Bleeding and bruising in Osteogenesis Imperfecta: International Society on Thrombosis and Haemostasis bleeding assessment tool and haemostasis laboratory assessment in 22 individuals.

Osteogenesis imperfecta (OI) is characterized by susceptibility to bone fractures. Other symptoms, such as easy bruising and bleeding complications during surgery necessitating transfusions, have also been reported. The aim of the cross-sectional pilot study was to assess the bleeding and bruising tendency in OI patients and to screen for possible underlying haematological disorders. Bleeding tendency was investigated using the International Society on Thrombosis and Haemostasis bleeding assessment tool (ISTH-BAT) in 22 adult OI patients. Laboratory testing was performed to investigate for bleeding disorders or abnormal coagulation. Four patients [OI type 1(n = 3), OI type 4(n = 1)] had a bleeding score (BS) fitting with a bleeding tendency, but without test results pointing to a coagulopathy. Two patients [OI type 1(n = 1), OI type 3 (n = 1)] without a bleeding tendency according to the BS had increased fibrinolysis. This is the second largest study to date addressing bleeding tendency in OI and the first study to use ISTH-BAT and elaborate laboratory testing for coagulopathies. Four patients had an increased bleeding tendency. However, laboratory testing demonstrated no bleeding disorder or abnormal coagulation. Increased fibrinolysis was demonstrated in two patients without bleeding tendency on BS. Vascular fragility as a cause of bleeding tendency in OI has been suggested earlier. Further research on bleeding tendency in OI is important.

[Diagnostic assessment and treatment concepts for thoracic trauma]. / Diagnostik und Behandlungskonzepte beim Thoraxtrauma.

Most patients with chest trauma can be successfully treated with tube thoracostomy and appropriate pain medication. Initial care of these patients is usually straightforward and performed by an emergency doctor or an emergency room surgeon, e.g. a general surgeon. If more extensive therapy of these polytraumatized patients appears to be required, tertiary care should be done in specialized centers or clinics with network structures. An appropriate structured network of surgical centers guarantees sufficient and efficient care of patients with severe chest trauma. In a best-case scenario the specialist disciplines work in a rendezvous system with close cooperation. Early communication with a thoracic surgeon is essential to minimize mortality and long-term morbidity. Improvement in understanding the underlying molecular physiological mechanisms involved in the various traumatic pathological processes and the advancement of diagnostic techniques, minimally invasive approaches and pharmacologic therapy, will contribute to decreasing morbidity of these critically injured patients.

Value of sonography combined with clinical assessment to evaluate muscle injury severity in athletes.

CONTEXT: Predicting when an athlete can return to sport after muscle injury is a major concern. OBJECTIVE: To determine whether combining objective clinical and ultrasound findings at presentation accurately predicted time to sport resumption in athletes with muscle injuries. DESIGN: Cohort study. SETTING: Sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS: A total of 93 consecutive patients, 87 male and 6 female, were seen over a 1-year period for sudden-onset muscle pain while engaging in a sporting activity within the last 5 days and inability to continue the training session or game. INTERVENTION(S): Standardized physical examination and sonogram. MAIN OUTCOME MEASURE(S): Statistical associations between clinical and sonographic features at presentation and time to sport resumption (<40 days or ≥ 40 days) were evaluated using multivariate models. Correlations between time to sport resumption predicted by a sports medicine specialist and actual time to sport resumption were evaluated using the Spearman rank correlation coefficient. RESULTS: The 93 patients had 95 injuries, caused by muscle contraction in 86 cases and impact in 9 cases. Only 7 injuries had normal sonogram findings. Late sport resumption was associated with 4 clinical criteria (bruising, tenderness to palpation, range-of-motion limitation compared with the other limb, and increased pain with isometric contraction during passive limb straightening) and 4 sonographic criteria (disorganized fibrous tissue, intramuscular hematoma, intermuscular hematoma, and power Doppler signal). The Spearman rank correlation coefficient between predicted and actual times was 0.669 (P < .0001) for mild exercise resumption and 0.804 (P < .0001) for full sport resumption. CONCLUSION: A combination of physical and sonographic data collected during the acute phase of sport-related muscle injury was effective in predicting time to sport resumption.

[Trauma of the spine and intervertebral disk. A challenge for the expert in compensation claims after sustained "trifle trauma"]. / Trauma der Wirbelsäule und Bandscheibe. Gutachterliche Herausforderungen bei "Bagatellverletzungen".

In the literature, the association between chronic pain syndromes of the spine and sustained "trifle trauma" is a matter of controversy. "Trifle trauma" is identified as a contusion, compression and/or sprain without a definite, acute imaging sign of injury to the bone, the disk or the ligaments of the spine. Most of the time, striking isolated changes to the intervertebral disks are interpreted as preexisting without relevance to an acute injury. However, complex chronic pain syndromes causing permanent and significant functional limitations in daily life and work may occur. Besides the diagnostic and therapeutic challenge for the treating physician, the expert confronted with compensation claims very often has to answer questions as to whether "trifle trauma" of the spine may lead to significant and permanent functional limitations or loss with chronic pain syndromes, and what the importance of possible isolated changes in intervertebral disks is. The data from literature dealing with this topic is contradictory and deficient. In this article, we critically examine the causality between "trifle trauma" to the spine and possible permanent chronic complaints based on currently available data from the literature in order to support the process of decision making in questions of litigation and controversial compensation claims.

Comprehensive multidetector computed tomography assessment of severe cardiac contusion in a pediatric patient: correlation with echocardiography.

Multidetector computed tomography (MDCT) cardiac findings in an unconscious teenager after blunt chest trauma are presented. Multidetector computed tomography enabled accurate comprehensive evaluation of the coronary arteries, myocardial perfusion, and left ventricular function. This case illustrates the full capabilities of MDCT in the evaluation of cardiac contusion in a noncooperative pediatric patient.

Whole spine MRI in the assessment of acute vertebral body trauma.

OBJECTIVE: To determine the incidence and types of multilevel vertebral body injury in association with acute spinal trauma as assessed by whole spine MRI. DESIGN AND PATIENTS: All acute admissions to a regional spinal injury unit had whole spine MRI carried out, to detect occult vertebral body injury. Two radiologists assessed 127 cases prospectively, over a period of 3 years. All cases had T2-weighted sagittal imaging of the whole spine (where possible using a T2-weighted fat-suppressed sequence), with T1-weighted imaging in both sagittal and axial planes covering the primary injury. The incidence of secondary injury (defined as either bone bruising, wedge compression fracture or burst fracture) was determined and defined by type, site and relationship to the primary injury. RESULTS: Seventy-seven per cent of cases had a secondary injury level. Of these, bone bruising was the commonest but often occurred in combination with secondary wedge compression fracture or burst fracture. MRI detected 27 non-contiguous wedge compression fractures and 16 non-contiguous burst fractures, giving an incidence of secondary level, non-contiguous fracture of approximately 34%. CONCLUSION: A higher frequency of secondary vertebral body injury may be defined by MRI than has been described in previous studies based on radiographic evaluation of the whole spine. Whole spine MRI in assessment for occult vertebral body fracture enables increased confidence in the conservative or surgical management of patients with severe spinal injury.

Knowledge and attitudes among California dental care providers regarding child abuse and neglect.

The authors surveyed California dentists about their knowledge, attitudes and practices regarding child abuse and neglect. Only 16 percent of the respondents claimed to have seen or suspected a case of child abuse or neglect during the preceding five years, and only 6 percent claimed to have reported such a case. The authors also found that the respondents had little knowledge of California law regarding the reporting of such cases and little information or training in diagnosing and reporting suspected child abuse and neglect.

[Accidents among students in professional or technological schools in Lorraine]. / Les accidents chez les élèves des lycées professionnels et technologiques en Lorraine.

BACKGROUND: School accidents in adolescents in professional and technological secondary schools are relatively frequent. This work investigates these accidents in Lorraine (a French region) to identify preventive measures. METHODS: A cross-sectional study was carried out in 4,751 adolescents from five volunteering schools. Only accidents occurring during one school-year and declared to the Social Security Services as work accidents were studied. RESULTS: Incidence of accidents per 1,000 subjects was 52.0: 21.3 for accidents during sports and physical training (SPT), 7.8 for those occurring during school training (except SPT), and 22.9 for spare time accidents. The incidence increased strongly with age and differed greatly between the type of schools. Girls had more accidents during SPT than boys. Injuries during school training were wounds and contusions of upper limb while the injuries during SPT and spare time were mainly articular disorders, contusions, and wounds of the upper limb, the lower limb, and the head and neck. A physician was consulted in almost 100% of the injuries, a radiological examination was performed for 75%, and a surgical intervention for 14% of the injuries. Absence from school, exemption from workshops and from SPT were frequent. The predominant risk factors were the type of activities, especially activities the adolescents were not accustomed to, personal behavior and risks taken by adolescents. CONCLUSION: Accidents are frequent, in particular among older adolescents. It is important to identify activities at risk, and to target prevention and awareness campaigns, assessment training to evaluate risks of each activity, and promoting safe behavior, although environmental factors cannot be excluded.

[An evaluation of the efficacy of nitrates (transdermal and peroral) in the management of the patient with a myocardial contusion]. / Valoración de la eficacia de los nitratos (transdérmicos y por vía oral) en el manejo del paciente con contusión miocárdica.

Although thoracic trauma is frequently accompanied by myocardial injury; this later is often oversighted at early stages of trauma and misdiagnosed by the time complications are present. Myocardial abnormalities have been attributed to a reduction of cardiac flow. Nitroglycerin and isosorbide dinitrate, both agents with a known vasodilator effect on coronary arteries, might improve myocardial ischemic resulting from traumatic contusion. In order to compare safety and efficacy between two nitrates and placebo on myocardial contusion resulting from thoracic trauma, we carried out a comparative, prospective, single blind study. Subjects were randomly allocated to one of the following 3 groups: a) transdermal nitroglycerin, b) isosorbide dinitrate and c) placebo. Medication was dispensed for five days. Major endpoint were electrocardiographic abnormalities at entry and their final modifications. Other were severity injury score and myocardial enzyme levels. Twelve patients were included in each group. Four measured enzymes were high at entry, but MB fraction in the nitroglycerin group showed the most rapid normalization. Creatine phosphokinase and lactic dehydrogenase significantly correlated with severity injury index, but not MB fraction. Electrocardiographic normalization was mainly observed in the nitroglycerin group. Transdermal nitroglycerin systems demonstrated to be effective on recovering from electrocardiographic abnormalities resulting of myocardial contusion.

Myocardial contusion: new concepts in diagnosis and management.

Myocardial contusion is diagnosed with one or a combination of four diagnostic procedures: electrocardiography, echocardiography, creatine kinase MB fractions and/or radionuclide procedures. This article presents a critical review of 18 recent studies addressing the utility, sensitivity and specificity of these tests. Careful review suggests that clinically significant myocardial contusions as a result of blunt trauma are rare and may be detected simply and inexpensively using electrocardiography and careful physical examination. Serum myocardial enzymes and radionuclide studies are nonspecific and are not predictive of cardiac complications. Echocardiography is useful in the management of myocardial decompensation but not as a primary screening tool in blunt cardiac injury. Cost comparisons, resource allocation and implications for critical care practice are discussed.

Occult cartilage and bone injuries of the knee: detection, classification, and assessment with MR imaging.

Scant attention has been paid to the role of magnetic resonance (MR) imaging in the assessment of posttraumatic disorders of bone and cartilage at the knee. The authors reviewed 66 cases and identified four types of injuries that were not clearly evident on plain radiographs. A bone bruise was the most common lesion, having a high association with anterior cruciate ligament tears. Osteochondral fractures, stress fractures, and supracondylar femoral and tibial plateau fractures were also identified. MR imaging appears extremely useful in the detection and assessment of bone and cartilage disorders around the knee.

Behavioral assessment of functional deficit in rats with contusive spinal cord injury.

We have previously reported a method for assessing functional deficits in rats after contusive spinal cord injury in which a Combined Behavioral Score (CBS) is calculated that is indicative of the overall percent deficit (Exp. Neurol., 88: 123-134, 1985). The test battery used includes several neurologic tests as well as the Motor Score in which use of the hindlimbs in locomotion is graded. In this report we present correction criteria in order to reduce potential interlaboratory variability in assessing functional deficit by the CBS. Groups of rats were subjected to contusive injury using a weight drop technique. The calculated CBS at 4 weeks was compared to that obtained if the Motor Score was over- or underestimated by 1 grade. The results indicated a considerable effect on the calculated CBS, especially when the Motor Score was underestimated in mildly injured animals. Behavioral test data were examined in terms of the distribution of the responses to the various other behavioral tests in relation to the Motor Score. The results were used to develop a set of correction criteria that minimized the effects on the CBS of subjective errors in the Motor Score.

Nursing assessment of blunt cardiac trauma.

Cardiac injuries due to blunt trauma are common and contribute to the overall mortality of the trauma victim. Such injuries may be difficult to detect, and the clinician must maintain a high degree of suspicion for their presence. Clinical findings are nonspecific, but the nurse should focus on assessing the adequacy of cardiac output and tissue perfusion. Initial management of the patient with blunt cardiac trauma is the same as for any trauma patient: stabilization of airway, breathing, and circulation. Intravascular volume replacement is an important aspect of the resuscitation. Injuries such as aortic transection or ventricular rupture lead to exsanguination and the need for rapid infusion of large volumes of blood. On the other hand, cardiac function may be severely depressed with myocardial contusion and septal or valvular rupture; volume replacement must proceed cautiously.