis or myxomatous degeneration. Echocardiography may play an important role for accurate and prompt diagnosis of cardiac lesions in patients with recent or a history of high-energy BCT.
Topics: Male; Humans; Middle Aged; Mitral Valve Insufficiency; Thoracic Injuries; Wounds, Nonpenetrating; Echocardiography; Mitral Valve
PubMed: 36754381
DOI: 10.2739/kurumemedj.MS681002