A woman suffered from massive blunt injuries in a motor vehicle accident at a presumed 4 weeks' gestation, but she successfully carried the fetus for an additional 29 weeks. Premature labor began at 33 weeks' gestation and a live 1,890 g male was delivered. His development was normal for the 12-months postnatal follow-up period. The patient remained in a persistent vegetative state. Only 12 cases of severely brain-injured pregnant patients who delivered babies have been reported in English literature. Such patients need special maternal and fetal monitoring. As shown in our patient, successful fetal outcome could be obtained in a mother who suffered from hypovolemic shock and diffuse axonal injury, was treated with numerous medications from 4 weeks' gestation, and survived premature labor at 33 weeks' gestation in a persistent vegetative state. This report represents the longest interval from maternal vegetative state to obstetric delivery. From our case, it would seem that no clear limit exists that restricts the phy-sician's ability to support a severely injured pregnant patient.
Adult ; Case Report ; Coma/*physiopathology ; Female ; Human ; Pregnancy ; Pregnancy Complications/*physiopathology ; Wounds and Injuries/*physiopathology

Mast cell(MC) takes an important role in trauma and the process of wound healing, and the pathophysiology reaction has a relationship to the time since trauma, which is helpful to determine the post-trauma and postmortem interval, and to distinguish the wound shaped whether before or after death. In this paper, the role of MC and its chemic medium in the process of wound healing, scar shaping, postburns inflammatory response, healing of bone fracture, as well as the signification for forensic medicine and the progress of researching in this field were reviewed.
Burns/physiopathology* ; Forensic Medicine/methods* ; Fractures, Bone/physiopathology* ; Humans ; Inflammation/physiopathology* ; Keloid/physiopathology* ; Mast Cells/physiology* ; Wound Healing/physiology* ; Wounds and Injuries/physiopathology*

Negative pressure therapy (NPT) has been widely used in clinic and obtained obvious curative effects. However, its mechanism has been relatively less studied. This article updated the enhancing mechanism, physical action and biomechanics effects, etc. and provided thinking for the further development of NPT.
Biomechanical Phenomena ; Humans ; Negative-Pressure Wound Therapy ; instrumentation ; methods ; Wound Healing ; Wounds and Injuries ; physiopathology ; therapy

Animals ; Apoptosis ; Caspase 3 ; metabolism ; Male ; Myocardium ; pathology ; Rats ; Rats, Wistar ; Time Factors ; Wounds and Injuries ; physiopathology

Angiogenesis plays a fundamental role in the development of the embryonic vascular tree as well as in several normal and pathologic conditions during postnatal life. Blood supply, established by neovascularization, is imperative for histogenesis during wound healing as well as the limb lengthening applied extensively in the treatment of skeletal trauma sequalae. But little attention has been paid to this area. This review aims to summarize angiogenesis regulation, the process of angiogenesis in wound healing and angiogenesis under mechanical stress, particularly in association with the tension-stress principle.
Humans ; Neovascularization, Physiologic ; Stress, Mechanical ; Wound Healing ; physiology ; Wounds and Injuries ; physiopathology ; therapy

OBJECTIVETo study the early change of serum nitric oxide (NO) after acute heat exposure with trauma and the effect of NO on mean arterial pressure (MAP), thus to provide theoretical basis for studying the mechanism of NO effect in acute stress.

METHODSThe rabbit model of acute heat exposure combined with trauma was established. The animals were divided into four groups, including control, trauma, hyperthermia and hyperthermia combined with trauma. The levels of NO were measured at different time points: 0 h, 1 h, 2 h and MAP was monitored throughout the whole experiment.

RESULTSThe concentration of NO declined at first and then increased at 1 h or so after acute heat exposure and trauma. The levels of NO in hyperthermia with trauma group at 1 h, 2 h were (42.75 +/- 8.24), (59.54 +/- 9.05) micro mol/L respectively (P < 0.05), while those in control group were (56.63 +/- 3.79) and (55.22 +/- 7.15) micro mol/L, the difference at 1h between two groups was significant (P < 0.05). Under the circumstance of hyperthermia and trauma, the level of MAP declined to the lowest point at 60 - 70 min and then showed a transient rise, after that, the level declined rapidly.

CONCLUSIONSAt the early stage of acute heat exposure and trauma, the concentration of serum NO declined at first and then increased, and had certain relationship with the change of MAP.

Animals ; Blood Pressure ; Cytokines ; biosynthesis ; Hot Temperature ; Male ; Nitric Oxide ; blood ; Rabbits ; Wounds and Injuries ; blood ; physiopathology

Evaluation of muscle function can be helpful in rehabilitation programs with knee injuries. The purposes of this study were to evaluate muscle performance and functional level through eccentric and concentric isokinetic testing after anterior cruciate ligament reconstruction, and to determine whether eccentric and concentric isokinetic values were correlated with functional level using the Modified Cincinnati Scale (MCS). In order to compare the characteristics of eccentric and concentric parameters, we tested 24 male patients (mean age; 31.1 years) after primary reconstruction of ruptured anterior cruciate ligaments of the knee (mean duration; 20.2 months), at angular velocities of 60 degree/sec using Cybex 6000 isokinetic dynamometer. We also evaluated the functional level using the MCS. The values of peak torque of the involved knee extensors and flexors were significantly lower than the uninvolved limb in all eccentric and concentric tests (p<0.01). The deficiency ratios of peak torque in knee extensors were significantly larger than knee flexors in both eccentric and concentric tests (p<0.01). The MCS was inversely correlated with the deficiency ratio in peak torque of eccentric knee extensors (p<0.05). These results suggest that eccentric knee extensor training is essential to restore the functional capacity of the injured knee and that isokinetic evaluation is necessary to plan rehabilitation programs to correct possible imbalances which may be predispose subjects to future injury.
Adult ; Anterior Cruciate Ligament/surgery* ; Anterior Cruciate Ligament/physiopathology ; Anterior Cruciate Ligament/injuries* ; Comparative Study ; Exercise Test/methods* ; Human ; Male ; Muscle, Skeletal/physiopathology ; Postoperative Period ; Severity of Illness Index ; Wounds and Injuries/surgery* ; Wounds and Injuries/physiopathology ; Time Factors

PURPOSETo evaluate the usefulness and information collecting ability of speckle tracking imaging techniques in the assessment of myocardial regional ventricular contractility in a rabbit model with blunt cardiac injury.

METHODSFifteen healthy New Zealand rabbits weighing (2.70 ±0.28) kg were anesthetized (3% pentobarbital sodium/i.v) and impacted using the BIM-II biological impact machine to induce myocardial contusion (MC). Hemodynamic parameters, such as heart rate, systolic pressure, mean arterial pressure, diastolic pressure and central venous pressure, were determined before and after MC. Further, parameters reflecting left ventricular functions, such as left ventricular end systolic pressure, left ventricular end diastolic pressure, isovolumic pressure (IP) and the maximal increasing/decreasing rate of left intraventricular pressure (±dp/dtmax), were also determined before and after MC. Left ventricular functions were determined either by two dimensional transthoracic echocardiography or by speckle tracking imaging for segmental abnormal ventricular wall motions.

RESULTSHeart rate, systolic pressure, diastolic pressure and mean arterial pressure decreased significantly but transiently, while central venous pressure markedly increased after MC. In contrast to significant changes in diastolic functions, there was no significant change in cardiac systolic functions after MC. The speckle tracking imaging demonstrated that strain values of different myocardial segment significantly decreased post impact, and that of the ventricular segment decreased from segment to segment.

CONCLUSIONSpeckle tracking imaging is useful and informative to assess myocardial regional dysfunctions post MC.

Animals ; Echocardiography ; Female ; Heart Injuries ; diagnostic imaging ; physiopathology ; Hemodynamics ; Male ; Myocardial Contraction ; Rabbits ; Ventricular Function ; Wounds, Nonpenetrating ; diagnostic imaging ; physiopathology

OBJECTIVECardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their management often requires immediate surgical intervention, excellent surgical technique and the ability to provide excellent postoperative critical care to patients. The aim of this study was to evaluate the outcome and survival rate of patients with penetrating cardiac injury in southern Iran, Shiraz.

METHODSFrom January 2001 to June 2007, medical records of all patients suffering from penetrating cardiac injuries were reviewed and their outcomes were investigated. The inclusion criterion was the presence of a confirmed penetrating cardiac injury intraoperatively or by autopsy. Patients with blunt cardiac injuries were excluded from the study.

RESULTSThe study consisted of 37 patients, including 1 gunshot wound (2.7%), 35 stab wounds (94.6%) and 1 (2.7%) shotgun wound. The overall survival rate was 76% (28 in 37) and that in stab wound patients was 80%. The collected data of 9 expired patients revealed 11% death on arrival, 67% hypotensive, and 22% normotensive considering physiologic presentation. Paired sample test showed significant correlation between mortality and electrocardiographic changes, amount of retained blood in pericardium, clinical stage and physiologic condition at presentation, as well as associated injury type (gunshot more than stab wound).

CONCLUSIONOur results show that injury mechanism and initial cardiac rhythm are significant predictors of outcomes in patients with penetrating cardiac injuries. Besides, gunshot injury and exsanguination are the most important predictive variables of mortality.

Adolescent ; Adult ; Electrocardiography ; Female ; Heart Injuries ; mortality ; physiopathology ; Humans ; Iran ; epidemiology ; Male ; Middle Aged ; Survival Rate ; Wounds, Penetrating ; mortality ; physiopathology

OBJECTIVE: To explore MSCT optimal examination time for patients with unconspicuous rib fracture. METHODS: Sixty-three patients with thoracic trauma from January 2009 to June 2011 were collected. They were examined by MSCT in the first week after trauma and re-examined during eighth weeks after trauma. The number of rib which had been found fractured in the first examination was compared to that in re-examinations. RESULTS: Patients with fine rib fracture often have different diagnostic results at different examination time after trauma. There was statistical difference between the number in the first week and the third week to the fifth week. CONCLUSION MSCT could show the pathophysiological changes of rib fracture objectively in the stage between the third week and the fifth week after trauma, which is optimal examination time for the fine rib fracture.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography ; Pleura/pathology* ; Radiography, Thoracic/methods* ; Rib Fractures/physiopathology* ; Thoracic Injuries/physiopathology* ; Time Factors ; Wounds, Nonpenetrating/physiopathology* ; Young Adult