Non-invasive assessment of muscle compartment elasticity by pressure-related ultrasound in pediatric trauma: a prospective clinical study in 25 cases of forearm shaft fractures.

BACKGROUND: Soft-tissue swelling after limb fractures in pediatric patients is well known to be a risk factor for developing acute compartment syndrome (ACS). Clinical assessment alone is uncertain in specific cases. Recently, we proposed a non-invasive ultrasound-based method to objectify muscle compartment elasticity for monitoring. We hypothesize a strong correlation between the soft-tissue swelling after stabilization of upper limb fractures and the compartment elasticity objectified with a novel ultrasound-based approach in pediatric trauma. PATIENTS AND METHODS: In a prospective clinical study, children suffering forearm fractures but not developing an ACS were included. The muscle compartment elasticity of the m. flexor carpi ulnaris was assessed after surgical intervention by a non-invasive, ultrasound-based method resulting in a relative elasticity (RE in %) in both the control (healthy limb) and study group (fractured limb). Soft-tissue swelling was categorized in four different levels (0-3) and correlated with the resulting RE (%). RESULTS: The RE in the study group (15.67%, SD ± 3.06) showed a significantly decreased level (p < 0.001) compared with the control (22.77%, SD ± 5.4). The categorized grade of soft-tissue swelling resulted in a moderate correlation with the RE (rs = 0.474). CONCLUSIONS: The presented study appears to represent a novel approach to assess the posttraumatic pressure changes in a muscle compartment after fracture stabilization non-invasively. In this first clinical study in pediatric cases, our measurement method represents a low-cost, easy, and secure approach that has the potential to substitute invasive measurement of suspected ACS in muscle compartment conditions. Further investigations in lager cohorts are required to prove its daily clinical practicability and to confirm the expected reliability.

Non-invasive and reliable assessment of compartment elasticity by pressure related ultrasound: An in-vitro study.

PURPOSE: The development of acute compartment syndrome is a serious threat to trauma patients. The clinical assessment alone is not reliable enough to determine the need for fasciotomy in many cases. The Physician´s assessment of the elasticity of the muscle compartment might be particularly important to objectively evaluate the pressure in this enclosed space. The purpose of this study was to determine the observer´s reproducibility, of compartment elasticity measurements by a novel ultrasonic approach. METHODS: Increasing intra-compartmental pressures (ICP) were simulated in a water filled in-vitro model. Pressure related ultrasound was used to determine the relative elasticity (RE) of soft tissue compartments. A pressure transducing probe head was combined with the ultrasonic probe to obtain cross section views of the simulated compartment and to detect the amount of applied pressure by the observer. In this model, the compartment depth without compression (P0) was set to be 100%. Changes of the compartment depth due to a probe pressure of 80 mmHg (P80) were correlated to P0 and an elasticity quotient as a value for RE (%) was calculated. Twelve blinded observers performed measurements for RE determination (%) under three pressure conditions. Reproducibility was calculated using intraclass correlation coefficient (ICC). RESULTS: Measurements (n = 432) revealed that the RE (%) in the control group was 17,06% (SD+/-2,13), whereas the RE of the group ICP30 significantly decreased to 12,66% (SD+/- 1,19) (p<0,001). The ICP50 group revealed a further significant decrease to 8,43% (SD+/- 0,67) (p<0,001). Repeated measurement of RE and ICP showed a high level of correlation (spearman correlation coefficient: roh=0,922). A RE <14% resulted in a sensitivity of 96% and a specificity of 90,3% for diagnosis of an ICP >30 mmHg. ICCinter was 0,986; 95%, CI: 0,977-0,992 (p<0,001). DISCUSSION: The presented ultrasound-based approach reliably assesses the elasticity in a simulated compartment model. In this pioneer study investigating the inter- and intra-observer reproducibility, this method of measurement appears to be of low cost in addition to being an easy and secure approach that may have the potential to substitute invasive measurement. Further investigations are required to improve its feasibility and to confirm the reliability under clinical conditions.

Non-invasive measurement of muscle compartment elasticity in lower limbs to determine acute compartment syndrome: Clinical results with pressure related ultrasound.

PURPOSE: Close monitoring of patients at risk to develop an acute compartment syndrome (ACS) is well known to be essential. There is a relevant risk that clinical assessment alone is not reliable enough. Reliable assessment of the elasticity of the muscle compartment might represent a helpful tool to assess the pressure in this enclosed space. Therefore, the purpose of this study was to determine the feasibility of muscle elasticity measurements by a non-invasive device. METHODS: In a prospective study, patients with elevated intra-compartmental pressure (ICP) were included. An ultrasound-based measurement approach was used to determine the relative elasticity (RE) of both, the affected and unaffected limb. A pressure transducing ultrasonic probe head was combined with the probe to obtain cross section views of the anterior tibial compartment and to detect the observer´s amount of pressure applied on the limb surface. The compartment depth without compression (P0) corresponds to 100%. The difference to the compartment depth with a probe pressure of 80mmHg (P80) on the limb (delta) related to P0 resulted in a value of relative elasticity (%). These values were compared with the invasive needle measurement (mmHg) regarding their intra-individual difference and correlation of the compartmental pressure. RESULTS: In six trauma patients the relative elasticity in their paired limbs showed a significant difference. The RE in the healthy compartments revealed a level of 17.95% (SD+/-5,4), whereas the RE of the affected limbs significantly decreased to a mean of 5,14% (SD+/-2,1) (p < 0,0001). The average values of the repetitively measured RE and the ICP showed a high level of correlation (spearman correlation coefficient: roh = 0,929). The RE less than 10,5% of the anterior tibial compartment had a sensitivity of 95,8% and a specificity of 87,5% to an appropriate diagnosis of ACS. DISCUSSION: The presented study appears to represent a promising approach to reliably assess the pressure in a muscle compartment. In this first clinical study, our measurement method represents a low cost, easy and secure approach that has the potential to substitute invasive measurement. Further investigations and development in lager cohorts are required to improve its practicality and to confirm the reliability.

Interactions between the Fusarium toxin deoxynivalenol and lipopolysaccharides on the in vivo protein synthesis of acute phase proteins, cytokines and metabolic activity of peripheral blood mononuclear cells in pigs.

The in vivo effects of the Fusarium toxin deoxynivalenol (DON) on albumin and fibrinogen synthesis in pigs and metabolic activity of porcine peripheral blood mononuclear cells (PBMCs) were studied alone or in combination with lipopolysaccharides (LPSs) in order to examine proposed synergistic effects of both substances. A total of 36 male castrated pigs (initial weight of 26 kg) were used. Uncontaminated (Control) and naturally DON-contaminated (chronic oral DON, 3.1mg/kg diet) wheat was fed for 37 days. On the day of protein synthesis measurement, pigs recruited from the Control group were treated once intravenously with (iv) DON (100 µg/kg live weight (LW)/h), iv LPS (7.5 µg/kgLW/h) or a combination of both substances, and six pigs from the chronic oral group were treated once with iv LPS. A treatment with DON alone exhibited no alterations of acute phase protein synthesis and metabolic activity of PBMC. There was no evidence that the chosen dosing regimen of DON had influences on the induced sub-acute stage of sepsis, as the LPS challenge, irrespective of DON co-exposure, mediated an acute phase reaction with a typical decrease of albumin synthesis, as well as changes in cytokine concentration and a loss of metabolic activity in PBMC.

Deoxynivalenol and E.coli lipopolysaccharide alter epithelial proliferation and spatial distribution of apical junction proteins along the small intestinal axis.

We investigated a proposed synergistic effect of deoxynivalenol (DON) and lipopolysaccharides (LPS) on small intestinal architecture and epithelial barrier integrity in pigs. Crypt depth and intestinal cell proliferation were analyzed, as well as expression of zonula occludens protein-1 (ZO-1) and ß-catenin of the apical junction complex along the small intestine. Barrows (26.2±4.1 kg) were fed restrictedly either a control diet (CON) or a diet naturally contaminated with 3.1 mg DON/kg feed (DON) for 37 d. At d 37, the control group was infused for 1 h either with 100 µg/kg BW of DON (CON-DON, n=6), 7.5 µg/kg BW of LPS (CON-LPS, n=6), a combination of both (CON-DON+LPS, n=7), or 0.9% NaCl (CON-CON, n=6) and the DON group with 7.5 µg/kg BW of LPS (DON-LPS, n=8) or 0.9% NaCl (DON-CON, n=6). Pigs were euthanized 3.25 h after start of infusion. Immunohistochemistry (5'-bromo-2'-deoxyuridine for proliferation) and immunofluorescence (ZO-1 and ß-catenin) from duodenum, proximal jejunum, mid-jejunum, proximal ileum, and terminal ileum were analyzed for crypt depth, cell proliferation, and apical junction proteins. Duodenal crypts were deeper compared with the other 4 intestinal regions, and proximal jejunal crypts were deeper than those of mid-jejunum and proximal ileum (P<0.001). Epithelial proliferation showed a bell-shaped distribution along the small intestinal axis. Duodenal proliferating cells had the least number compared with jejunal sections and proximal ileum (P<0.001). Neither DON nor LPS affected these variables. Zonula occludens-1 displayed a distinct spatial distribution in the epithelium with an apical and a cytosolic component. Apical expression of ZO-1 was severely damaged in the mid-jejunum (P<0.001) of CON-DON compared with animals treated with LPS. Also, in all animals receiving LPS systemically, the cytosolic ZO-1 fraction in the 3 upper gut sections disappeared completely. This effect was independent of DON presence. Control pigs had a greater basolateral ß-catenin accumulation (P<0.05) in the cells, whereas the protein distribution did not differ in CON-DON pigs. In conclusion, results of this experiment demonstrated that epithelial proliferation has a distinct pattern along the small intestine and is not necessarily positively linked to crypt depth in pigs. Furthermore, results indicate that LPS changed the spatial distribution of ZO-1. A synergistic effect of DON and LPS on intestinal architecture could not be verified in the present study.

Cellular profiles of induced sputum in children with stable cystic fibrosis: comparison with BAL.

Neutrophil-dominated endobronchial inflammation is a major characteristic of cystic fibrosis (CF) and there is increasing demand for easy-to-perform noninvasive monitoring for prediction and intervention. Fourteen stable paediatric CF patients (8-17 yrs; mean forced expiratory volume in one second 86.7% of the predicted value) were investigated once by fractional bronchoalveolar lavage (BAL) and by sputum induction on three occasions, 2-6 weeks apart. Sputum was induced by consecutive 10-min inhalations of 3, 4 and 5% saline. CF sputum cellular profiles were compared with BAL fluid cell counts and samples from age-matched healthy children, and between different time points to assess reproducibility. Adequate sputum was recovered on >95% of occasions. In all sputum fractions, CF patients showed higher neutrophil counts than healthy children. Neutrophil percentages were highest in the first BAL fraction (median 92%), followed by sputum, in which the percentages decreased in consecutive fractions (72, 66 and 64%), whereas counts were lowest in the pooled BAL fraction (53%). Increasing percentages of macrophages mirrored the decreases in neutrophil percentage. Results of sputum induction at different time points in the CF patients showed good reproducibility and nonoverlap with counts from healthy children. In conclusion, the results of sputum induction in children with mild stable cystic fibrosis adequately describe airway inflammation by providing cellular profiles with lower relative neutrophil counts than in the first ("bronchial") bronchoalveolar lavage fraction and higher relative neutrophil counts than in subsequent pooled ("more peripheral") bronchoalveolar lavage fractions.

Serum hyaluronan (hyaluronic acid) in breast cancer patients.

Eighty-three women with breast cancer (57 with systemic metastasis, 26 without) were investigated for serum hyaluronan (HA) and compared to 50 patients with benign diseases of the breast. Hyaluronan was significantly increased in sera of metastatic patients compared to sera of non-metastatic patients (p less than 0.0001) and also in sera of non-metastatic patients when compared to control sera (p less than 0.01). The difference was not related to the number of metastatic sites involved. Three months after starting cytotoxic chemotherapy in metastatic patients, lower HA concentrations were observed in patients responding to chemotherapy. The initial level of serum HA had no predictive value concerning response to chemotherapy.

A study of 204 consecutive deliveries in Abidjan--Anthropometric data of newborns, mothers and placentas.

Anthropometric measurements of newborns, mothers and placentas were taken in 204 consecutive deliveries at Adjamé Maternity Hospital in Abidjan. Aclinical assessment of gestational age was made. Low mean birthweight can be attributed to a higher incidence of pre-term newborns in the present sample. Incidence of small for gestational age and large for gestational age babies is similar to that found in developed countries. Detailed analysis of correlations between maternal, placental and neonatal variables show that birthweight is dependent on nutritional status of the mothers and on size of the placenta. Young primiparae are shown to become pregnant before reaching full growth. Their weight and weight for height are significantly lower than for multiparae. The main group at risk for impaired foetal growth, prematurity and low birthweight are the children born to primiparous mothers.