Muscle contusion injuries: current treatment options.

Muscle contusion is second only to strain as the leading cause of morbidity from sports-related injuries. Severity depends on the site of impact, the activation status of the muscles involved, the age of the patient, and the presence of fatigue. The diagnosis has traditionally been one of clinical judgment; however, newer modalities, including ultrasonography, magnetic resonance imaging, and spectroscopy, are becoming increasingly important in both identifying and delineating the extent of injury. Although controlled clinical studies are scarce, animal research into muscle contusions has allowed the description of the natural healing process, which involves a complex balance between muscle repair, regeneration, and scar-tissue formation. Studies are being performed to evaluate the effects of anti-inflammatory medications, corticosteroids, operative repair, and exercise protocols. Prevention and treatment of complications such as myositis ossificans have also been stressed, but recognition may improve the outcome of these ubiquitous injuries.

The effect of anabolic steroids and corticosteroids on healing of muscle contusion injury.

The effect of an anabolic steroid (nandrolone decanoate, 20 mg/kg) and a corticosteroid (methylprednisolone acetate, 25 mg/kg) on healing muscle injured with a drop-mass technique in a reproducible muscle contusion injury model in the rat was studied. Healing was determined by measuring active contractile tension in each muscle and histologic analysis. At day 2, the corticosteroid group showed significant improvement in both twitch and tetanic strength relative to the controls. At day 7, this effect was reversed and the corticosteroid muscles were significantly weaker than the control muscles, but there was still no significant effect seen in the anabolic steroid group. At day 14, the corticosteroid muscles were totally degenerated, with disorganized muscle fiber architecture. The anabolic steroid muscles were significantly stronger in twitch, and a similar trend was seen in tetanus relative to control muscles. The results indicate that in an animal model corticosteroids may be beneficial in the short term, but they cause irreversible damage to healing muscle in the long term, including disordered fiber structure and a marked diminution in force-generating capacity. Anabolic steroids may aid in the healing of muscle contusion injury to speed the recovery of force-generating capacity. Although anabolic steroids are considered renegade drugs, they may have an ethical clinical application to aid healing in severe muscle contusion injury, and their use in the treatment of muscle injuries warrants further research.

Cerebral blood flow changes in response to elevated intracranial pressure in rabbits and bluefish: a comparative study.

In mammals, the cerebrovascular response to increases in intracranial pressure may take the form of the Cushing response, which includes increased mean systemic arterial pressure, bradycardia and diminished respirations. The mechanism, effect and value of these responses are debated. Using laser-Doppler flowmetry to measure cerebral blood flow, we analyzed the cardiovascular responses to intracranial pressure raised by epidural infusion of mock cerebrospinal fluid in the bluefish and in the rabbit, and compare the results. A decline in cerebral blood flow preceding a rise in mean systemic arterial pressure was observed in both species. Unlike bluefish, rabbits exhibit a threshold of intracranial pressure below which cerebral blood flow was maintained and no cardiovascular changes were observed. The difference in response between the two species was due to the presence of an active autoregulatory system in the cerebral tissue of rabbits and its absence in bluefish. For both species studied, the stimulus for the Cushing response seems to be a decrement in cerebral blood flow. The resulting increase in the mean systemic arterial pressure restores cerebral blood flow to levels approaching controls.

Glucose-dependent turnover of the mRNAs encoding succinate dehydrogenase peptides in Saccharomyces cerevisiae: sequence elements in the 5' untranslated region of the Ip mRNA play a dominant role.

We have demonstrated previously that glucose repression of mitochondrial biogenesis in Saccharomyces cerevisiae involves the control of the turnover of mRNAs for the iron protein (Ip) and flavoprotein (Fp) subunits of succinate dehydrogenase (SDH). Their half-lives are > 60 min in the presence of a nonfermentable carbon source (YPG medium) and < 5 min in glucose (YPD medium). This is a rare example in yeast in which the half-lives are > 60 min in the presence of a nonfermentable carbon source (YPG medium) and < 5 min in glucose (YPD medium). This is a rare example in yeast in which the half-life of an mRNA can be controlled by manipulating external conditions. In our current studies, a series of Ip transcripts with internal deletions as well as chimeric transcripts with heterologous sequences (internally or at the ends) have been examined, and we established that the 5'-untranslated region (5' UTR) of the Ip mRNA contains a major determinant controlling its differential turnover in YPG and YPD. Furthermore, the 5' exonuclease encoded by the XRN1 gene is required for the rapid degradation of the Ip and Fp mRNAs upon the addition of glucose. In the presence of cycloheximide the nucleolytic degradation of the Ip mRNA can be slowed down by stalled ribosomes to allow the identification of intermediates. Such intermediates have lost their 5' ends but still retain their 3' UTRs. If protein synthesis is inhibited at an early initiation step by the use of a prt1 mutation (affecting the initiation factor eIF3), the Ip and Fp mRNAs are very rapidly degraded even in YPG. Significantly, the arrest of translation by the introduction of a stable hairpin loop just upstream of the initiation codon does not alter the differential stability of the transcript in YPG and YPD. These observations suggest that a signaling pathway exists in which the external carbon source can control the turnover of mRNAs of specific mitochondrial proteins. Factors must be present that control either the activity or more likely the access of a nuclease to the select mRNAs. As a result, we propose that a competition between initiation of translation and nuclease action at the 5' end of the transcript determines the half-life of the Ip mRNA.

Carcinoid heart disease: report of a case secondary to a pure carcinoid tumour of the ovary.

Carcinoid heart disease secondary to ovarian carcinoid is a rare finding, with only 12 cases reported in the literature to date. Most ovarian carcinoids arise from ovarian cysts or teratomata, the 'pure' carcinoid being exceedingly rare. We present a case of carcinoid syndrome with tricuspid valve involvement in a patient with 'pure' ovarian carcinoid.