pyrophosphate and Wounds-and-Injuries

No currently used diagnostic test is an accurate predictor of patients who will develop morbidity or mortality from cardiac contusion. In a prospective study we used gated cardiac radionuclide angiography to assess cardiac function in 30 patients with blunt chest trauma, and we compared the results of this test with those of other diagnostic studies for cardiac contusion to determine whether gated angiography is a more accurate predictor of serious cardiac injury. Diagnostic tests included the following: serial electrocardiograms (ECG), serial creatine phosphokinase muscle-brain isoenzyme (CPK-MB) and lactic dehydrogenase (LDH) isoenzymes, gated cardiac radionuclide angiography, and technetium-99m (Tc-99m) pyrophosphate scintigraphy. Abnormal studies were present in 26 patients; 22 showed abnormalities in CPK-MB, 19 on ECG, and five on gated scan. No patient demonstrated an abnormal Tc-99m pyrophosphate scan or abnormal elevation of LDH isoenzyme. Although no diagnostic test was predictive of morbidity and mortality, CPK-MB isoenzyme was the only test to correlate with morbidity and mortality. Morbidity and mortality correlated most closely with the number of associated major injuries and the presence of hypotension or hypoxia.

Topics: Adolescent; Adult; Aged; Angiography; Creatine Kinase; Diphosphates; Electrocardiography; Evaluation Studies as Topic; Female; Heart Injuries; Humans; Hypotension; Hypoxia; Isoenzymes; L-Lactate Dehydrogenase; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Wounds and Injuries

The potential role of bone scanning in the early detection of occult fractures following acute trauma was investigated. Technetium 99m pyrophosphate bone scans were obtained in patients with major clinical findings (e.g., pain, swelling, tenderness) and negative or equivocal roentgenograms following trauma. Bone scanning facilitated the prompt diagnosis of occult fractures in the hip, knee, wrist, ribs and costochondral junctions, sternum, vertebrae, sacrum, and coccyx. Several illustrative cases are presented. Roentgenographic confirmation occurred following a delay of days to weeks and, in some instances, the roentgenographic findings were subtle and could be easily overlooked. This study demonstrates bone scanning to be invaluable and definitive in the prompt detection of occult fractures.

Topics: Acetabulum; Aged; Bone and Bones; Coccyx; Diphosphates; Female; Fractures, Bone; Fractures, Closed; Humans; Radiography; Radionuclide Imaging; Radius Fractures; Sacrum; Sternum; Technetium; Technetium Tc 99m Pyrophosphate; Wounds and Injuries; Wrist Injuries

Topics: Acute Disease; Animals; Diphosphates; Dogs; Endothelium, Vascular; Evaluation Studies as Topic; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Wounds and Injuries