The Efficacy of Hyaluronidase in Early Surgery of Nasal Bone Fracture.

A nasal bone fracture is one of the most common facial injuries and is often treated by closed reduction. Typically, 2 to 3 weeks are needed for patients to return to daily life because the operation is performed after swelling around the fracture site is reduced. This study aimed to investigate that hyaluronidase injection could reduce swelling, perform early operation and return to daily life accelerated.From January 2017 to December 2017, 181 patients with nasal bone fracture were analyzed. 60 patients underwent hyaluronidase injection and massage to reduce edema, then performed surgery within 2 to 4 days. The remaining patients were treated conservatively (massage alone); they then underwent surgery. Ultrasonography was used to measure changes in skin thickness, and the treatment duration, outcome, and patient satisfaction were compared.The duration from injury to surgery was short in the early operation group, and the period of recovery and return to ordinary life was significantly shorter than in the conventional group. The difference in skin thickness after hyaluronidase injection and massage was 0.8 mm in the early operation group; there was no significant difference in the conventional group. There was no statistically significant difference in satisfaction between the 2 groups, but the mean satisfaction was higher in the early operation group.In patients with nasal bone fracture after facial trauma, hyaluronidase injection, and massage led to reduced edema. This might improve patient satisfaction by allowing earlier operation and earlier return to daily life.

Cyclooxygenase-2 activity is important in craniofacial fracture repair.

The aim of this study was to examine the effect of cyclooxygenase (COX)-2 on bone repair after craniofacial fracture in mice. A 4-mm fracture was created in the parietal bone of 8-week-old male COX-2 wild-type (COX-2(+/+)) and knockout (COX-2(-/-)) mice. Ribonucleic acid was extracted from the fractured bone and analysed. For morphological and histological analysis, the mice were killed 8 and 12 weeks after treatment, and sections were prepared. Three-dimensional computed tomography was performed, and the sections were stained with hematoxylin-eosin for histological examination. Expression of COX-2 messenger ribonucleic acid was induced in COX-2(+/+) mice, but not in COX-2(-/-) mice. Ossification at the fracture site was almost complete 12 weeks after fracture in COX-2(+/+) mice. In COX-2(-/-) mice, incomplete union had occurred at the fracture site. In both types of mice, the fracture site contained no cartilaginous tissue, and the callus formed from the periosteal side. These results suggest that COX-2 plays an important role in craniofacial fracture repair and that COX-2-selective non-steroidal anti-inflammatory drugs might interfere with fracture repair of the membranous viscerocranium in the clinical setting.

The prognostic value of the brain sodium-potassium ATPase enzyme concentration in head injury.

Sodium-potassium adenosine triphosphatase (ATPase) enzyme was determined in the brain tissue of 11 patients with head injury and 6 control patients. Patients with head injury included in this study were selected from two categories: (a) patients in deep coma due to severe head injury [Glasgow Coma Scale (GCS) less than 8; 6 cases]; (b) patients with depressed skull fractures with dural tears who were conscious and able to give an adequate verbal response (GCS greater than 10; 5 cases). The level of the enzyme was significantly reduced in comatose patients with severe head injury as compared to the controls (P less than 0.001) or to conscious patients with depressed fractures (P less than 0.001). In the group of conscious patients with depressed fractures, the enzyme level was no different from that of the controls (P = 0.4215). All comatose patients with severely reduced enzyme levels subsequently died, whereas those with depressed fractures with normal enzyme levels survived. The relationship between a low enzyme level and brain edema in severe head injury is discussed.

Clinical application of a new enzyme-linked assay for the estimation of brain-specific creatine kinase in head injured patients.

The clinical value of serum brain specific creatine kinase (CK-BB) was assessed in head injured patients (group A) using a new enzyme-linked immunosorbent assay (ELISA). The results were compared to healthy controls (group B) and patients post-myocardial infarction (group C). None of the head injured patients had undergone a surgical procedure or ventricular puncture. CK-BB was significantly higher in group A than in controls. The level of CK-BB in group A was inversely proportional to the Glasgow Coma Scale on admission. All patients with a CK-BB greater than 100 micrograms/l died. The ELISA technique is a simple and reliable assay with prognostic significance in patients with head injury and has wider clinical application than the previously described radioimmunoassay methods.

[Special aspects of fracture healing in cranio-cerebral injuries]. / Spezielle Aspekte der Frakturheilung beim Schädelhirnverletzten.

This study demonstrates the changes of concentration and elimination of calcium, phosphate and zinc, as well as alteration of serum alkaline phosphatase and acid phosphatase especially in patients with severe brain injuries in connection with bone fractures. Because the study has not been completed, the presently acquired results should only demonstrate possible development of the examined parameters. To find out the pathogenesis of overgrowing callus in brain-injured patients, further examinations are being carried out to find the histochemical activities of alkaline and acid phosphatase, lactate dehydrogenase, adenosine triphosphatase and acetylcholine esterase.

[Proteolytic enzyme activity in the cerebrospinal fluid after head injury--a preliminary report (author's transl)]. / Proteolytische Enzymaktivität im Liquor Cerebrospinalis nach Schädel-Hirn-Trauma.

Report on seven cases of severe head injury, where proteolytic enzyme activity in the ventricular fluid was measured within a period of eight days. The result was positive in four cases. This finding is discussed in relation to clinical features and morphology. Earlier reports and these results are considered.

[Activities of lactate dehydrogenase, acetylcholinesterase and cholinesterase in the cerebrospinal fluid and blood of patients with craniocerebral injuries]. / Die Aktivität der Laktatdehydrogenase, Acetylcholinesterase und Cholinesterase im Liquor cerebrospinalis und Serum von Patienten mit Schädel-Hirn-Verletzungen.

LDH, ACHE, and CHE are determined in liquor and serum of 31 patients with commontio cerebri and 20 patients with contusio cerebri and the values are compared with a reference range found in 25 test persons. Functional cerebral lesion causes an increase in LDH in the cerebrospinal fluid. After cerebral contusions, the behaviour of LDH is uncharacteristic whereas ACHE and CHE show a distinct decrease in activity. When considering the individual values, a considerable scattering is found, so that the clinical applicability of the method for a differentiation of functional and primary-morphological brain lesions remains doubtful.