Cardiac involvement in seatbelt-related and direct sternal trauma: a prospective study and management implications.

The study set out to assess the incidence and consequences of pericardial and myocardial involvement in seatbelt-related sternal injury. Comparison was made with that from direct sternal trauma and implications for patient management were examined. The study was designed as a prospective sequential single centre study of 60 patients, from a total of 63 consecutive admissions over a 13 month period, admitted with blunt central chest trauma or multiple injuries involving the torso. Clinical status, correlated with echocardiographic, ECG and cardiac enzyme abnormalities were the main outcome measures. The study showed that 25% of 32 patients with seatbelt-related chest injury and 30% of 10 patients with multiple injuries had clinically unsuspected pericardial effusions detected by echocardiography. Pericardial effusion was not associated with an adverse outcome in the seatbelt-related injuries. Abnormalities of ECG or CK-MB isoenzyme levels were non-specific and did not correlate with the presence of pericardial effusion. From these data it is concluded that seatbelt-related sternal trauma is usually relatively benign. Echocardiography detects unsuspected pericardial effusion in a significant minority but ECG and cardiac enzyme estimations are of limited value. The routine admission to hospital of all patients with isolated seatbelt-related sternal trauma for cardiological monitoring is unnecessary. Inpatient treatment should be reserved for patients whose clinical condition, social circumstances or other injuries necessitate admission.

Serum osteocalcin and total alkaline phosphatase levels as prognostic indicators in tibial shaft fractures.

Serum samples were obtained periodically from 50 adult patients with closed tibial shaft fractures. Total alkaline phosphatase activity was measured in all cases and osteocalcin activity was measured in 14 patients. Fractures produced by high-energy violence generally had lower values of osteocalcin activity. This could be due to depressed circulating vitamin K levels throughout the healing period in the former fractures. In addition, normally uniting fractures had generally higher values of osteocalcin activity compared with fractures exhibiting delayed union. This indicates depressed osteoblastic activity in slowly healing fractures. The results suggest that measurement of osteocalcin activity after fracture could provide a useful prognostic indicator. By contrast, total serum alkaline phosphatase activity was not significantly different between the injury groups and between the healing groups.

[Effect of a combined radiation lesion on the enzyme activity of the glutathione redox system of the rat liver]. / Vliianie kombinirovannogo radiatsionnogo porazheniia na aktivnost' fermentov redoks-sistemy glutationa pecheni krys.

A study was made of activity of glutathione peroxidase, glutathione reductase and glutathione-dehydroascorbate oxidoreductase in the rat liver under x-ray treatment in doses of 206 or 155 mC/kg coupled with mechanical injury (closed fracture of the leg bones). Radiation in a dose of 206 mC/kg gave rise to the following changes in activity of glutathione redox-system enzymes: reduced activity of glutathione peroxidase on the 3d day, and increased activity of glutathione reductase, and glutathione-dehydroascorbate oxidoreductase on the 7th day after combined radiation injury. Radiation in a dose of 155 mC/kg was accompanied by increased activity of glutathione-dehydroascorbate oxidoreductase on the 7th day and reduced glutathione reductase activity on the 30th day after the injury infliction.

[Enzymatic activity in the osteoblasts of rabbits following combined trauma]. / Fermentativnaia aktivnost' v osteoblastakh u krolikov posle kombinirovannoi travmy

Experiments were conducted on young rabbits by the histochemical methods; the activity of NAD-, NADP-diaphorases, cytochromoxidase and alkaline phosphatase was studied in the osteoblasts 3, 6, 12, 24, 48 and 72 hours after combined radiation trauma. It appeared that a bone fracture led to an increase in the level of metabolic and energic processes in the osteoblasts as soon as in 12 hours. Irradiation of the animals depressed the activation (caused by the fracture) of all the enzymes investigated.