- Email: [email protected]
Heart trauma: Myocardial involvement (contusion) following a nonpenetrating injury to the chest (airplane accident)
146 Hecht,
AMERICAN
H. H.: penetrating 1947.
Heart Injury
Trauma: to the
HEART
JOURNAL
Myocardial Involvement Chest (Airplane Accident).
(Contusion) Ann. Int.
Following a NonMed. 27:126 (July).
A 34-year-old civilian air pilot had always been in good health prior to a severe chest injury which he suffered when he was violently pulled forward against the resistance of his safety belt during a plane crash. When admitted to the hospital, he was in shock and roentgenograms revealed fractures of the left fifth and sixth ribs, the right sixth and tenth ribs, the sacrum, the transverse processes of the fifth lumbar vertebra, the right radius and ulna, and the left tibia and fibula. There was a small collection of fluid in both pleural cavities. Shock was treated with plasma,‘, blood transfusion, and intravenous glucose and saline; with this therapy, the blood pressure rose from 90/60 to llOi70 and his shock state disappeared. Examination of the heart at the time of admission revealed no abnormalities. Twenty-four hours after the injury, he received an injection of IO C.C. of adrenal cortical extract which was followed two hours later by the development of cyanosis, severe dyspnea, and diaphoresis. The heart sounds during this episode of respiratory distress were m&led and the pulse rate had in creased to 145 per minute. Within several hours he was again comfortable but the following morning the examiner noted a persistent tachycardia and an apical protodiastolic gallop rhythm. Because of the persistence of the gallop rhythm and the tachycardia, even on the fourth hospital day, an elctrocardiogram was made. This was found to be normal. Seven days following the injury another electrocardiogram was made and minor T wave changes in the unipolar precordial leads derived from Position 1 to Position 5 were noted. Electrocardiograms on succeeding days showed a progressive distortion of the T waves in these same leads and sixteen days after the accident, this deflection remained negative in precordial leads derived from Potisions 1, 2, and 3. He was discharged from the hospital twenty days after the accident, since he seemed to have When seen six months later he was quite well except for nonunion made a good clinical recovery. of the fractured left wrist. The electrocardiogram nlade at the rime of this follow-up visit was entirely normal. The clinical findings and the temporary T-wave changes in the precordial leads are interpretecl by the author as manifestations of contusion to the superficial layers of the myocardium close to the interventricular septum. He does not cotnpletely discard the diagnosis of a traumatic pericarditis. The possibility that the cardiac complications and the T-wave changes were causally related to the injection of adrenal cortical extract is dismissed hy the author. WENDKOS. (Zavelti, Philip Production Arch. Path.
A.: of 44:l
Studies on the Autoantibodies (July), 1947.
Pathogenesis to Heart,
of Rheumatic Skeletal Muscle
Fever. I: Experimental and Connective Tissue.
to kidney tissue in rabbits and rats by The author previously developed “autoantibodies” injecting renal material in combination with bacterial substances, producing at the same time a glomerulonephritis. He then investigated the ability of streptococci to render other tissues antigenic, especially heart muscle, skeletal muscle, and connective tissue; structures that are chiefly damaged in rheumatic fever. Group A beta hemolytic streptococci were the source of the streptococcic pretein which was emulsified, mixed with emulsions of ground tissues from rats, and injected into other rats intraperitoneally on ten successive days. This schedule was repeated as often as six times at month15 intervals. Serologic tests on the blood of these rats showed the presence of antibodies (high agglutination titer) when their serums reacted in vitro with extracts of plain (untreated) homologous tissues. These autoantibodies reached their highest titer on the seventh day after the last injection, but they were present to some degree many weeks after immunization. Control serums from normal untreated rats and from rats treated with streptococci alone and with tissue emulsion alone were also tested. All control serums were negative. Serums from rats treated with the streptococcus-tissue emulsion showed true specificity of the autoantibodies when they failed to react with heterologous tissue extracts, such as liver, kidney, or spleen.
AMERICAN
H. H.: penetrating 1947.
Heart Injury
Trauma: to the
HEART
JOURNAL
Myocardial Involvement Chest (Airplane Accident).
(Contusion) Ann. Int.
Following a NonMed. 27:126 (July).
A 34-year-old civilian air pilot had always been in good health prior to a severe chest injury which he suffered when he was violently pulled forward against the resistance of his safety belt during a plane crash. When admitted to the hospital, he was in shock and roentgenograms revealed fractures of the left fifth and sixth ribs, the right sixth and tenth ribs, the sacrum, the transverse processes of the fifth lumbar vertebra, the right radius and ulna, and the left tibia and fibula. There was a small collection of fluid in both pleural cavities. Shock was treated with plasma,‘, blood transfusion, and intravenous glucose and saline; with this therapy, the blood pressure rose from 90/60 to llOi70 and his shock state disappeared. Examination of the heart at the time of admission revealed no abnormalities. Twenty-four hours after the injury, he received an injection of IO C.C. of adrenal cortical extract which was followed two hours later by the development of cyanosis, severe dyspnea, and diaphoresis. The heart sounds during this episode of respiratory distress were m&led and the pulse rate had in creased to 145 per minute. Within several hours he was again comfortable but the following morning the examiner noted a persistent tachycardia and an apical protodiastolic gallop rhythm. Because of the persistence of the gallop rhythm and the tachycardia, even on the fourth hospital day, an elctrocardiogram was made. This was found to be normal. Seven days following the injury another electrocardiogram was made and minor T wave changes in the unipolar precordial leads derived from Position 1 to Position 5 were noted. Electrocardiograms on succeeding days showed a progressive distortion of the T waves in these same leads and sixteen days after the accident, this deflection remained negative in precordial leads derived from Potisions 1, 2, and 3. He was discharged from the hospital twenty days after the accident, since he seemed to have When seen six months later he was quite well except for nonunion made a good clinical recovery. of the fractured left wrist. The electrocardiogram nlade at the rime of this follow-up visit was entirely normal. The clinical findings and the temporary T-wave changes in the precordial leads are interpretecl by the author as manifestations of contusion to the superficial layers of the myocardium close to the interventricular septum. He does not cotnpletely discard the diagnosis of a traumatic pericarditis. The possibility that the cardiac complications and the T-wave changes were causally related to the injection of adrenal cortical extract is dismissed hy the author. WENDKOS. (Zavelti, Philip Production Arch. Path.
A.: of 44:l
Studies on the Autoantibodies (July), 1947.
Pathogenesis to Heart,
of Rheumatic Skeletal Muscle
Fever. I: Experimental and Connective Tissue.
to kidney tissue in rabbits and rats by The author previously developed “autoantibodies” injecting renal material in combination with bacterial substances, producing at the same time a glomerulonephritis. He then investigated the ability of streptococci to render other tissues antigenic, especially heart muscle, skeletal muscle, and connective tissue; structures that are chiefly damaged in rheumatic fever. Group A beta hemolytic streptococci were the source of the streptococcic pretein which was emulsified, mixed with emulsions of ground tissues from rats, and injected into other rats intraperitoneally on ten successive days. This schedule was repeated as often as six times at month15 intervals. Serologic tests on the blood of these rats showed the presence of antibodies (high agglutination titer) when their serums reacted in vitro with extracts of plain (untreated) homologous tissues. These autoantibodies reached their highest titer on the seventh day after the last injection, but they were present to some degree many weeks after immunization. Control serums from normal untreated rats and from rats treated with streptococci alone and with tissue emulsion alone were also tested. All control serums were negative. Serums from rats treated with the streptococcus-tissue emulsion showed true specificity of the autoantibodies when they failed to react with heterologous tissue extracts, such as liver, kidney, or spleen.