Inflammatory activation after experimental cardiac tamponade.

BACKGROUND/PURPOSE: Cardiac tamponade is a medical emergency situation associated with a high rate of life-threatening complications, even after immediate interventions. Our aim was to characterize the acute inflammatory consequences of this event in a clinically relevant large animal model. METHODS: Cardiac tamponade was induced for 60 min in anesthetized, ventilated and thoracotomized minipigs by intrapericardial fluid administration, the mean arterial pressure (MAP) being maintained in the interval of 40-45 mm Hg (n = 8). A further group (n = 7) served as sham-operated control. The global macrohemodynamics, including the right- and left-heart end-diastolic volumes (RHEDV and LHEDV), the pulmonary vascular resistance index (PVRI) and the superior mesenteric artery (SMA) flow, were monitored for 240 min, and the intestinal microcirculatory changes (pCO2 gap) were evaluated by indirect tonometry. Blood samples were taken for the determination of cardiac troponin T and vasoactive inflammatory mediators, including histamine, nitrite/nitrate, big-endothelin, superoxide and high-mobility group box protein-1 levels in association with intestinal leukocyte and complement activation. RESULTS: The cardiac tamponade induced significant decreases in MAP, cardiac output, LHEDV and SMA flow, while the PVRI and the pCO2 gap increased significantly. After the removal of fluid from the pericardial sac, the MAP and the LHEDV were decreased, while the PVRI and the pCO2 gap remained elevated when compared with those in the sham-operated group. In the posttamponade period, the abrupt release of inflammatory mediators was accompanied by a significant splanchnic leukocyte accumulation and complement activation. CONCLUSIONS: The macrocirculatory and splanchnic microcirculatory disturbances were accompanied by a significant proinflammatory reaction; endothelin and the complement system may be significant components of the inflammatory cascade that is activated in this porcine model of pericardial tamponade.

[Use of the "pronation worm" in the early functional active-conservative treatment of lateral ligamentous rupture of the ankle]. / Frühfunktionelle aktiv-konservative Behandlung der Aussenknöchelbandrupturen mit dem "Pronationswurm".

The "pronation worm", a method of early functional active conservative treatment for sprained ankle, is presented. In our department 75 patients were treated with this method with great success. Recent lateral tears in the ankle were confirmed by stress X-ray examinations, and according to these the patients were divided into two groups: group 1, containing patients with opening of the joint gap to 10-14 degrees (one-ligament injuries); and group 2, containing those with opening to 15 degrees or more (more-ligament injuries). The patients were required to wear ankle boots with a "pronation worm" for 6 weeks though they could take them off to get bathed, clean the boots and at bedtime. They were also asked to perform muscle training exercises for the peroneus muscles three times a day. The clinical-radiological evaluation showed complete healing in 97.3% after 6 weeks and after 6 months, and the stress X-ray photographs confirmed that there was no pathological opening of the joint gap (this applies to all patients in group 1 and 46 in group 2). In two patients in group 2 (2.7%) the X-ray pictures revealed pathologic opening of the joint-gap, but these patients had no subjective symptoms. These preliminary results suggest that recent tears of the lateral ligament ankle should be treated with this early functional active conservative method, i.e. without a surgical operation.