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Sample records for abdominal gunshot wounds

  1. Management of gunshot wounds

    SciTech Connect

    Ordog, G.; Drew, R.

    1987-01-01

    Management of Gunshot Wounds provides a review of wound ballistics and a systemic review of gunshot wound management of all major body areas and systems. This volume includes information on pre-hospital care, nursing care, and care of infants, children, and the elderly patient with gunshot wounds. This volume also features information on: lead toxicity; complications of gunshot wounds; socioeconomic aspects of gunshot wounds; the forensic and pathological aspects of gunshot wounds; future directions in the care of gunshot wounds.

  2. Impact of hollow viscus injuries on outcome of abdominal gunshot wounds.

    PubMed

    Harris, Brady T; Franklin, Glen A; Harbrecht, Brian G; Richardson, J David

    2009-05-01

    Abdominal gunshot wounds (GSW) are a source of morbidity and mortality. Limited data are available on the effect of hollow viscus injuries (HVI) secondary to gunshot wounds. GSW sustained in the Louisville area from 2004 to 2007 were reviewed. Attention was given to the impact of HVI from abdominal GSW. Statistical significance was determined. One-hundred ten patients sustained GSW with peritoneal violation. Eighty-six had HVI. Eighteen died after laparotomy with 15 having an HVI. Patients undergoing damage control (DC) have a significant increase in mortality compared with those not requiring DC. Exsanguination was the major cause of mortality (67%). Mortality directly related to HVI was found in 11 per cent. Twenty patients underwent DC with 11 deaths. Isolated HVI did not show a significantly increased mortality compared with other injury patterns involving solid organ or major vascular structures. Various methods of repair showed no significant survival advantage. Recognition and repair of HVI in abdominal GSW is crucial to patient salvage. Definitive repair of HVI at the initial operation should be considered. Primary repair of HVI is preferred although no survival disadvantage is seen in other forms of repair in marginally stable patients. Definitive repair at the initial operation decreases complications.

  3. Abdominal gunshot wounds. An urban trauma center's experience with 300 consecutive patients.

    PubMed Central

    Feliciano, D V; Burch, J M; Spjut-Patrinely, V; Mattox, K L; Jordan, G L

    1988-01-01

    From July 1983 through December 1987, 300 consecutive patients with penetrating gunshot wounds of the abdomen causing visceral or vascular injuries were treated. Resuscitative thoracotomy was required in 20 patients (6.6%), and only two survived. The most commonly injured organs were the small bowel (60%), colon (41.6%), liver (29.3%), vascular structures (24.6%), stomach (17.3%), and kidney (17.0%). The overall survival rate for the series was 88.3%; however, if only the 226 patients without vascular injuries are considered, the survival rate was 97.3%. In the 35 patients who died, the blood pressure on admission was 51 mmHg, 18 required a resuscitative thoracotomy, four visceral or vascular injuries were present, and the median blood replacement was 18 units. The cause of death was perioperative shock in 30 patients (85.7%), whereas five patients (14.3%) died of sepsis and multiple organ failure. The most common postoperative complication in survivors and patients who died later in the study was an intra-abdominal abscess (3.0%). Rapid conservative operative techniques for civilian gunshot wounds leads to few postoperative complications and an excellent survival rate, especially if vascular injuries are not present. PMID:3421760

  4. [Gunshot wounds: forensic pathology].

    PubMed

    Lorin de la Grandmaison, Geoffroy

    2012-02-01

    Gunshot wounds are among the most complex traumatic lesions encountered in forensic pathology. At the time of autopsy, careful scrutiny of the wounds is essential for correct interpretation of the lesions. Complementary pathological analysis has many interests: differentiation between entrance and exit wounds, estimation of firing distance, differentiation between vital and post mortem wounds and wounds dating. In case of multiple headshots, neuropathological examination can provide arguments for or against suicide. Sampling of gunshot wounds at autopsy must be systematic. Pathological data should be confronted respectively to autopsy and death scene investigation data and also ballistic studies. Forensic pathologist must be aware of the limits of optic microscopy.

  5. Laparoscopic Bullet Removal in a Penetrating Abdominal Gunshot

    PubMed Central

    Koulas, Spyridon; Tsimoyiannis, Ioannis

    2016-01-01

    Penetrating abdominal trauma has been traditionally treated by exploratory laparotomy. Nowadays laparoscopy has become an accepted practice in hemodynamically stable patient without signs of peritonitis. We report a case of a lower anterior abdominal gunshot patient treated laparoscopically. A 32-year-old male presented to the Emergency Department with complaint of gunshot penetrating injury at left lower anterior abdominal wall. The patient had no symptoms or obvious bleeding and was vitally stable. On examination we identified 1 cm diameter entry wound at the left lower abdominal wall. The imaging studies showed the bullet in the peritoneal cavity but no injured intraperitoneal and retroperitoneal viscera. We decided to remove the bullet laparoscopically. Twenty-four hours after the intervention the patient was discharged. The decision for managing gunshot patients should be based on clinical and diagnostic findings. Anterior abdominal injuries in a stable patient without other health problems can be managed laparoscopically. PMID:27525150

  6. Laparoscopic Bullet Removal in a Penetrating Abdominal Gunshot.

    PubMed

    Stefanou, Christos; Zikos, Nicolaos; Pappas-Gogos, George; Koulas, Spyridon; Tsimoyiannis, Ioannis

    2016-01-01

    Penetrating abdominal trauma has been traditionally treated by exploratory laparotomy. Nowadays laparoscopy has become an accepted practice in hemodynamically stable patient without signs of peritonitis. We report a case of a lower anterior abdominal gunshot patient treated laparoscopically. A 32-year-old male presented to the Emergency Department with complaint of gunshot penetrating injury at left lower anterior abdominal wall. The patient had no symptoms or obvious bleeding and was vitally stable. On examination we identified 1 cm diameter entry wound at the left lower abdominal wall. The imaging studies showed the bullet in the peritoneal cavity but no injured intraperitoneal and retroperitoneal viscera. We decided to remove the bullet laparoscopically. Twenty-four hours after the intervention the patient was discharged. The decision for managing gunshot patients should be based on clinical and diagnostic findings. Anterior abdominal injuries in a stable patient without other health problems can be managed laparoscopically. PMID:27525150

  7. [Liver gunshot wounds].

    PubMed

    Botoi, G; Blăjan, I; Nemeş, S

    2000-01-01

    The paper presents the 6 cases of liver shot wounds that were in supervision of the general surgery unit, County Hospital of Baia Mare, between the years 1990-1997. The patients were males, most of them being 20 to 30 years old. In 3 situations hunting rifles were involved, all followed by retention of metal foreign body. The wounds were plurivisceral in 5 of the 6 cases, the most frequently wounded was the right liver lobe. All the patients presented serious traumatic shock and haemorrhagic shock. Livertectomy was used in 40% of the cases being imposed by the dilacerant and transfixiant character of the wounds and also by the retention of foreign bodies in parenchime. We registered 2 demises, both in the first postoperatory hours. The paper proposes a few criteria that allow the application of a conservatory treatment:rapid favourable answer at deshocking therapy; hemodynamic stability; minimal hemoperitoneus (echographical and tomographical); absence of associated visceral wounds or, when they exist, of serious physiopathological consequences; access to performant means of imagistics.

  8. Concept of Gunshot Wound Spine

    PubMed Central

    Mittal, Radhey Shyam

    2013-01-01

    Gunshot wound (GSW) to the spine which was earlier common in the military population is now being increasingly noted in civilians due to easy availability of firearms of low velocity either licensed or illegal combined with an increased rate of violence in the society. Contributing to 13% to 17% of all spinal injuries, the management of complex injury to the spine produced by a GSW remains controversial. Surgery for spinal cord injuries resulting from low velocity GSWs is reserved for patients with progressive neurologic deterioration, persistent cerebrospinal fluid fistulae, and sometimes for incomplete spinal cord injuries. Surgery may also be indicated to relieve active neural compression from a bullet, bone, intervertebral disk, or a hematoma within the spinal canal. Spinal instability rarely results from a civilian GSW. Cauda equina injuries from low velocity GSWs have a better overall outcome after surgery. In general, the decision to perform surgery should be made on consideration of multiple patient factors that can vary over a period of time. Although there have been plenty of individual case reports regarding GSW to the spine, a thorough review of unique mechanical and biological factors that affect the final outcome has been lacking. We review the key concepts of pathogenesis and management of GSW to the spine and propose an algorithm to guide decision making in such cases. PMID:24353856

  9. [Gunshot wound to the kidney: case report and therapeutic management].

    PubMed

    Maruschke, M; Hakenberg, O W

    2008-04-01

    Gunshot wounds to the kidney occur with different regional incidence. They are commonly combined with thoracic and abdominal injuries. Gunshot wounds may be caused by low-velocity or high-velocity bullets. The latter are usually used with military weapons and cause a higher degree of tissue damage. The therapeutic management of renal gunshot wounds has changed in recent decades resulting in more organ-preserving strategies. An imperative indication for surgical exploration of the kidney is critical renal bleeding with symptoms of hypovolaemic shock. We report the case of a 23-year-old male admitted to the hospital with combined gunshot wounds from a small-bore weapon with damage of the liver, stomach and the left kidney. There were no signs of thoracic injuries. The patient underwent transabdominal exploration with treatment of the liver and stomach lesions, removal of the bullet and preservation of the left kidney. A percutaneous nephrostomy and drainage of the retroperitoneal region were inserted; antibiotic prophylaxis was given. A 4-week postoperative intravenous pyelogram showed complete integrity of the upper left tract and good renal function.

  10. Gunshot wounds: epidemiology, wound ballistics, and soft-tissue treatment.

    PubMed

    Dougherty, Paul J; Najibi, Soheil; Silverton, Craig; Vaidya, Rahul

    2009-01-01

    The extremities are the most common anatomic location for gunshot wounds. Because of the prevalence of gunshot injuries, it is important that orthopaedic surgeons are knowledgeable about caring for them. The most common injuries seen with gunshot wounds are those of the soft tissues. Nonsurgical management of patients who have gunshot wounds with minimal soft-tissue disruption has been successfully accomplished in emergency departments for several years; this includes extremity wounds without nerve, intra-articular, or vascular injury. Stable, nonarticular fractures of an extremity have also been successfully treated with either minimal surgical or nonsurgical methods in the emergency department. Indications for surgical treatment include unstable fractures, intra-articular injuries, a significant soft-tissue injury (especially with skin loss), vascular injury, and/or a large or expanding hematoma.

  11. Gunshot wounds: epidemiology, wound ballistics, and soft-tissue treatment.

    PubMed

    Dougherty, Paul J; Najibi, Soheil; Silverton, Craig; Vaidya, Rahul

    2009-01-01

    The extremities are the most common anatomic location for gunshot wounds. Because of the prevalence of gunshot injuries, it is important that orthopaedic surgeons are knowledgeable about caring for them. The most common injuries seen with gunshot wounds are those of the soft tissues. Nonsurgical management of patients who have gunshot wounds with minimal soft-tissue disruption has been successfully accomplished in emergency departments for several years; this includes extremity wounds without nerve, intra-articular, or vascular injury. Stable, nonarticular fractures of an extremity have also been successfully treated with either minimal surgical or nonsurgical methods in the emergency department. Indications for surgical treatment include unstable fractures, intra-articular injuries, a significant soft-tissue injury (especially with skin loss), vascular injury, and/or a large or expanding hematoma. PMID:19385526

  12. The ability to act--multiple suicidal gunshot wounds.

    PubMed

    Hejna, Petr; Safr, Miroslav; Zátopková, Lenka

    2012-01-01

    Multiple self-inflicted gunshot wounds are rare and usually present a challenge to the forensic pathologist in determining the manner of death. Determining a person's capability to act following a gunshot wound can be of major importance in crime scene reconstruction and in differentiation between homicide and suicide. Questions concerning the possibility of physical activity following a given gunshot wound are repeatedly raised in court. We report herein three unusual cases of suicide involving multiple gunshot wounds; all the victims suffered gunshot wounds of the head without immediate incapacitation. In the first two cases, the head was target for two gunshots. Third case was a combination of two gunshots to the head and chest. In the text, we focus on the victim's ability to act after the first shot, with regards to the character and localization of the gunshot wound. Also, we focus on findings that are typical for a repeated suicidal shot. PMID:22152440

  13. Atypical gunshot wound: Bullet trajectory analyzed by computed tomography

    PubMed Central

    Ro, Tae; Murray, Richard; Galvan, Dan; Nazim, Muhammad H.

    2015-01-01

    Introduction Gunshot injuries are a result of a bullet or projectile fired from a weapon that penetrates the body. Homicide, suicide, and occasionally, accidental events are a significant cause of firearm-related injuries. In rare cases, the damage from the gunshot injury can be masked due to an atypical bullet trajectory. Presentation of case A 63-year-old male was found with a gunshot wound to the anterior left knee. Computed tomography (CT) scans revealed a bullet track extending from the anterior aspect of the left knee that traveled cephalad subcutaneously and entered into the peritoneal cavity, perforating the distal descending colon. The bullet was found to be at rest adjacent to the spleen and posterior chest wall, with no injury to the lungs, kidneys or the spleen. The patient required a sigmoid colectomy with descending colostomy and was subsequently discharged home without any complications. Discussion Intra-abdominal organ damage from a gunshot wound to the distal limb is a rare occurrence. Atypical gun shot wounds, such as this case, have the potential for multiple issues including: delayed diagnostic tests, inaccurate radiological readings, and inappropriate medical management. Conclusion If an abnormal trajectory is maintained, it is possible for a bullet to traverse half the length of the body without the patient realizing it. Accurate CT analysis and quick decisions in surgical and medical management are critical takeaways to provide quality care to patients with these injuries. PMID:26263447

  14. Staged reconstruction after gunshot wounds to the abdomen.

    PubMed

    Cohen, M; Morales, R; Fildes, J; Barrett, J

    2001-07-01

    Immediate closure of abdominal incisions after exploration and treatment of gunshot wounds is not always feasible or advisable. Significant bowel edema after massive fluid resuscitation might preclude primary closure, whereas any attempt to close under tension might result in complications ranging from wound dehiscence, infection, and necrosis to the abdominal compartment syndrome with abdominal, cardiopulmonary, and renal complications. For these difficult cases, the open technique has been recommended. The abdomen is left open and is closed when the patient's condition permits. When immediate wound approximation is not possible, temporary coverage can be achieved with a mesh, patch, or a split-thickness skin graft and the definitive reconstruction is deferred for a more optimal time. The purpose of this retrospective study is to report the authors' experience with staged abdominal wall reconstruction after gunshot wounds. From 1989 to 1998, 1933 patients underwent exploratory laparotomy for penetrating wounds to the abdomen. Twenty-nine patients in grave condition and with multiple medical problems were comanaged by the Trauma and Plastic Surgery Services at Cook County Hospital with the following protocol: The abdomen was initially left open and exposed viscera were covered with a variety of methods, including a Gore-Tex patch (W. L. Gore and Associates, Inc., Flagstaff, Ariz.). A split-thickness graft was subsequently placed on the granulation tissue over viscera at an average of 14 days after the last laparotomy. These planned ventral hernias were definitively treated at an average of 7 months after the skin grafting procedure, primarily using the components separation technique. In 24 patients, the fascia was closed primarily without tension, while five patients required the use of synthetic mesh to restore fascial continuity. Nine patients underwent closure of a colostomy or repair of fistulas simultaneously with abdominal wall reconstruction. One patient

  15. Transabdominal gunshot wounds of the hip and pelvis.

    PubMed

    Miller, Anna N; Carroll, Eben A; Pilson, Holly Tyler-Paris

    2013-05-01

    Transabdominal gunshot wounds (GSWs) of the hip and pelvis are those that traverse the gastrointestinal system before entering the pelvis and/or hip. These injuries may be contaminated by bowel contents. Some require urgent surgical intervention; others can be managed nonsurgically. A primary survey with attention to hemodynamic status is of utmost priority. After obtaining hemodynamic stability and addressing abdominal injuries, careful attention must be paid to evaluating hip joint involvement and injuries to the genitourinary and vascular systems. The available literature shows that transabdominal GSW with intra-articular contamination should be urgently débrided and irrigated; extra-articular transabdominal GSW with stable fracture patterns may be managed with observation and empiric antibiotics. Extent of soft-tissue injury dictates the need for wound débridement. Bullets lodged in intra-articular locations should be removed, but retained bullets in other anatomic locations do not necessarily warrant removal.

  16. Facial Gunshot Wounds: Trends in Management

    PubMed Central

    Kaufman, Yoav; Cole, Patrick; Hollier, Larry H.

    2009-01-01

    Facial gunshot wounds, often comprising significant soft and bone tissue defects, pose a significant challenge for reconstructive surgeons. Whether resulting from assault, accident, or suicide attempt, a thorough assessment of the defects is essential for devising an appropriate tissue repair and replacement with a likely secondary revision. Immediately after injury, management is centered on advanced trauma life support with patient stabilization as the primary goal. Thorough examination along with appropriate imaging is critical for identifying any existing defects. Whereas past surgical management advocated delayed definitive treatment using serial debridement, today’s management favors use of more immediate reconstruction. Recent advances in microsurgical technique have shifted favor from local tissue advancement to distant free flap transfers, which improve cosmesis and function. This has resulted in a lower number of surgeries required to achieve reconstruction. Because of the diversity of injury and the complexity of facial gunshot injuries, a systematic algorithm is essential to help manage the different stages of healing and to ensure that the best outcome is achieved. PMID:22110801

  17. Gunshot wound to the frontal sinus.

    PubMed

    Key, J M; Tami, T; Donald, P J

    1990-01-01

    Immediate treatment of this patient, evaluation of the wound, the use of antibiotics, and eventual reconstruction are all concerns in this complicated gunshot wound to the frontal sinus. The consultants agree that the first priority in this patient is to assess and stabilize the airway, examine the wound, and obtain a CT scan to ascertain the extent of the defect. Dr. Key feels that these wounds are contaminated and would prophylactically order a broad-spectrum cephalosporin and/or chloramphenicol. Dr. Tami would use antibiotics aimed at Staphylococcus and oral flora; Dr. Donald prefers to treat specific infections as they develop. They also agree that initial reconstruction should be conservative, aimed at covering exposed bone and minimizing local/regional flaps; however, Dr. Donald suggests using an arch bar on the intact side and eyelet wires on the injured side to address the maxillary defect. Drs. Key and Donald feel that it was a mistake to close this wound primarily and use a skin graft, because there was an inadequate soft tissue bed. Dr. Tami states that the initial management of the wound was reasonable. All agree on a basic approach to frontal sinus fractures. CT scanning is the imaging modality of choice. Nondisplaced fractures may be observed. Disruption of the posterior wall or the nasofrontal duct usually require exploration and obliteration of the sinus. Dr. Key would ablate the sinus only in cases where the anterior table is completely lost. Drs. Tami and Donald agree that cranialization should be reserved for comminuted posterior table fractures. After recognizing a CSF leak, Dr. Key would begin a broad-spectrum antibiotic.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Civilian gunshot wounds--outpatient management.

    PubMed

    Ordog, G J; Wasserberger, J; Balasubramanium, S; Shoemaker, W

    1994-01-01

    Cost containment is important in this time of inner-city economic and health-care crisis. Of 28,150 patients treated for gunshot wounds (GSWs) from 1977 through 1991, 16,892 (60%) were treated as outpatients after emergency department evaluation and treatment. The complication rate was 1.8% (mostly infections), and nine patients were later found to have vascular injuries requiring surgical treatment. These were identified later at outpatient follow-up and treated with no long-term morbidity or mortality. A conservative estimate of the cost savings from this study was more than $37 million. With a more liberal use of angiography to eliminate rare missed vascular injuries, many GSW victims can be safely treated as outpatients, eliminating the need for expensive in-hospital observation.

  19. Pediatric intracranial gunshot wounds: the Memphis experience.

    PubMed

    DeCuypere, Michael; Muhlbauer, Michael S; Boop, Frederick A; Klimo, Paul

    2016-05-01

    OBJECTIVE Penetrating brain injury in civilians is much less common than blunt brain injury but is more severe overall. Gunshot wounds (GSWs) cause high morbidity and mortality related to penetrating brain injury; however, there are few reports on the management and outcome of intracranial GSWs in children. The goals of this study were to identify clinical and radiological factors predictive for death in children and to externally validate a recently proposed pediatric prognostic scale. METHODS The authors conducted a retrospective review of penetrating, isolated GSWs sustained in children whose ages ranged from birth to 18 years and who were treated at 2 major metropolitan Level 1 trauma centers from 1996 through 2013. Several standard clinical, laboratory, and radiological factors were analyzed for their ability to predict death in these patients. The authors then applied the St. Louis Scale for Pediatric Gunshot Wounds to the Head, a scoring algorithm that was designed to provide rapid prognostic information for emergency management decisions. The scale's sensitivity, specificity, and positive and negative predictability were determined, with death as the primary outcome. RESULTS Seventy-one children (57 male, 14 female) had a mean age of 14 years (range 19 months to 18 years). Overall mortality among these children was 47.9%, with 81% of survivors attaining a favorable clinical outcome (Glasgow Outcome Scale score ≥ 4). A number of predictors of mortality were identified (all p < 0.05): 1) bilateral fixed pupils; 2) deep nuclear injury; 3) transventricular projectile trajectory; 4) bihemispheric injury; 5) injury to ≥ 3 lobes; 6) systolic blood pressure < 100 mm Hg; 7) anemia (hematocrit < 30%); 8) Glasgow Coma Scale score ≤ 5; and 9) a blood base deficit < -5 mEq/L. Patient age, when converted to a categorical variable (0-9 or 10-18 years), was not predictive. Based on data from the 71 patients in this study, the positive predictive value of the St

  20. Aide memoire for the management of gunshot wounds.

    PubMed

    MacFarlane, C

    2002-07-01

    The hospitals in Johannesburg deal with about 4,000 gunshot wounds a year. Although most are from hand guns, a number are from high velocity, military-type weapons. Extensive experience has been built up and many lessons learned. Attention is directed to the actual damage inflicted rather than on theoretical predictions based on presumed velocity of the bullets involved, as this can often be misleading. Some patients are delayed in their presentation to emergency departments, in other cases several gunshot wound patients arrive at the same time, requiring appropriate triage and urgent management.

  1. Aide memoire for the management of gunshot wounds.

    PubMed Central

    MacFarlane, C.

    2002-01-01

    The hospitals in Johannesburg deal with about 4,000 gunshot wounds a year. Although most are from hand guns, a number are from high velocity, military-type weapons. Extensive experience has been built up and many lessons learned. Attention is directed to the actual damage inflicted rather than on theoretical predictions based on presumed velocity of the bullets involved, as this can often be misleading. Some patients are delayed in their presentation to emergency departments, in other cases several gunshot wound patients arrive at the same time, requiring appropriate triage and urgent management. PMID:12215024

  2. [Gunshot wounds--homicide, suicide or accident?].

    PubMed

    Schyma, P; Schyma, C

    1997-08-01

    Gunshot residues on the hand are an important evidence of shooting. Different methods for sampling gunshot residues from the hands are presented and critically analyzed. The topographic methods-adhesive film and polyvinyl alcohol technique (PVAL)-have serious advantages over the cumulative methods like tape-lift or cotton swab. Case examples demonstrate the limited interpretation of results with cumulative methods. Negative results of tape-lifts or cotton swabs can also be explained by the presence of blood or dirt, positive results however don't prove shooting. The sampling method with the highest gain of gunshot residues is the PVAL technique which takes about 2 hours of sampling traces. Therefore PVAL is mostly applied post mortem. PVAL shows the distribution of gunshot residues also on bloody hands and is a powerful instrument for the reconstruction of the firing position. But the final differentiation between homicide, suicide or accident is not only based on gunshot residues, but requires a complex analysis of all findings in a case (scene, blood traces, autopsy, shot range). PMID:9340911

  3. Emergency first-aid treatment of gunshot and stab wounds.

    PubMed

    Melby, V; Deeny, P

    The number of violent crimes in Great Britain is on the increase and therefore there is a possibility that nurses will encounter a casualty with stab or gunshot wounds. On encountering a casualty with stab or gunshot wounds, the first aider must immediately assess the scene to avoid personal injury or risk to life. No matter how ugly or bad the injuries look, the basic principles of first aid still apply. Never attempt to remove any penetrating object still in situ as this may cause more serious bleeding. Any penetrating injury to the chest may result in instant respiratory distress. Make use of people present at the scene of the injury. Always ensure that the emergency services are notified immediately. PMID:8038560

  4. Constrictive Pericarditis Long after a Gunshot Wound

    PubMed Central

    Choi, Jung-Ho; Uhm, Jae-Sun; Lee, Sang-Eun; Chun, Kyung-Hyeon; Lee, Hye-Jeong; Lee, Seung Hyun; Hong, Geu-Ru

    2015-01-01

    Constrictive pericarditis is an uncommon post-inflammatory disorder characterized by a variably thickened, fibrotic, and frequently calcified, pericardium. Etiology of the constriction can occur for many reasons. Although foreign bodies are not the common cause of constrictive pericarditis, the long-term presence of foreign bodies, like bullets, is presumed to cause chronic constrictive pericarditis even after a very long asymptomatic period. A 69-year-old patient with atrial flutter was admitted to the hospital. A cardiac computed tomography showed a bullet located adjacent to the right atrium. The transthoracic echocardiography showed a thickened pericardium and septal bouncing motion, which were compatible with constrictive pericarditis. The history of the patient revealed an injury by gunshot during the Korean War in 1950. Radiofrequency ablation of the atrial flutter was performed, and after ablation, the bullet was removed surgically. The patient was discharged home after surgery without complications. PMID:26240588

  5. Costs associated with gunshot wounds in Canada in 1991.

    PubMed Central

    Miller, T R

    1995-01-01

    OBJECTIVE: To estimate the costs (in 1993 dollars) associated with gunshot wounds in Canada in 1991. DESIGN: Cost analysis using separate estimates of gunshot incidence rates and costs per incident for victims who died, those who survived and were admitted to hospital and those who survived and were treated and released from emergency departments. Estimates were based on costs for medical care, mental health care, public services (i.e., police investigation), productivity losses, funeral expenses, and individual and family pain, suffering and lost quality of life. SETTING: Canada. OUTCOME MEASURES: Costs per case, costs by type of incident (e.g., assault, suicide or unintentional shooting) and costs per capita. RESULTS: The total estimated cost associated with gunshot wounds was $6.6 billion. Of this, approximately $63 million was spent on medical and mental health care and $10 million on public services. Productivity losses exceeded $1.5 billion. The remaining cost represented the value attributed to pain, suffering and lost quality of life. Suicides and attempted suicides accounted for the bulk of the costs ($4.7 billion); homicides and assaults were the next most costly ($1.1 billion). The cost per survivor admitted to hospital was approximately $300,000; this amount included just over $29,000 for medical and mental health care. CONCLUSION: Costs associated with gunshot wounds were $235 per capita in Canada in 1991, as compared with $595 in the United States in 1992. The differences in these costs may be due to differences in gun availability in the two countries. This suggests that increased gun control may reduce Canada's costs, especially those related to suicide. PMID:7497388

  6. Principles of ballistics applicable to the treatment of gunshot wounds.

    PubMed

    Swan, K G; Swan, R C

    1991-04-01

    Ballistics is the science of the motion of a projectile through the barrel of a firearm (internal ballistics), during its subsequent flight (external ballistics), and during its final complicated motion after it strikes a target (terminal ballistics). Wound ballistics is a special case of terminal ballistics. Although wound ballistics is at best sets of approximations, its principles enter usefully into an evaluation of a gunshot wound and its treatment. A special consideration in these cases is their medicolegal aspects. At a minimum, the medical team receiving the patient should exert care not to destroy the clothing and in particular to cut around and not through bullet holes, to turn over to law enforcement officials any metallic foreign body recovered from the patient, and to describe precisely, or even to photograph, any entrance or exit wounds.

  7. Gunshot wounds to the face--acute management.

    PubMed

    McLean, J Nicolas; Moore, Charles E; Yellin, Seth A

    2005-08-01

    The complex facial trauma victim poses a genuine therapeutic challenge as a whole, and may be particularly challenging to the medical team. The literature on acute management of gunshot wounds to the face is scarce. We performed an extensive review of the English-language literature in an effort to better delineate the diagnosis and acute management of these injuries. Most of these injuries do not present with initial threat to life and can safely be managed non-operatively. Definitive treatment is often deferred in patients with multiple, or more severe, injuries. Airway compromise is the most frequent and most life-threatening early problem reported in most series. CT scan remains the most useful method in the evaluation of these types of injuries and associated cervical spine lesions. Facial bleeding is best controlled by angiography and subsequent embolization. Anatomic repair of soft tissue and bony injuries is recommended to obtain an optimal functional and aesthetic outcome. Despite the creation of some algorithms, no clear correlation has been found between the site of entrance wound and the injuries and outcome of gunshot wounds to the face. PMID:16307399

  8. Penetrating intracranial gunshot wound transecting the right transverse sinus

    PubMed Central

    Beaty, Narlin Bennet; Diaz, Cara; Crandall, Kenneth; Sansur, Charles

    2012-01-01

    A 23-year-old man sustained a gunshot wound to the posterior head. Imaging demonstrated a transection of the right transverse sinus, a retained bullet fragment and significant cerebellar oedema. The patient emergently underwent suboccipital decompression associated with brisk bleeding from the transverse sinus. Reported examples of surgical management of cerebral venous sinuses include: packing, grafting, patching and ligation. Our patient had a codominant transverse sinus and underwent successful unilateral ligation. His postoperative course was uneventful, however, he did require a ventriculoperitoneal shunt. He was subsequently discharged to rehab with a favourable outcome. PMID:22987903

  9. Homicide or suicide? Gunshot wound interpretation: a Bayesian approach.

    PubMed

    Cave, Rowena; DiMaio, Vincent J; Molina, D Kimberley

    2014-06-01

    Many studies have been published examining various features of fatal gunshot wounds such as type of firearm, range of fire, number of shots, and wound location as a way of determining between homicidal and suicidal deaths. Pathologists frequently have to give evidence in court, and may have their opinion about probable manner of death challenged or be questioned about how sure they can be. In the literature, the features are always discussed in isolation, but in practice, the pathologist has to consider such details in combination. Using pooled data from a systematic review to obtain large data sets, this study shows how Bayesian analysis can be applied to consideration of combined features and can thus provide a quantified degree of confidence to support the pathologist's opinion through the use of likelihood ratios. Case examples are provided to illustrate the impact of different features.

  10. Concomitant injuries of the hip joint and abdomen resulting from gunshot wounds.

    PubMed

    Brien, E W; Brien, W W; Long, W T; Kuschner, S H

    1992-11-01

    Septic arthritis is a devastating complication of transabdominal gunshot wounds to the hip. Five patients sustained gunshot wounds to the hip which violated the alimentary tract. Diagnosis was established with plain radiographs in three patients, arthrogram in one patient, and a gastrointestinal series in one patient. Three patients had an exploratory laparotomy with diverting colostomy followed by immediate hip arthrotomy within 24 hours and no joint infections occurred. In the other two patients, hip involvement was identified late after septic arthritis occurred. Early diagnosis, diverting colostomy, and immediate arthrotomy are recommended for gunshot wounds to the hip which involve the alimentary tract.

  11. Typical external skull beveling wound unlinked with a gunshot.

    PubMed

    Delannoy, Y; Colard, T; Becart, A; Tournel, G; Gosset, D; Hedouin, V

    2013-03-10

    Lesions of the cranial vault resulting from firearms are traditionally described in forensic medical literature with many reports illustrating atypical bone lesions carried out to the skull by gunshot wounds. The authors present this report which illustrates an external beveled skull wound, associated with internal beveling damage, caused by a stabbing injury. A partially buried human skeleton was found in a forest. The examining of the skull revealed a hole resembling the exit wound caused by a bullet and two other smaller stab wounds. No typical entering bullet wound and no other bone lesions were found. During the course of the investigation, one of the perpetrators admitted to hitting the victim, using a sickle, and to hiding the body. For this purpose, he dragged the corpse with the sickle still implanted in the skull, using it as a hook. Upon retrieving the sickle, a piece of cranial vault was removed, thus creating an external beveled wound. In order to identify the mechanism which brought about this kind of lesion, experimental work was carried out on a human skull. In this particular case, the tip of the sickle penetrated into the bone, creating a lesion that would typically be produced with a stabbing instrument when applied with vertical force. When the body was dragged, using the sickle as a hook, this was a hand-produced vertical force, which was applied in the opposite direction. It caused the tearing of a piece of bone and the creation of an outer bevel. This atypical lesion should be made known to medical examiners and pathologists in order to help investigating and understanding of the circumstances of injuries.

  12. Discrimination of bullet types using analysis of lead isotopes deposited in gunshot entry wounds.

    PubMed

    Wunnapuk, Klintean; Minami, Takeshi; Durongkadech, Piya; Tohno, Setsuko; Ruangyuttikarn, Werawan; Moriwake, Yumi; Vichairat, Karnda; Sribanditmongkol, Pongruk; Tohno, Yoshiyuki

    2009-01-01

    In order to discriminate bullet types used in firearms, of which the victims died, the authors investigated lead isotope ratios in gunshot entry wounds from nine lead (unjacketed) bullets, 15 semi-jacketed bullets, and 14 full-jacketed bullets by inductively coupled plasma-mass spectrometry. It was found that the lead isotope ratio of 207/206 in gunshot entry wounds was the highest with lead bullets, and it decreased in order from full-jacketed to semi-jacketed bullets. Lead isotope ratios of 208/206 or 208/207 to 207/206 at the gunshot entry wound were able to discriminate semi-jacketed bullets from lead and full-jacketed ones, but it was difficult to discriminate between lead and full-jacketed bullets. However, a combination of element and lead isotope ratio analyses in gunshot entry wounds enabled discrimination between lead, semi-jacketed, and full-jacketed bullets.

  13. Gunshot wounds to the thigh. Evaluation of vascular and subclinical vascular injuries.

    PubMed

    Payne, W K; Gabriel, R A; Massoud, R P

    1995-01-01

    A retrospective review of 173 patient charts, angiograms, surgical reports, and plain radiographs were performed for all patients admitted with gunshot wounds to the thigh from May 1988 to January 1991 at Martin Luther King, Jr. Hospital. A zonal classification of gunshot wounds to the thigh was created and defined to determine if a zonal classification was predictive of a positive angiogram. Associations and relationships of patients with vascular injury are presented.

  14. Ballistics and gunshot wounds: effects on musculoskeletal tissues.

    PubMed

    Bartlett, C S; Helfet, D L; Hausman, M R; Strauss, E

    2000-01-01

    As a result of the increasing number of weapons in this country, as many as 500,000 missile wounds occur annually, resulting in 50,000 deaths, significant morbidity, and striking socioeconomic costs. Wounds are generally classified as low-velocity (less than 2,000 ft/sec) or high-velocity (more than 2,000 ft/sec). However, these terms can be misleading; more important than velocity is the efficiency of energy transfer, which is dependent on the physical characteristics of the projectile, as well as kinetic energy, stability, entrance profile and path traveled through the body, and the biologic characteristics of the tissues injured. Although bullets are not sterilized on discharge, most low-velocity gunshot wounds can be safely treated nonoperatively with local wound care and outpatient management. Typically, associated fractures are treated according to accepted protocols for each area of injury. Treatment of low-velocity, low-energy fractures is generally dictated by the osseous injuries, as these are similar in many regards to closed fractures. Soft tissues play a more critical role in high-velocity and shotgun fractures, which are essentially open injuries. Aside from perioperative prophylaxis, antibiotics are probably required only for grossly contaminated wounds; however, because contamination is not always apparent, most authors still recommend routine prophylaxis. High-energy injuries and grossly contaminated wounds mandate aggressive irrigation and debridement, including a thorough search for foreign material. Open fracture protocols including external fixation or intramedullary nailing and intravenous antibiotic therapy for 48 to 72 hours should be instituted. If there is vascular damage, exploration and repair are best performed after prompt fracture stabilization. Evaluation of the "four Cs"-color, consistency, contractility, and capacity to bleed-provides valuable information regarding the viability of muscle. Skin grafting is preferable when tension

  15. Haemostasis of a right ventricle-gunshot wound using a novel haemostatic vacuum device.

    PubMed

    Porcu, Paolo; Moreau-Gaudry, Alexandre; Chavanon, Olivier; Blin, Dominique

    2012-08-01

    Heart wounds are frequently fatal. The haemorrhage from a right ventricle-gunshot wound in a male patient was successfully controlled using a novel haemostatic vacuum device. This case report shows how this simple, quick and efficient method can be used to control critical bleedings.

  16. Management of penetrating abdominal and thoraco-abdominal wounds: A retrospective study of 186 patients.

    PubMed

    Barbois, S; Abba, J; Guigard, S; Quesada, J L; Pirvu, A; Waroquet, P A; Reche, F; Risse, O; Bouzat, P; Thony, F; Arvieux, C

    2016-08-01

    This is a single center retrospective review of abdominal or abdomino-thoracic penetrating wounds treated between 2004 and 2013 in the gastrointestinal and emergency unit of the university hospital of Grenoble, France. This study did not include patients who sustained blunt trauma or non-traumatic wounds, as well as patients with penetrating head and neck injury, limb injury, ano-perineal injury, or isolated thoracic injury above the fifth costal interspace. In addition, we also included cases that were reviewed in emergency department morbidity and mortality conferences during the same period. Mortality was 5.9% (11/186 patients). Mean age was 36 years (range: 13-87). Seventy-eight percent (145 patients) suffered stab wounds. Most patients were hemodynamically stable or stabilized upon arrival at the hospital (163 patients: 87.6%). Six resuscitative thoracotomies were performed, five for gunshot wounds, one for a stab wound. When abdominal exploration was necessary, laparotomy was chosen most often (78/186: 41.9%), while laparoscopy was performed in 46 cases (24.7%), with conversion to laparotomy in nine cases. Abdominal penetration was found in 103 cases (55.4%) and thoracic penetration in 44 patients (23.7%). Twenty-nine patients (15.6%) had both thoracic and abdominal penetration (with 16 diaphragmatic wounds). Suicide attempts were recorded in 43 patients (23.1%), 31 (72.1%) with peritoneal penetration. Two patients (1.1%) required operation for delayed peritonitis, one who had had a laparotomy qualified as "negative", and another who had undergone surgical exploration of his wound under general anesthesia. In conclusion, management of clear-cut or suspected penetrating injury represents a medico-surgical challenge and requires effective management protocols. PMID:27318585

  17. Characteristics of firearms and gunshot wounds as markers of suicide.

    PubMed

    Stone, I C

    1992-12-01

    Data from a total of 1,200 cases that the Medical Examiner of Dallas County, Texas, ruled as suicide with a firearm have been compared with the results of forensic laboratory examinations and tests; 75% are with handguns and 25% are with long guns. The incidence of suicides by gender yields 82% males and 18% females, with the most common entrance site being the head. With regard to racial distribution of persons committing suicide, > 88% are white in the study population group, which is 76% white. Data are presented for the incidence of blood detected inside and on the muzzle end of the barrel of the firearm, and for the persistence of blood inside the barrel even after the weapon was discharged to obtain test bullets. The analysis of handwipings for primer residues shows that "positive" results are obtained for approximately 50% of the revolvers and approximately 32% of the pistols when the caliber is > 22. Other projects such as transfer of gunshot residues to the hand by simply handling the weapon, the incidence of single-contact wounds in homicide versus suicide cases, and the percent of positive identification of bullets with weapons submitted are described.

  18. A Rare Case of an Intact Bone Plug Associated with a Gunshot Exit Wound.

    PubMed

    Bird, Cate E; Fleischman, Julie M

    2015-07-01

    This case study presents an unusual manifestation of gunshot trauma in skeletal tissue from a post-World War II human rights abuse sample uncovered in Vilnius, Lithuania. After briefly reviewing the typical wound appearance of projectile trauma in the cranium, we discuss the presence of an intact bone plug associated with a gunshot exit wound in an individual from the Tuskulenai Case. While this individual demonstrated typical gunshot entry and exit wounds to the cranium consistent with high-velocity trauma, the bone plug indicates that the projectile likely lost much of its kinetic energy while traveling through the cranium resulting in a low-velocity impact at the exit site. This study reviews a similar instance of a bone plug recovered from a bioarcheological sample in Peru and emphasizes the importance of thorough archeological excavations of mass graves.

  19. A Rare Case of an Intact Bone Plug Associated with a Gunshot Exit Wound.

    PubMed

    Bird, Cate E; Fleischman, Julie M

    2015-07-01

    This case study presents an unusual manifestation of gunshot trauma in skeletal tissue from a post-World War II human rights abuse sample uncovered in Vilnius, Lithuania. After briefly reviewing the typical wound appearance of projectile trauma in the cranium, we discuss the presence of an intact bone plug associated with a gunshot exit wound in an individual from the Tuskulenai Case. While this individual demonstrated typical gunshot entry and exit wounds to the cranium consistent with high-velocity trauma, the bone plug indicates that the projectile likely lost much of its kinetic energy while traveling through the cranium resulting in a low-velocity impact at the exit site. This study reviews a similar instance of a bone plug recovered from a bioarcheological sample in Peru and emphasizes the importance of thorough archeological excavations of mass graves. PMID:25832722

  20. Surgical management of civilian gunshot wounds to the head.

    PubMed

    Bizhan, Aarabi; Mossop, Corey; Aarabi, Judith Ann

    2015-01-01

    Each year close to 20000 Americans are involved in gunshot wounds to the head (GSWH). Over 90% of the victims of GSWH eventually fail to survive and only a meager 5% of the patients have a chance to continue with a useful life. One of the fundamental jobs of providers is to realize who the best candidate for the best possible management is. Recent evidence indicates that a good Glasgow Coma Scale (GCS) score at the time of admission puts such patients at high priority for management. Lack of abnormal pupillary response to light, trajectory of slug away for central gray, and visibility of basal cisterns upgrade the need for utmost care for such a victim. Surgical management is careful attention to involvement of air sinuses and repair of base dura. Patients with diffuse injury should have intraventricular intracranial pressure (ICP) monitoring and if needed a timely decompressive craniectomy. Since close to 2% of patients with penetrating brain injury may harbor a vascular injury, subjects with injuries close to the Sylvian fissure and those with the fragment crossing two dural compartments should have computed tomography angiography and if needed digital subtraction angiography to rule out traumatic intracranial aneurysms. In case of a positive study, these patients should have endovascular management of their vascular injuries in order to prevent catastrophic intracerebral hematomas and permanent deficit. Although supported by class III data, subjects of GSWH need to be on broad spectrum antibiotics for a period of 3-5 days. If cerebrospinal fluid (CSF) fistulas are observed at any time during the patient's hospital course, they should be taken very seriously and appropriate management is needed to prevent deep intracranial infections.

  1. Heterotopic Ossification Secondary to Gunshot and Fragment Wounds in a Golden Eagle ( Aquila chrysaetos ).

    PubMed

    Javdani, Moosa; Hashemnia, Mohammad; Nikousefat, Zahra

    2016-03-01

    Heterotopic ossification is the process of pathologic bone formation in soft tissue structures that usually do not form bone. An immature golden eagle ( Aquila chrysaetos ) was examined 2 months after a gunshot wound in the right wing. A solid oval mass with a gun pellet at its core was found attached to the ulna by a bony pedicle and was surgically excised. Heterotopic ossification secondary to gunshot and fragment wounds in the right ulna was diagnosed based on clinical, radiographic, and histopathologic findings. This report is the first to describe heterotopic ossification occurring around a gun pellet in a bird. PMID:27088747

  2. [The results of the treatment of gunshot wounds by applying laser therapy].

    PubMed

    Agakhanian, N V; Ter-Avetikian, Z A; Mkrtchian, M E

    2009-05-01

    The treatment results of not penetrating in cavities surface gunshot wounds of border regional hospitals are studied. The injured are divided into 3 groups depending on the terms of first surgical processing of wounds. It is mentioned that putting dense sutures is not always justified. Very often inflammatory infiltrate and suppuration is arisen after suturing. Inflammatory process develops into tumoral and cicatricial disorders which are removed by surgical intervention. The gunshot wound processing with helium-neon red ray made favorable conditions for early closing of wound surface by means of saturation with bringing the edges of the wound closer and preventing the development of severe suppuration complications as well as reduced the treatment terms promoting good functional and cosmetic results. PMID:19556630

  3. Microscopic and spectroscopic features of gunpowder and its documentation in gunshot wounds in charred bodies.

    PubMed

    Dolinak, David; Wise, Steven H; Jones, Curtiss

    2008-12-01

    Determining the direction and range of fire of gunshot wounds in charred bodies can be difficult because soot resulting from thermal injury can grossly be identical to soot arising from a contact or close-range firearm discharge. Two charred bodies had gunshot wounds of the head and neck region that were distorted by thermal effect, precluding determination of the direction and range of fire by gross findings alone. By microscopy, deep wound tissue from each charred body had foreign material suggestive of gunpowder. Samples of the foreign material were examined by Fourier transform infrared (FT-IR) microscopy and determined to be cellulose nitrate (nitrocellulose), a main component of gunpowder. In addition, 12 cases of suicide in well-preserved bodies with contact gunshot wounds were examined with FT-IR microscopy, confirming the presence of cellulose nitrate in 6 (50%) of the cases. Identification of cellulose nitrate in the tracks of gunshot wounds can assist in the determination of direction and range of fire when the surface features are charred.

  4. Gunshot-like wound caused by sling shot injury – a case report

    PubMed Central

    Vinuthinee, Naidu; Azreen-Redzal, Anuar; Juanarita, Jaafar; Zunaina, Embong

    2015-01-01

    We report a rare case of sling shot injury that presented with a gunshot-like wound with preseptal cellulitis, in a toddler. An 11-month-old Malay child presented with a gunshot-like wound over the forehead following sling shot injury. On examination, he had a deep circular laceration wound over the forehead, measuring 2.0 cm in diameter, with minimal bleeding. There was no obvious foreign body seen inside the wound and no palpable foreign body surrounding the wound. The gunshot-like wound was associated with left preseptal cellulitis. A skull X-ray showed a white opaque foreign body in the left frontal bone. Computed tomography (CT) scan of orbit and brain revealed a left comminuted fracture of the left orbital roof, and left frontal brain contusion with prelesional edema. Wound exploration was performed and revealed a 0.5 cm unshattered marble embedded in the left frontal bone. The marble and bone fragments were removed. The left preseptal cellulitis responded well to intravenous antibiotic and topical antibiotic. PMID:25709507

  5. Suicidal gunshot wounds to the head: a retrospective review of 406 cases.

    PubMed

    Blumenthal, Ryan

    2007-12-01

    A retrospective review of 406 suicidal gunshot wounds to the head, investigated at the Medico-Legal Laboratory of Pretoria, between 1997 and 2000 was performed. Fifty-seven percent of fatal suicidal firearm injury to the head occurred in the 21- to 40-year age range in both male and female victims. Eighty-two percent of all these victims of suicidal firearm fatalities to the head were male. Of the 406 cases, 63% were white, 31% were black, and 6% were of mixed ethnic and/or Asian decent. There was a slight increase in incidence around spring and autumn. Handguns were used in the majority of cases with shoulder weapons being used in 18 of the 406 cases. Ninety-two percent of the suicidal gunshot wounds to the head occurred indoors. A positive blood alcohol concentration was seen in 40% of cases. Of those examined, 81% were contact gunshot wounds. The trajectory was upward in 51% of cases and horizontal in 24% of cases. The right temple was the most common entrance gunshot wound site. Findings are in keeping with previously published literature. PMID:18043013

  6. The survival of metallic residues from gunshot wounds in cremated bone: a SEM-EDX study.

    PubMed

    Amadasi, Alberto; Brandone, Alberto; Rizzi, Agostino; Mazzarelli, Debora; Cattaneo, Cristina

    2012-07-01

    The research and analysis of gunshot residues has a relevant role in the examination of gunshot wounds. Nevertheless, very little literature exists concerning gunshot wounds on charred material. In this study, 16 adult bovine ribs (eight still with soft tissues and eight totally skeletonized) underwent a shooting test with two types of projectiles (9 mm full metal-jacketed bullet and 9 mm unjacketed bullet). Each rib then underwent a charring process in an electric oven, reaching the stage of complete calcination at 800°C. The area of each entrance wound was analyzed before and after the carbonization process via a scanning electron microscope (SEM) equipped with an energy dispersive X-ray analyzer (EDX). In each sample, metallic residues composed of lead, barium, and antimony were found. These metallic residues were thus preserved also after exposure to the extremely high temperatures reached within the oven, especially with unjacketed bullets, although the particles seem to be more irregular in shape as a result of the heating process. In conclusion, this study proved that gunshot residues survive extremely high temperatures and can be detected via SEM/EDX even in cases of charred tissues.

  7. The survival of metallic residues from gunshot wounds in cremated bone: a SEM-EDX study.

    PubMed

    Amadasi, Alberto; Brandone, Alberto; Rizzi, Agostino; Mazzarelli, Debora; Cattaneo, Cristina

    2012-07-01

    The research and analysis of gunshot residues has a relevant role in the examination of gunshot wounds. Nevertheless, very little literature exists concerning gunshot wounds on charred material. In this study, 16 adult bovine ribs (eight still with soft tissues and eight totally skeletonized) underwent a shooting test with two types of projectiles (9 mm full metal-jacketed bullet and 9 mm unjacketed bullet). Each rib then underwent a charring process in an electric oven, reaching the stage of complete calcination at 800°C. The area of each entrance wound was analyzed before and after the carbonization process via a scanning electron microscope (SEM) equipped with an energy dispersive X-ray analyzer (EDX). In each sample, metallic residues composed of lead, barium, and antimony were found. These metallic residues were thus preserved also after exposure to the extremely high temperatures reached within the oven, especially with unjacketed bullets, although the particles seem to be more irregular in shape as a result of the heating process. In conclusion, this study proved that gunshot residues survive extremely high temperatures and can be detected via SEM/EDX even in cases of charred tissues. PMID:22249273

  8. Incidence of cervical spine injury in patients with gunshot wounds to the head.

    PubMed

    Kennedy, F R; Gonzalez, P; Beitler, A; Sterling-Scott, R; Fleming, A W

    1994-06-01

    Cervical spine immobilization is standard during the early stages of prehospital and hospital care of patients with blunt head injury. However, the need for cervical spine immobilization in patients with gunshot wounds to the head has not been addressed. To determine the incidence and types of cervical spine injury in this group, we retrospectively examined the records of 308 consecutive patients who had computed tomographic (CT) scans of the head to evaluate brain injury after gunshot wounds. Of the 266 patients with data adequate for review, 157 (59%) had a complete lateral x-ray film of the cervical spine. Of these 157, 105 had wounds limited to the calvaria, and none had cervical spine injury. Of 52 patients with complete lateral x-ray films and wounds not limited to the calvaria, 5 (10%) had cervical spine or spinal cord injury. Of the 192 patients who had CT-proven intracranial injury, 86 (45%) required immediate intubation before x-ray films were obtained, and 67 (35%) died. We conclude that cervical spine immobilization may not be required during endotracheal intubation of brain-injured gunshot victims with wounds limited to the calvaria.

  9. A review of 187 gunshot wound admissions to a teaching hospital over a 54-month period: training and service implications.

    PubMed Central

    Cowey, A.; Mitchell, P.; Gregory, J.; Maclennan, I.; Pearson, R.

    2004-01-01

    BACKGROUND: Violence involving the use of firearms has increased in the UK over the past decade. This study assesses the implications of such injuries for service provision and training by reviewing the experience at one hospital. METHODS: Accident and emergency triage data were searched for patients presenting with gunshot wounds over a 54-month period. Case notes were reviewed and patterns of care established. The resources required for clinical management were ascertained, and the financial consequences determined at contemporary full cost. RESULTS: There were 187 attendances with 247 wounds. Mean age was 21 years (range, 8-63 years). Of the attendances, 69% were out of normal working hours. Of the 187 cases, 97 patients were admitted to one hospital (83 of whom required surgery) and 10 patients were transferred to other hospitals (6 for plastic surgery not available at the Manchester Royal Infirmary and 4 due to lack of beds). Of the 80 patients who were not admitted, 4 died in accident and emergency, the rest were either air gun wounds or relatively simple higher calibre injuries. A wide range of surgical specialties was involved (limb injury, 53; thoraco-abdominal and vascular, 28; head and neck, 5; and orbit, 2), and combinations of injuries transgressed specialty and sub-specialty boundaries. The total cost of patient care was pound 267,000. CONCLUSIONS: Gunshot wounds present a heavy demand on the clinical and financial resources of the receiving hospital, and surgeons responsible for unselected acute admissions in "general surgery" should be capable of dealing with these indiscriminate injuries. Current training and service trends towards increasing sub-specialisation may mitigate against them achieving or retaining this capability. PMID:15005928

  10. A Case Report of Spinal Cord Injury Patient From a High Velocity Gunshot Wound to the Lumbar Spine

    PubMed Central

    Kim, Juyong; Kim, Je Ho

    2013-01-01

    We report on operational and rehabilitation management, as well as the outcome, of a patient who with sustained spinal cord injury from a high velocity gunshot wound to the lumbar spine. More specifically, a patient with a gunshot wound to the spine is more likely to sustain a complete injury and have a poor prognosis. As such, there should be concerns regarding associated and extended injuries related to bullet fragmentation as well as the possibility of long-term sequelae. PMID:23526072

  11. [Penetrating abdominal wounds. Apropos of 330 cases].

    PubMed

    Nejjar, M; Bennani, S; Zerouali, O N

    1991-01-01

    Penetrating abdominal wounds are frequent and serious. 330 cases have been treated in the Department of Emergencies and visceral Surgery at Averroes Hospital of Casablanca from 1980 to 1990. The predominance of male sex is noted, and these wounds are always the result of aggression by white arm. All patients have been operated, the white laparotomy rate is of 36%. The classic interventionist attitude is still recommended in spite of this high rate, because our present conditions can't permit us a rigorous watching. According to abdominal lesions, the different interventions are reviewed, and their indications are detailed. PMID:1960187

  12. [Gunshot wounds in the material of Forensic Medicine Institute, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz].

    PubMed

    Bloch-Bogusławska, Elzbieta; Engelgardt, Piotr; Paradowska, Agnieszka

    2007-01-01

    The Medical Forensic Institute, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz annually conducts approximately 600 autopsies. Gunshot wounds constitute only a small percentage of that number. The authors of this work have conducted an analysis of autopsy protocols prepared at the Institute in the years 1995-2005. During this period, 48 people were found dead as a result of gunshot wounds. This number constitutes 0.66% of all autopsies conducted within that time-frame. The objective of this study was an attempt at assessing the character of this phenomenon with due consideration given to the following parameters: age, sex, sobriety, circumstances and locality of the event, as well as season of the year, at comparing the results with data found in the literature on the subject.

  13. Fatal gunshot wound to the head with lack of immediate incapacitation.

    PubMed

    Aesch, Bruno; Lefrancq, Thierry; Destrieux, Christophe; Saint-Martin, Pauline

    2014-06-01

    Investigation of deaths caused by penetrating gunshot wounds to the head often raises the possibility of foul play. The forensic pathologist may be asked if the victim was able to perform certain acts after the gunshot, and how quickly this person might have become incapacitated. The possibility of a suicidal act can depend on these answers. We report the case of a 45-year-old woman whose body was found with a right temporal entrance wound. A shotgun was found 60 ft from the body location. The question of knowing if this woman had been able to shoot herself in the head and then walk a distance of 60 ft before dying was essential for the investigation, as suicide was the first hypothesis. The autopsy and a careful neuropathology investigation allowed to answer this question. In the literature, multiple publications report cases of victims who were able to act following penetrating ballistic head injury. PMID:24781406

  14. Gunshot wounds to the hand. The Martin Luther King, Jr, General Hospital experience.

    PubMed

    Phillips, P; Hansraj, K K; Cox, E E; Ashley, E M

    1995-01-01

    This article is a retrospective review of patients who presented to Martin Luther King, Jr./Drew Medical Center with gunshot wounds and had either isolated or associated injuries to the hand. The following is an account of those injuries noting the location, soft-tissue or bony involvement, and interventional methods that were implemented in the treatment of these patients who resided primarily in South Central Los Angeles. Prompt evaluation and initiation of treatment is essential in the management of both high- and low-velocity gunshot wounds so as to decrease the potential morbidity that often follows. Society must also look at the prevalence of these injuries and address the underlying issues that often are the root of the acts of violence.

  15. Simulating backspatter of blood from cranial gunshot wounds using pig models.

    PubMed

    Radford, G E; Taylor, M C; Kieser, J A; Waddell, J N; Walsh, K A J; Schofield, J C; Das, R; Chakravorty, E

    2016-07-01

    Few studies have examined the biomechanical basis for backspatter from cranial gunshot wounds. Backspatter is material which travels against the direction of fire following ejection from a gunshot entrance wound. Our paper focuses on the use of animals for reconstructing this phenomenon. Five live pigs and several slaughtered pigs were shot using either 9 × 19 mm, 115 grain, full metal jacketed ammunition or .22 long rifle, 40 grain, lead, round-nose ammunition. A high-speed camera was used to record the entrance wound formation and backspatter. A small amount of backspattered material was produced with all targets, and blood backspatter was seen in a few cases. However, we conclude that our model provides an understanding of the phenomenon of backspatter and the physical mechanisms associated with it. The various components of the mechanism of backspatter formation are complex and overlap. The principle mechanism observed in pig cranial gunshots was the high-speed impact response of the skin overlying the skull bone. This study has also produced evidence supporting the view that backspatter can result from the splashing of superficial blood if it is already present on the skin. Subcutaneous gas effects have been demonstrated for backspatter from contact shots. There has been no clear evidence of the role of the collapse of a temporary cavity within the brain. PMID:26156450

  16. [On the treatment of gunshot wounds of extremities in the conditions of local military actions].

    PubMed

    Agakhanian, N V; Ter-Avetikian, Z A; Mkrtchian, M E; Amirian, E G

    2009-04-01

    Together with the improvement of new types of weapons with more destroying effect, the treatment methods of gunshot wounds including laser therapy, extrafocal osteosynthesis, new antibacterial means are also developing. The application of these methods makes it possible to create optimal conditions for the treatment of different types of injuries of extremities with positive results in 88% cases. These results were received due to early and thorough first surgical processing of wounds by wide usage of helium-neon laser radiation as well as with the help of traumatologists who are the skilled in the new treatment methods including the extrafocal compressional osteosynthesis. PMID:19430037

  17. [On the treatment of gunshot wounds of extremities in the conditions of local military actions].

    PubMed

    Agakhanian, N V; Ter-Avetikian, Z A; Mkrtchian, M E; Amirian, E G

    2009-04-01

    Together with the improvement of new types of weapons with more destroying effect, the treatment methods of gunshot wounds including laser therapy, extrafocal osteosynthesis, new antibacterial means are also developing. The application of these methods makes it possible to create optimal conditions for the treatment of different types of injuries of extremities with positive results in 88% cases. These results were received due to early and thorough first surgical processing of wounds by wide usage of helium-neon laser radiation as well as with the help of traumatologists who are the skilled in the new treatment methods including the extrafocal compressional osteosynthesis.

  18. Post mortem computed tomography: useful or unnecessary in gunshot wounds deaths? Two case reports.

    PubMed

    Maiese, Aniello; Gitto, Lorenzo; De Matteis, Alessandra; Panebianco, Valeria; Bolino, Giorgio

    2014-11-01

    Post-mortem computer tomography (PMCT) is currently an useful procedure that can elucidate patterns of injuries, providing strong medical evidence that is very useful during litigation and at trial. This technique is especially useful in gunshot wounds cases, allowing an easier location and retrieval of the bullet and/or its fragments inside the body. In such cases, the use of 3D rendering can be very useful in order to obtain essential information, such as: accurate depict of the wound track, discerning between entrance and exit wounds, show bone's fracture and its fragments course inside the body. The authors performed analysis on two cases of death by gunshot wounds, and a PMCT before the postmortem examination was made. The obtained CT scans were evaluated using the open-source software OsiriX on a Mac OS X computer, performing 3D rendering of the DICOM images. The crime scene reconstruction was performed using the software Poser Debut® on a Mac OS X computer. In both cases, PMCT showed multiple advantages: objectivity, reproducibility, ease visualization of the wound paths, easy localization of bullet and their fragments, allowing us to clarify the cause of death before the traditional autopsy. PMCT should became a standard in forensic practice as an aid to the tradition postmortem examination to obtain as much information as possible in order to clarify the cause and manner of death. PMID:25001050

  19. Post mortem computed tomography: useful or unnecessary in gunshot wounds deaths? Two case reports.

    PubMed

    Maiese, Aniello; Gitto, Lorenzo; De Matteis, Alessandra; Panebianco, Valeria; Bolino, Giorgio

    2014-11-01

    Post-mortem computer tomography (PMCT) is currently an useful procedure that can elucidate patterns of injuries, providing strong medical evidence that is very useful during litigation and at trial. This technique is especially useful in gunshot wounds cases, allowing an easier location and retrieval of the bullet and/or its fragments inside the body. In such cases, the use of 3D rendering can be very useful in order to obtain essential information, such as: accurate depict of the wound track, discerning between entrance and exit wounds, show bone's fracture and its fragments course inside the body. The authors performed analysis on two cases of death by gunshot wounds, and a PMCT before the postmortem examination was made. The obtained CT scans were evaluated using the open-source software OsiriX on a Mac OS X computer, performing 3D rendering of the DICOM images. The crime scene reconstruction was performed using the software Poser Debut® on a Mac OS X computer. In both cases, PMCT showed multiple advantages: objectivity, reproducibility, ease visualization of the wound paths, easy localization of bullet and their fragments, allowing us to clarify the cause of death before the traditional autopsy. PMCT should became a standard in forensic practice as an aid to the tradition postmortem examination to obtain as much information as possible in order to clarify the cause and manner of death.

  20. An Analysis of the Characteristics of Thoracic and Abdominal Injuries Due to Gunshot Homicides in Israel.

    PubMed

    Maiden, Nicholas R; Hiss, Jehuda; Gips, Hadas; Hocherman, Gil; Levin, Nadav; Kosachevsky, Olga; Vinokurov, Asya; Zelkowicz, Avraham; Byard, Roger W

    2016-01-01

    De-identified wound data from 197 homicidal gunshot postmortems were obtained between 2000 and 2008. Forensic ballistics data were only available for cases between 2004 and 2008. Males represent 91% of gunshot victims and were struck in the thorax/abdomen with an average of 2.3 bullets. The type of firearms involved were semi-automatic pistols in the predominant caliber 9-mm Luger and assault rifles in caliber 5.56 × 45 mm and caliber 7.62 × 39 mm Soviet, using full metal jacket bullets. The majority of shootings occurred at ranges of 1 m or greater. The most common bullet path was front to back in 66% of cases. Entry wounds occurred more often on the left side of the thorax, abdomen, and back. The most common critical organs/tissues to sustain bullet trauma in descending order were as follows: heart, lungs, liver, aorta, spleen, kidneys, and vena cava. Ribs were struck by most bullets that entered the thorax. PMID:26264376

  1. An Analysis of the Characteristics of Thoracic and Abdominal Injuries Due to Gunshot Homicides in Israel.

    PubMed

    Maiden, Nicholas R; Hiss, Jehuda; Gips, Hadas; Hocherman, Gil; Levin, Nadav; Kosachevsky, Olga; Vinokurov, Asya; Zelkowicz, Avraham; Byard, Roger W

    2016-01-01

    De-identified wound data from 197 homicidal gunshot postmortems were obtained between 2000 and 2008. Forensic ballistics data were only available for cases between 2004 and 2008. Males represent 91% of gunshot victims and were struck in the thorax/abdomen with an average of 2.3 bullets. The type of firearms involved were semi-automatic pistols in the predominant caliber 9-mm Luger and assault rifles in caliber 5.56 × 45 mm and caliber 7.62 × 39 mm Soviet, using full metal jacket bullets. The majority of shootings occurred at ranges of 1 m or greater. The most common bullet path was front to back in 66% of cases. Entry wounds occurred more often on the left side of the thorax, abdomen, and back. The most common critical organs/tissues to sustain bullet trauma in descending order were as follows: heart, lungs, liver, aorta, spleen, kidneys, and vena cava. Ribs were struck by most bullets that entered the thorax.

  2. Gunshot wounds: a review of firearm type, range, and location as pertaining to manner of death.

    PubMed

    Molina, D Kimberley; DiMaio, Vincent; Cave, Rowena

    2013-12-01

    Many studies have examined the characteristics of gunshot wounds by manner of death; however, no published study has directly compared these characteristics for the different types of firearms. This study was designed to address that deficiency. Existing data sets of nonaccidental deaths by handguns, shotguns, and rifles were reviewed. The victim data were analyzed by age and sex of the victims, wound location, range of fire, manner of death, and type of firearm. Handguns were the most common firearm used in both suicides and homicides, followed by rifles and then shotguns. For both homicides and suicides, there were significant differences between the firearm types for age of victims, range of fire, and wound locations. Possible reasons for those differences are discussed. It is concluded that information about the type of firearm is crucial to have when examining the nature of a firearm injury and determining the manner of death.

  3. Analysis of septic morbidity following gunshot wounds to the colon: the missile is an adjuvant for abscess.

    PubMed

    Poret, H A; Fabian, T C; Croce, M A; Bynoe, R P; Kudsk, K A

    1991-08-01

    Over a 7-year period, 151 patients with gunshot wounds to the colon surviving beyond 24 hours were managed. The bullet was retained in the body in 66% and exited in 34%. Thirty-four (23%) developed major septic complications (diffuse peritonitis, 21%; intraperitoneal abscesses 24%; and extraperitoneal abdominal abscesses, 56%). The septic complication rate was 26% in the bullet-present group compared with 16% in the remainder (p less than 0.15). The increased septic rate in those with bullets present was the result of abscesses developing around the retained missile. That group with missile abscesses had a lesser degree of injury as measured by the abdominal trauma index compared with the other patients with septic complications (p less than 0.001). Fifteen (79%) of the 19 patients with missile and missile track abscesses had them develop in the psoas muscle. These abscesses occur by fecal contamination of the muscle following inoculation by the bullet, which passes through the large bowel. Computed tomography-guided and operative drainage tend to fail if the foreign body is not removed. Computed tomography-guided or operative drainage should be successful in draining missile track abscesses when the bullet has exited the patient. PMID:1831510

  4. [Thoracic and abdominal and limb wounds by gun shot].

    PubMed

    Naomi, Akira; Oyamatsu, Yoshinori; Narita, Kunio; Nakayama, Masato

    2015-02-01

    In Japan, we are permitted to own fire arms only for hunting and clay pigeon shooting, but gunshot wound victims have neen rarely seen due to the strict laws against owing guns, and the lack of related crimes. Therefore, surgeons should be familiar with ballistics, practical gunshot wound management, and the possibility of delayed lead poisoning ssociated with bullet residue. A 69-year-old man was brought to our hospital because he was accidentally shot by his companion's shotgun during hunting. On admission, although he had stable vital sign and multiple gunshot wounds on his right forearm and femur, chest X-ray and computed tomography (CT) revealed a few of bullets and its flagments on his back, into spleen and pericardium. Following local debridment after removal of the bullets in his right forearm and femur at an emergency room, broken heart muscle and diaphragm were repaired and hematoma in the anterior mediastinum was removed at the operating room. The patient was discharged on the 25th post-operative day and his post-operative course was uneventful. In case of gunshot injuries, in addition to prompt diagnosis and evaluation of organ injuries, careful follow up for possible delayed lead poisoning is important. PMID:25743351

  5. Conventional and contrast-enhanced ultrasound assessment of craniocerebral gunshot wounds.

    PubMed

    Deng, D; Dan, G; Tao, J; Wu, X-B; Chen, Z; Chang, M; Liao, M-S; He, F

    2015-01-01

    This study aimed to investigate the characteristic features of craniocerebral gunshot wounds by conventional ultrasound (CUS) and evaluate the efficacy of contrast-enhanced ultrasound (CEUS) in differentiation of tissue condition in wounds. Twenty crossbreed dogs (treatment: N = 15; control: N = 5) were used in the study. Pipe-shaped hyperechoes of varying size were found by CUS in most of the treated animals. The echoic areas were distinct from the neighboring brain tissue and did not change with time. CEUS revealed that the pipe-shaped echo was unenhanced in majority of the injured brains and the surrounding tissue was either heterogeneously enhanced or unenhanced. Pathological analysis confirmed that the contrast-filling-defect area indicated necrotic tissue and the heterogeneous minimally enhanced areas indicated degenerative tissue. CUS imaging enabled detection of hematomas and CEUS indicated that the filling defect was in the center of the hematoma, with enhancement gradually increasing towards the periphery. CUS could effectively detect a wound tract, hematoma, and the craniocerebral area injured by a gunshot, while CEUS could accurately reveal necrotic tissue in the injured area and differentiate the degenerative from normal tissue.

  6. Skin tears away from the entrance wound in gunshots to the head.

    PubMed

    Faller-Marquardt, M; Pollak, S

    2002-10-01

    The present investigation covers 116 contact shots to the head and shots into the mouth from the Freiburg forensic autopsy material including 20 gunshot wounds which showed stretchmark-like tears of the facial skin away from the entrance wound. In these cases the gunshot entrance wounds were localised either in the mouth, the forehead, or the submental region. The stretchmark-like tears were found in the region of the eyes and the nasolabial folds. Radial tears were seen on the lips and in the vicinity of the corners of the mouth, particularly in cases involving shots into the mouth. The stretchmark-like tears essentially followed the skin tension lines and the expression-related lines of the face. They were apparently caused by the subcutaneous or intraoral expansion of the muzzle gases and/or the radial forces of the bullet resulting in ballooning and overextension of the facial soft tissues. The weapons used were not only rifles and shotguns, but also revolvers and pistols.

  7. Determined to Die! Ability to Act Following Multiple Self-inflicted Gunshot Wounds to the Head. The Cook County Office of Medical Examiner Experience (2005-2012) and Review of Literature.

    PubMed

    Arunkumar, Ponni; Maiese, Aniello; Bolino, Giorgio; Gitto, Lorenzo

    2015-09-01

    Cases of multiple (considered 2+) self-inflicted gunshot wounds are a rarity and require careful examination of the scene of occurrence; thorough consideration of the decedent's psychiatric, medical, and social histories; and accurate postmortem documentation of the gunshot wounds. We present a series of four cases of multiple self-inflicted gunshot wounds to the head from the Cook County Medical Examiner's Office between 2005 and 2012 including the first case report of suicide involving eight gunshot wounds to the head. In addition, a review of the literature concerning multiple self-inflicted gunshot wounds to the head is performed. The majority of reported cases document two gunshot entrance wound defects. Temporal regions are the most common affected regions (especially the right and left temples). Determining the capability to act following a gunshot wound to the head is necessary in crime scene reconstruction and in differentiation between homicide and suicide. PMID:25845674

  8. Determined to Die! Ability to Act Following Multiple Self-inflicted Gunshot Wounds to the Head. The Cook County Office of Medical Examiner Experience (2005-2012) and Review of Literature.

    PubMed

    Arunkumar, Ponni; Maiese, Aniello; Bolino, Giorgio; Gitto, Lorenzo

    2015-09-01

    Cases of multiple (considered 2+) self-inflicted gunshot wounds are a rarity and require careful examination of the scene of occurrence; thorough consideration of the decedent's psychiatric, medical, and social histories; and accurate postmortem documentation of the gunshot wounds. We present a series of four cases of multiple self-inflicted gunshot wounds to the head from the Cook County Medical Examiner's Office between 2005 and 2012 including the first case report of suicide involving eight gunshot wounds to the head. In addition, a review of the literature concerning multiple self-inflicted gunshot wounds to the head is performed. The majority of reported cases document two gunshot entrance wound defects. Temporal regions are the most common affected regions (especially the right and left temples). Determining the capability to act following a gunshot wound to the head is necessary in crime scene reconstruction and in differentiation between homicide and suicide.

  9. Gunshot wounds (resulting from execution) of exhumed victims of the communist regime in Poland.

    PubMed

    Szleszkowski, Łukasz; Thannhäuser, Agata; Szwagrzyk, Krzysztof; Kawecki, Jerzy; Jurek, Tomasz

    2014-07-01

    This study presents the results of the analysis of the remains of 23 executed male individuals aged between 21 and 63 years, recovered from Osobowicki Cemetery in Wroclaw (Poland), field 83B, in 2012. In 1948 and 1949, prisoners sentenced to death by firing squad--most of them associated with the post-war anti-communist underground independence movement in Poland--were buried there. The aim of the study was to analyse fatal wounds and the method of execution, and to compare the results to data from archival documents. The results were also compared with studies concerning executions during a later period, i.e. 1949-1954. The research on the method of execution during this period of history carried out during the exhumations in Osobowicki Cemetery was the first conducted on such a scale in Poland. Forensic analysis revealed a wide variety of gunshot wounds inflicted during executions, revealing both gunshots to the head, especially single shots to the back of the head, and cases corresponding to the use of a firing squad, probably equipped with machine guns. The results of the research indicate that capital punishment by shooting was carried out in ways both similar to those the specified in the regulations and completely different.

  10. Gunshot wounds (resulting from execution) of exhumed victims of the communist regime in Poland.

    PubMed

    Szleszkowski, Łukasz; Thannhäuser, Agata; Szwagrzyk, Krzysztof; Kawecki, Jerzy; Jurek, Tomasz

    2014-07-01

    This study presents the results of the analysis of the remains of 23 executed male individuals aged between 21 and 63 years, recovered from Osobowicki Cemetery in Wroclaw (Poland), field 83B, in 2012. In 1948 and 1949, prisoners sentenced to death by firing squad--most of them associated with the post-war anti-communist underground independence movement in Poland--were buried there. The aim of the study was to analyse fatal wounds and the method of execution, and to compare the results to data from archival documents. The results were also compared with studies concerning executions during a later period, i.e. 1949-1954. The research on the method of execution during this period of history carried out during the exhumations in Osobowicki Cemetery was the first conducted on such a scale in Poland. Forensic analysis revealed a wide variety of gunshot wounds inflicted during executions, revealing both gunshots to the head, especially single shots to the back of the head, and cases corresponding to the use of a firing squad, probably equipped with machine guns. The results of the research indicate that capital punishment by shooting was carried out in ways both similar to those the specified in the regulations and completely different. PMID:24767546

  11. Intersecting fractures of the skull and gunshot wounds. Case report and literature review.

    PubMed

    Viel, Guido; Gehl, Axel; Sperhake, Jan P

    2009-01-01

    When two fracture lines of a solid surface (ice, glass, eggshell, etc.) intersect, it is always possible to tell which one has been made first. Indeed pre-existing damage of the surface arrests all the fracture lines produced by subsequent impacts. This well-known principle (established by Puppe in 1903) has been largely used in glass fracture analysis, but can be applied also to the examination of skull fractures. It can help sequencing blunt force or gunshot injuries determining the direction of fire and differentiating entrance from exit wounds in the absence of specific distinguishing features (i.e., internal/external beveling of the skull or overlying skin indicators). In this context, we report the case of a 76-year-old man who shot himself in the mouth with a Walther PPK 7.65 handgun and highlight the utility of the application of both Puppe's Rule and Multislice Computed Tomography (MSCT) in the examination of gunshot wounds to the skull.

  12. Micro-CT features of intermediate gunshot wounds covered by textiles.

    PubMed

    Giraudo, Chiara; Fais, Paolo; Pelletti, Guido; Viero, Alessia; Miotto, Diego; Boscolo-Berto, Rafael; Viel, Guido; Montisci, Massimo; Cecchetto, Giovanni; Ferrara, Santo Davide

    2016-09-01

    The analysis of gunshot residue (GSR) on the clothing and the underlying skin of the victim may play an important role in the reconstruction of the shooting incident. The aim of the present study was to test micro-computed tomography (micro-CT) for the analysis of firearm wounds experimentally produced on human skin covered by textiles. Firing trials were performed on 60 sections of human calves enveloped by a single layer of fabric (cotton or jeans or leather or nylon) and 15 controls consisting of bare calves. Experimental firings were conducted in a ballistic laboratory at three different muzzle-to-target distances (5, 15, and 30 cm), using a .32 ACP pistol (Beretta Mod. 81) loaded with full-jacketed bullets coming from the same production lot (7.65 × 17 mm, Browning SR). The visual inspection revealed the classic pattern of GSR distribution on the fabrics and the skin of control samples, while only a dark ring around the entrance lesion was identified on the skin beneath the fabrics. Micro-CT analysis showed the presence of radiopaque material on all entrance wounds, with a statistically significant difference between cases and controls. No differences were found among specimens covered by fabrics, with regard to the firing distance and the type of clothing. No GSR-like deposits were detected in exit wounds. Our results suggest that micro-CT analysis may be a useful screening tool for differentiating entry from exit gunshot wounds when the covering textiles are contaminated, damaged, or missing. PMID:27325255

  13. Micro-CT features of intermediate gunshot wounds covered by textiles.

    PubMed

    Giraudo, Chiara; Fais, Paolo; Pelletti, Guido; Viero, Alessia; Miotto, Diego; Boscolo-Berto, Rafael; Viel, Guido; Montisci, Massimo; Cecchetto, Giovanni; Ferrara, Santo Davide

    2016-09-01

    The analysis of gunshot residue (GSR) on the clothing and the underlying skin of the victim may play an important role in the reconstruction of the shooting incident. The aim of the present study was to test micro-computed tomography (micro-CT) for the analysis of firearm wounds experimentally produced on human skin covered by textiles. Firing trials were performed on 60 sections of human calves enveloped by a single layer of fabric (cotton or jeans or leather or nylon) and 15 controls consisting of bare calves. Experimental firings were conducted in a ballistic laboratory at three different muzzle-to-target distances (5, 15, and 30 cm), using a .32 ACP pistol (Beretta Mod. 81) loaded with full-jacketed bullets coming from the same production lot (7.65 × 17 mm, Browning SR). The visual inspection revealed the classic pattern of GSR distribution on the fabrics and the skin of control samples, while only a dark ring around the entrance lesion was identified on the skin beneath the fabrics. Micro-CT analysis showed the presence of radiopaque material on all entrance wounds, with a statistically significant difference between cases and controls. No differences were found among specimens covered by fabrics, with regard to the firing distance and the type of clothing. No GSR-like deposits were detected in exit wounds. Our results suggest that micro-CT analysis may be a useful screening tool for differentiating entry from exit gunshot wounds when the covering textiles are contaminated, damaged, or missing.

  14. [Energy dispersive x-ray fluorescence spectrometry--a forensic necrochemical method for determination of entry and exit of gunshot wounds].

    PubMed

    Havel, J

    2003-07-01

    The article is a continuation of the experiences Ing. J. Havel and Ing. K. Zelenka Energodispersive X-ray fluorescence spectrometry (EDXRF) as the forensic necrochemical method as the tool for detection of metals (gunshot residues--GSR) in connection with gunshot-wounds of persons.

  15. Gunshot wounds: causing myocardial infarction, delayed ventricular septal defect, and congestive heart failure.

    PubMed

    Kumar, Sudeep; Moorthy, Nagaraja; Kapoor, Aditya; Sinha, Nakul

    2012-01-01

    Penetrating chest trauma can cause a wide variety of cardiac injuries, including myocardial contusion, damage to the interventricular septum, laceration of the coronary arteries, and free-wall rupture. Herein, we describe the case of a 21-year-old man who presented with congestive heart failure, which was secondary to an old myocardial infarction and complicated by the delayed formation of a ventricular septal defect. All of these conditions were attributable to multiple gunshot wounds that the patient had sustained 6 months earlier. Left ventricular angiography showed an apical aneurysm; a large, muscular, ventricular septal defect; and 19 gunshot pellets in the chest wall. Three months after aneurysmectomy and surgical closure of the septal defect, the patient had recovered fully and was asymptomatic.This case reaffirms the fact that substantial cardiac injuries can appear months after chest trauma. The possibility of traumatic ventricular septal defect should be considered in all multiple-trauma patients who develop a new heart murmur, even when overt chest-wall injury is absent.

  16. Shoulder fusion after a self-inflicted gunshot wound: an injury pattern and treatment option.

    PubMed

    Zsoldos, C M; Basamania, C J; Bal, G K

    2013-06-01

    Gunshot injuries to the shoulder are rare and difficult to manage. We present a case series of seven patients who sustained a severe shoulder injury to the non-dominant side as a result of a self-inflicted gunshot wound. We describe the injury as 'suicide shoulder' caused by upward and outward movement of the gun barrel as the trigger is pulled. All patients were male, with a mean age of 32 years (21 to 48). All were treated at the time of injury with initial repeated debridement, and within four weeks either by hemiarthroplasty (four patients) or arthrodesis (three patients). The hemiarthroplasty failed in one patient after 20 years due to infection and an arthrodesis was attempted, which also failed due to infection. Overall follow-up was for a mean of 26 months (12 to 44). All four hemiarthroplasty implants were removed with no feasible reconstruction ultimately possible, resulting in a poor functional outcome and no return to work. In contrast, all three primary arthrodeses eventually united, with two patients requiring revision plating and grafting. These patients returned to work with a good functional outcome. We recommend arthrodesis rather than replacement as the treatment of choice for this challenging injury.

  17. Chromatic variation of soot soiling: a possible marker for gunshot wounds in burnt bone.

    PubMed

    Amadasi, Alberto; Merli, Daniele; Brandone, Alberto; Cattaneo, Cristina

    2014-01-01

    Soot soiling is a crucial forensic parameter around gunshot lesions. Carbonization, however, can severely alter human tissues and mimic such clues. This study aims at evaluating the survival of soot soiling even after carbonization in bone. A total of 36 bovine ribs (half fleshed and half defleshed) were shot with two types of bullet (both 9-mm; full metal-jacketed and unjacketed) with a near-contact range. With unjacketed bullets, the shot left in every case a clear, black, and roughly round soot stain around the entrance wound, whereas full metal-jacketed bullets left no signs of soot. Every specimen then underwent calcination in an oven at 800°C. The analysis of the charred samples clearly showed the survival of the soot soiling in both fleshed and bony samples, with a clear correspondence with the former position, but with a different color (yellow). Thus, soot soiling may survive, although with a different color, even after charring.

  18. The Glasgow Coma Scale and prognosis in gunshot wounds to the brain.

    PubMed

    Kennedy, F; Gonzalez, P; Dang, C; Fleming, A; Sterling-Scott, R

    1993-07-01

    To determine which factors predict survival in patients with gunshot wounds to the brain, 192 patients who had intracranial injury demonstrated on computed tomographic (CT) scanning were retrospectively reviewed. Glasgow Coma Scale (GCS) scores on admission seemed to be the most important factor in predicting survival. Age, the presence of extruded brain, and use of a shotgun could not be shown to be factors independent of admission GCS score. Findings on CT scans (single lobe vs. multilobe involvement) helped to predict survival only in patients with GCS scores 5-13. The mortality rate was 35%. Among survivors 18% had brain-related long-term disability, and an additional 27% had long-term disability related to associated eye injury.

  19. Concordance Rate for the Identification of Distant Entrance Gunshot Wounds of the Back by Experienced Forensic Pathologists Examining Only Images of Autopsies.

    PubMed

    Heninger, Michael

    2016-03-01

    The images of 66 gunshot entrance wounds with a defect on the back, a bullet in the body, hemorrhage along the wound track, and logical certainty that it was an entrance wound were collected from the files of a moderately busy medical examiner's office. Participants numbering 22 board-certified forensic pathologists viewed a single digital archival image of each of the 66 entrance wounds randomly mixed with 74 presumptive exit wounds to determine whether they were entrance or exit wounds. The concordance rate for correctly identifying the 66 logically known entrance wounds was 82.8% with a range from 58% to 97%. This pilot study was conducted to provide an evidence-based approach to the interpretation of the direction of gunshot wounds by reviewing pathologists with access only to archival photographs, and it is not a measure of the accuracy to distinguish entrance from exit wounds when given all of the circumstances. PMID:27404608

  20. Spinal cord injury from civilian gunshot wounds: the Rancho experience 1980-88.

    PubMed

    Kane, T; Capen, D A; Waters, R; Zigler, J E; Adkins, R

    1991-09-01

    We performed a retrospective review of the medical records of 316 patients with spinal cord injury (SCI) secondary to gunshot wounds (GSW) admitted to Rancho Los Amigos Medical Center for rehabilitation between 1980 and 1988. There were 289 male and 27 female patients whose mean age was 25.9 years (range, 11-56 years). Of these, 238 were paraplegic (103 incomplete, 135 complete), and 78 were quadriplegic (45 incomplete, 33 complete). Forty were shot by handguns of known caliber and four by shotguns; in 272 cases, the type of weapon was unknown. A total of 230 cases sustained a single bullet wound, and 86 had multiple bullet wounds. The length of acute hospitalization, but not rehabilitation hospital stay, increased with the number of associated injuries. Rehabilitation and, hence, total length of stay was significantly less (mean, 100 and 130 days, respectively) for SCI/GSW victims than for SCI victims of motor vehicle accidents, falls, or diving accidents. The methods of calculating costs for admission were based upon Rancho Los Amigos Medical Center financial statistics. This hospital has charged for a daily occupancy fee. The fee is based upon an average of all charges for all patients. No additional fees are charged for special tests or procedures. In 1980, the average daily admission hospitalization charge was $785. In 1990, the last quoted hospital charge was $1,125. This is for the basic spinal cord injury rehabilitative stay. In general, at Rancho Los Amigos, patients are admitted for rehabilitation when all acute medical and surgical problems have been cleared and the patient is ready to participate in rehabilitation evaluation and therapy programs.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1802161

  1. Nausea, Vomiting, and Weight Loss in a Young Adult Patient With a History of a Gunshot Wound.

    PubMed

    James, Jessica; Fitzgibbon, James; Blackford, Martha

    2016-09-01

    Assessing victims of gunshot wounds with retained bullets/bullet fragments for lead toxicity is not always considered until the patient develops signs and symptoms of toxicity. We discuss the case of a 19-year-old young man who received a diagnosis of chronic lead toxicity (serum lead concentration 51 μg/dL) 5 weeks after a hunting accident. Extensive wound debridement occurred following the accident; however, lead toxicity was not diagnosed until after his fourth emergency department visit. Oral chelation therapy was required for the management of his lead toxicity.

  2. [Compensation for disordered functions and the problems of rehabilitative treatment of disabled veterans of World War II who suffered gunshot wounds of the upper extrememities].

    PubMed

    Degtiar', G P

    1977-02-01

    The data of dynamic observations and clincal examination of 128 invalids of the Great Patriotic War having gunshot wounds of the upper extremities after 20 years and longer evidence considerable improvement of the wounded extremity function and a reduced degree of disability in the late period due to compensatory phenomena under the influence of active labour life.

  3. Self-inflicted gunshot wounds to the face: a review of 18 cases.

    PubMed

    Shuck, L W; Orgel, M G; Vogel, A V

    1980-05-01

    A 9-year experience at the University of New Mexico affiliated hospitals involving 18 patients with self-inflicted gunshot wounds to the face is reviewed. Almost all were young males, averaging 27.9 years of age. Fourteen patients were Native American, six from the same pueblo. Four shootings were 'accidental' and the rest suicidal. Sixteen patients were intoxicated at the time of injury. Interpersonal conflict with an important female and acculturation difficulties were thought to play major roles. Rifles were most commonly used, and injuries tended to be severe. High muzzle velocity (greater than or equal to 2,000 ft/sec), high muzzle energy (greater than or equal to 2,000 ft-lbs) weapons tended to be the most injurious, and low muzzle energy (less than or equal to 1,000 ft-lbs) guns were related to a lesser extent of injury regardless of muzzle velocity. Patient compliance during reconstruction has been excellent, and functional return to society with gainful employment and a stable marriage has been the rule. Subsequent suicide attempts have been uncommon. PMID:7365849

  4. Kyphotic deformity after laminectomy surgery for a gunshot wound to the spine: a case report

    PubMed Central

    Taheri, Morteza

    2016-01-01

    Spinal kyphotic deformity after spinal laminectomy or laminoplasty is more common in pediatric patients than adults. Laminectomy can lead to decreased cartilage growth, anterior wedging and posterior spinal muscle insufficiency which can result in kyphotic deformity. Herein we outline a case report of a child presenting with kyphotic deformity after receiving a spinal laminectomy to treat a penetrating spinal trauma. The 8-year-old male presented with penetrating spinal trauma following a gunshot wound and subsequently underwent L1 laminectomy and thecal sac decompression to remove the foreign body. In a follow-up examination approximately one month after surgery, imaging revealed kyphotic deformity and the patient was referred to the Rasoul-e-Akram Hospital. The patient then underwent surgical reconstruction. The postoperative computed tomography (CT) scan showed appropriate repair of sagittal balance and the patient’s symptoms gradually improved. Post-laminectomy kyphosis is a notable concern and complication in the pediatric population and can occur shortly after surgery. The following interventions can decrease the likelihood of post-laminectomy kyphosis: minimal muscle dissection and bone removal during laminectomy, avoidance of facet disruption, use of laminoplasty rather than laminectomy, postoperative immobilization/bracing and regular follow-up for early detection and treatment of any deformity.

  5. Single Operation to Repair Multifocal Cerebrospinal Fluid Fistulae Following Gunshot Wound: A Case Report

    PubMed Central

    White-Dzuro, Gabrielle A.; Entezami, Pouya; Wanna, George; Russell, Paul; Chambless, Lola B.

    2016-01-01

    Introduction Traumatic cerebrospinal fluid (CSF) fistulae can be a challenging neurosurgical disease, often requiring complicated surgical intervention. Case Presentation A 54-year-old man presented with a gunshot wound to the head with complex injury to the skull base and significant CSF leakage from multiple sites. A single surgery was performed using a combined Neurosurgery, Neurotology, and Rhinology team, which was successful in repairing the multiple skull base defects and preventing further CSF leak. Discussion Trauma to the skull base is a common inciting factor for the development of CSF fistulae. Endoscopic approaches are often preferred for repairing these defects, but craniotomy remains a viable option that may be required in more complex cases. A combined approach has not been described previously, but was successful for this severe multifocal defect. Conclusion A multidisciplinary approach allowed for a combined intervention that addressed both the anterior and middle fossae fistulae simultaneously. This limited the potential infectious complications of continued CSF leak and allowed for early rehabilitation. PMID:27330926

  6. Kyphotic deformity after laminectomy surgery for a gunshot wound to the spine: a case report.

    PubMed

    Babashahi, Ali; Taheri, Morteza

    2016-03-01

    Spinal kyphotic deformity after spinal laminectomy or laminoplasty is more common in pediatric patients than adults. Laminectomy can lead to decreased cartilage growth, anterior wedging and posterior spinal muscle insufficiency which can result in kyphotic deformity. Herein we outline a case report of a child presenting with kyphotic deformity after receiving a spinal laminectomy to treat a penetrating spinal trauma. The 8-year-old male presented with penetrating spinal trauma following a gunshot wound and subsequently underwent L1 laminectomy and thecal sac decompression to remove the foreign body. In a follow-up examination approximately one month after surgery, imaging revealed kyphotic deformity and the patient was referred to the Rasoul-e-Akram Hospital. The patient then underwent surgical reconstruction. The postoperative computed tomography (CT) scan showed appropriate repair of sagittal balance and the patient's symptoms gradually improved. Post-laminectomy kyphosis is a notable concern and complication in the pediatric population and can occur shortly after surgery. The following interventions can decrease the likelihood of post-laminectomy kyphosis: minimal muscle dissection and bone removal during laminectomy, avoidance of facet disruption, use of laminoplasty rather than laminectomy, postoperative immobilization/bracing and regular follow-up for early detection and treatment of any deformity. PMID:27683698

  7. Trauma Deserts: Distance From a Trauma Center, Transport Times, and Mortality From Gunshot Wounds in Chicago

    PubMed Central

    Sharp, Douglas; Unger, Erin; Straus, David; Brasel, Karen; Hsia, Renee; Esposito, Thomas

    2013-01-01

    Objectives. We examined whether urban patients who suffered gunshot wounds (GSWs) farther from a trauma center would have longer transport times and higher mortality. Methods. We used the Illinois State Trauma Registry (1999–2009). Scene address data for Chicago-area GSWs was geocoded to calculate distance to the nearest trauma center and compare prehospital transport times. We used multivariate regression to calculate the effect on mortality of being shot more than 5 miles from a trauma center. Results. Of 11 744 GSW patients during the study period, 4782 were shot more than 5 miles from a trauma center. Mean transport time and unadjusted mortality were higher for these patients (P < .001 for both). In a multivariate model, suffering a GSW more than 5 miles from a trauma center was associated with an increased risk of death (odds ratio = 1.23; 95% confidence interval = 1.02, 1.47; P = .03). Conclusions. Relative “trauma deserts” with decreased access to immediate care were found in certain areas of Chicago and adversely affected mortality from GSWs. These results may inform decisions about trauma systems planning and funding. PMID:23597339

  8. Prospective Randomized Trial of Two Wound Management Strategies for Dirty Abdominal Wounds

    PubMed Central

    Cohn, Stephen M.; Giannotti, Giovanni; Ong, Adrian W.; Esteban Varela, J.; Shatz, David V.; McKenney, Mark G.; Sleeman, Danny; Ginzburg, Enrique; Augenstein, Jeffrey S.; Byers, Patricia M.; Sands, Laurence R.; Hellinger, Michael D.; Namias, Nicholas

    2001-01-01

    Objective To determine the optimal method of wound closure for dirty abdominal wounds. Summary Background Data The rate of wound infection for dirty abdominal wounds is approximately 40%, but the optimal method of wound closure remains controversial. Three randomized studies comparing delayed primary closure (DPC) with primary closure (PC) have not conclusively shown any advantage of one method over the other in terms of wound infection. Methods Fifty-one patients with dirty abdominal wounds related to perforated appendicitis, other perforated viscus, traumatic injuries more than 4 hours old, or intraabdominal abscesses were enrolled. Patients were stratified by cause (appendicitis vs. all other causes) and prospectively randomized to one of two wound management strategies: E/DPC (wound packed with saline-soaked gauze, evaluated 3 days after surgery for closure the next day if appropriate) or PC. In the E/DPC group, wounds that were not pristine when examined on postoperative day 3 were not closed and daily dressing changes were instituted. Wounds were considered infected if purulence discharged from the wound, or possibly infected if signs of inflammation or a serous discharge developed. Results Two patients were withdrawn because they died less than 72 hours after surgery. The wound infection rate was greater in the PC group than in the E/DPC group. Lengths of hospital stay and hospital charges were similar between the two groups. Conclusion A strategy of DPC for appropriate dirty abdominal wounds 4 days after surgery produced a decreased wound infection rate compared with PC without increasing the length of stay or cost. PMID:11224630

  9. A comparative audit of gunshot wounds and stab wounds to the neck in a South African metropolitan trauma service.

    PubMed

    Madsen, A S; Laing, G L; Bruce, J L; Clarke, D L

    2016-09-01

    Introduction The aim of this comparative study of gunshot wounds (GSWs) and stab wounds (SWs) to the neck was to quantify the impact of the mechanism of injury on the outcome and management of penetrating neck injury (PNI). Methods A prospective trauma registry was interrogated retrospectively. Data were analysed pertaining to demographics and injury severity score (ISS), physiology on presentation, anatomical site of wounds and injuries sustained, investigations, management, outcome and complications. Results There were 452 SW and 58 GSW cases over the 46 months of the study. Patients with GSWs were more likely to have extracervical injuries than those with SWs (69% vs 63%). The incidence of a 'significant cervical injury' was almost twice as high in the GSW cohort (55% vs 31%). For patients with transcervical GSWs, this increased to 80%. The mean ISS was 17 for GSW and 11 for SW patients. Those in the GSW cohort presented with threatened airways and a requirement for an emergency airway three times as often as patients with SWs (24% vs 7% and 14% vs 5% respectively). The incidence among GSW and SW patients respectively was 5% and 6% for airway injuries, 12% and 8% for injuries to the digestive tract, 21% and 16% for vascular injuries, 59% and 10% for associated cervical injuries, 36% and 14% for maxillofacial injuries, 16% and 9% for injuries to the head, and 35% and 45% for injuries to the chest. In the GSW group, 91% underwent computed tomography angiography (CTA), with 23% of these being positive for a vascular injury. For SWs, 74% of patients underwent CTA, with 17% positive for a vascular injury. Slightly more patients with GSWs required operative intervention than those with SWs (29% vs 26%). Conclusions Patients with GSWs to the neck have a worse outcome than those with injuries secondary to SWs. However, the proportion of neck injuries actually requiring direct surgical intervention is not increased and most cases with PNI secondary to GSWs can be managed

  10. Suicidal single gunshot injury to the head: differences in site of entrance wound and direction of the bullet path between right- and left-handed--an autopsy study.

    PubMed

    Nikolić, Slobodan; Zivković, Vladimir; Babić, Dragan; Juković, Fehim

    2012-03-01

    The aim of this study was to determine the differences in the anatomical site of a gunshot entrance wound and the direction of the bullet path between right- and left-handed subjects who committed a suicide by a single gunshot injury to the head. The retrospective autopsy study was performed for a 10-year period, and it included selected cases of single suicidal gunshot head injury, committed by handguns. We considered only contact or near-contact wounds. The sample included 479 deceased, with average age 47.1 ± 19.1 years (range, 12-89 years): 432 males and 47 females, with 317 right-handed, 25 left-handed, and 137 subjects with unknown dominant hand. In our observed sample, most cases involved the right temple as the site of entrance gunshot wound (about 67%), followed by the mouth (16%), forehead (7%), left temple (6%), submental (2%), and parietal region (1%). The left temple, right temple, and forehead were the sites of the gunshot entrance wounds, which were the best predictors of the handedness of the deceased (Spearman ρ = 0.149, P = 0.006). Our study showed that the direction of the bullet intracranial path in cases of suicide was even a more potent predictor of the handedness of the deceased (Spearman ρ = 0.263, P = 0.000; Wald = 149.503, P = 0.000).

  11. Management of low velocity gunshot wounds to the anterior urethra: the role of primary repair versus urinary diversion alone.

    PubMed

    Husmann, D A; Boone, T B; Wilson, W T

    1993-07-01

    The management of partial transection of the anterior urethra following penetrating penile injuries is controversial. Optional therapeutic techniques range from a primary sutured reapproximation to urinary diversion alone. We recently managed 17 low velocity gunshot wounds to the external genitalia in which the missile traversed the penile corpus cavernosum, and was associated with less than 40% transection of the corpus spongiosum and anterior urethra. Nine patients were managed with suprapubic diversion, skin débridement and corporeal closure along with placement of a urethral catheter. Eight patients were managed by suprapubic diversion, débridement, closure of the corporeal bodies and a primary sutured reapproximation of the anterior urethra. Urethral strictures developed in 7 patients (78%) managed by a suprapubic tube and urethral stenting during an average followup of 20 months (range 18 to 24). In contrast, 1 patient (12%) managed by a sutured urethral approximation had a urethral stricture during an average followup of 20 months (range 18 to 30, p < 0.01). Our data support a significantly better prognosis for partial transection of the anterior urethra secondary to low velocity gunshot wounds if managed by aggressive wound débridement, corporeal repair, placement of a suprapubic catheter and primary repair of the urethra. PMID:8510278

  12. Gunshot wound causing complete spinal cord injury without mechanical violation of spinal axis: Case report with review of literature

    PubMed Central

    Patil, Rahul; Jaiswal, Gaurav; Gupta, Tarun Kumar

    2015-01-01

    Penetrating spine injury (PSI) forms the third most common cause of spine injury, only next to road traffic accidents and fall. Gunshot wound (GSW) forms the major bulk of PSI. Due to easy availability of firearms and antisocial behavior, GSW which were predominant in military population is now increasingly seen in civilized society. Here, we present a detail case review of unique case of civilian GSW indirectly causing complete spinal cord injury due to shock wave generated by the bullet, along with its systematic management. PMID:26692690

  13. Bedside open abdominal surgery. Utility and wound management.

    PubMed

    Mayberry, J C

    2000-01-01

    Abdominal pathology in the critically ill or injured patient frequently leads to the use of open abdominal techniques or the actual performance of abdominal surgery in the ICU. All individuals responsible for the care of patients in the ICU should be familiar with the concepts and techniques of open abdomen wound management. ICU bedside abdominal surgery may be indicated if the patient is too unstable for transport to the operating room and the surgeon believes a limited procedure, such as a decompression of IAH, will be life-saving. Smaller procedures are also feasible, such as intra-abdominal packing changes for which the operating room is unnecessary. Development of a successful Surgery Outside the Operating Room program depends on mature cooperation between the surgeons and other professional ICU staff. Logistic details of such a program should be discussed and a scheduling protocol should be prepared before an emergent need for bedside surgery.

  14. Imaging Assessment of Gunshot Injuries.

    PubMed

    Clark, Kevin R

    2016-07-01

    Gunshot wounds are the third-leading cause of injury-related death nationwide. Most people with gunshot injuries undergo diagnostic imaging to evaluate their injuries in the clinical or forensic setting. Radiologic technologists must be knowledgeable about common injuries associated with gunshot wounds. Digital radiography and computed tomography play essential roles in the assessment of gunshot injuries. When clinically indicated, magnetic resonance imaging also is a valuable imaging modality for evaluating these injuries. Radiologic technologists should obtain quality images to assist with proper assessment of gunshot injuries. PMID:27390231

  15. Imaging Assessment of Gunshot Injuries.

    PubMed

    Clark, Kevin R

    2016-07-01

    Gunshot wounds are the third-leading cause of injury-related death nationwide. Most people with gunshot injuries undergo diagnostic imaging to evaluate their injuries in the clinical or forensic setting. Radiologic technologists must be knowledgeable about common injuries associated with gunshot wounds. Digital radiography and computed tomography play essential roles in the assessment of gunshot injuries. When clinically indicated, magnetic resonance imaging also is a valuable imaging modality for evaluating these injuries. Radiologic technologists should obtain quality images to assist with proper assessment of gunshot injuries.

  16. Overutilization of bracing in the management of penetrating spinal cord injury from gunshot wounds.

    PubMed

    Eftekhary, Nima; Nwosu, Kenneth; McCoy, Eric; Fukunaga, Dudley; Rolfe, Kevin

    2016-07-01

    OBJECTIVE Penetrating gunshot wounds (GSWs) to the spinal column are stable injuries and do not require spinal orthoses or bracing postinjury. Nonetheless, a high number of GSW-related spinal cord injury (SCI) patients are referred with a brace to national rehabilitation centers. Unnecessary bracing may encumber rehabilitation, create skin breakdown or pressure ulcers, and add excessive costs. The aim of this study was to confirm the stability of spinal column injuries from GSWs and quantify the overutilization rate of bracing based on long-term follow-up. METHODS This retrospective cohort study was performed at a nationally renowned rehabilitation center. In total, 487 GSW-related SCI patients were transferred for rehabilitation and identified over the last 14 years. Retrospective chart review and telephone interviews were conducted to identify patients who were braced at the initial treating institution and determine if late instability, deformity, or neurological deterioration resulted in secondary surgery or intervention. In addition, 396 unoperated patients were available for analysis after 91 patients were excluded for undergoing an initial destabilizing surgical dissection or laminectomy, thereby altering the natural history of the injury. All of these 396 patients who presented with a brace had bracing discontinued upon reaching the facility. RESULTS In total, 203 of 396 patients were transferred with a spinal brace, demonstrating an overutilization rate of 51%. No patients deteriorated neurologically or needed later surgery for spinal column deformity or instability attributable to the injury. All patients had stable injuries. The patterns of injury and severity of neurological injury did not vary between patients who were initially braced or unbraced. The average follow-up was 7.8 years (range 1-14 years) and the average age was 25 years (range 10-62 years). CONCLUSIONS The incidence of brace overutilization for penetrating GSW-related SCI was 51%. Long

  17. Visualization of the air ejected from the temporary cavity in brain and tissue simulants during gunshot wounding.

    PubMed

    Lazarjan, M S; Geoghegan, P H; Taylor, M C; Jermy, M C

    2015-01-01

    One hypothesis for the physical mechanism responsible for backspatter during cranial gunshot wounding is that air is ejected by the collapse of the temporary cavity formed around the bullet path. Using bovine and ovine heads and simulant materials, evidence of this ejection was sought by measuring the velocity of the air that was drawn in and ejected from the cavity in front of the wound channel after bullet impact. A laminar flow of fog-laden air was arranged in front of the wound channel and two high speed cameras recording at 30,000 frames/second captured the air motion. All samples were shot with standard 9 mm × 19 mm FMJ ammunition. Different concentrations of ballistic gelatine were used to characterize the effect of elasticity of the material on the velocity of the air. Fresh bovine and ovine heads were shot with the same experimental set up to investigate if there was induction of air into, and ejection of air from the entrance wounds. The results show, for the first time, that the temporary cavity does eject air in gelatine. The velocity of in-drawn air for 3, 5 and 10% concentration of gelatine was 81, 76 and 65 m/s respectively and the velocity of ejected air for 5 and 10% concentration of gelatine were 43 and 72 m/s respectively. The results show that when the concentration of gelatine is increased, the velocity of the air drawn into the cavity decreases and the velocity of the ejected air increases. However, no ejection was observed in 3% gelatine, ovine or bovine heads. Although ejection of air was not observed, ejection of brain from the wound channel was seen. Using the velocity of the ejected brain, the minimum intracranial pressure required to eject the brain tissue was estimated to be 712 kPa and 468 kPa for the sheep and bovine heads respectively.

  18. Visualization of the air ejected from the temporary cavity in brain and tissue simulants during gunshot wounding.

    PubMed

    Lazarjan, M S; Geoghegan, P H; Taylor, M C; Jermy, M C

    2015-01-01

    One hypothesis for the physical mechanism responsible for backspatter during cranial gunshot wounding is that air is ejected by the collapse of the temporary cavity formed around the bullet path. Using bovine and ovine heads and simulant materials, evidence of this ejection was sought by measuring the velocity of the air that was drawn in and ejected from the cavity in front of the wound channel after bullet impact. A laminar flow of fog-laden air was arranged in front of the wound channel and two high speed cameras recording at 30,000 frames/second captured the air motion. All samples were shot with standard 9 mm × 19 mm FMJ ammunition. Different concentrations of ballistic gelatine were used to characterize the effect of elasticity of the material on the velocity of the air. Fresh bovine and ovine heads were shot with the same experimental set up to investigate if there was induction of air into, and ejection of air from the entrance wounds. The results show, for the first time, that the temporary cavity does eject air in gelatine. The velocity of in-drawn air for 3, 5 and 10% concentration of gelatine was 81, 76 and 65 m/s respectively and the velocity of ejected air for 5 and 10% concentration of gelatine were 43 and 72 m/s respectively. The results show that when the concentration of gelatine is increased, the velocity of the air drawn into the cavity decreases and the velocity of the ejected air increases. However, no ejection was observed in 3% gelatine, ovine or bovine heads. Although ejection of air was not observed, ejection of brain from the wound channel was seen. Using the velocity of the ejected brain, the minimum intracranial pressure required to eject the brain tissue was estimated to be 712 kPa and 468 kPa for the sheep and bovine heads respectively. PMID:25485950

  19. Gunshot-induced plumbism in an adult male.

    PubMed Central

    Akhtar, Abbasi J.; Funnyé, Allen S.; Akanno, Jonathan

    2003-01-01

    Our objective is to present a case of symptomatic lead toxicity (plumbism) with abdominal colic and hemolytic anemia following a gunshot wound. It is a retrospective case report and the setting is in a teaching hospital in south central Los Angeles. The case report is that of a patient who presented with abdominal pain, generalized weakness, and hypertension following multiple gunshot wounds, 15 years previously. Other causes of abdominal pain and weakness--such as diabetes mellitus, alcohol abuse, pancreatitis, and substance abuse--were ruled out. Interventions included treatment with the newer oral chelating agent, Succimer (2, 3-dimercaptosuccinic acid), and subsequent surgery. The main outcome was the initial reduction in blood lead levels with improvement of symptoms. Because of a recurrent rise in the blood lead levels, the patient was again treated with Succimer and underwent surgery to remove two bullet fragments from the face. We conclude that lead toxicity should be ruled out in patients presenting with abdominal cramps and a history of a gunshot wound. Prompt therapy--including environmental intervention and chelation therapy--is mandatory, and surgical intervention may be necessary. Images Figure 1 Figure 2 Figure 3 PMID:14620713

  20. Extremity gunshot wounds: Part one--Identification and treatment of patients at high risk of vascular injury.

    PubMed

    Ordog, G J; Balasubramanium, S; Wasserberger, J; Kram, H; Bishop, M; Shoemaker, W

    1994-03-01

    Cost containment is important in this time of inner-city economic and health-care crisis. This paper examines patients who were treated for gunshot wounds (GSWs) of the extremities. During the study period 1978 through 1992, 16,316 patients (18,349 extremities) were treated for extremity GSWs. Nine patients with asymptomatic injuries in proximity to vascular structures who were treated before the use of duplex Doppler ultrasonography (DDU) were later found to have surgically treatable vascular injuries. These were identified and treated on an outpatient basis with no long-term morbidity or mortality. With the advent of DDU, asymptomatic vascular injuries were no longer missed. A conservative estimate of the cost savings from this study is more than $47,000,000.00. The use of DDU and the enclosed protocols for treating asymptomatic extremity wounds prevented 16,450 needless angiograms, with an additional savings of $32,900,000.00, for a total savings of more than $79,900,000.00. With a more liberal use of DDU and angiography to eliminate the rare missed vascular injuries (0.09%), and the use of protocols to analyze patients with asymptomatic injuries, many extremity GSW victims (79% in this study) can be safely treated as outpatients, eliminating the need for expensive in-hospital observation.

  1. The survival of metallic residues from gunshot wounds in cremated bone: a radiological study.

    PubMed

    Amadasi, Alberto; Borgonovo, Simone; Brandone, Alberto; Di Giancamillo, Mauro; Cattaneo, Cristina

    2012-05-01

    In literature, many studies have been performed in order to investigate the presence of GSR ("gunshot residue") and metallic residues in general with radiological techniques on several types of material, but the survival of metallic residues on charred samples has never been systematically performed. In this study, 31 adult bovine ribs underwent a shooting test. Every rib was shot with a single bullet, at a near-contact shooting distance, using two kinds of projectile: 17 samples were shot with a full metal-jacketed bullet and the remaining 14 with an unjacketed bullet. After the shooting test, every rib underwent a "charring cycle" in an electric oven up to 800°C. Every sample underwent radiological investigation with conventional radiography, before and after the burning process, to evaluate any changes in number and distribution of metallic residues. Radiographs showed survival of radiopaque residues in every sample, even after the charring process, especially when the bullet used was of the unjacketed type.

  2. Fractures Due to Gunshot Wounds: Do Retained Bullet Fragments Affect Union?

    PubMed Central

    Riehl, John T.; Connolly, Keith; Haidukewych, George; Koval, Ken

    2015-01-01

    Background Many types of projectiles, including modern hollow point bullets, fragment into smaller pieces upon impact, particularly when striking bone. This study was performed to examine the effect on time to union with retained bullet material near a fracture site in cases of gunshot injury. Methods All gunshot injuries operatively treated with internal fixation at a Level 1 Trauma Center between March 2008 and August 2011 were retrospectively reviewed. Retained bullet load near the fracture site was calculated based on percentage of material retained compared to the cortical diameter of the involved bone. Analyses were performed to assess the effect of the lead-cortical ratio and amount of comminution on time to fracture union. Results Thirty-two patients (34 fractures) met the inclusion criteria, with an equal number of comminuted (17) and non-comminuted fractures (17). Seventeen of 34 fractures (50%) united within 4 months, 16/34 (47%) developed a delayed union, and 1/34 (3%) developed a nonunion requiring revision surgery. Sixteen of 17 fractures (94%) that united by 4 months had a cumulative amount of bullet fragmentation retained near the fracture site of less than 20% of the cortical diameter. Nine out of 10 fractures (90%) with retained fragments near the fracture site was equal to or exceeding 20% of the cortical diameter had delayed or nonunion. Fracture comminution had no effect on time to union. Conclusions The quantity of retained bullet material near the fracture site was more predictive of the rate of fracture union than was comminution. Fractures with bullet fragmentation equal to or exceeding 20% of the cortical width demonstrated a significantly higher rate of delayed union/nonunion compared to those fractures with less retained bullet material, which may indicate a local cytotoxic effect from lead on bone healing. These findings may influence decisions on timing of secondary surgeries. Level of Evidence Level III PMID:26361445

  3. Outcomes Following Low-Energy Civilian Gunshot Wound Trauma to the Lower Extremities: Results of a Standard Protocol at an Urban Trauma Center

    PubMed Central

    Abghari, Michelle; Monroy, Alexa; Schubl, Sebastian; Davidovitch, Roy; Egol, Kenneth

    2015-01-01

    Background Lower extremity injuries secondary to low-energy gunshot wounds are frequently seen in the civilian populations of urban areas. Although these wounds have fewer complications than high-energy gunshot injuries, the functional and psychological damage is still significant making appropriate timely orthopaedic treatment and follow-up imperative. Purpose The purpose of this study is to present our outcomes in the treatment of low-energy gunshot wounds in a civilian population at an urban, level one trauma center in patients treated by a standard protocol. Methods One hundred and thirty three patients who sustained 148 gunshot wound injuries were treated at our level one trauma center between January 1st, 2009 and October 1st, 2011. Following IRB approval, we extracted information from medical records regarding hospital course, length of stay and type of operative or non-operative treatment. If available, injury and post-operative radiographs were also reviewed. Patients were contacted by telephone to obtain Short Musculoskeletal Function Assessment (SMFA) surveys, pain on a scale of 0–10 and for the determination of any adverse events related to their shooting. Results There were 125 men (94.0%) and 8 women (6.0%) with an average age of 27.1 years (range 15.2–56.3). Seventy-six patients (57.1%) did not have any health insurance upon admission. The average length of stay in the hospital was 4.5 days (range 0.0–88.0). Fifty-one gun shots (34.5%) resulted in fractures of the lower extremities. Patients underwent a total of 95 lower extremity-related procedures during their hospitalization. Twenty-two patients (16.5%) experienced a complication related to their gunshot wounds. 38% of the cohort was available for long-term functional assessment At a mean 23.5 months (range 8–48) of follow up, patients reported mean Functional and Bothersome SMFA scores of 19.6 (SD 15.9) and 10.9 (SD 15.6) suggesting that these patients have poorer function scores than the

  4. A civilian perspective on ballistic trauma and gunshot injuries

    PubMed Central

    2010-01-01

    Background Gun violence is on the rise in some European countries, however most of the literature on gunshot injuries pertains to military weaponry and is difficult to apply to civilians, due to dissimilarities in wound contamination and wounding potential of firearms and ammunition. Gunshot injuries in civilians have more focal injury patterns and should be considered distinct entities. Methods A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed. Results Craniocerebral gunshot injuries are often lethal, especially after suicide attempts. The treatment of non space consuming haematomas and the indications for invasive pressure measurement are controversial. Civilian gunshot injuries to the torso mostly intend to kill; however for those patients who do not die at the scene and are hemodynamically stable, insertion of a chest tube is usually the only required procedure for the majority of penetrating chest injuries. In penetrating abdominal injuries there is a trend towards non-operative care, provided that the patient is hemodynamically stable. Spinal gunshots can also often be treated without operation. Gunshot injuries of the extremities are rarely life-threatening but can be associated with severe morbidity. With the exception of craniocerebral, bowel, articular, or severe soft tissue injury, the use of antibiotics is controversial and may depend on the surgeon's preference. Conclusion The treatment strategy for patients with gunshot injuries to the torso mostly depends on the hemodynamic status of the patient. Whereas hemodynamically unstable patients require immediate operative measures like thoracotomy or laparotomy, hemodynamically stable patients might be treated with minor surgical procedures (e.g. chest tube) or even conservatively. PMID:20565804

  5. [A method for the determination of spatial orientation of wound canals caused by gunshot bullets to be applied in corpse examination].

    PubMed

    Svetlakov, A V; Sotin, A V

    2013-01-01

    A new approach to the determination of spatial orientation of wound canals caused by gunshot bullets is proposed and substantiated; its application for the purpose of forensic medical expertise is described. The direction of penetrating wound canals in three dimensions was determined by measuring the distance of the input and output wound holes from the level of the soles, anterior and posterior midlines, and the posterior body surface; the results of the measurements were used to construct triangles. The parameters thus obtained allowed the spatial orientation of the wound canals to be determined in three dimensions for the subsequent judgment about the relative direction of the gun barrel with respect to the human body at the time of the shot and the objective expert conclusion concerning the circumstances of firearm-related injuries.

  6. [Criteria for the determination of the distance of a gunshot from limited-range firearms based on the morphological characteristics of the wound and the results of inductively coupled plasma mass spectrometry].

    PubMed

    Svetlolobov, D Iu; Luzanova, I S; Demidov, I V; Zorin, Iu V; Sonis, M A; Likhachev, A S

    2013-01-01

    We have developed the criteria allowing to determine the distance of a gunshot from limited-range firearms (an IZh-79-9TGM pistol with the elastic bullet cartridges) based on the morphological characteristics of the wound and the results of inductively coupled plasma mass spectrometry. The method has been developed for the quantitative determination of barium, lead, and antimony in the targets depending on the gunshot distance.

  7. [Early specialized surgical care for gunshot wounds of major vessels in Donbas].

    PubMed

    Rozin, Yu A; Ivanenko, A A

    2016-01-01

    The authors share their experience gained in rendering early specialized surgical care during combat operations in Donbas, having operated on a total of 139 wounded with lesions of large vessels, of these, 21 (15.1%) presenting with concomitant lesions of vessels. Reconstructive operations were carried out in 122 (87.8%) wounded, ligating operations - in 12 (8.6%), and primary amputations - in 5 (3.6%). Two (1.4%) patients died. Blood flow was restored in 117 (84.2%) patients, with six amputations performed after primary operations. The limb was saved in 116 (83.4%) wounded. Peculiarities of a vascular injury in Donbas comprise a large proportion of severe concomitant vascular wounds and lack of intermediate stages of evacuation. The prognosis of life and limb salvage largely depends on correctly chosen method of temporary arrest of bleeding at first stages of medical evacuation and shortening the terms of rendering first specialized surgical care. The variant of operation (reconstruction, ligation or primary amputation) in severe concomitant vascular wounds should be determined proceeding from the degree of ischaemia and severity of the condition of the wounded person, assessed by means of the Military Surgery - Mangled Extremity Severity Score.

  8. An alarming presentation of Creutzfeldt-Jakob disease following a self-inflicted gunshot wound to the head.

    PubMed

    Harnish, Carissa; Gross, Brian; Rittenhouse, Katelyn; Bupp, Katherine; Vellucci, Ashley; Anderson, Jeffrey; Riley, Deborah; Rogers, Frederick B

    2015-05-01

    Transmissible spongiform encephalopathies (TSE), also known as prion diseases, are characterized by rapid and fatal neurological decline. They not only detrimentally affect the patient, but also present additional challenges to healthcare systems due to the infectivity of the tissues and the difficulty of inactivating the prion. The most common TSE is Creutzfeldt-Jakob disease (CJD), which can occur after familial, spontaneous or acquired transmission. TSEs received more attention after the development of variant CJD (vCJD), also known as Mad Cow Disease, in the UK during the mid-1990s. Unlike familial or spontaneous CJD, this variant was connected to consumption of cattle contaminated with the prion disease, bovine spongiform encephalopathy.This development increased interest in the etiology of CJD and other TSEs and the risk it presents as an infectious disease. The following details the case of a 59-year-old male infected with CJD presented to our level II trauma center for treatment following a self-inflicted gunshot wound to the head. PMID:25530409

  9. An alarming presentation of Creutzfeldt-Jakob disease following a self-inflicted gunshot wound to the head.

    PubMed

    Harnish, Carissa; Gross, Brian; Rittenhouse, Katelyn; Bupp, Katherine; Vellucci, Ashley; Anderson, Jeffrey; Riley, Deborah; Rogers, Frederick B

    2015-05-01

    Transmissible spongiform encephalopathies (TSE), also known as prion diseases, are characterized by rapid and fatal neurological decline. They not only detrimentally affect the patient, but also present additional challenges to healthcare systems due to the infectivity of the tissues and the difficulty of inactivating the prion. The most common TSE is Creutzfeldt-Jakob disease (CJD), which can occur after familial, spontaneous or acquired transmission. TSEs received more attention after the development of variant CJD (vCJD), also known as Mad Cow Disease, in the UK during the mid-1990s. Unlike familial or spontaneous CJD, this variant was connected to consumption of cattle contaminated with the prion disease, bovine spongiform encephalopathy.This development increased interest in the etiology of CJD and other TSEs and the risk it presents as an infectious disease. The following details the case of a 59-year-old male infected with CJD presented to our level II trauma center for treatment following a self-inflicted gunshot wound to the head.

  10. Three-dimensional reconstitution of bullet trajectory in gunshot wounds: a case report.

    PubMed

    Puentes, Katerina; Taveira, Francisco; Madureira, António J; Santos, Agostinho; Magalhães, Teresa

    2009-10-01

    In the medico-legal assessment of cases of aggression with firearms, imaging techniques have a particularly important role, especially in the study of a bullet's path through the victim's body. The analysis of these trajectories can be performed by the use of three-dimensional reconstitution techniques, namely Three-Dimensional Multi-Slice Computed Tomography (3D-MSCT). This imaging technique has been widely used in fatal cases, as a very important complement of the classical autopsy procedures, becoming known as "virtual autopsy" or "Virtopsy". To our knowledge, no reports describing the use of 3D-MSCT in non-fatal cases have been described in the medico-legal literature. The authors present a case of a man with a gunshot injury, in the context of a multiple aggressor situation, in which it was not possible to extract the bullet. To accurately determine the bullet's trajectory, 3D-MSCT was performed, thus contributing to a more reliable reconstruction of the crime scene in which the victim and the suspects were located. PMID:19733332

  11. Three-dimensional reconstitution of bullet trajectory in gunshot wounds: a case report.

    PubMed

    Puentes, Katerina; Taveira, Francisco; Madureira, António J; Santos, Agostinho; Magalhães, Teresa

    2009-10-01

    In the medico-legal assessment of cases of aggression with firearms, imaging techniques have a particularly important role, especially in the study of a bullet's path through the victim's body. The analysis of these trajectories can be performed by the use of three-dimensional reconstitution techniques, namely Three-Dimensional Multi-Slice Computed Tomography (3D-MSCT). This imaging technique has been widely used in fatal cases, as a very important complement of the classical autopsy procedures, becoming known as "virtual autopsy" or "Virtopsy". To our knowledge, no reports describing the use of 3D-MSCT in non-fatal cases have been described in the medico-legal literature. The authors present a case of a man with a gunshot injury, in the context of a multiple aggressor situation, in which it was not possible to extract the bullet. To accurately determine the bullet's trajectory, 3D-MSCT was performed, thus contributing to a more reliable reconstruction of the crime scene in which the victim and the suspects were located.

  12. The survival of metallic residues from gunshot wounds in cremated bone: a radiological study.

    PubMed

    Amadasi, Alberto; Borgonovo, Simone; Brandone, Alberto; Di Giancamillo, Mauro; Cattaneo, Cristina

    2012-05-01

    In literature, many studies have been performed in order to investigate the presence of GSR ("gunshot residue") and metallic residues in general with radiological techniques on several types of material, but the survival of metallic residues on charred samples has never been systematically performed. In this study, 31 adult bovine ribs underwent a shooting test. Every rib was shot with a single bullet, at a near-contact shooting distance, using two kinds of projectile: 17 samples were shot with a full metal-jacketed bullet and the remaining 14 with an unjacketed bullet. After the shooting test, every rib underwent a "charring cycle" in an electric oven up to 800°C. Every sample underwent radiological investigation with conventional radiography, before and after the burning process, to evaluate any changes in number and distribution of metallic residues. Radiographs showed survival of radiopaque residues in every sample, even after the charring process, especially when the bullet used was of the unjacketed type. PMID:22037901

  13. Use of negative pressure wound therapy in the management of infected abdominal wounds containing mesh: an analysis of outcomes.

    PubMed

    Baharestani, Mona Mylene; Gabriel, Allen

    2011-04-01

    The purpose of this study was to examine the clinical outcomes of negative pressure wound therapy (NPWT) using reticulated open-cell foam (ROCF) in the adjunctive management of abdominal wounds with exposed and known infected synthetic mesh. A non randomised, retrospective review of medical records for 21 consecutive patients with infected abdominal wounds treated with NPWT was conducted. All abdominal wounds contained exposed synthetic mesh [composite, polypropylene (PP), or knitted polyglactin 910 (PG) mesh]. Demographic and bacteriological data, wound history, pre-NPWT and comparative post-NPWT, operative procedures and complications, hospital length of stay (LOS) and wound healing outcomes were all analysed. Primary endpoints measured were (1) hospital LOS prior to initiation of NPWT, (2) total time on NPWT, (3) hospital LOS from NPWT initiation to discharge and (4) wound closure status at discharge. A total of 21 patients with abdominal wounds with exposed, infected mesh were treated with NPWT. Aetiology of the wounds was ventral hernia repair (n = 11) and acute abdominal wall defect (n = 10). Prior to NPWT initiation, the mean hospital LOS for the composite, PP and PG meshes were 76 days (range: 21-171 days), 51 days (range: 32-62 days) and 19 days (range: 12-39 days), respectively. The mean hospital LOS following initiation of NPWT for wounds with exposed composite, PP and PG mesh were 28, 31 and 32 days, respectively. Eighteen of the 21 wounds (86%) reached full closure after a mean time of 26 days of NPWT and a mean hospital LOS of 30 days postinitiation of NPWT. Three wounds, all with composite mesh left in situ, did not reach full closure, although all exhibited decreased wound dimensions, granulating beds and decreased surface area exposure of mesh. During NPWT/ROCF, one hypoalbuminemic patient with exposed PP mesh developed an enterocutaneous fistula over a prior enterotomy site. This patient subsequently underwent total mesh extraction, takedown of

  14. Of blood, inflammation and gunshot wounds: the history of the control of sepsis.

    PubMed

    Thurston, A J

    2000-12-01

    Galen (AD 129-199) propounded the notion that all wounds healed by second intention and the concept of laudable pus became unshakeable for almost 15 centuries. But William of Saliceto (AD ca 1210-1280) held quite firmly that pus formation was bad for both wound and patient and proclaimed that wounds should heal by first intention. The first rational theory of the nature of infection was by Fracastoro (1478-1553), a physician of Verona who regarded infection as being due to the passage of minute bodies from one person to another. But it was not until the work of Pasteur (1822-1895) that bacteriology took a significant leap forward. The association between bacteria and infection was slow to be accepted. The work of Semmelweis (1818-1865) is notable for his association between bacterial infection and puerperal fever. Lister (1827-1912) began the modern movement to control infection with his pioneering work in antiseptic surgery. Other contributions came from von Bergman (1836-1907; steam sterilization of instruments) and Halstead (1852-1922; rubber gloves for surgeons). The aseptic system has changed very little since then except for the innovations of Sir John Charnley (1911-1982; the laminar flow enclosure). The development of safe antibacterial drugs has been confined to the 20th century. This was led by Domagk (1895-1964; sulfonamides) and was followed by Sir Alexander Fleming (1881-1955), Sir Howard Walter Florey (1898-1968) and Sir Ernest Boris Chain (1906-1979; penicillin) and Selman Waksman (1888-1973; actinomycin).

  15. Bedside placement of polyglycolic acid mesh: a novel treatment of uncomplicated abdominal wound dehiscence.

    PubMed

    Chendrasekhar, A

    1996-01-01

    Uncomplicated abdominal wound dehiscence is a common problem in critically ill patients undergoing general surgical procedures. In the past, a majority of these patients have been subjected to an emergency return to the operating room for wound closure to prevent evisceration. In this article, we present two successful cases of a novel bedside approach using local anesthesia and polyglycolic acid mesh in uncomplicated abdominal dehiscence to prevent evisceration.

  16. [CHARACTERISTICS OF ANTIBIOTICORESISTANCE OF MICROFLORA IN A COMBAT (THE GUN-SHOT ANO THE MINE-EXPLOSION) WOUNDS OF THE EXTREMITIES].

    PubMed

    Kondratyuk, V M

    2016-04-01

    Abstract Results of bacteriological investigations of a gun-shot and a mine-explosion woundings of the extremities were analyzed in Military-Medical Clinical Centres (MMCC) of Kyiv, Lviv and Vinnytsya. Spectrum of the allotted microorganisms and profile of their antibioticoresistance were disclosed. The patterns of resistance were determined in accordance to offering of international experts of European Committee on Antimicrobial Susceptibility Testing (EUCAST). Dominating microflora in a Chief MMCC (Kyiv) and MMCC of a Western Region (Lviv) were various species of the Enterobacteriaceae and P. aeruginosa families, while in MMCC of a Central Region (Vinnytsya)--a gramm-negative non-fermentative bacilli of the Acinetobacter genus and Pseudomonas genus. The majority (79.5%) of isolates were characterized by polyresistance for antibiotics. Maximal quantity of strains with a widened spectrum of resistance was revealed in 2 - 3 weeks after a wounding--in 71.4 and 96.9% accordingly.

  17. [CHARACTERISTICS OF ANTIBIOTICORESISTANCE OF MICROFLORA IN A COMBAT (THE GUN-SHOT ANO THE MINE-EXPLOSION) WOUNDS OF THE EXTREMITIES].

    PubMed

    Kondratyuk, V M

    2016-04-01

    Abstract Results of bacteriological investigations of a gun-shot and a mine-explosion woundings of the extremities were analyzed in Military-Medical Clinical Centres (MMCC) of Kyiv, Lviv and Vinnytsya. Spectrum of the allotted microorganisms and profile of their antibioticoresistance were disclosed. The patterns of resistance were determined in accordance to offering of international experts of European Committee on Antimicrobial Susceptibility Testing (EUCAST). Dominating microflora in a Chief MMCC (Kyiv) and MMCC of a Western Region (Lviv) were various species of the Enterobacteriaceae and P. aeruginosa families, while in MMCC of a Central Region (Vinnytsya)--a gramm-negative non-fermentative bacilli of the Acinetobacter genus and Pseudomonas genus. The majority (79.5%) of isolates were characterized by polyresistance for antibiotics. Maximal quantity of strains with a widened spectrum of resistance was revealed in 2 - 3 weeks after a wounding--in 71.4 and 96.9% accordingly. PMID:27434956

  18. Gunshot wounds - aftercare

    MedlinePlus

    ... You may feel shock, fear for your safety, depression, or anger as a result. These are completely normal feelings for someone who has been through a traumatic event . These feelings are not signs of weakness. ...

  19. Use of computerized tomography of the abdominal wall in the diagnosis of partial post-operative wound dehiscence.

    PubMed Central

    Smith-Behn, J.; Arnold, M.; Might, J.

    1986-01-01

    A patient had occult post-operative partial wound dehiscence which was accurately diagnosed by performing a CT scan of the abdomen. It is suggested that CT scan of the abdominal wall is useful for early diagnosis of occult abdominal wound dehiscence. Images Figure 1 Figure 2 PMID:2946035

  20. Isolated abdominal wound recurrence of an endometrial adenocarcinoma confined to a polyp

    SciTech Connect

    Barter, J.F.; Hatch, K.D.; Orr, J.W. Jr.; Shingleton, H.M.

    1986-11-01

    An unusual case of Stage IB moderately well-differentiated endometrial adenocarcinoma that was confined to a polyp and recurred only in the abdominal wound is presented. Eighteen months following complete excision, local electron beam therapy, and the institution of hormonal therapy, the patient is alive and without other evidence of recurrence. The mechanisms of metastasis in this case are discussed.

  1. [Treatment organization for patients with gunshot wounds of the maxillo-facial region evacuated during the military operations in the Far East (1938-1939) and the war with Finland (1939-1940)].

    PubMed

    Pavlovskiĭ, L N

    2013-01-01

    This article describes the path of the maxillo-facial surgery to becoming an independent part of the general surgery. We will look closely at the experience, gained y field surgeons during the events at Lake Hasan and Halkin-Gol river. The war with Finland, that enabled the surgeons to develop the system of specialized dental help for the gunshot wounds, to create standarts of specialized equipment, examples of splints, etc, which were widely used during the World War II.

  2. Joint and long-bone gunshot injuries.

    PubMed

    Dougherty, Paul J; Vaidya, Rahul; Silverton, Craig D; Bartlett, Craig S; Najibi, Soheil

    2010-01-01

    Gunshot wounds remain a major clinical problem, with the number of nonfatal gunshot wounds reported as 60,000 to 80,000 per year in the United States. Bone or joint injuries comprise a major portion of gunshot wound injuries. It is paramount for orthopaedic surgeons to be thorough in their treatment of patients with these injuries. Intra-articular injuries remain a source of significant clinical morbidity because of joint stiffness, arthritis, and the risk of infection. Treatment of long-bone fractures is a challenging clinical problem, and further studies are needed to investigate modern treatment methods. Lead toxicity is a potential risk for patients with gunshot injuries, particular for those with joint injuries. The clinician's recognition of the signs and symptoms of lead toxicity is important to achieve the best care for these patients. PMID:20415399

  3. The efficacy of serial physical examination in penetrating abdominal trauma.

    PubMed

    van Haarst, E P; van Bezooijen, B P; Coene, P P; Luitse, J S

    1999-11-01

    Over a 10-year period we reviewed the records of 370 consecutive patients with potentially penetrating abdominal wounds (48 gunshot and 322 stab wounds). Selective non-operative management for abdominal stab wounds was introduced, guided by serial physical examination. In our study the terms therapeutic and non-therapeutic laparotomies were used, the latter comprising negative as well as insignificant findings. Initially diagnostic peritoneal lavage and local wound exploration were used, but these methods were later abandoned. Mortality was 10.2% and morbidity 25% in the group of gunshot wounds and 1.2% and 8.6% in the group of stab wounds. During this period the rate of laparotomies for stab wounds decreased from 55% to 30%, while the rate of non-therapeutic laparotomies decreased from 24% to 0% in the last year. Delayed laparotomy did not cause death or increase morbidity. Our results support the concept of selective non-operative management of abdominal stab wounds using repeated physical examination. Peritoneal perforation and haemoperitoneum should not be an indication for routine laparotomy.

  4. [SURGICAL TREATMENT MANAGEMENT OF ABDOMEN GUNSHOT INJURIES].

    PubMed

    Linyov, K A

    2015-07-01

    The medical records of 100 patients with gunshot abdomen injuries were analysed. The damaging nature of the projectile, the nature of the damage and the combination with damage to other body parts were studied. The anesthesiologist--resuscitator and surgeon actions after hospitalisation of injured persons were postulated. The emergency victim examination was reduced to ultrasound and SCT. The indications for laparotomy in abdominal gunshot injuries were defined. Three most common variants of gunshot abdomen injuries were found. In surgical treatment we applied "damage control" strategy included the initial (abbreviated) operation, resuscitative therapy and final operation. The postoperative complications, couse of deaths was investigated.

  5. Efficacy of postoperative continuous wound infiltration with local anesthetic after major abdominal surgery.

    PubMed

    Abadir, Adel R; Nicolas, Fred; Gharabawy, Ramiz; Shah, Trusha; Michael, Rafik

    2009-01-01

    The aim of this study was to evaluate the analgesic efficacy, safety, opioid sparing effects and improvement of respiratory function when using 0.2% ropivacaine continuous wound infiltration after major intra-abdominal surgery. Forty patients undergoing major intra-abdominal surgery requiring a midline incision of > or = 20 cm were enrolled into this IRB-approved, randomized, prospective controlled study. Group 1: 20 patients, parenteral analgesia (control group). Group II: 20 patients, with local anesthetic wound infiltration (pain pump group). At the end of the procedure, in the pain pump group of patients, a multi hole, 20-gauge catheter was inserted percutaneously, above the fascia. An initial dose of 10 ml of 0.2% ropivacaine was injected in the wound through the catheter. A device provided continuous delivery of 0.2% ropivacaine; the infusion was initiated at 6 ml/h for the following two days. The total "rescue" morphine and oxycodone/acetaminophen tablets administered were significantly lower in the pain pump group. At all time intervals, resting pain scores were significantly lower in the pain pump group when compared with the control group. However, at the 4-48 and 12-48 hours pain scores generated after leg raise and coughing, respectively, were significantly lower in group II. The patient vital capacities were insignificantly higher in group II. We conclude that after major abdominal surgery, infiltration and continuous wound instillation with 0.2% ropivacaine decreases postoperative pain, opioid requirements and oral analgesia. Early patient rehabilitation, hastening convalescence, and preventing respiratory complications are expected outcomes of this approach.

  6. Prevention of abdominal wound infection (PROUD trial, DRKS00000390): study protocol for a randomized controlled trial

    PubMed Central

    2011-01-01

    Background Wound infection affects a considerable portion of patients after abdominal operations, increasing health care costs and postoperative morbidity and affecting quality of life. Antibacterial coating has been suggested as an effective measure to decrease postoperative wound infections after laparotomies. The INLINE metaanalysis has recently shown the superiority of a slowly absorbable continuous suture for abdominal closure; with PDS plus® such a suture has now been made available with triclosan antibacterial coating. Methods/Design The PROUD trial is designed as a randomised, controlled, observer, surgeon and patient blinded multicenter superiority trial with two parallel groups and a primary endpoint of wound infection during 30 days after surgery. The intervention group will receive triclosan coated polydioxanone sutures, whereas the control group will receive the standard polydioxanone sutures; abdominal closure will otherwise be standardized in both groups. Statistical analysis is based on intention-to-treat population via binary logistic regression analysis, the total sample size of n = 750 is sufficient to ensure alpha = 5% and power = 80%, an interim analysis will be carried out after data of 375 patients are available. Discussion The PROUD trial will yield robust data to determine the effectiveness of antibacterial coating in one of the standard sutures for abdominal closure and potentially lead to amendment of current guidelines. The exploration of clinically objective parameters as well as quality of life holds immediate relevance for clinical management and the pragmatic trial design ensures high external validity. Trial Registration The trial protocol has been registered with the German Clinical Trials Register (DRKS00000390). PMID:22103965

  7. Analysis of abdominal wounds made by surgical trocars using functional luminal imaging probe (FLIP) technology.

    PubMed

    McMahon, Barry P; O'Donovan, Deidre; Liao, Donghua; Zhao, Jingbo; Schiretz, Rich; Heninrich, Russell; Gregersen, Hans

    2008-09-01

    The aim was to use a novel functional luminal imaging probe for evaluation of wound defects and tissue damage resulting from the use of trocars. Following general anesthesia of 4 adult pigs, 6 different trocars were randomly inserted at preselected locations in the porcine abdominal wall. The functional luminal imaging probe was used to profile the trocar holes during bag distension from 8 axial cross-sectional area measurements. The cross-sectional areas and pressure in the bag were recorded and exported to Matlab for analysis and data display. Geometric profiles were generated, and the minimum cross-sectional area and hole length (abdominal wall thickness) were used as endpoints. Successful distensions were made in all cases. The slope of the contours increased away from the narrowest point of the hole. The slope increased more rapidly toward the inner abdominal wall than toward the outer wall. The slope of the linear trend lines for the cross-sectional area-pressure relation represents the compliance at the narrowest point in the wall. The hole length (abdominal wall thickness) could be obtained at different cross-sectional area cutoff points. A cutoff point of 300 mm(2) gave good results when compared to the length of the hole measured after the tissue was excised. This technique represents a new and straightforward way to evaluate the effects of trocars on the abdominal wall. It may also prove useful in comparing techniques and technology from different manufacturers. PMID:18757380

  8. Two simultaneous suicidal gunshots to the head with robbed police guns.

    PubMed

    Padosch, S A; Dettmeyer, R B; Schyma, C W; Schmidt, P H; Madea, B

    2006-05-10

    The suicidal infliction of two gunshot wounds to the head represents a critical issue for medicolegal investigation. In principle, simultaneous infliction with two firearms or third parties' involvement, i.e. two consecutive gunshots, have to be considered. We report for the first time on a case of suicidal infliction of two simultaneous gunshots to the head (oral, temporal) with Action 4 expanding ammunition. A male had robbed two service guns and committed suicide thereafter under the influence of high-dose alcohol and cocaine. Interestingly, Action 4 ammunition had been used, leading to an uncommon gunshot wound morphology and extensive backspatter. At the scene, these findings caused confusion; moreover, the number of gunshot wounds was unclear, until autopsy revealed two gunshot wounds to the head, which had obviously been inflicted simultaneously. Expanding ammunition like QD-PEP and Action 4, used by several German federal state police forces, can cause an atypical gunshot wound morphology, most probably due to its peculiar deformation behaviour. Investigators should be careful when interpreting gunshot wound morphology at the scene after usage of such expanding ammunition. With regard to reconstruction in cases of two gunshot wounds to the head and two guns at the scene, two simultaneous gunshots should be taken into consideration. PMID:15978762

  9. Lead Toxicity Risks in Gunshot Victims

    PubMed Central

    de Araújo, Gabriel Costa Serrão; Mourão, Natália Teixeira; Pinheiro, Igor Natário; Xavier, Analúcia Rampazzo; Gameiro, Vinicius Schott

    2015-01-01

    Background Gunshot wounds require surgeons to decide whether to remove or leave bullet fragments in the body. Surgeons also decide how to follow up with patients who have lead fragments retained in their body. Current literature recommends to remove only intra-articular fragments without the need for a follow-up for patients with the metal retained. Therefore, this study investigates chronic lead toxicity for gunshot wounds. Methods The study was performed in the metropolitan area of Rio de Janeiro/Brazil, between 2013 and 2015. It was a case-control study that included 45 victims of gunshot lesions with metallic fragments retained for more than 6 months. The 45 controls were matched for gender, age, and race. We compared the lead blood levels and frequency of symptoms. Results The control group had average blood lead levels of 2.17 μg/dL (95% Confidence Interval [CI]; 1.71–2.63) and median 2.1 μg/dL. The case group had average values of 9.01 μg/dL (CI; 6.07–11.96) and median values of 6.5 μg/dL with p-values < = 0.001. The case group reported the following more frequently: irritancy, bad mood, headache, memory losses, daylight drowsiness, myalgia, weakness, abdominal pain, joint pain, trembling, tingling limbs. There was statistical significance for the differences of symptoms frequencies and for odds ratio between groups. Conclusions Although the mean lead levels found were lower than the current laboratory references, low levels have been associated with both rising morbidity and mortality. The WHO stated: “There is no known level of lead exposure that is considered safe”. In conclusion, this work showed that bullets retained in the body are not innocuous. There are impacts in the blood lead levels and symptoms related to it, even with few fragments, extra-articular located or existing with low blood lead levels. PMID:26509498

  10. [COMPLEX OF THE TREATMENT MEASURES IN A SYSTEM OF THE MEDICAL CARE DELIVERY TO WOUNDED PERSONS WITH THE GUN-SHOT AND MINE-EXPLOSIVE INJURIES OF THE FOOT].

    PubMed

    Korohl, S O

    2015-11-01

    Complex of the treatment measures, conducted in 302 wounded persons, suffering the gun-shot and mine-explosive injuries of the foot in 2014 - 2015 yrs, was analyzed. Primary surgical processing of the wound was conducted in all injured persons, secondary surgical processing--in 64.6%, the foot bones osteosynthesis--in 13.9%, primary immobilization, using improvised tire--in 77.8%, secondary immobilization, using the plaster splint--in 48.1%, llizarov's spokes--in 35.2%, Ilizarov's apparatus--in 18.5%, the rods apparatuses of external fixation--in 16.7%. For improvement of functioning of a modern system for the treatment-evacuation provision it is necessary, to reduce the quantity of levels of the medical help provision maximally.

  11. Craniocerebral gunshot injury in newborn

    PubMed Central

    Dabdoub, CB; Serra, SM; da Cunha, AH; Silveira, EN; Lopez, A; Azevedo-Filho, H

    2012-01-01

    Head wounds caused by firearms in newborns are an under-studied phenomenon in Latin America due to either the low frequency of such events or inadequate documentation. Nonetheless, a progressive increase is noted, with different frequencies reported for different geographic areas. We present the case of a 28-day-old newborn who suffered traumatic brain injury from a gunshot wound stemming from urban violence. This is one of the youngest patients reported with this type of head trauma in the literature. PMID:24960794

  12. [Should routine exploratory laparotomy be performed in the presence of an abdominal wound? Discussion apropos of 176 cases].

    PubMed

    Guiberteau, B; Kohen, M; Borde, L; Sartre, J Y; Bourseau, J C; Le Neel, J C

    1992-10-01

    Management of abdominal wounds is presently the subject of discussion between the partisans of routine laparotomy and those preferring "armed" surveillance. Results of study of a series of 176 abdominal wounds subjected to surgical dogma showed: that the diagnosis of non penetrating wounds (17.6%) was not always evident, due either to their anatomical localization (frontier region wounds) or to insufficient local exploration in urgent cases (6.6% of false-negatives), that the existence of serious clinical signs (50 cases) was always associated with one or more visceral lesions, requiring urgent laparotomy with a morbidity of 20% and a mortality of 8% (4 cases), that in the case of asymptomatic penetrating wounds (96 cases), routine laparotomy did nevertheless allow the diagnosis of visceral lesions in 50 cases (including 23 major lesions) but was of no utility in 46 cases (31.5% of blind laparotomies for the total series). The elevated proportion of useless laparotomies (30% in the literature), the result of a dogmatic attitude, or the risk of a delayed intervention (5 to 8%) in the series practising the selective method, led to a modification in the authors' attitude. The existence of serious signs should obviously result in a laparotomy. In their absence, and when confronted with a penetrating or doubtful (frontier region) wound, an exploratory celioscopy is proposed to ensure complete abdominal exploration, to confirm the presence or absence of penetration, to treat minimal lesions and to perform a classical laparotomy in case of evident necessity.

  13. Non-fatal gunshot wounds in the context of intimate partner violence. The importance of a multidisciplinary approach: a case report.

    PubMed

    Puentes, Katerina; Ribeiro, Cristina; Jardim, Patrícia; Santos, Agostinho; Magalhães, Teresa

    2011-07-01

    According to Portuguese law, if a case of intimate partner violence is noticed or suspected by a professional working in public services, reporting it to the police, medico-legal services or directly to the public prosecutor is mandatory. However, in most cases, reporting does not take place, despite its vital importance in triggering the multidisciplinary intervention that will ensure the correct and timely diagnosis and protection of the victim. In the present case, the victim, a 37 year-old woman, was sexually and physically abused by her husband in their home, and was physically abused again at the victim's mother's house. The victim mentioned that her husband struck her in the head with a hammer and shot a handgun while in her mother's house. However, she denied having a gunshot wound. The couple's daughter was also slapped in the face by her father. The police took the victim to the emergency room of a central hospital to receive medical attention, while the medical examiner on duty was called to the same emergency room to perform a medico-legal evaluation in the context of the intimate partner violence reported to the police. Medico-legal assessment revealed scalp injuries that had not been detected during the first inspection by the emergency room attending physicians who had performed a neurological examination, which revealed no neurological dysfunction. A cranial computed tomography with three-dimensional reconstitution and virtual dissection, requested by the medical examiner, revealed two projectiles trapped in between the inner and the outer table of the cranium, with linear fractures only in the inner table and no brain injuries. Gynecological examination with the collection of biological evidence, also performed by the medical examiner, made it possible to identify a male DNA profile matching her husband's. The victim was subjected to neurosurgery and a follow-up, and was released one month after the traumatic event. A forensic psychological

  14. Non-fatal gunshot wounds in the context of intimate partner violence. The importance of a multidisciplinary approach: a case report.

    PubMed

    Puentes, Katerina; Ribeiro, Cristina; Jardim, Patrícia; Santos, Agostinho; Magalhães, Teresa

    2011-07-01

    According to Portuguese law, if a case of intimate partner violence is noticed or suspected by a professional working in public services, reporting it to the police, medico-legal services or directly to the public prosecutor is mandatory. However, in most cases, reporting does not take place, despite its vital importance in triggering the multidisciplinary intervention that will ensure the correct and timely diagnosis and protection of the victim. In the present case, the victim, a 37 year-old woman, was sexually and physically abused by her husband in their home, and was physically abused again at the victim's mother's house. The victim mentioned that her husband struck her in the head with a hammer and shot a handgun while in her mother's house. However, she denied having a gunshot wound. The couple's daughter was also slapped in the face by her father. The police took the victim to the emergency room of a central hospital to receive medical attention, while the medical examiner on duty was called to the same emergency room to perform a medico-legal evaluation in the context of the intimate partner violence reported to the police. Medico-legal assessment revealed scalp injuries that had not been detected during the first inspection by the emergency room attending physicians who had performed a neurological examination, which revealed no neurological dysfunction. A cranial computed tomography with three-dimensional reconstitution and virtual dissection, requested by the medical examiner, revealed two projectiles trapped in between the inner and the outer table of the cranium, with linear fractures only in the inner table and no brain injuries. Gynecological examination with the collection of biological evidence, also performed by the medical examiner, made it possible to identify a male DNA profile matching her husband's. The victim was subjected to neurosurgery and a follow-up, and was released one month after the traumatic event. A forensic psychological

  15. [Gunshot injuries in the pediatric area].

    PubMed

    Baeza-Herrera, C; Baeza-Herrera, M A

    1998-01-01

    Gunshot and air weapon wounds in children have become a significant source of morbidity and mortality in our community in the last four years. Ninety five children, 15 years of age and younger, were admitted to the Pediatric Surgical Service for gunshot and air mechanism wounds during this period. Review of the circumstances of injury revealed that more than 50% were accidental 71% were male patients, and 65% were caused by gunshots and outside of the home. Thoracic region was affected in 42%; abdomen, 20%; skull, face and neck, 13.4%; lower extremities, 13.4%; upper extremities 9%; genitalia, 2.0%; and perineal region, 0.8%. Rapid resuscitation and triage of major injury allowed us a survival of 97%. Social service intervention and educational task can offer significant benefit to these children but, ultimately gun control laws with strict enforcement are needed to stop this type of violence toward children. PMID:9780489

  16. Gunshot and Explosion Injuries

    PubMed Central

    Peleg, Kobi; Aharonson-Daniel, Limor; Stein, Michael; Michaelson, Moshe; Kluger, Yoram; Simon, Daniel; Noji, Eric K.

    2004-01-01

    Context: An increase of terror-related activities may necessitate treatment of mass casualty incidents, requiring a broadening of existing skills and knowledge of various injury mechanisms. Objective: To characterize and compare injuries from gunshot and explosion caused by terrorist acts. Methods: A retrospective cohort study of patients recorded in the Israeli National Trauma Registry (ITR), all due to terror-related injuries, between October 1, 2000, to June 30, 2002. The ITR records all casualty admissions to hospitals, in-hospital deaths, and transfers at 9 of the 23 trauma centers in Israel. All 6 level I trauma centers and 3 of the largest regional trauma centers in the country are included. The registry includes the majority of severe terror-related injuries. Injury diagnoses, severity scores, hospital resource utilization parameters, length of stay (LOS), survival, and disposition. Results: A total of 1155 terror-related injuries: 54% by explosion, 36% gunshot wounds (GSW), and 10% by other means. This paper focused on the 2 larger patient subsets: 1033 patients injured by terror-related explosion or GSW. Seventy-one percent of the patients were male, 84% in the GSW group and 63% in the explosion group. More than half (53%) of the patients were 15 to 29 years old, 59% in the GSW group and 48% in the explosion group. GSW patients suffered higher proportions of open wounds (63% versus 53%) and fractures (42% versus 31%). Multiple body-regions injured in a single patient occurred in 62% of explosion victims versus 47% in GSW patients. GSW patients had double the proportion of moderate injuries than explosion victims. Explosion victims have a larger proportion of minor injuries on one hand and critical to fatal injuries on the other. LOS was longer than 2 weeks for 20% (22% in explosion, 18% in GSW). Fifty-one percent of the patients underwent a surgical procedure, 58% in the GSW group and 46% in explosion group. Inpatient death rate was 6.3% (65 patients), 7

  17. Endovascular Repair of an Actively Hemorrhaging Stab Wound Injury to the Abdominal Aorta

    SciTech Connect

    Hussain, Qasim; Maleux, Geert Heye, Sam; Fourneau, Inge

    2008-09-15

    Traumatic injury of the abdominal aorta is rare and potentially lethal (Yeh et al., J Vasc Surg 42(5):1007-1009, 2005; Chicos et al., Chirurgia (Bucur) 102(2):237-240, 2007) as it can result in major retroperitoneal hemorrhage, requiring an urgent open surgery. In case of concomitant bowel injury or other conditions of hostile abdomen, endovascular repair can be an alternative treatment. This case report deals with a 50-year-old man presenting at the emergency ward with three stab wounds: two in the abdomen and one in the chest. During explorative laparotomy, liver laceration and bowel perforation were repaired. One day later, abdominal CT-scan revealed an additional retroperitoneal hematoma associated with an aortic pseudoaneurysm, located anteriorly 3 cm above the aortic bifurcation. Because of the risk of graft infection, an endovascular repair of the aortic injury using a Gore excluder stent-graft was performed. Radiological and clinical follow-up revealed a gradual shrinkage of the pseudo-aneurysm and no sign of graft infection at two years' follow-up.

  18. Evaluation of clonidine as an adjuvant to bupivacaine in wound infiltration for providing postoperative analgesia after abdominal hysterectomy

    PubMed Central

    Selvaraj, Venkatesh

    2016-01-01

    Background: Clonidine is an effective adjuvant to local anesthetics in peripheral nerve blocks. We studied the effect of clonidine as an adjuvant in wound infiltration for postoperative analgesia. Aim: To evaluate the role of clonidine as an adjuvant to bupivacaine in wound infiltration in terms of quality and duration of postoperative analgesia in patients undergoing total abdominal hysterectomy. Settings and Study Design: Prospective, randomized, double-blinded study. Materials and Methods: One hundred patients of American Society of Anesthesiologists I–II posted for abdominal hysterectomy were randomly allotted to two groups. Group A received wound infiltration with 45 ml of 0.25% bupivacaine with 3 μg/kg clonidine while Group B received wound infiltration with 45 ml of 0.25% bupivacaine. A standard general anesthesia technique was used in all the patients. Postoperative analgesia was provided with injection ketorolac 0.5 mg/kg intravenous infusion and tramadol being the rescue analgesic. Postoperative pain score, duration of effective analgesia before the first rescue analgesic, percentage of patients requiring rescue analgesic at different time intervals, and total number of rescue analgesic doses in 24 h were compared between the groups. Statistical Analysis: Difference between the bivariate samples in independent groups with Mann–Whitney U-test. For categorical data, Chi-square test was used. Results: Clonidine group has better pain score, longer duration of effective analgesia, lower percentage of patients requiring rescue analgesic, and less number of doses of rescue analgesia in the first 24 h. Conclusion: We conclude that Clonidine 3 μg/kg is an effective adjuvant to bupivacaine for wound infiltration in terms of quality and duration of postoperative analgesia following total abdominal hysterectomy. PMID:27746524

  19. Penetrating abdominal trauma.

    PubMed

    Henneman, P L

    1989-08-01

    The management of patients with penetrating abdominal trauma is outlined in Figure 1. Patients with hemodynamic instability, evisceration, significant gastrointestinal bleeding, peritoneal signs, gunshot wounds with peritoneal violation, and type 2 and 3 shotgun wounds should undergo emergency laparotomy. The initial ED management of these patients includes airway management, monitoring of cardiac rhythm and vital signs, history, physical examination, and placement of intravenous lines. Blood should be obtained for initial hematocrit, type and cross-matching, electrolytes, and an alcohol level or drug screen as needed. Initial resuscitation should utilize crystalloid fluid replacement. If more than 2 liters of crystalloid are needed to stabilize an adult (less in a child), blood should be given. Group O Rh-negative packed red blood cells should be immediately available for a patient in impending arrest or massive hemorrhage. Type-specific blood should be available within 15 minutes. A patient with penetrating thoracic and high abdominal trauma should receive a portable chest x-ray, and a hemo- or pneumothorax should be treated with tube thoracostomy. An unstable patient with clinical signs consistent with a pneumothorax, however, should receive a tube thoracostomy prior to obtaining roentgenographic confirmation. If time permits, a nasogastric tube and Foley catheter should be placed, and the urine evaluated for blood (these procedures can be performed in the operating room). If kidney involvement is suspected because of hematuria or penetrating trauma in the area of a kidney or ureter in a patient requiring surgery, a single-shot IVP should be performed either in the ED or the operating room. An ECG is important in patients with possible cardiac involvement and in patients over the age of 40 going to the operating room. Tetanus status should be updated, and appropriate antibiotics covering bowel flora should be given. Operative management should rarely be delayed

  20. Gunshot Wound of the Thoracic Aorta with Right Popliteal Artery Embolization: A Case Report of Bullet Embolism with Review of Relevant Literature

    PubMed Central

    Biswas, Saptarshi; Cadot, Hadley; Abrol, Sunil

    2013-01-01

    Bullet embolism is a well-known but relatively uncommon complication of gunshot injuries. Their rarity and the potential lack of early symptoms lead to delays in diagnosis and often in inadequate early management that can potentially result in the loss of a limb or life. We present an interesting case in which a small caliber bullet to the upper anterior abdomen penetrated the thoracic aorta and traveled to the right popliteal artery embolizing the vessel. The exploratory laparotomy failed to locate neither the bullet nor the trajectory resulting in sudden deterioration and eventual death 5 hours into the postoperative period. PMID:23662217

  1. Extremity gunshot injuries treated in an urban children's hospital.

    PubMed

    Victoroff, B N; Robertson, W W; Eichelberger, M R; Wright, C

    1994-02-01

    In the years 1985 to 1989 75 children and adolescents presented to an urban children's hospital for treatment of 76 incidents of extremity gunshot wounds. Although the population ranged widely, the "typical" patient was a preteen or teenager (n = 70) who was shot in the lower extremity (n = 53) with a low velocity handgun (n = 74). No vascular injuries and only two transient nerve injuries accompanied the wounds. Only 30% of the shots caused fractures. Many (43%) of the patients had other relevant psychosocial or medical problems. Previous treatment for other gunshot wounds or trauma had occurred in 27 patients. Although follow-up was not good, no consequent infections were identified. Outpatient local wound irrigation with minimal debridement sufficed as treatment for entry/exit wounds without contamination or fracture. Intravenous antibiotics are necessary in these wounds only for short-term prophylactic coverage of fractures. Larger soft tissue wounds, intraarticular foreign bodies, and fracture stabilization require operative treatment. PMID:8177799

  2. Conservative management of abdominal injuries

    PubMed Central

    Okuş, Ahmet; Sevinç, Barış; Ay, Serden; Arslan, Kemal; Karahan, Ömer; Eryılmaz, Mehmet Ali

    2013-01-01

    Objective: Non-operative management of abdominal injuries has recently become more common. Especially non-operative treatment of blunt abdominal trauma is gaining wide acceptance. In this study, the efficacy of non-operative treatment in abdominal trauma (blunt penetrating) is discussed. Material and Methods: All patients who received treatment due to abdominal trauma from November 2008 to January 2013 were retrospectively analyzed. The demographic characteristics, type of injury, injured organ, type of treatment (operative vs. nonoperative) and mortality data were evaluated. Results: The study includes 115 patients treated for abdominal trauma in our department. The mechanism of trauma was stab wounds in 60%, blunt abdominal trauma in 23.5% and gunshot wounds in 16.5%. Forty-two patients (36.5%) were operated for hemodynamic instability and/or peritonitis on admission. The remaining 63.5% of patients (n=73) were treated nonoperatively, 10 of whom required laparotomy during follow-up. The remaining 63 patients were treated with non-operative management. The success rate for non-operative treatment was 86.3% and there was no difference in terms of the types of injuries. The mortality rate was 4.3% (n= 5) in the whole series, but there were no deaths among the patients who had received non-operative treatment. In the whole patient group 54.2% (n=63) were treated nonoperatively. Conclusion: Nonoperative treatment in abdominal trauma is safe and effective. Patients with clinical stability and normal physical examination findings can be treated nonoperatively with close monitoring. PMID:25931868

  3. Usefulness and limitations of postmortem computed tomography in forensic analysis of gunshot injuries: Three case reports.

    PubMed

    Usui, Akihito; Kawasumi, Yusuke; Hosokai, Yoshiyuki; Kozakai, Masataka; Saito, Haruo; Funayama, Masato

    2016-01-01

    Gunshot injury has always been an important field of investigation in postmortem forensic radiology. The localization and retrieval of the bullet and of potentially important fragments are vital to these cases. Using postmortem multidetector-row computed tomography (MDCT) prior to forensic autopsy, we sought to illustrate the importance of this modality in the noninvasive characterization of gunshot wounds. We obtained and analyzed MDCT images in three cases of gunshot wounds (accidental close-range shotgun shooting, suicidal contact gunshot to the head and accidental long-range buckshot shooting). We discuss the value of postmortem MDCT findings in gunshot wound cases by comparing with forensic autopsy findings in Japan, a developing country with miserably low autopsy rate. PMID:26832386

  4. Macroscopic, microscopic, and chemical assessment of gunshot lesions on decomposed pig skin.

    PubMed

    Gibelli, Daniele; Brandone, Alberto; Andreola, Salvatore; Porta, Davide; Giudici, Elena; Grandi, Marco Aurelio; Cattaneo, Cristina

    2010-07-01

    Very little literature exists on gunshot wounds on decomposed material. In this study, seven pig heads underwent a shooting test. Entrance wounds from the first head underwent neutron activation analysis (NAA) and histological testing immediately after the firing test; the other six heads were exposed to two different environments (open air and soil) and analyzed by radiochemical and histological tests every 15 days. Gunshot wounds in air maintained their morphological characteristics, and those in soil showed severe alteration after 5 weeks. Microscopic testing verified positive results for lead in all gunshot wounds in open air, whereas in most of those in soil lead could not be detected. Radiochemical analysis performed by NAA yielded for all gunshot wounds but one antimony quantities in the range of 0.07-13.89 microg. In conclusion, it may be possible to detect residues of antimony even in degraded tissues.

  5. Wound Edge Protectors in Open Abdominal Surgery to Reduce Surgical Site Infections: A Systematic Review and Meta-Analysis

    PubMed Central

    Mihaljevic, André L.; Müller, Tara C.; Kehl, Victoria; Friess, Helmut; Kleeff, Jörg

    2015-01-01

    Importance Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality. Objective To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections. Evidence Review A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted. Findings We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51–0.83; p = 0.0007; I2 = 52%). The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44–0.97; p = 0.04; I2 = 56%). Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15–0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54–0.92), but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28–0.67; p = 0.0002, I2 = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57–0.91; p = 0.005; I2 = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24–0.82; p = 0.001; I2 = 72%). Conclusions and Relevance Wound edge protectors significantly reduce the rate of

  6. Perforated second trimester appendicitis with abdominal compartment syndrome managed with negative pressure wound therapy and open abdomen

    PubMed Central

    Turnock, Adam R.; Fleischer, Brian P.; Carney, Martin J.; Vanderlan, Wesley B.

    2016-01-01

    Abdominal compartment syndrome (ACS) is a known complication of laparotomy; however, the literature is lacking in regards to treatment of this entity in pregnant patients. We present a case of acute perforated appendicitis in a second trimester primagravida, complicated by gangrenous necrosis of the contiguous bowel with subsequent development of ACS and intra-abdominal sepsis. This was treated with a novel approach, using non-commercial negative pressure wound therapy and open abdomen technique. Gestational integrity was preserved and the patient went on to experience a normal spontaneous vaginal delivery. At 5 years post-delivery the patient has had no surgical complications and her baby has met all developmental milestones. PMID:27302498

  7. Successful management of abdominal wound dehiscence using a vacuum assisted closure system combined with mesh-mediated medial traction.

    PubMed

    Lord, A C; Hompes, R; Venkatasubramaniam, A; Arnold, S

    2015-01-01

    Management of the open abdomen has advanced significantly in recent years with the increasing use of vacuum assisted closure (VAC) techniques leading to increased rates of fascial closure. We present the case of a patient who suffered two complete abdominal wall dehiscences after an elective laparotomy, meaning primary closure was no longer possible. She was treated successfully with a VAC system combined with continuous medial traction using a Prolene(®) mesh. This technique has not been described before in the management of patients following wound dehiscence. PMID:25519257

  8. Successful management of abdominal wound dehiscence using a vacuum assisted closure system combined with mesh-mediated medial traction.

    PubMed

    Lord, A C; Hompes, R; Venkatasubramaniam, A; Arnold, S

    2015-01-01

    Management of the open abdomen has advanced significantly in recent years with the increasing use of vacuum assisted closure (VAC) techniques leading to increased rates of fascial closure. We present the case of a patient who suffered two complete abdominal wall dehiscences after an elective laparotomy, meaning primary closure was no longer possible. She was treated successfully with a VAC system combined with continuous medial traction using a Prolene(®) mesh. This technique has not been described before in the management of patients following wound dehiscence.

  9. “Time is brain” the Gifford factor - or: Why do some civilian gunshot wounds to the head do unexpectedly well? A case series with outcomes analysis and a management guide

    PubMed Central

    Lin, David J.; Lam, Fred C.; Siracuse, Jeffrey J.; Thomas, Ajith; Kasper, Ekkehard M.

    2012-01-01

    Background: Review of intracranial gunshot wounds (GSWs) undergoing emergent neurosurgical intervention despite a very low Glasgow Coma Scale (GCS) score on admission in order to identify predictors of good outcome, with correlates to recent literature. Methods: A retrospective review of select cases of GSWs presenting to our trauma center over the past 5 years with poor GCS requiring emergent neurosurgical intervention and a minimum of 1-year follow-up. Results: Out of a total of 17 patients who went to the operating room (OR) for GSW to the head during this period, 4 cases with a GCS < 5 on admission were identified. All cases required a hemicraniectomy to alleviate cerebral swelling. Two cases presented with a unilaterally blown pupil due to raised intracranial pressure. The remaining 2 cases had equal and reactive pupils. One patient with a GCS of 3 and a significant bilateral pattern of parenchymal bullet injury was initially assessed in moribund status but rallied and received a delayed hemicraniectomy on day 7. Three out of 4 patients are functionally independent at 1-year follow-up. The fourth patient who received a delayed decompression remains wheelchair dependent. Conclusion: Victims of GSWs can have good outcomes despite having a very poor admission GCS score and papillary abnormalities. Factors predicting good outcomes include the following: time from injury to surgical intervention of < 1 h; injury to noneloquent brain; and absence of injury to midbrain, brainstem, and major vessels. PMID:23061014

  10. Identification of gunpowder in healed wounds.

    PubMed

    Smith, O C; Berryman, H E; Symes, S A; LeVaughn, M M

    1993-05-01

    A woman received a contact gunshot wound to the abdomen from a .22 caliber revolver. She recovered only to succumb to another gunshot wound six months later. The initial wound was dissected and multiple intact granules of round flake gunpowder were recovered. Cross sections of granules were clearly identifiable in histologic slides. Recovery of intact powder in remote wounds has not been previously described and may help classify the ammunition and weapon used to produce the injury.

  11. Gunshot residue preservation in seawater.

    PubMed

    Lindström, Anne-Christine; Hoogewerff, Jurian; Athens, Josie; Obertova, Zuzana; Duncan, Warwick; Waddell, Neil; Kieser, Jules

    2015-08-01

    Little is known about the persistence of gunshot residue (GSR) in soft tissue and bones during decomposition in marine environments. For a better understanding, qualitative and quantitative data were obtained on GSR retention on soft tissue and bony gunshot wounds (GSWs). A quantity of 36 fleshed and 36 defleshed bovine ribs were shot at contact range with 0.22 calibre hollow point ammunition using a Stirling 0.22 calibre long rifle. Bone specimens in triplicate were placed in three environments: submerged, intertidal and in supralittoral zone. Sets of triplicates were recovered on day 3, 10, 24 and 38, and analysed with scanning electron microscopy with energy dispersive X-ray spectrometry (SEM-EDX), and inductive coupled plasma mass spectrometry (ICP-MS). The SEM-EDX recorded GSR-indicative particles surrounding the bullet entrance on all bone types (fleshed and defleshed) in all environments throughout the study. GSR-unique particles were only detected on the supralittoral bones. The ICP-MS analysis showed faster GSR loss on submerged than intertidal and supralittoral defleshed specimens. Fleshed specimens showed a faster GSR loss on intertidal than submerged and supralittoral specimens. In conclusion, the GSR disappeared faster from submerged and intertidal than non-submerged specimens. The difference of detection of GSR between analysed specimens (defleshed versus fleshed) disappeared upon defleshing. This study highlights the potential of finding evidence of GSR in a submerged body and the potential of microscopic and analytical methods for examining suspected GSW in highly decomposed bodies in marine habitats.

  12. USE OF ALLOPLASTIC MESHES IN ABDOMINAL WOUNDS OF RATS WITH INDUCED PERITONITIS

    PubMed Central

    BARBUTO, Rafael Calvão; DUVAL-ARAUJO, Ivana; BARRAL, Sumara Marques; ROCHA, Raphael Grossi; BECHARA, Cristiane de Souza; BARBOSA, Alfredo José Afonso

    2014-01-01

    Background The use of alloplastic meshes has been historically contra-indicated in patients with infection. Aim To evaluate the use of polypropylene meshes in the treatment of abdominal wall defects in rats with peritonitis. Methods Twenty Wistar female rats were divided into two groups: induction of peritonitis (test group) and without peritonitis (control group). An abdominal wall defect was created in all animals, and polypropylene mesh was applied. The evaluation of the tensile strength of the mesh was carried out using tensiometer and microscopic analysis of the healing area was done. Results More adhesion of the mesh to the rat abdominal wall was observed in test group. The histopathological analyses showed prevalence of moderate to accentuated granulation tissue in both groups, without significant differences. Conclusion The use of the mesh coverage on abdominal wall defects of rats with induced peritonitis did not show worse results than its use in healthy animals, nor was its integration to the resident tissue any worse. PMID:24676294

  13. Gunshot residue preservation in seawater.

    PubMed

    Lindström, Anne-Christine; Hoogewerff, Jurian; Athens, Josie; Obertova, Zuzana; Duncan, Warwick; Waddell, Neil; Kieser, Jules

    2015-08-01

    Little is known about the persistence of gunshot residue (GSR) in soft tissue and bones during decomposition in marine environments. For a better understanding, qualitative and quantitative data were obtained on GSR retention on soft tissue and bony gunshot wounds (GSWs). A quantity of 36 fleshed and 36 defleshed bovine ribs were shot at contact range with 0.22 calibre hollow point ammunition using a Stirling 0.22 calibre long rifle. Bone specimens in triplicate were placed in three environments: submerged, intertidal and in supralittoral zone. Sets of triplicates were recovered on day 3, 10, 24 and 38, and analysed with scanning electron microscopy with energy dispersive X-ray spectrometry (SEM-EDX), and inductive coupled plasma mass spectrometry (ICP-MS). The SEM-EDX recorded GSR-indicative particles surrounding the bullet entrance on all bone types (fleshed and defleshed) in all environments throughout the study. GSR-unique particles were only detected on the supralittoral bones. The ICP-MS analysis showed faster GSR loss on submerged than intertidal and supralittoral defleshed specimens. Fleshed specimens showed a faster GSR loss on intertidal than submerged and supralittoral specimens. In conclusion, the GSR disappeared faster from submerged and intertidal than non-submerged specimens. The difference of detection of GSR between analysed specimens (defleshed versus fleshed) disappeared upon defleshing. This study highlights the potential of finding evidence of GSR in a submerged body and the potential of microscopic and analytical methods for examining suspected GSW in highly decomposed bodies in marine habitats. PMID:26115226

  14. Nasolabial Flap in Maxillofacial Gunshot Trauma: A Case Series

    PubMed Central

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2016-01-01

    Introduction The nasolabial flap (NLF) has many advantages in oromaxillary reconstruction, but the majority of cases are reconstructions after pathologic resections. Its usage in trauma surgery, especially in the management of gunshot wounds, is rarely mentioned. Case Presentation Three cases involving gunshot injuries to the face are presented: one for reconstruction of the nasal ala, another for bone graft coverage in mandibular reconstruction, and the third for the repair of premaxillary hard and soft tissue avulsive defects. Conclusions The NLF is a thin, pliable flap and is useful for intraoral and facial reconstruction of trauma patients with small to moderate soft tissue loss. PMID:27148497

  15. Unusually low mortality of penetrating wounds of the chest. Twelve years' experience.

    PubMed

    Mandal, A K; Oparah, S S

    1989-01-01

    Within a 12-year period ending in March 1984, 1109 patients with penetrating thoracic injuries were treated at King-Drew Medical Center located in south central Los Angeles. The average age of the patients was 28.1 years. There were 607 stab wounds and 502 gunshot wounds. Antibiotic prophylaxis was prescribed only for the 428 patients who had laparotomy, thoracotomy, and pulmonary contusion with hemoptysis. Of the 1109 patients, 105 had cardiac injuries. All patients with cardiac trauma underwent thoracotomy, and the mortality rate was 18.1%. Specifically, the mortality rate of gunshot wound of the heart 24.5% and that of stab wound of the heart, 11.5%. In contrast, of the 1004 patients without cardiac injuries, only 115 required thoracotomy and the mortality rate in this group was 0.8% (8/1004). The mortality rate was 69.6% in patients who had a thoracotomy in the emergency room but only 2.8% in patients who had a thoracotomy in the operating room within the first 24 hours after admission. In the 242 patients who had associated abdominal injuries, the mortality rate was 2.1% (5/242), as compared with 2.5% (22/867) for those who had isolated chest injuries. In the entire group, the incidence of complications was 5.1%, of which 1.8% were infectious complications. The presence of associated abdominal injuries did not influence the outcome. The mortality rate in noncardiac thoracic injuries is very low compared with that of cardiac injury. Because of the complexity of the injury, gunshot wound of the heart has the highest mortality rate.

  16. Penetrating wounds to the anterior chest. Analysis of thoracotomy and laparotomy.

    PubMed

    Borlase, B C; Metcalf, R K; Moore, E E; Manart, F D

    1986-12-01

    This study of the records of 193 consecutive patients admitted for penetrating anterior chest wounds was carried out to specifically define the need for emergent thoracotomy or laparotomy. The mechanism of injury was a stab wound in 119 patients and a gunshot wound in 74 patients. Seventy-three of the patients (38 percent) required either early thoracotomy (21 percent) or laparotomy (17 percent). In the upper chest region, 83 percent of the operations were thoracotomies, whereas in the lower chest region, 81 percent were laparotomies. Pericardial tamponade, chest tube output, and hypovolemic shock comprised 91 percent of the decisive signs for thoracotomy. The predominant reason for laparotomy was diagnostic peritoneal lavage (63 percent of patients). Plain abdominal roentgenograms were helpful to confirm diaphragmatic missile traverse. Our findings support selective operative management of anterior chest wounds as guided by injury mechanism and entrance location. PMID:3789289

  17. Gunshot injuries in the neck area: ballistics elements and forensic issues.

    PubMed

    Pinto, Antonio; Brunese, Luca; Scaglione, Mariano; Scuderi, Maria Giuseppina; Romano, Luigia

    2009-06-01

    The neck is an interesting structure as far as penetrating trauma is concerned because of the multiple vital structures that are concentrated in a small anatomic area. Gunshot wounding is an interaction between the penetrating projectile, the anatomy of the wounded subject, and the chance occurrences that determine the exact missile path. The mass and velocity of the projectile establish the upper limit of possible tissue damage. Management of gunshot neck injuries depends on a clear understanding of the anatomy of the neck. The radiologist can contribute substantially to the successful treatment of the patient with a gunshot wound. Important analysis includes the assessment of the missile path in emergency conditions by using plain film and multidetector row computed tomography. The radiologist further evaluates the extent of wounding by determining missile fragmentation and secondary missile paths.

  18. [Comparative evaluation of drainage methods used for penetrating gunshot cerebral injuries].

    PubMed

    Orlov, V P

    2016-04-01

    The paper presents a comparative evaluation of the methods of gunshot craniocerebral wounds draining, applied when the primary surgical treatment at the stages of medical evacuation of the limited contingent of Soviet troops in Afghanistan. An analysis of occurring infectious complications and outcomes of surgical treatment of the wounded is given. Based on clinical observations revealed most effective method of the active drainage gunshot traumatic brain injuries. The advantages of tidal drainage, appropriate for mechanical cleaning of wounds, allows controlling hemostasis, using antibacterial solutions are given. PMID:27416716

  19. Porcine acellular lung matrix for wound healing and abdominal wall reconstruction: A pilot study.

    PubMed

    Fernandez-Moure, Joseph S; Van Eps, Jeffrey L; Rhudy, Jessica R; Cabrera, Fernando J; Acharya, Ghanashyam S; Tasciotti, Ennio; Sakamoto, Jason; Nichols, Joan E

    2016-01-01

    Surgical wound healing applications require bioprosthetics that promote cellular infiltration and vessel formation, metrics associated with increased mechanical strength and resistance to infection. Porcine acellular lung matrix is a novel tissue scaffold known to promote cell adherence while minimizing inflammatory reactions. In this study, we evaluate the capacity of porcine acellular lung matrix to sustain cellularization and neovascularization in a rat model of subcutaneous implantation and chronic hernia repair. We hypothesize that, compared to human acellular dermal matrix, porcine acellular lung matrix would promote greater cell infiltration and vessel formation. Following pneumonectomy, porcine lungs were processed and characterized histologically and by scanning electron microscopy to demonstrate efficacy of the decellularization. Using a rat model of subcutaneou implantation, porcine acellular lung matrices (n = 8) and human acellular dermal matrices (n = 8) were incubated in vivo for 6 weeks. To evaluate performance under mechanically stressed conditions, porcine acellular lung matrices (n = 7) and human acellular dermal matrices (n = 7) were implanted in a rat model of chronic ventral incisional hernia repair for 6 weeks. After 6 weeks, tissues were evaluated using hematoxylin and eosin and Masson's trichrome staining to quantify cell infiltration and vessel formation. Porcine acellular lung matrices were shown to be successfully decellularized. Following subcutaneous implantation, macroscopic vessel formation was evident. Porcine acellular lung matrices demonstrated sufficient incorporation and showed no evidence of mechanical failure after ventral hernia repair. Porcine acellular lung matrices demonstrated significantly greater cellular density and vessel formation when compared to human acellular dermal matrix. Vessel sizes were similar across all groups. Cell infiltration and vessel formation are well-characterized metrics of incorporation

  20. Porcine acellular lung matrix for wound healing and abdominal wall reconstruction: A pilot study

    PubMed Central

    Fernandez-Moure, Joseph S; Van Eps, Jeffrey L; Rhudy, Jessica R; Cabrera, Fernando J; Acharya, Ghanashyam S; Tasciotti, Ennio; Sakamoto, Jason; Nichols, Joan E

    2016-01-01

    Surgical wound healing applications require bioprosthetics that promote cellular infiltration and vessel formation, metrics associated with increased mechanical strength and resistance to infection. Porcine acellular lung matrix is a novel tissue scaffold known to promote cell adherence while minimizing inflammatory reactions. In this study, we evaluate the capacity of porcine acellular lung matrix to sustain cellularization and neovascularization in a rat model of subcutaneous implantation and chronic hernia repair. We hypothesize that, compared to human acellular dermal matrix, porcine acellular lung matrix would promote greater cell infiltration and vessel formation. Following pneumonectomy, porcine lungs were processed and characterized histologically and by scanning electron microscopy to demonstrate efficacy of the decellularization. Using a rat model of subcutaneou implantation, porcine acellular lung matrices (n = 8) and human acellular dermal matrices (n = 8) were incubated in vivo for 6 weeks. To evaluate performance under mechanically stressed conditions, porcine acellular lung matrices (n = 7) and human acellular dermal matrices (n = 7) were implanted in a rat model of chronic ventral incisional hernia repair for 6 weeks. After 6 weeks, tissues were evaluated using hematoxylin and eosin and Masson’s trichrome staining to quantify cell infiltration and vessel formation. Porcine acellular lung matrices were shown to be successfully decellularized. Following subcutaneous implantation, macroscopic vessel formation was evident. Porcine acellular lung matrices demonstrated sufficient incorporation and showed no evidence of mechanical failure after ventral hernia repair. Porcine acellular lung matrices demonstrated significantly greater cellular density and vessel formation when compared to human acellular dermal matrix. Vessel sizes were similar across all groups. Cell infiltration and vessel formation are well-characterized metrics of incorporation

  1. [Forensic aspects of gunshot suicides in Germany].

    PubMed

    Kunz, Sebastian Niko; Meyer, Harald J; Kraus, Sybille

    2013-12-01

    Suicidal gunshot wounds are a common appearance in forensic casework. The main task of the coroner lies in the detection of typical pathomorphological correlates, thus differentiating between homicide, suicide and accident. Apart from characteristic bloodstain patterns on the gun and shooting hand, the localisation of the entrance wound and the position of the weapon, additional details such as family background or medical history are important aspects of forensic investigation. An uncommon choice of weaponry and its unusual morphological manifestation often complicate the examination and reconstruction of such cases. Furthermore, due to social stigmatisation, the possibility of secondary changes by relatives at the crime scene should be considered. In addition to autopsy findings, a careful crime scene investigation and bloodstain pattern analysis, a ballistic reconstruction can be an essential tool to gain knowledge of the shooting distance and position of the gun. PMID:23857247

  2. [Forensic aspects of gunshot suicides in Germany].

    PubMed

    Kunz, Sebastian Niko; Meyer, Harald J; Kraus, Sybille

    2013-12-01

    Suicidal gunshot wounds are a common appearance in forensic casework. The main task of the coroner lies in the detection of typical pathomorphological correlates, thus differentiating between homicide, suicide and accident. Apart from characteristic bloodstain patterns on the gun and shooting hand, the localisation of the entrance wound and the position of the weapon, additional details such as family background or medical history are important aspects of forensic investigation. An uncommon choice of weaponry and its unusual morphological manifestation often complicate the examination and reconstruction of such cases. Furthermore, due to social stigmatisation, the possibility of secondary changes by relatives at the crime scene should be considered. In addition to autopsy findings, a careful crime scene investigation and bloodstain pattern analysis, a ballistic reconstruction can be an essential tool to gain knowledge of the shooting distance and position of the gun.

  3. Potent anti-inflammatory agent escin does not affect the healing of tibia fracture and abdominal wound in an animal model

    PubMed Central

    ZHANG, LEIMING; WANG, HONGSHENG; WANG, TIAN; JIANG, NA; YU, PENGFEI; LIU, FEIYAN; CHONG, YATING; FU, FENGHUA

    2012-01-01

    Escin, a potent anti-inflammatory and anti-edematous agent, has been widely used clinically in preventing inflammatory edema after trauma, such as fracture and surgery. The aim of this study was to investigate whether escin has an inhibitory effect on fracture healing, and whether escin has an inhibitory effect on wound healing after surgery. Male New Zealand white rabbits underwent tibial mid-diaphyseal osteotomy, and were administered escin once per day for 10 days. At weeks 2, 4 and 6, bone fracture healing and bone mineral density were measured. The histologic examination of callus, osteocalcin, alkaline phosphatase, calcium and phosphate in the serum were also assayed. In another experiment, the rats underwent midline laparotomy, and received escin once prior to or after the operation. Six days later, the abdominal incision wounds were excised for measuring hydroxyproline levels. The results showed that there were no significant differences in fracture healing between the model and rabbits administered escin, and escin did not affect the hydroxyproline levels in the abdominal incision wounds of the rats. These findings suggest that escin has no inhibitory effect on fracture and wound healing in animal models. PMID:22969961

  4. A case report of a 19-week gravid patient with a dehisced abdominal wound and treated with V.A.C. ATS(®) Therapy System.

    PubMed

    Asukai, Kei; Kashiwazaki, Masaki; Koizumi, Kaori; Nobunaga, Toshikatsu; Yano, Hiroshi

    2016-10-01

    Negative pressure wound therapy (NPWT) is an effective treatment for various non-healing wounds, and V.A.C.(®) Therapy was the first-approved NPWT device by the Japanese government in 2009. We report the case of a 19-week pregnant patient where V.A.C.(®) Therapy was applied to her dehisced laparotomy wound with satisfactory results. The patient was a 30-year-old female who was referred to our hospital from her previous doctor because of the presence of an ovarian cyst on the left ovary. The patient presented at 14 weeks into her pregnancy, and surgery was considered because of no reduction in the size of the cyst. An oophorocystectomy was performed, and then the surgical incision was re-opened at postoperative day (POD) 10 due to a surgical site infection. V.A.C.(®) Therapy was initiated on POD 26 (20 weeks of pregnancy) and continued for 28 days. After 28 days of V.A.C.(®) Therapy (POD 54), the wound was sutured for complete closure. The foetus did not experience any adverse affects from the surgery and, subsequently, normal vaginal delivery was achieved. This case is the first report of the use of V.A.C.(®) Therapy over a dehisced abdominal wound on a pregnant patient in our country.

  5. Multiple gunshot suicides: potential for physical activity and medico-legal aspects.

    PubMed

    Karger, B; Brinkmann, B

    1997-01-01

    Out of 138 clearly defined gunshot suicides which were autopsied, 11 persons (8%) fired two or more gunshots to the body. From these 11, 5 cases involved 2 gunshots to the head where the bullets fired first had missed the brain. The trajectories were restricted to the chest in three cases and a combination of gunshots to the head and chest including two perforating heart wounds without immediate incapacitation occurred in three more cases. Reliable incapacitation is based on physiological effects (tissue disruption) and can only be achieved by decreasing the functioning capability of the CNS. This can be accomplished by direct disruption of brain tissue or indirectly by cerebral hypoxemia from massive bleeding. Targets of immediate incapacitation are restricted to certain CNS areas and targets of rapid incapacitation include the heart, the (thoracic) aorta and the pulmonary artery. Other major blood vessels and major organs (lungs, kidneys, liver, spleen) constitute targets of delayed incapacitation. This general classification can be derived from the literature and is illustrated by the cases presented. A thorough post mortem can exclude or quantify the potential for physical activity. Typical features of single gunshot suicides such as contact shots, classical entrance wound sites and soot/backspatter on a hand also occur in multiple gunshot suicides.

  6. Intrauterine Fetal Death in Gunshot Injury to the Gravid Uterus: Forensic Perspective

    PubMed Central

    Kumar, Senthil; Rao, Murali G

    2015-01-01

    Assault on pregnant women is not a rare event; however forensic analysis of gunshot injuries among the same group requires a greater deliberation. This is the report of a 38-week-old fetus which succumbed following gunshot injuries to the mother while the latter survived. The uniqueness of fetal injuries in the form of avulsed wound with complete detachment of anus is of great forensic interest. Such unusual wound pattern could have been the result of a blast wave effect created due to the high velocity projectile affecting the fluid filled uterine cavity. PMID:26435965

  7. Abdominal injuries in communal crises: The Jos experience

    PubMed Central

    Ojo, Emmanuel Olorundare; Ozoilo, Kenneth N.; Sule, Augustine Z.; Ugwu, Benjamin T.; Misauno, Michael A.; Ismaila, Bashiru O.; Peter, Solomon D.; Adejumo, Adeyinka A.

    2016-01-01

    Background: Abdominal injuries contribute significantly to battlefield trauma morbidity and mortality. This study sought to determine the incidence, demographics, clinical features, spectrum, severity, management, and outcome of abdominal trauma during a civilian conflict. Materials and Methods: A prospective analysis of patients treated for abdominal trauma during the Jos civil crises between December 2010 and May 2012 at the Jos University Teaching Hospital. Results: A total of 109 victims of communal conflicts with abdominal injuries were managed during the study period with 89 (81.7%) males and 20 (18.3%) females representing about 12.2% of the total 897 combat related injuries. The peak age incidence was between 21 and 40 years (range: 3–71 years). The most frequently injured intra-abdominal organs were the small intestine 69 (63.3%), colon 48 (44%), and liver 41 (37.6%). Forty-four (40.4%) patients had extra-abdominal injuries involving the chest in 17 (15.6%), musculoskeletal 12 (11%), and the head in 9 (8.3%). The most prevalent weapon injuries were gunshot 76 (69.7%), explosives 12 (11%), stab injuries 11 (10.1%), and blunt abdominal trauma 10 (9.2%). The injury severity score varied from 8 to 52 (mean: 20.8) with a fatality rate of 11 (10.1%) and morbidity rate of 29 (26.6%). Presence of irreversible shock, 3 or more injured intra-abdominal organs, severe head injuries, and delayed presentation were the main factors associated with mortality. Conclusion: Abdominal trauma is major life-threatening injuries during conflicts. Substantial mortality occurred with loss of nearly one in every 10 hospitalized victims despite aggressive emergency room resuscitation. The resources expenditure, propensity for death and expediency of timing reinforce the need for early access to the wounded in a concerted trauma care systems. PMID:26957819

  8. Gunshot residues on dry bone after decomposition--a pilot study.

    PubMed

    Taborelli, Anna; Gibelli, Daniele; Rizzi, Agostino; Andreola, Salvatore; Brandone, Alberto; Cattaneo, Cristina

    2012-09-01

    Very little literature exists concerning radiochemical and microscopic analyses of gunshot wounds in decomposed material, and even less concerning skeletonized samples; the most advanced technologies may provide useful indications for the diagnosis of suspect lesions, especially if gunshot wounds are no longer recognizable. However, we know very little of the survival of gunshot residues (GSR) in skeletonized samples. This study examined nine gunshot wounds produced on pig heads which then underwent skeletonization for 4 years, and four gunshot entries on human heads from judicial cases which were then macerated to the bone in water; the samples underwent scanning electron microscopy coupled with energy dispersive X-ray (SEM-EDX) analysis. Positive results for GSR were observed only in four of the nine animal samples and in all four human samples. Among the human samples, two lesions showed Pb and Sb, one lesion only Pb, and one Pb, Sb, and Ba. This pilot study showed the survival of GSR in skeletal material and therefore the crucial importance of SEM-EDX analyses on skeletonized material. Further studies are needed in order to ascertain the role of environmental modifications of GSR.

  9. [Atypical trajectory of gunshot injury].

    PubMed

    Aygün, Mert; Tulay, Cumhur Murat

    2014-11-01

    Gunshot injuries are common medical-legal issues. Atypical tract lines resulting from this type of injuries cause difficulties in diagnosis and treatment. In this paper, a gunshot injury on the right anterior thigh extending to the right hemithorax was presented. A 67-year-old Syrian refugee patient was brought to the emergency service due to gunshot injury. Bullet entrance hole was determined on the right anterior thigh region; however, exit side could not be seen. Bullet was determined on the right thorax at tomography and the patient was taken to operation due to diaphragm rupture and lung parenchymal injury. Other body parts must be examined radiologically for the bullet which cannot be determined at gunshot injury side. PMID:25541926

  10. [Gunshot into the eye].

    PubMed

    Schyma, C; Schyma, P

    1996-01-01

    A 55-year-old man was found dead sitting at his work-bench. A pistol Parabellum 1908 (9 mm Luger) was disassembled on the work-table. A pack of 9 mm Luger full metal jacket ammunition was opened. The left side of his glasses and the left eye were injured. The autopsy proved the death from air embolism. Radiography of the head revealed metallic fragments along the bullet path. The bullet had lost the jacket and the core was fragmented. Gunshot residues on the hands of the deceased and on the left side of the face indicated that the lethal injury was self inflicted. The function of the pistol "08" explicated that a shot could be fired from the isolated barrel which formed a unit with the bolt. The bullet showed traces of manipulation. In the house there were found other self-made dumdum-bullets. Death could be explained as an accident while cleaning the pistol.

  11. Analysis of gunshot residues on human tissues and clothing by X-ray microfluorescence.

    PubMed

    Brazeau, J; Wong, R K

    1997-05-01

    The analysis of gunshot residues on human tissues and clothing in suicide, homicide, suspicious death, or attempted murder events, permits the forensic scientist to confirm the possibility of an entry wound caused by a gunshot bullet from a pistol, revolver, rifle, etc. The residues to be detected are lead (Pb), antimony (Sb), barium (Ba) usually from the primer, copper (Cu) and zinc (Zn) usually from the metal jacket bullet and iron (Fe) possibly from the barrel of the gun used. The presence or absence of these elements and their relative concentrations can help in the interpretation of the event.

  12. Imaging of gunshot injuries in a west Dublin teaching hospital--a ten year review.

    PubMed

    Murphy, I; Lavelle, L; Ni Mhurchu, E; McCarthy, R; Heffernan, E

    2014-09-01

    There has been an increase in gun-related crime in Ireland over the last decade to gangland violence, especially in west Dublin. This places a burden on hospital services not previously encountered. The aim of this study was to examine the demographics of gunshot: injuries presenting to a Dublin teaching hospital, and the impact on radiology over a ten year period. A total of 65 gunshot injuries were seen. Mortality for high velocity wounds was much higher (10/23, 43%) than for low-velocity shotgun injuries (2/34, 6%).

  13. Wound infiltration with plain bupivacaine as compared with bupivacaine fentanyl mixture for postoperative pain relief after abdominal surgery

    PubMed Central

    Chander, Reetika; Liddle, Dootika; Kaur, Baljinder; Varghese, Mary

    2011-01-01

    Aim: To compare the efficacy of wound infiltration with Bupivacaine or Bupivacaine with fentanyl for post operative analgesia. Background: The role of Bupivacaine and fentanyl mixture as wound infiltration for post operative analgesia is less explored in human subjects. Materials and Methods: This prospective, randomized included 60 ASA grade I, II, and III patients in the age group of 20-75 years of age. The patients were randomized into two groups of 30 patients each: Group A received wound infiltration with a solution containing 0.5% bupivacaine (2 mg/kg), while, Group B received infiltration with a solution containing fentanyl 25 μg added to 0.5% bupivacaine (2 mg/kg). Results: None of the patients in both groups had unbearable incisional pain but addition of fentanyl to 0.5% bupivacaine reduced analgesic consumption in the postoperative period (P<0.05). Conclusion: Addition of opioids to local anesthetics results in better postoperative analgesia and reduced opioid requirement post operatively. PMID:25885377

  14. Late presentation of a shrapnel wound-induced traumatic intra-thoracic abdominal evisceration, as colon perforation with left faecopneumothorax.

    PubMed

    Popentiu, A I; Weber-Lauer, C; Nieman, C; Kauvar, D S; Sabau, D

    2010-01-01

    The diaphragmatic hernia is a well recognized and common complication of both the penetrating and blunt thoracoabdominal trauma.The clinical presentation is eather in the acute phase, or later, when it features the symptoms of obstructive complications. The aim of the study is to report a case of delayed presentation of a blast wound with diaphragmatic hernia, complicated by herniation and perforation of the left colonic angle in the pleural cavity. The report highlights the multiple complications following the initial event and the staged management of the case.

  15. Reconstruction and rehabilitation of short-range gunshot injury to lower part of face: A systematic approach of three cases.

    PubMed

    Vatsyayan, Ashutosh; Adhyapok, Apurba-Kumar; Debnath, Subhas-Chandra; Malik, Kapil

    2016-08-01

    Gunshot injuries are always known to cause severe morbidity and mortality when head and neck are involved. They vary in morbidity, which can occur in civilian surroundings. The wound largely depends on the type of weapon, mass and velocity of the bullet, and the distance from where it has been shot. Close-range gunshot wounds in the head and neck region can result in devastating aesthetic and functional impairment. The complexity in facial skeletal anatomy cause multiple medical and surgical challenges to an operating surgeon, demanding elaborate soft and hard tissue reconstruction. Here we presented the successful management of three patients shot by short-range pistol with basic life support measures, wound management, reconstruction and rehabilitation. PMID:27578384

  16. Detectability and medico-legal value of the gunshot residues in the intracorporeal channel.

    PubMed

    Migliorini, Arnaldo Stanislao; Andreola, Salvatore; Battistini, Alessio; Gentile, Guendalina; Muccino, Enrico; Vancheri, Giulia; Zoja, Riccardo

    2015-11-01

    The application of the histochemical stain of sodium rhodizonate to the entrance wound for the detection of the lead (Pb) residues coming from the gunshot may be affected by false positive cases due to the contamination of the environmental Pb. The aim of the Authors is to histochemically search the Pb of GSR in a region which should be more protected by the contamination: the intracorporeal channel. Two hundreds and eighteen serial histological specimens of the intracorporeal channels coming from 25 subjects (dead due to gunshots and being autopsied at the Section of Legal Medicine of the Milan University, in the years 2013-2014) were stained with the sodium rhodizonate and sodium rhodizonate in acid environment (HCl 5%), and then observed by the microscope. The sodium rhodizonate showed a positivity for the Pb residues in the intracorporeal channel, with the detection of the particles within the first 2 cm beyond the entrance wound in 6 cases over the total number of 25 (24%). Victims were characterized by common features: short-barreled weapon; contact shots or short-distance shots; involvement of regions that were not covered by clothing; preservation of the microscopic structure of organs interested by the intracorporeal channel. The searching of GSR in the intracorporeal channel, even in conditions securing a high sensitivity, could represent an important test for the discrimination between an environmental contamination of Pb and the presence of Pb residues by GSR: once confirmed the presence of GSR in the intracorporeal channel by the histochemical analysis, the diagnostic process should require the application of the SEM-EDX for the confirmation of the results. Although not yet studied, this combination could be applied to cadavers exposed to the environment, with advanced post-mortal phenomena permitting at least the suspects of the existence of gunshot wounds at the macroscopic autopsy evaluation. Indeed, in some cases, the putrefaction is so advanced

  17. High-speed documented experimental gunshot to a skull-brain model and radiologic virtual autopsy.

    PubMed

    Thali, Michael J; Kneubuehl, Beat P; Vock, Peter; Allmen, Gabriel v; Dirnhofer, Richard

    2002-09-01

    The authors documented and evaluated experimental gunshots to a skull-brain model with high-speed photography and subsequent radiographic examination for comparison of the morphologic findings in the model. The artificial skull was a polyurethane ball constructed in layers, with a porous diploe sandwiched between a tabula externa and a tabula interna. The brain itself was simulated with gelatin 10% at 4 degrees C, a material well known in wound ballistics. Gunshots were fired at the model from a distance of 10 m and documented with high-speed photography (up to 50 million frames/sec). Subsequently, a complete examination of the artificial skull was performed, including spiral computed tomography (with two-dimensional and three-dimensional reconstructions) and classic skull autopsy. The high-speed photographs clearly showed the dynamic development of the skull fracture system from an external perspective. The subsequent radiographic examination of the entire head volume created two-dimensional reformations in any plane and three-dimensional reconstructions of the gunshot injury of the polyurethane skull-brain model, especially the wound channel and the fracture system. Thanks to the model and high-speed photographs, the dynamic development of the morphology of a gunshot wound could be documented and studied. The data from computed tomography, using two-dimensional and three-dimensional postprocessing with a perspective view, were very similar to those from classic head autopsy, but derived in a hands-off and nondestructive manner. This examination method leads the way to radiographic digital autopsy or virtual autopsy.

  18. Gunshot residue inserted under hair scales as a result of a muzzle blast

    NASA Astrophysics Data System (ADS)

    Burnett, Bryan R.

    2009-05-01

    The victim was alleged to have been shot in the head with a .40 caliber pistol from several feet. The defendant claimed that the shot was on the order of inches. Examination in the scanning electron microscope of the hair from around the victim's wound showed no adherent gunshot residue (GSR). However, when the hair was pulled apart by the adhesive of a standard GSR sampler, GSR was found associated with the exposed inner surfaces of the cuticle and cortex fragments. The pistol was discharged close enough to the victim's head that some of the cuticular scales were lifted in the muzzle blast which allowed GSR to be inserted under those scales. Gunshot residue associated with the surface of the victim's hair had somehow been removed. The defendant's account of the shooting was verified by the presence of under-scale GSR.

  19. Detection of blunt, sharp force and gunshot lesions on burnt remains: a cautionary note.

    PubMed

    Poppa, Pasquale; Porta, Davide; Gibelli, Daniele; Mazzucchi, Alessandra; Brandone, Alberto; Grandi, Marco; Cattaneo, Cristina

    2011-09-01

    The study of skin and bone lesions may give information concerning type and manner of production, but in burnt material modification of tissues by the high temperatures may considerably change the morphological characteristics of the lesions. This study aims at pointing out the effects of burning head of pigs with several types of lesions (blunt trauma, sharp force, and gunshot lesions) on soft tissues and bones, both from a morphological and chemical point of view. Results show that the charring process does not completely destroy signs of lesions on bones, which can often be recovered by cleaning bone surface from charred soft-tissue residues. Furthermore, neutron activation analysis test proved that antimony may be detectable also on gunshot entry wounds at the final stages of charring process.

  20. The demographics and outcome of patients with penetrating abdominal trauma admitted to emergency medicine department: A descriptive cross-sectional study

    PubMed Central

    Derakhshanfar, Hojjat; Azizkhani, Reza; Masoumi, Babak; Hashempour, Azam; Amini, Afshin

    2013-01-01

    Background: This study was performed to determine the demographic and outcome of penetrating abdominal trauma in patients attending to emergency medicine department. Materials and Methods: This was a descriptive cross-sectional study in Imam Hossein Medical Center. Seventy five patients who came to our department with penetrating abdominal trauma during a 1 year period were enroled into this study and their demographic data and outcome (during the hospitalization) were recorded. The study was at Imam Hossein Medical Center, Tehran, Iran, from 2009 to 2010. Results: Our findings indicate these notable results: 84% of patients were less than 40 years old, most patients attended emergency department during the spring and summer, 72 patients (96%) arrived between 7 pm and 7 am, 74 patients (98.7%) had stab wound and one person (1.3%) was shot, eventually 46 patients (61%) had laparatomy performed and 2 patients (2.7%) died. 59 patients out of 75 study cases appealed to police department and legal medicine council. Conclusions: The incidence of abdominal penetrating trauma due to stab wound is much higher than gunshot in our community, which indicates the importance of educating the emergency staff and preparing the emergency department work place to attend to these patients, especially during the night hours. PMID:23977658

  1. Detecting gunshots using wearable accelerometers.

    PubMed

    Loeffler, Charles E

    2014-01-01

    Gun violence continues to be a staggering and seemingly intractable issue in many communities. The prevalence of gun violence among the sub-population of individuals under court-ordered community supervision provides an opportunity for intervention using remote monitoring technology. Existing monitoring systems rely heavily on location-based monitoring methods, which have incomplete geographic coverage and do not provide information on illegal firearm use. This paper presents the first results demonstrating the feasibility of using wearable inertial sensors to recognize wrist movements and other signals corresponding to firearm usage. Data were collected from accelerometers worn on the wrists of subjects shooting a number of different firearms, conducting routine daily activities, and participating in activities and tasks that could be potentially confused with firearm discharges. A training sample was used to construct a combined detector and classifier for individual gunshots, which achieved a classification accuracy of 99.4 percent when tested against a hold-out sample of observations. These results suggest the feasibility of using inexpensive wearable sensors to detect firearm discharges.

  2. Detecting Gunshots Using Wearable Accelerometers

    PubMed Central

    Loeffler, Charles E.

    2014-01-01

    Gun violence continues to be a staggering and seemingly intractable issue in many communities. The prevalence of gun violence among the sub-population of individuals under court-ordered community supervision provides an opportunity for intervention using remote monitoring technology. Existing monitoring systems rely heavily on location-based monitoring methods, which have incomplete geographic coverage and do not provide information on illegal firearm use. This paper presents the first results demonstrating the feasibility of using wearable inertial sensors to recognize wrist movements and other signals corresponding to firearm usage. Data were collected from accelerometers worn on the wrists of subjects shooting a number of different firearms, conducting routine daily activities, and participating in activities and tasks that could be potentially confused with firearm discharges. A training sample was used to construct a combined detector and classifier for individual gunshots, which achieved a classification accuracy of 99.4 percent when tested against a hold-out sample of observations. These results suggest the feasibility of using inexpensive wearable sensors to detect firearm discharges. PMID:25184416

  3. Three rounds as "tandem bullets": unusual findings in a case of a suicidal gunshot to the head.

    PubMed

    Tattoli, Lucia; Schmid, Simone; Tsokos, Michael

    2014-12-01

    We report an unusual case of suicide in which three 7.65 caliber projectiles were found in the single gunshot wound to the head of a 53-year-old man. Based on data collected at the death scene, CT scan, autopsy findings, and ballistics analysis, the events were reconstructed as follows: two 7.65 mm rounds had already been fired from the 9 mm Makarov pistol the subject was using but, being a smaller caliber, the cartridges had slipped forward and lodged within the barrel. When a third 7.65 mm cartridge was chambered and the gun fired for the third time, the nose of the last bullet hit the lodged bullets and all three rounds were propelled out of the muzzle in tandem as a single shot. Ballistic investigations confirmed that the kinetic energy of the three tandem bullets would have been sufficient to perforate the skull. In cases of gunshot wounds where the manner of death is unclear, a number of well-described circumstantial parameters, such as an atypical anatomical location of the gunshot, unusual firearm, or ammunition, as well as ambiguous autopsy findings, can raise doubts about the manner of death. In very rare cases, despite a single entrance wound, two or more bullets are recovered from the body, fired by the same weapon at the same time (the so-called "tandem bullet" phenomenon). Injuries by "tandem bullets" have crucial implications in gunshot deaths because of the mismatch between the number of entrance and exit wounds and the number of bullets found in or near the body.

  4. Abdominal tap

    MedlinePlus

    Peritoneal tap; Paracentesis; Ascites - abdominal tap; Cirrhosis - abdominal tap; Malignant ascites - abdominal tap ... abdominal cavity ( most often cancer of the ovaries ) Cirrhosis of the liver Damaged bowel Heart disease Infection ...

  5. A novel method for repair of testis rupture after gunshot trauma: repair with Tutoplast processed pericardium.

    PubMed

    Ciftci, Seyfettin; Ozkul, Bahattin; Ustuner, Murat; Nagihanlnan; Culha, Mustafa Melih

    2014-12-01

    Gunshot wound injury to the external genitalia is relatively uncommon. However, if a testis isaffected in such a case, early surgical exploration should be carried out. A 16-year-old boy presented with right testicular rupture. Tunica albugineal defect could not be closed primarily. We used a Tutoplast® processed bovine pericardium to repair the defect of tunica albuginea. At his 3-month follow-up visit, there was no complication. Doppler blood flow of testis was normal. In this case, preservation of testis tissue was obtained with early exploration and repair of the big tunica albugineal defect with Tutoplast® processed pericardium. PMID:25842593

  6. Fatal gunshot injuries in Benin City, Nigeria.

    PubMed

    Akhiwu, Wilson O; Igbe, Alex P

    2013-10-01

    An upsurge in gun violence in recent times in our environment necessitated this study, which aims to document the patterns of fatal gunshot injuries with the hope of finding a solution to this problem. The study was a retrospective analysis of cases of fatal gunshot injuries on which autopsies were carried out over the 5-year period from January 1998 to December 2002 at Police Medical Services, Benin City - a Nigerian ancient town located in the South-South zone of the country. Most cases of medico-legal death in Benin City and environs are referred to the Police Pathologist at the center for autopsy. A total of 210 cases representing 27.2% of all medico-legal deaths during the study period were reviewed. Males were far more affected than females (M:F = 10.7:1). The intent for the fatal gunshots was murder (88.5%), excusable homicide (4.8%), accident (4.3%) and suicide (0.5%). In 1.9% of the deaths, the circumstances were not clear. Armed robbers, thugs and assassins accounted for 88.1% of the fatal shots, while the Police accounted for 9.0%. The trunk was affected much more than the head, neck and limbs. There is a need to improve security in the country and reduce poverty. Illegal firearms should also be removed from circulation. An improvement in emergency health services will reduce deaths from gunshots.

  7. Occult gunshot injury of the temporal bone.

    PubMed Central

    Geary, U M; Ritchie, D A; Luke, L C

    1997-01-01

    Increasing firearms violence has produced much public disquiet in recent months and Liverpool has seen a particularly well publicized spate of shootings. This is a case report of an initially occult intracranial injury which illustrates the unpredictable nature of missile trauma and the importance of computerised tomography in all cases of gunshot injury to the head. Images Figure 1 Figure 2 PMID:9193993

  8. Assets and pitfalls of chemical and microscopic analyses on gunshot residues in skeletonized bodies: a report of five cases.

    PubMed

    Amadasi, Alberto; Gibelli, Daniele; Mazzarelli, Debora; Porta, Davide; Gaudio, Daniel; Salsarola, Dominic; Brandone, Alberto; Rizzi, Agostino; Cattaneo, Cristina

    2015-07-01

    In case of gunshot wounds, forensic anthropologists and pathologists have many tools at hand, and the assistance that chemical and microscopic investigations can provide in such scenarios is often valuable and crucial. However, the results of such analyses in the search of gunshot residues (GSR) ought not to be acritically considered. We report five cases where chemical (sodium rhodizonate) and microscopic (scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM-EDX)) analyses were performed for the search of GSR. Four cases concerned the forensic field and analyses on buried, charred, or submerged remains, whereas one case concerned the historical remains of a soldier of the First World War. In every case, the search for GSR with these techniques showed their persistence even after long periods and preservation in peculiar environments. However, chemical analyses provided their contribution, but in two cases, anthropological analyses provided crucial and solving results. The five cases show the indisputable usefulness of chemical and microscopic analyses in the search of GSR in gunshot wounds and especially how such residues may survive in time and in adverse environmental conditions. However, experts should always be dubious about some pitfalls (such as contamination) one can frequently find in these scenarios. PMID:25394744

  9. Assets and pitfalls of chemical and microscopic analyses on gunshot residues in skeletonized bodies: a report of five cases.

    PubMed

    Amadasi, Alberto; Gibelli, Daniele; Mazzarelli, Debora; Porta, Davide; Gaudio, Daniel; Salsarola, Dominic; Brandone, Alberto; Rizzi, Agostino; Cattaneo, Cristina

    2015-07-01

    In case of gunshot wounds, forensic anthropologists and pathologists have many tools at hand, and the assistance that chemical and microscopic investigations can provide in such scenarios is often valuable and crucial. However, the results of such analyses in the search of gunshot residues (GSR) ought not to be acritically considered. We report five cases where chemical (sodium rhodizonate) and microscopic (scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM-EDX)) analyses were performed for the search of GSR. Four cases concerned the forensic field and analyses on buried, charred, or submerged remains, whereas one case concerned the historical remains of a soldier of the First World War. In every case, the search for GSR with these techniques showed their persistence even after long periods and preservation in peculiar environments. However, chemical analyses provided their contribution, but in two cases, anthropological analyses provided crucial and solving results. The five cases show the indisputable usefulness of chemical and microscopic analyses in the search of GSR in gunshot wounds and especially how such residues may survive in time and in adverse environmental conditions. However, experts should always be dubious about some pitfalls (such as contamination) one can frequently find in these scenarios.

  10. The "skin-skull-brain model": a new instrument for the study of gunshot effects.

    PubMed

    Thali, M J; Kneubuehl, B P; Zollinger, U; Dirnhofer, R

    2002-02-18

    In order to create and study wound morphology, a "skin-skull-brain model" had to be designed which would make the laboratory reproduction of a real ballistic injury possible. To simulate the human skin, an artificial skin (a silicon cap) is used. This silicon scalp contains synthetic fibers (artificial leather) to simulate the collagen and fat of the scalp. The artificial skull is a layered polyurethane sphere (19 cm o.d.; and 5, 6, or 7 mm thick) constructed in a specially designed form with a Tabula externa, Tabula interna, and a porous Diploe sandwiched in between. The periostium of the artificial skull is made of latex. This elastic latex layer prevents the bone fragments from scattering after the model has been struck by gunfire. The brain itself is simulated with ordnance gelatin, 10% at 4 degrees C, a material well known in wound ballistics. Gunshots were fired at a distance of 10 m from the model. During the evaluation of the "skin-skull-brain model", it was possible to show that injuries inflicted to this model are fully comparable to the morphology of equivalent real gunshot injuries. Using the "skin-skull-brain model" has some significant advantages: the model is inexpensive, easy to construct, instantly available for use, and eliminates ethics conflicts. The main advantage of such a model is, in comparison with biological substances, the high reproducibility of inflicted traumas. PMID:11909661

  11. Prediction of blood back spatter from a gunshot in bloodstain pattern analysis

    NASA Astrophysics Data System (ADS)

    Comiskey, P. M.; Yarin, A. L.; Kim, S.; Attinger, D.

    2016-08-01

    A theoretical model for predicting and interpreting blood-spatter patterns resulting from a gunshot wound is proposed. The physical process generating a backward spatter of blood is linked to the Rayleigh-Taylor instability of blood accelerated toward the surrounding air, allowing the determination of the initial distribution of drop sizes and velocities. Then the motion of many drops in air is considered with governing equations accounting for gravity and air drag. Based on these equations, a numerical solution is obtained. It predicts the atomization process, the trajectories of the back-spatter drops of blood from the wound to the ground, the impact angle, and the impact Weber number on the ground, as well as the distribution and location of bloodstains and their shape and sizes. A parametric study is undertaken to predict patterns of backward blood spatter under realistic conditions corresponding to the experiments conducted in the present work. The results of the model are compared to the experimental data on back spatter generated by a gunshot impacting a blood-impregnated sponge.

  12. Detection of Gunshot Residues Using Mass Spectrometry

    PubMed Central

    Blanes, Lucas; Cole, Nerida; Doble, Philip; Roux, Claude

    2014-01-01

    In recent years, forensic scientists have become increasingly interested in the detection and interpretation of organic gunshot residues (OGSR) due to the increasing use of lead- and heavy metal-free ammunition. This has also been prompted by the identification of gunshot residue- (GSR-) like particles in environmental and occupational samples. Various techniques have been investigated for their ability to detect OGSR. Mass spectrometry (MS) coupled to a chromatographic system is a powerful tool due to its high selectivity and sensitivity. Further, modern MS instruments can detect and identify a number of explosives and additives which may require different ionization techniques. Finally, MS has been applied to the analysis of both OGSR and inorganic gunshot residue (IGSR), although the “gold standard” for analysis is scanning electron microscopy with energy dispersive X-ray microscopy (SEM-EDX). This review presents an overview of the technical attributes of currently available MS and ionization techniques and their reported applications to GSR analysis. PMID:24977168

  13. [Forensic medical estimation of gunshot fractures of the flat bones].

    PubMed

    Dubrovin, I A; Dubrovina, I A

    2012-01-01

    The principal characteristics of the investigations into the mechanisms of gunshot injuries are considered. The general and peculiar features of gunshot fractures and the pathological processes underlying them are discussed. The theory of bullet impact effect put forward by the Russian surgeons in the late XIXth century is verified. The explanation is proposed for the physical nature of direct and side impacts and the phenomenon of a temporary oscillating cavity from the standpoint of the theory of bullet impact effect. The new forensic medical criteria for the gunshot origin of an injury have been developed that allow the gunshot distance and the geometric characteristics of the bullet to be determined. A methodological basis for the determination of the long-range gunshot distance has been created. The results of the present study may be of interest for criminal lawyers and military specialists.

  14. Wound Care.

    PubMed

    Balsa, Ingrid M; Culp, William T N

    2015-09-01

    Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an individual with regard to cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing. Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing. Inappropriate product use can cause delays in healing. As a wound healing progresses, management of a wound and the bandage material used must evolve.

  15. Forensic value of gunpowder tattooing in identification of multiple entrance wounds from one bullet.

    PubMed

    Tokdemir, Mehmet; Kafadar, Huseyin; Turkoglu, Abdurrahim; Bork, Turgay

    2007-05-01

    Multiple entrance gunshot wounds can give useful information in forensic evaluation of deaths from homicide and suicide. Although the presence of multiple entrance gunshot wounds does not absolutely exclude the possibility of suicide, they are important to the forensic investigators and pathologists in cases of assault, attempted homicide and suicide as they provide important clues for determination of number of shots fired and direction of firing. We present a case of 16 years of young woman who was shot to death by her husband. External examination revealed an entrance wound with semi-lunar shot residue at the dorsal side of her left hand at 5th metacarpus, and exit wound on the hypothenar muscle. There was also a second wound entrance located on her left zygoma. Direction of the bullet was downward traveling from left-to-right. Initially it was thought that there were two close shots, but when her left hand was placed over the malar area her face, it was determined that the gunshot powder tattoos were completing the nature of a single shot from a close distance. Crime scene investigation revealed only one cartridge casing. The autopsy and radiography findings showed that the bullet was entered from dorsal site of the left hand exiting from the palm and re-entering from the zygomatic region, hit the base of the skull, and remained in the soft tissue of the right mandible after passing the soft palate. The bullet was caused an incomplete laceration of the right internal arteria carotid and she died of internal and external bleeding. Detailed investigation of gunshot residues can provide important information for clarification of close distance gunshot wounding. We present this case due to its interesting nature, and to highlight the importance of detailed investigation of the gun powder residues in cases with multiple entry wounds.

  16. Standard abdominal wound edge protection with surgical dressings vs coverage with a sterile circular polyethylene drape for prevention of surgical site infections (BaFO): study protocol for a randomized controlled trial

    PubMed Central

    2012-01-01

    Background Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. Methods/design To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45 days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided) and sample size (n = 258 per group) is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. Discussion The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance. Trial registration http://www.clinicaltrials.gov NCT01181206. Date of registration: 11 August 2010; date of first patient randomized: 8 September 2010 PMID:22587425

  17. Island Latissimus Dorsi Muscle Flap and a Perforator Flap in Repairing Post-Gunshot Thoracic Spine CSF Fistula: Case Presentation

    PubMed Central

    Wanjala, Nangole F.; Stanley, Khainga Ominde

    2015-01-01

    Persistent posttraumatic CSF fluid leakage may present a challenge to manage. Failure to address the leakage may result in complications such as meningitis, septicemia, radiculopathy, muscle weakness, and back pains. While the majority of the leakages may be managed conservatively, large dura defects as a result of gunshot wounds or motor vehicle accidents are best managed by surgical interventions. This may range from primary closure of the defect to fascial grafts, adhesive glues, and flaps. We present our experience with the use of flaps in a patient who had sustained such wounds in the thoracic spine. An island latissimus dorsal flap and a perforator fasciocutaneous flap were used to close the defect. Postoperatively the patient recovered well and the wounds healed without any complications. PMID:26491596

  18. Forensic issues in suicidal single gunshot injuries to the chest: an autopsy study.

    PubMed

    Strajina, Veljko; Živković, Vladimir; Nikolić, Slobodan

    2012-12-01

    This study presents a case series of suicides carried out by self-inflicted gunshot wounds to the chest-a relatively uncommon means of suicide. The retrospective autopsy study performed included all cases of single suicidal gunshot injuries to the chest during a 20-year period and which were committed by the use of a handgun. The sample included 67 deceased persons that were an average of 44.4 ± 19.1 years old (range, 12-89 years; 58 men and 9 women). The most common region of the entrance wound was the left side of the chest (54/67), followed by the sternum (10/67), and the right side of the chest (3/67). For 9 subjects, the range of fire could not be determined, as well as whether the shot went through their clothing. In the remaining 58 subjects, only contact or near-contact wounds were found. Of the 58, only 3 subjects had their clothing removed between the chest wall and the muzzle. Three directions of the internal bullet paths were those most frequently found: downward right-to-left (27/67), downward left-to-right (20/67), and downward parallel (10/67) (χ = 101.045, P = 0.000). Also, most bullet paths were directed downward (57/67, χ = 32.970, P = 0.000). The most frequently injured organ was the heart (47/67), and the immediate causes of death were exsanguination (49/67), heart disruption (14/67), and tamponade (4/67).

  19. Acoustic gunshot location in complex environments: concepts and results

    NASA Astrophysics Data System (ADS)

    Showen, R. L.; Calhoun, R. B.; Chu, Wai C.; Dunham, J. W.

    2008-04-01

    A gunshot location system can be implemented in complex urban environments using a distributed array of acoustic sensors. A primary difficulty in computing the source location is that unknown path obstructions in the environment interfere with the reception of the sound at the sensor, by blocking the sound entirely, by refracting the path, or by creating echoes. Other complications are created by the similarity between gunshot sounds and other less interesting urban noises, frequency-dependent absorption of sound, and possible computational difficulty when multiple gunshots generate large data sets that stress real-time analysis routines. The ShotSpotter Gunshot Location System®1, deployed in over two dozen cities in the United States, detects and locates gunfire using a network of acoustic sensors placed on rooftops and utility poles, on moving vehicles, or on personnel. This sensor network, combined with a software system to collate and compute location results from the array of sensors, accurately locates gunshot sounds in complex urban environments. A classifier discards solutions incorporating non-gunshot audio pulses produced by the complex environment. Examples of difficult detection problems, including gunshots from a moving source, show that the detection and classification algorithms described are effective at recovering useful results from signals found in real-world urban scenarios.

  20. Routine techniques in forensic neuropathology as demonstrated by gunshot injury to the head.

    PubMed

    Oehmichen, Manfred; Meissner, Christoph

    2009-04-01

    It will be vital to the practical activity of every forensic and/or clinical pathologist to be able to answer three questions regarding the reconstruction of a lethal event: the type and cause of death, as well as the survival time. The authors offer an overview of the application of selected morphological techniques in general forensic neuropathology, techniques that provide answers to some of the main questions in forensic neurotraumatology. The methods are illustrated by individual cases of lethal gunshot injury to the head from low velocity handguns. Besides the general forensic tasks of interpretation of the crime scene and postmortem external examination of the victim's body a computed tomography is recommended for documentation and reconstruction of the missile track. The microscopic techniques involve Nissl-stain for neurons, hematoxylin and eosin for delayed ischemic neuronal alterations, microtubule-associated protein (MAP) expression for acute neuronal ischemia, luxol-fast-blue-stain for myelin destruction (and demyelination), silver-stain for axons, beta-amyloid precursor protein (beta-APP) for axonal injury, glial fibrillary acidic protein (GFAP) for astrocytic characterization, naphthol AS-D-chloroacetate esterase for neutrophilic infiltration and CD68-expression for microglial reaction. The pattern of methods lead--in the case of gunshot injury as well as in any traumatic impact to the head--to answers according the extent of tissue destruction (and the cause of death), the biometric reconstruction of the criminal event, and the timing of (gunshot) wounds of the brain. These methods will be indispensable for the preparation of future neuropathological expert reports addressing questions of type of injury, the consequent pathological symptoms, timing of the injury, and the cause of death. PMID:19278884

  1. Dynamic finite element simulation of the gunshot injury to the human forehead protected by polyvinyl alcohol sponge.

    PubMed

    Karimi, Alireza; Razaghi, Reza; Navidbakhsh, Mahdi; Sera, Toshihiro; Kudo, Susumu

    2016-04-01

    Although there are some traditional models of the gunshot wounds, there is still a need for more modeling analyses due to the difficulties related to the gunshot wounds to the forehead region of the human skull. In this study, the degree of damage as a consequence of penetrating head injuries due to gunshot wounds was determined using a preliminary finite element (FE) model of the human skull. In addition, the role of polyvinyl alcohol (PVA) sponge, which can be used as an alternative to reinforce the kinetic energy absorption capacity of bulletproof vest and helmet materials, to minimize the amount of skull injury due to penetrating processes was investigated through the FE model. Digital computed tomography along with magnetic resonance imaging data of the human head were employed to launch a three-dimensional (3D) FE model of the skull. Two geometrical shapes of projectiles (steel ball and bullet) were simulated for penetrating with an initial impact velocity of 734 m/s using nonlinear dynamic modeling code, namely LS-DYNA. The role of the damaged/distorted elements were removed during computation when the stress or strain reached their thresholds. The stress distributions in various parts of the forehead and sponge after injury were also computed. The results revealed the same amount of stress for both the steel ball and bullet after hitting the skull. The modeling results also indicated the time that steel ball takes to penetrate into the skull is lower than that of the bullet. In addition, more than 21% of the steel ball's kinetic energy was absorbed by the PVA sponge and, subsequently, injury sternness of the forehead was considerably minimized. The findings advise the application of the PVA sponge as a substitute strengthening material to be able to diminish the energy of impact as well as the load transmitted to the object. PMID:26886822

  2. Positive Outcome After a Small-Caliber Gunshot Fracture of the Upper Cervical Spine without Neurovascular Damage

    PubMed Central

    Walter, Thula; Schwabe, Philipp; Schaser, Klaus-Dieter; Maurer, Martin

    2016-01-01

    Summary Background Gunshot wounds to the cervical spine most frequently concur with serious injuries to the spinal cord and cervical vessels and often have a fatal outcome. Case Report We describe the case of a 35-year-old male with a complex fracture of the C2 vertebra body and a mandibular fracture after a penetration gunshot to the cervical spine. Computed tomography (CT) at admission revealed the exact extent of the fractures and the small caliber bullet lodged next to the C2 vertebra. In this rare and extremely lucky case no collateral vascular or neurological damage was detected. Eighteen months after surgical bullet removal and posterior C1–C3 fusion complete bone healing of the C2 vertebra was achieved and there were no secondary neurovascular deficits. Conclusions Immediate surgical C1–C3 fixation resulted in an excellent outcome without secondary neurovascular deficits in this rare case of traumatic complex C2 vertebral fracture caused by a gunshot injury. PMID:27081417

  3. Reconstruction and rehabilitation of short-range, high-velocity gunshot injury to the lower face: a case report.

    PubMed

    Behnia, H; Motamedi, M H

    1997-08-01

    War injuries can range from the most minor to the devastating and life-threatening. Multidisciplinary care is required for successful management of survivors. In the acute phase, care may involve emergency surgeons, anaesthetists, neurosurgeons, ophthalmic surgeons, vascular surgeons and ENT specialists in addition to the oral and maxillofacial surgeon. Afterwards, definitive treatment of facial hard and soft tissue gunshot injuries depends ultimately on the abilities and skills of the oral and maxillofacial surgeon and his appreciation of such injuries. The timing and sequence of the surgical procedures used for reconstruction and rehabilitation of maxillofacial gunshot injuries are crucial to a successful outcome and aesthetic result. If incorrect, they may lead indefinitely to infection, graft rejection, wound dehiscence with consequent multiple revisional operations and complications which will prolong hospital stay, and increase treatment costs and morbidity in these patients. In this article, we describe the treatment protocol for reconstruction and rehabilitation of a typical case of devastating gunshot injury to the lower face and propose a staged sequence of surgical treatment based on an 8-year experience gained in treating war casualties during the Iraq-Iran war (1980-1988). PMID:9268901

  4. Unusual Case of Gunshot Injury to the Face

    PubMed Central

    Guruprasad, Yadavalli; Giraddi, Girish

    2011-01-01

    An unusual case of facial gunshot injury with the missile lodged in the cervical spine region, but without any neurological impairment, is reported. The extent of tissue damage and missile track termination in a male patient who sustained gunshot trauma to the face was assessed by plain radiography and by computed tomography scans. The patient was treated conservatively and observed for clinical manifestations of neurological deficit for one year. We present a case of gunshot injury to the face with the missile lodged in the cervical spine region and atypical absence of clinical manifestation that may occur even when a bullet remains in the vicinity of the cervical spine. PMID:21915384

  5. [Intraoperative ultrasonography in surgery on organs of abdominal cavity and retroperitoneal space].

    PubMed

    Shkrob, O S; Dadvani, S A; Kuzin, N M; Vetshev, P S; Lotov, A N; Egorov, A V; Kulezneva, Iu V; Musaev, G Kh

    2000-01-01

    Since 1984 to 1999 intraoperative US examination (IOUSE) was made in 863 patients. 236 of them had diseases of the liver, 137 diseases of the gall bladder and biliary tract, 158 pancreatic disorders, 151 diseases of gastro-intestinal tract, 72 diseases of the adrenal glands, 101 constitutional obesity, 3 splenic disorders and 5 gunshot wounds of the organs of the abdominal cavity and the retroperitoneal soft tissues. In masses of the liver IOUSE showed limits for resection of the liver, location of the diseased area with the vessels and biliary ducts, unpalpablefoci. OUSE allowed to perform US-guided puncture and sclerosizing small metastatic nodes as well as a puncture and antiparasitic treatment of inaccessible echinococcal cysts. In cholelithiasis IOUSE allows to reveal or to rule out the presence of the concrements in bile ducts. In cases of diseases of the pancreas IOUSE helps to localize pathologic area, defines its interrelations with adjacent major vessels and ducts, reveals unpalpable masses and enables US-guided puncture of the major pancreatic duct followed by its further opening. In gastric tumors it is possible under US control to determine precisely the limits of the infiltration of gastric wall which defines the volume for resection. In operation on the adrenals from thoracophrenolumbar approach IOUSE through the diaphragmatic cupula determines the place and the length of phrenotomy and elucidates interrelations of the tumor with adjacent organs. Sensibility of IOUSE made up from 87 to 100%, and specificity--92-100% depending on the disease.

  6. Negative Pressure Wound Therapy in the Management of Combat Wounds: A Critical Review

    PubMed Central

    Maurya, Sanjay; Bhandari, Prem Singh

    2016-01-01

    Significance: Wounds sustained in a combat trauma often result in a composite tissue loss. Combat injuries, due to high energy transfer to tissues, lead to trauma at multiple anatomical sites. An early wound cover is associated with lower rate of infections and a faster wound healing. The concept of negative pressure wound therapy (NPWT) in the management of combat-related wounds has evolved from the civilian trauma and the wounds from nontraumatic etiologies. Recent Advances: Encouraged by the results of NPWT in noncombat-related wounds, the military surgeons during Operation Iraqi Freedom and Operation Enduring Freedom used this novel method in a large percentage of combat wounds, with gratifying results. The mechanism of NPWT in wound healing is multifactorial and often complex reconstructive procedure can be avoided in a combat trauma setting. Critical Issues: Wounds sustained in military trauma are heavily contaminated with dirt, patient clothing, and frequently associated with extensive soft tissue loss and osseous destruction. Delay in evacuation during an ongoing conflict carries the risk of systemic infection. Early debridement is indicated followed by delayed closure of wounds. NPWT helps to provide temporary wound cover during the interim period of debridement and wound closure. Future Directions: Future area of research in combat wounds is related to abdominal trauma with loss of abdominal wall. The concept of negative pressure incisional management system in patients with a high risk of wound breakdown following surgery is under review, and may be of relevance in combat wounds. PMID:27679749

  7. Negative Pressure Wound Therapy in the Management of Combat Wounds: A Critical Review

    PubMed Central

    Maurya, Sanjay; Bhandari, Prem Singh

    2016-01-01

    Significance: Wounds sustained in a combat trauma often result in a composite tissue loss. Combat injuries, due to high energy transfer to tissues, lead to trauma at multiple anatomical sites. An early wound cover is associated with lower rate of infections and a faster wound healing. The concept of negative pressure wound therapy (NPWT) in the management of combat-related wounds has evolved from the civilian trauma and the wounds from nontraumatic etiologies. Recent Advances: Encouraged by the results of NPWT in noncombat-related wounds, the military surgeons during Operation Iraqi Freedom and Operation Enduring Freedom used this novel method in a large percentage of combat wounds, with gratifying results. The mechanism of NPWT in wound healing is multifactorial and often complex reconstructive procedure can be avoided in a combat trauma setting. Critical Issues: Wounds sustained in military trauma are heavily contaminated with dirt, patient clothing, and frequently associated with extensive soft tissue loss and osseous destruction. Delay in evacuation during an ongoing conflict carries the risk of systemic infection. Early debridement is indicated followed by delayed closure of wounds. NPWT helps to provide temporary wound cover during the interim period of debridement and wound closure. Future Directions: Future area of research in combat wounds is related to abdominal trauma with loss of abdominal wall. The concept of negative pressure incisional management system in patients with a high risk of wound breakdown following surgery is under review, and may be of relevance in combat wounds.

  8. Elemental quantification of large gunshot residues

    NASA Astrophysics Data System (ADS)

    Duarte, A.; Silva, L. M.; de Souza, C. T.; Stori, E. M.; Boufleur, L. A.; Amaral, L.; Dias, J. F.

    2015-04-01

    In the present work we embarked on the evaluation of the Sb/Pb, Ba/Pb and Sb/Ba elemental ratios found in relatively large particles (of the order of 50-150 μm across) ejected in the forward direction when a gun is fired. These particles are commonly referred to as gunshot residues (GSR). The aim of this work is to compare the elemental ratios of the GSR with those found in the primer of pristine cartridges in order to check for possible correlations. To that end, the elemental concentration of gunshot residues and the respective ammunition were investigated through PIXE (Particle-Induced X-ray Emission) and micro-PIXE techniques. The ammunition consisted of a .38 SPL caliber (ogival lead type) charged in a Taurus revolver. Pristine cartridges were taken apart for the PIXE measurements. The shooting sessions were carried out in a restricted area at the Forensic Institute at Porto Alegre. Residues ejected at forward directions were collected on a microporous tape. The PIXE experiments were carried out employing 2.0 MeV proton beams with a beam spot size of 1 mm2. For the micro-PIXE experiments, the samples were irradiated with 2.2 MeV proton beams of 2 × 2 μm2. The results found for the ratios of Sb/Pb, Ba/Pb and Sb/Ba do not correlate with those stemming from the analysis of the primer.

  9. The survival of gunshot residues in cremated bone: an inductively coupled plasma optical emission spectrometry study.

    PubMed

    Amadasi, Alberto; Merli, Daniele; Brandone, Alberto; Poppa, Pasquale; Gibelli, Daniele; Cattaneo, Cristina

    2013-07-01

    Gunshot residue (GSR) has been sought and demonstrated on many types of material and with many techniques. Inductively coupled plasma optical emission spectrometry (ICP-OES) could be a useful method on difficult substrates, but a systematic study on burnt material has never been performed. Hence, this study aims at evaluating the usefulness and reliability of this method on burnt samples. Sixteen adult bovine ribs (eight with soft tissues, eight totally skeletonized) were shot using two kinds of projectile (both 9 mm full metal-jacketed or unjacketed). Then, every sample was led to complete calcination in an electric oven. The area of the gunshot entrance wound was swabbed and analyzed by ICP-OES; the results were also correlated with a previously published parallel study by scanning electron microscopy (SEM) equipped with an SEM-energy dispersive X-ray analyzer. ICP-OES proved to be very sensitive and reliable even on degraded material and can be an appropriate nondestructive method for detecting residues on difficult and delicate substrates such as burnt bone. PMID:23692414

  10. The survival of gunshot residues in cremated bone: an inductively coupled plasma optical emission spectrometry study.

    PubMed

    Amadasi, Alberto; Merli, Daniele; Brandone, Alberto; Poppa, Pasquale; Gibelli, Daniele; Cattaneo, Cristina

    2013-07-01

    Gunshot residue (GSR) has been sought and demonstrated on many types of material and with many techniques. Inductively coupled plasma optical emission spectrometry (ICP-OES) could be a useful method on difficult substrates, but a systematic study on burnt material has never been performed. Hence, this study aims at evaluating the usefulness and reliability of this method on burnt samples. Sixteen adult bovine ribs (eight with soft tissues, eight totally skeletonized) were shot using two kinds of projectile (both 9 mm full metal-jacketed or unjacketed). Then, every sample was led to complete calcination in an electric oven. The area of the gunshot entrance wound was swabbed and analyzed by ICP-OES; the results were also correlated with a previously published parallel study by scanning electron microscopy (SEM) equipped with an SEM-energy dispersive X-ray analyzer. ICP-OES proved to be very sensitive and reliable even on degraded material and can be an appropriate nondestructive method for detecting residues on difficult and delicate substrates such as burnt bone.

  11. Application of proton-induced X-ray emission technique to gunshot residue analyses

    SciTech Connect

    Sen, P.; Panigrahi, N.; Rao, M.S.; Varier, K.M.; Sen, S.; Mehta, G.K.

    1982-04-01

    The proton-induced X-ray emission (PIXE) technique was applied to the identification and analysis of gunshot residues. Studies were made of the type of bullet and bullet hole identification, firearm discharge element profiles, the effect of various target backings, and hand swabbings. The discussion of the results reviews the sensitivity of the PIXE technique, its nondestructive nature, and its role in determining the distance from the gun to the victim and identifying the type of bullet used and whether a wound was made by a bullet or not. The high sensitivity of the PIXE technique, which is able to analyze samples as small as 0.1 to 1 ng, and its usefulness for detecting a variety of elements should make it particularly useful in firearms residue investigations.

  12. Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

    PubMed Central

    2014-01-01

    Introduction Gunshot injuries of the head and neck from the AK-47 rifle (a common assault rifle, submachine gun type) are a significant contributor to morbidity and mortality among civilians in Sub-Saharan Africa. They may cause significant damage to the closely arranged structures in this region, and the bullet’s trajectory can be very difficult to determine. We present an unusual case of gunshot injury with an atypical bullet entry wound, profound injury to the face, lodgment in the right carotid sheath, and 'wandering’; a first of its kind in East Africa. Case presentation A 27-year-old African-Ugandan woman of Nilotic ethnicity was referred to the Accident and Emergency Department of a tertiary hospital in Uganda, having sustained complex injuries due to an inadvertent AK-47 rifle gunshot injury. The gunshot injury was to the right side of her face with a large ragged entry wound and no exit wound. Prior basic wound care and radiological imaging showed a comminuted fracture of her mandible with lodgment of the bullet in her neck, anterior to her sixth and seventh cervical vertebrae. Standard debridement of her wound was done. A computed tomography scan showed an apparent cephalad shift ('wandering’) of the bullet, leaving it lying partially anterior to her fifth cervical vertebra as well as within her carotid sheath. Other injuries were to her facial and trigeminal nerves, and her middle ear. The 'wandering’ bullet was successfully removed surgically. It had caused no damage to any part of her neck structure. Conclusion AK-47 rifle bullet injuries may present with uncharacteristically large entry wounds and cause complex structural injuries at the area of impact. The consequent trajectory is difficult to predict making regional examination and radiological investigations essential in management. Bullets may be retained, leaving no exit wound. Securing the airway, controlling hemorrhage and identifying other injuries are the first vital steps. This case

  13. Management of laparotomy wound dehiscence.

    PubMed

    Abbott, Daniel E; Dumanian, Gregory A; Halverson, Amy L

    2007-12-01

    Many studies identify risk factors for dehiscence, but a paucity of data exist suggesting an optimal treatment strategy. This study examines repair of abdominal wound dehiscence, comparing closure and interposition of mesh. We conducted a retrospective review of 37 individuals who suffered a wound dehiscence after laparotomy. Outcomes of repairs with either primary closure or polyglactin mesh interposition were examined. Twenty-seven individuals underwent repair with primary closure. Twelve of these individuals suffered repeat wound dehiscence; 10 were treated with repeat fascial closure, 2 with polyglactin mesh interposition. Seven individuals initially underwent successful repair with polyglactin mesh interposition; all subsequently had their hernias repaired. Three patients had minor fascial separation managed nonoperatively. Primary closure is associated with a relatively high rate of recurrent wound dehiscence. Closure with polyglactin mesh interposition has a higher initial success rate, but necessitates additional surgeries for repair of the abdominal wall defect.

  14. [Forensic medical characteristics of Glock 19 pistol-shot wounds].

    PubMed

    Musin, E Kh; Lepik, D; Viali, M

    2006-01-01

    An experimental study was made of gun-shot wounds inflicted by shots from a modern stub-barrelled pistol 9mm Glock 19. The study has ascertain characteristics differentiating injuries inflicted by shots from this pistol: specific recoil injury, specific topography, intensity and distribution of begrime, gunpowder and metal particles and relevant lesions. It was found that depth of penetration under the skin depends both on shooting distance and the position of the particle from the inlet.

  15. Distinction between entrance and exit wounds by energy dispersive X-ray fluorescence spectrometry.

    PubMed

    Tanaka, Naoko; Kinoshita, Hiroshi; Takakura, Ayaka; Jamal, Mostofa; Ito, Asuka; Kumihashi, Mitsuru; Tsutsui, Kunihiko; Kimura, Shoji; Ameno, Kiyoshi

    2016-09-01

    We investigated gunshot wounds in two autopsy cases using energy dispersive X-ray spectrometry (EDX). Lead and copper were detected in the entrance wound of one case and lead, antimony, and copper were detected in that of the other case. In the exit wounds of both cases, lead, antimony, and copper were below detection limits. These findings indicate that the detection of metallic elements, such as lead, antimony, and copper, which are found in bullets, may be useful for differentiating entrance from exit wounds using EDX. PMID:27591531

  16. [Surgical peculiarities of gunshot injuries to arteries of the extremities caused by modern small arms and light weapons].

    PubMed

    Samokhvalov, I M; Reva, V A; Denisov, A V; Ozeretskovskiĭ, L B; Pronchenko, A A

    2014-10-01

    The aim of the given study was development of surgical tactics in case of femoral artery injury, caused by medium-calibre bullet, on the basis acute experiment on large biological objects. Experimental animals were shot into mid third of the femora by a rifle cartridge in 7,62-mm calibre (AK-47 made in 1943). The analysis of microstructure, made in 5 cross-sections performed every 1-centimetre way from the wound canal, showed that there were no any damages of arterial wall. Authors came to conclusion that the surgical debridement of the gunshot wound, made by a rifle cartridge in 7,62-mm calibre of AK-47, should consist of exsection of devitalized section of artery.

  17. [Surgical peculiarities of gunshot injuries to arteries of the extremities caused by modern small arms and light weapons].

    PubMed

    Samokhvalov, I M; Reva, V A; Denisov, A V; Ozeretskovskiĭ, L B; Pronchenko, A A

    2014-10-01

    The aim of the given study was development of surgical tactics in case of femoral artery injury, caused by medium-calibre bullet, on the basis acute experiment on large biological objects. Experimental animals were shot into mid third of the femora by a rifle cartridge in 7,62-mm calibre (AK-47 made in 1943). The analysis of microstructure, made in 5 cross-sections performed every 1-centimetre way from the wound canal, showed that there were no any damages of arterial wall. Authors came to conclusion that the surgical debridement of the gunshot wound, made by a rifle cartridge in 7,62-mm calibre of AK-47, should consist of exsection of devitalized section of artery. PMID:25532307

  18. [THE PRINCIPLES OF ORGANIZATION AND TREATMENT FOR SORTING OF WOUNDED PERSONS WITH A COMBAT SURGICAL TRAUMA OF EXTREMITIES ON THE IV LEVEL OF THE MEDICAL CARE PROVISION].

    PubMed

    Korohl, S O; Zherdev, I I; Domanskiy, A M

    2015-12-01

    Experience of medical sorting of 434 injured persons with a gun-shot woundings of extremities in 2014-2015 yrs is adduced. The principles of organization and treatment for medical sorting of wounded persons were elaborated. Prognostic intrahospital, diagnostic and evacuation--transport sorting was introduced in wounded persons in the IV level hospital, concerning severity of traumatic shock and prognosis of their survival.

  19. [THE PRINCIPLES OF ORGANIZATION AND TREATMENT FOR SORTING OF WOUNDED PERSONS WITH A COMBAT SURGICAL TRAUMA OF EXTREMITIES ON THE IV LEVEL OF THE MEDICAL CARE PROVISION].

    PubMed

    Korohl, S O; Zherdev, I I; Domanskiy, A M

    2015-12-01

    Experience of medical sorting of 434 injured persons with a gun-shot woundings of extremities in 2014-2015 yrs is adduced. The principles of organization and treatment for medical sorting of wounded persons were elaborated. Prognostic intrahospital, diagnostic and evacuation--transport sorting was introduced in wounded persons in the IV level hospital, concerning severity of traumatic shock and prognosis of their survival. PMID:27025033

  20. Abdominal Pain

    MedlinePlus

    ... can help the overall situation for the child. Teaching kids self-hypnosis [8] or guided imagery [8a] ... related topics? Functional Abdominal Pain (English, French or Spanish)—from The North American Society for Pediatric Gastroenterology, ...

  1. Abdominal pain

    MedlinePlus

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is ...

  2. Management of Craniocerebral Gunshot Injuries: A Review

    PubMed Central

    Alvis-Miranda, Hernando Raphael; Adie Villafañe, Roberto; Rojas, Alejandro; Alcala-Cerra, Gabriel

    2015-01-01

    Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately this is a prevalent condition in developing countries, with major armed conflicts which is not very likely to achieve a high rate of prevention. Management goals should focus on early aggressive, vigorous resuscitation and correction of coagulopathy; those with stable vital signs undergo brain computed tomography scan. Neuroimaging is vital for surgical purposes, especially for determine type surgery, size and location of the approach, route of extraction of the foreign body; however not always surgical management is indicated, there is also the not uncommon decision to choose non-surgical management. The treatment consist of immediate life salvage, through control of persistent bleeding and cerebral decompression; prevention of infection, through extensive debridement of all contaminated, macerated or ischemic tissues; preservation of nervous tissue, through preventing meningocerebral scars; and restoration of anatomic structures through the hermetic seal of dura and scalp. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients; classic studies in military and civil environment have identified that this is a highly lethal or devastating violent condition, able to leave marked consequences for the affected individual, the family and the health system itself. Various measures have been aimed to lower the incidence of CGI, especially in civilians. It is necessarily urgent to promote research in a neurocritical topic such as CGI, looking impact positively the quality of life for those who survive. PMID:27169063

  3. Management of Craniocerebral Gunshot Injuries: A Review.

    PubMed

    Alvis-Miranda, Hernando Raphael; Adie Villafañe, Roberto; Rojas, Alejandro; Alcala-Cerra, Gabriel; Moscote-Salazar, Luis Rafael

    2015-10-01

    Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately this is a prevalent condition in developing countries, with major armed conflicts which is not very likely to achieve a high rate of prevention. Management goals should focus on early aggressive, vigorous resuscitation and correction of coagulopathy; those with stable vital signs undergo brain computed tomography scan. Neuroimaging is vital for surgical purposes, especially for determine type surgery, size and location of the approach, route of extraction of the foreign body; however not always surgical management is indicated, there is also the not uncommon decision to choose non-surgical management. The treatment consist of immediate life salvage, through control of persistent bleeding and cerebral decompression; prevention of infection, through extensive debridement of all contaminated, macerated or ischemic tissues; preservation of nervous tissue, through preventing meningocerebral scars; and restoration of anatomic structures through the hermetic seal of dura and scalp. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients; classic studies in military and civil environment have identified that this is a highly lethal or devastating violent condition, able to leave marked consequences for the affected individual, the family and the health system itself. Various measures have been aimed to lower the incidence of CGI, especially in civilians. It is necessarily urgent to promote research in a neurocritical topic such as CGI, looking impact positively the quality of life for those who survive. PMID:27169063

  4. Gunshot residue testing in suicides: Part II: Analysis by inductive coupled plasma-atomic emission spectrometry.

    PubMed

    Molina, D Kimberley; Castorena, Joe L; Martinez, Michael; Garcia, James; DiMaio, Vincent J M

    2007-09-01

    Several different methods can be employed to test for gunshot residue (GSR) on a decedent's hands, including scanning electron microscopy with energy dispersive x-ray (SEM/EDX) and inductive coupled plasma-atomic emission spectrometry (ICP-AES). In part I of this 2-part series, GSR results performed by SEM/EDX in undisputed cases of suicidal handgun wounds were studied. In part II, the same population was studied, deceased persons with undisputed suicidal handgun wounds, but GSR testing was performed using ICP-AES. A total of 102 cases were studied and analyzed for caliber of weapon, proximity of wound, and the results of the GSR testing. This study found that 50% of cases where the deceased was known to have fired a handgun immediately prior to death had positive GSR results by ICP/AES, which did not differ from the results of GSR testing by SEM/EDX. Since only 50% of cases where the person is known to have fired a weapon were positive for GSR by either method, this test should not be relied upon to determine whether someone has discharged a firearm and is not useful as a determining factor of whether or not a wound is self-inflicted or non-self-inflicted. While a positive GSR result may be of use, a negative result is not helpful in the medical examiner setting as a negative result indicates that either a person fired a weapon prior to death or a person did not fire a weapon prior to death.

  5. Experimental investigation of the mechanical properties of brain simulants used for cranial gunshot simulation.

    PubMed

    Lazarjan, Milad Soltanipour; Geoghegan, Patrick Henry; Jermy, Mark Christopher; Taylor, Michael

    2014-06-01

    The mechanical properties of the human brain at high strain rate were investigated to analyse the mechanisms that cause backspatter when a cranial gunshot wound occurs. Different concentrations of gelatine and a new material (M1) developed in this work were tested and compared to bovine brain samples. Kinetic energy absorption and expansion rate of the samples caused by the impact of a bullet from .22 air rifle (AR) (average velocity (uav) of 290m/s) and .22 long rifle (LR) (average velocity (uav) of 330m/s) were analysed using a high speed camera (24,000fps). The AR projectile had, in the region of interest, an average kinetic energy (Ek) of 42±1.3J. On average, the bovine brain absorbed 50±5% of Ek, and the simulants 46-58±5%. The Ek of the .22 LR was 141±3.7J. The bovine brain absorbed 27% of the .22LR Ek and the simulants 15-29%. The expansion of the sample, after penetration, was measured. The bovine brain experienced significant plastic deformation whereas the gelatine solution exhibited a principally elastic response. The permanent damage patterns in the M1 material were much closer to those in brain tissue, than were the damage patterns in the gelatine. The results provide a first step to developing a realistic experimental simulant for the human brain which can produce the same blood backspatter patterns as a human brain during a cranial gunshot. These results can also be used to improve the 3D models of human heads used in car crash and blast trauma injury research.

  6. [Confusing injury findings in a suicidal gunshot fired to the chest from a carbine with a sawed-off barrel].

    PubMed

    Perdekamp, Markus Grosse; Bohnert, Michael; Braunwarth, Roland; Pollak, Stefan

    2006-01-01

    The stellate bullet entrance wound is one of the facultative features of a contact shot. For the formation of a star-shaped wound two factors are of special importance: first, an extensive bony support underlying the skin in the entrance region, and second, a strong propellant charge of the cartridge fired. Contact shots to the precordial region usually do not cause stellate entrance wounds, even if high-powered rifle ammunition is used. In the reported case, an injury pattern was observed that was not in line with normal findings and seemed confusing at first. Following a suicidal gunshot to the chest from a sawed-off carbine 98a (cal. 8 x 57 Js), a 4.5 cm wide, gaping bullet entrance wound with radiating tears was found. Instead of the usual pocket, the anterior thoracic wall showed a fist-sized area of destruction with extensive undermining of the subcutis. Not far from the entrance hole, a rib fragment had become displaced retrogradely thus perforating the skin from the inside out. The unusual pattern of findings could be explained by the fact that the barrel had been sawed off: as a result of this manipulation, a considerable part of the propellant charge had been converted outside the barrel, i.e. in the initial section of the bullet path.

  7. Abdominal Sepsis.

    PubMed

    De Waele, Jan J

    2016-08-01

    Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy. PMID:27363829

  8. Body models in forensic ballistics: reconstruction of a gunshot injury to the chest by bullet fragmentation after shooting through a finger.

    PubMed

    Thali, M J; Kneubuehl, B P; Dirnhofer, R; Zollinger, U

    2001-11-15

    Forensic science uses substitutes to reconstruct injury patterns in order to answer questions regarding the dynamic formation of unusual injuries. Using a case study, an experimental simulation of a finger was designed, for the first time with a combination of hard wood and glycerin soap. With this model as an intermediate target simulation, it was possible not only to demonstrate the "bullet-body (finger) interaction", but also to recreate the wound pattern found in the victim. This case demonstrates that by using ballistic models and body-part substitutes, gunshot cases can be reproduced simply and economically, without coming into conflict with ethical guidelines.

  9. Gunshot acoustic signature specific features and false alarms reduction

    NASA Astrophysics Data System (ADS)

    Donzier, Alain; Millet, Joel

    2005-05-01

    This paper provides a detailed analysis of the most specific parameters of gunshot signatures through models as well as through real data. The models for the different contributions to gunshot typical signature (shock and muzzle blast) are presented and used to discuss the variation of measured signatures over the different environmental conditions and shot configurations. The analysis is followed by a description of the performance requirements for gunshot detection systems, from sniper detection that was the main concern 10 years ago, to the new and more challenging conditions faced in today operations. The work presented examines the process of how systems are deployed and used as well as how the operational environment has changed. The main sources of false alarms and new threats such as RPGs and mortars that acoustic gunshot detection systems have to face today are also defined and discussed. Finally, different strategies for reducing false alarms are proposed based on the acoustic signatures. Different strategies are presented through various examples of specific missions ranging from vehicle protection to area protection. These strategies not only include recommendation on how to handle acoustic information for the best efficiency of the acoustic detector but also recommends some add-on sensors to enhance system overall performance.

  10. Scientific working group on gunshot residue (SWGGSR): a progress report

    NASA Astrophysics Data System (ADS)

    Trimpe, Michael A.

    2011-06-01

    The Scientific Working Group on Gunshot Residue (SWGGSR) was founded in 2007. Twenty-four experienced and well-recognized scientists throughout the world are working toward internationally accepted guidelines in the analysis of gunshot residue. With this goal in mind the group has set up specific committees to cogitate and develop recommendations in key areas of gunshot residue analysis. The SWGGSR meets annually and is in constant contact throughout the year via email. In 2007 SWGGSR assumed responsibility for updating ASTM E-1588 the Standard Guide for Gunshot Residue Analysis by Scanning Electron Microscopy/ Energy Dispersive Xray Spectrometry. In 2010 a revised E-1588 was published. The SWGGSR is currently working on a more comprehensive guide that will be published through NIJ (National Institute of Justice) and available for free to everyone in the world. In addition, we have attended meetings hosted by the federal government's SoFs (Subcommittee on Forensic Science) IWG (Interagency Working Groups) to insure our input on the future of forensic science in the Untied States.

  11. A molecular method to correlate bloodstains with wound site for crime scene reconstruction.

    PubMed

    Johnson, Donald J; Andersen, Cheryl; Scriven, Katherine A; Klein, Amberly N; Choi, Mo Re; Carroll, Cindy; de Leon, Ray D

    2014-05-01

    Bloodstain pattern analysis to determine the wound-of-origin of bloodstains is problematic with nonspecific patterns. In this proof-of-concept study, the authors examined a molecular approach to correlate bloodstains with injuries using the rat as a model. Specifically, investigations were conducted on the rat brain marker, rno-miR-124-3p, with the QIAGEN miScript System and real-time PCR analysis. Rno-miR-124-3p was detected in brain homogenates diluted 100,000 times; in 3-week-old, room temperature stored, simulated brain-blood stains; and in bloodstains from head gunshot wounds collected with swabs and subsequently frozen for 9-18 months; however, rno-miR-124-3p was not detected in whole blood. Proof-of-principle was demonstrated by the ability to distinguish bloodstains from a gunshot wound to the head versus bloodstains from a gunshot wound to the chest, by the testing of otherwise identical bloodstains from the two patterns for the presence of the marker. The results suggest a viable approach to a longstanding problem in casework. PMID:24606037

  12. Abdominal thrusts

    MedlinePlus

    ... call 911 . If the person loses consciousness, start CPR . If you are not comfortable performing abdominal thrusts, ... American Red Cross. First Aid/CPR/AED Participant's Manual. 2nd ... Red Cross; 2014. Berg RA, Hemphill R, Abella BS, et al. Part 5: ...

  13. Abdominal Aortic Aneurysms: Treatments

    MedlinePlus

    ... information Membership Directory (SIR login) Interventional Radiology Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists ...

  14. Detection of gunshot residue in blowfly larvae and decomposing porcine tissue using inductively coupled plasma mass spectrometry (ICP-MS).

    PubMed

    Lagoo, Lisa; Schaeffer, Luther S; Szymanski, David W; Smith, Ruth Waddell

    2010-05-01

    Blowfly larvae and porcine tissue contaminated with gunshot residue (GSR) were collected during summer and winter months, over a 37-day and a 60-day sampling period, respectively. Wound samples were microwave-digested and analyzed by inductively coupled plasma mass spectrometry (ICP-MS) for the detection of antimony, barium, and lead. During summer, the 37-day sampling period encompassed all stages of decomposition, except skeletonization. The three elements were detected in larvae only on days 3 and 4 after death but were detected at significant levels in tissue samples throughout the entire sampling period. In winter, no significant decomposition was observed throughout the 60-day sampling. Although temperatures were too low for blowfly activity, the three elements were detected in the tissue samples at relatively constant, significant levels. Hence, GSR determination in tissue was more dependent on decomposition stage rather than time since death.

  15. Comparison of gunshot entrance morphologies caused by .40-caliber Smith & Wesson, .380-caliber, and 9-mm Luger bullets: a finite element analysis study.

    PubMed

    Matoso, Rodrigo Ivo; Freire, Alexandre Rodrigues; Santos, Leonardo Soriano de Mello; Daruge Junior, Eduardo; Rossi, Ana Claudia; Prado, Felippe Bevilacqua

    2014-01-01

    Firearms can cause fatal wounds, which can be identified by traces on or around the body. However, there are cases where neither the bullet nor gun is found at the crime scene. Ballistic research involving finite element models can reproduce computational biomechanical conditions, without compromising bioethics, as they involve no direct tests on animals or humans. This study aims to compare the morphologies of gunshot entrance holes caused by.40-caliber Smith & Wesson (S&W), .380-caliber, and 9×19-mm Luger bullets. A fully metal-jacketed.40 S&W projectile, a fully metal-jacketed.380 projectile, and a fully metal-jacketed 9×19-mm Luger projectile were computationally fired at the glabellar region of the finite element model from a distance of 10 cm, at perpendicular incidence. The results show different morphologies in the entrance holes produced by the three bullets, using the same skull at the same shot distance. The results and traits of the entrance holes are discussed. Finite element models allow feasible computational ballistic research, which may be useful to forensic experts when comparing and analyzing data related to gunshot wounds in the forehead.

  16. Comparison of Gunshot Entrance Morphologies Caused by .40-Caliber Smith & Wesson, .380-Caliber, and 9-mm Luger Bullets: A Finite Element Analysis Study

    PubMed Central

    Matoso, Rodrigo Ivo; Freire, Alexandre Rodrigues; Santos, Leonardo Soriano de Mello; Daruge Junior, Eduardo; Rossi, Ana Claudia; Prado, Felippe Bevilacqua

    2014-01-01

    Firearms can cause fatal wounds, which can be identified by traces on or around the body. However, there are cases where neither the bullet nor gun is found at the crime scene. Ballistic research involving finite element models can reproduce computational biomechanical conditions, without compromising bioethics, as they involve no direct tests on animals or humans. This study aims to compare the morphologies of gunshot entrance holes caused by.40-caliber Smith & Wesson (S&W), .380-caliber, and 9×19-mm Luger bullets. A fully metal-jacketed.40 S&W projectile, a fully metal-jacketed.380 projectile, and a fully metal-jacketed 9×19-mm Luger projectile were computationally fired at the glabellar region of the finite element model from a distance of 10 cm, at perpendicular incidence. The results show different morphologies in the entrance holes produced by the three bullets, using the same skull at the same shot distance. The results and traits of the entrance holes are discussed. Finite element models allow feasible computational ballistic research, which may be useful to forensic experts when comparing and analyzing data related to gunshot wounds in the forehead. PMID:25343337

  17. Treatment of close-range, low-velocity gunshot fractures of tibia and femur diaphysis with consecutive compression-distraction technique: a report of 11 cases.

    PubMed

    Ateşalp, A Sabri; Kömürcü, Mahmut; Demiralp, Bahtiyar; Bek, Dogan; Oğuz, Erbil; Yanmiş, Ibrahim

    2004-01-01

    Lower extremity injuries secondary to close-range, low-velocity gunshot wounds are frequently seen in both civilian and military populations. A close-range, low-velocity injury produces high energy and often results in comminuted and complicated fractures with significant morbidity. In this study, four femoral, four tibial, and three combined tibia and fibular comminuted diaphyseal fractures secondary to close-range, low-velocity gunshot wounds in 11 military personnel were treated with debridement followed by compression-distraction lengthening using a circular external fixator frame. Fracture union was obtained in all without significant major complications. Fracture consolidation occurred at a mean of 3.5 months. At follow-up of 46.8 months, there were no delayed unions, nonunions, or malunions. Minor complications included four pin-tract infections and knee flexion limitation in two femur fractures. Osteomyelitis and deep soft tissue infection were not observed. This technique provided an alternative to casting, open reduction internal fixation, or intermedullary fixation with an acceptable complication rate.

  18. Real-time vehicle noise cancellation techniques for gunshot acoustics

    NASA Astrophysics Data System (ADS)

    Ramos, Antonio L. L.; Holm, Sverre; Gudvangen, Sigmund; Otterlei, Ragnvald

    2012-06-01

    Acoustical sniper positioning systems rely on the detection and direction-of-arrival (DOA) estimation of the shockwave and the muzzle blast in order to provide an estimate of a potential snipers location. Field tests have shown that detecting and estimating the DOA of the muzzle blast is a rather difficult task in the presence of background noise sources, e.g., vehicle noise, especially in long range detection and absorbing terrains. In our previous work presented in the 2011 edition of this conference we highlight the importance of improving the SNR of the gunshot signals prior to the detection and recognition stages, aiming at lowering the false alarm and miss-detection rates and, thereby, increasing the reliability of the system. This paper reports on real-time noise cancellation techniques, like Spectral Subtraction and Adaptive Filtering, applied to gunshot signals. Our model assumes the background noise as being short-time stationary and uncorrelated to the impulsive gunshot signals. In practice, relatively long periods without signal occur and can be used to estimate the noise spectrum and its first and second order statistics as required in the spectral subtraction and adaptive filtering techniques, respectively. The results presented in this work are supported with extensive simulations based on real data.

  19. SECURES: system for reporting gunshots in urban environments

    NASA Astrophysics Data System (ADS)

    Page, Edward A.; Sharkey, Brian

    1995-05-01

    SECURESTM (System for the Effective Control of Urban Environment Security) is being developed to support local law enforcement in the critical problem of gun-related violence on America's streets. Once deployed, SECURES will instantaneously detect, recognize, and pinpoint the location of gunfire, and transmit this finding to the police dispatcher or directly to scout cars in the vicinity. Local law enforcement and trauma care resourses will be able to respond quickly, thereby dramatically increasing the probability of arrest of the gunman and survival of the victim. SECURES will employ an air-acoustic detection grid composed of small, low-cost, battery powered sensor modules, called Pole Units. These modules will be located on utility poles and buildings primarily at city block intersections, and consists of an acoustic sensor, signal processing electronics, and a transmitter. Development efforts have concentrated on i) developing and testing algorithms capable of identifying gunshots with an extremely low false alarm rate, ii) developing ultra- low power electronics capable of reliable operation for long periods in outdoor environments, and iii) determining the RF communications design. Pole Unit prototype electronics and gunshot identification algorithms have been developed and successfully tested on an extensive database of recorded gunshots and background noises.

  20. [Current concepts of the mechanisms of formation of gunshot fractures].

    PubMed

    Pigolkin, Iu I; Dubrovin, I A; Leonov, S V; Mikhaĭlenko, A V; Dubrovin, A I; Zotkin, D A

    2013-01-01

    The mechanisms of formation of gunshot fractures in flat bones inflicted by a semispherical bullet were investigated using expert and experimental materials. The process of crack formation was considered in terms of the Hertzian contact problem and the Hill-Johnson model. It was shown that the fracture develops as a result of combination of stresses and strains in the bone tissue leading to the formation of a hydrostatic nucleus prior to tissue fragmentation. Dynamic fluctuations (waves) generated in the zone of hydrostatic compression resulting from the gunshot injury propagate with the velocity of sound from the nucleus in the direction of the bullet movement. According to the Hill-Johnson model, the waves propagate in the direction of the impact within a parabolically expanding space; this accounts for the mechanism of formation of parabolic cracks and the specific shape of the defect that the bullet produces in the flat bones. The dynamic load applied by means of an indentor forms at a higher rate than the velocity of sound in the affected material. It gives reason to consider the effect of a bullet moving with the speed of 250 m/s as quasi-static loading. The results obtained in this study make a contribution to the theory of impact effect of a bullet and provide a deeper insight into the physical nature of the direct and sideway action of a gunshot projectile. Moreover, they explain the cause behind the widening of the outlet part of the perforating fracture in the flat bones.

  1. Puerperal endometritis after abdominal twin delivery.

    PubMed

    Suonio, S; Huttunen, M

    1994-04-01

    The infectious complications of 122 consecutive abdominal twin deliveries over the period 1984-1989 were analyzed in a prospective clinical study, comparing them with 761 singleton abdominal deliveries over the period 1984-1986. The incidence of endometritis was nearly three-fold after twin deliveries and the incidence of abdominal wound infections nearly two-fold compared with singleton abdominal pregnancies (13.1/4.7% and 5.6/3.0%). The risk of amnionitis was increased ten-fold, 6 hours after rupture of the membranes in abdominal twin delivery, but no connection was found between amnionitis and endometritis, as in singleton abdominal deliveries. Multiple regression analysis indicated only two risk factors as regards puerperal endometritis after abdominal twin delivery: age under 25 years (odds ratio 6.9, 95% confidence limits 1.9-24.8), an association also seen in singleton abdominal deliveries, and a period of more than 6 hours from rupture of membranes to delivery (odds ratio 7.8, 95% confidence limits 2.1-28.5). Multiple pregnancy appears to be associated with an increased risk of endometritis. The etiological factors remain unknown, but a large placental bed and/or immunological factors may be implicated. PMID:8160537

  2. [Wounds from modern small arms and international humanitarian law].

    PubMed

    Dyskin, E A; Ozeretskovskiĭ, V L; Popov, M; Tiurin, M V

    1992-01-01

    The article cites the concept, basic standards and principles of international humane law concerning the banning or restriction of some types of conventional weapons. The authors describe international methods for appreciation of destructive effects of wounding missiles. On the basis of literature and their own experiments the authors make a conclusion that actually it would be impossible to formulate a straight definition between "human" and "inhumane" bullets, as well as to establish a criterion which could determine the admissible or inadmissible limits for gunshot injuries. PMID:1570694

  3. Treatment Protocol for High Velocity/High Energy Gunshot Injuries to the Face

    PubMed Central

    Peled, Micha; Leiser, Yoav; Emodi, Omri; Krausz, Amir

    2011-01-01

    Major causes of facial combat injuries include blasts, high-velocity/high-energy missiles, and low-velocity missiles. High-velocity bullets fired from assault rifles encompass special ballistic properties, creating a transient cavitation space with a small entrance wound and a much larger exit wound. There is no dispute regarding the fact that primary emergency treatment of ballistic injuries to the face commences in accordance with the current advanced trauma life support (ATLS) recommendations; the main areas in which disputes do exist concern the question of the timing, sequence, and modes of surgical treatment. The aim of the present study is to present the treatment outcome of high-velocity/high-energy gunshot injuries to the face, using a protocol based on the experience of a single level I trauma center. A group of 23 injured combat soldiers who sustained bullet and shrapnel injuries to the maxillofacial region during a 3-week regional military conflict were evaluated in this study. Nine patients met the inclusion criteria (high-velocity/high-energy injuries) and were included in the study. According to our protocol, upon arrival patients underwent endotracheal intubation and were hemodynamically stabilized in the shock-trauma unit and underwent total-body computed tomography with 3-D reconstruction of the head and neck and computed tomography angiography. All patients underwent maxillofacial surgery upon the day of arrival according to the protocol we present. In view of our treatment outcomes, results, and low complication rates, we conclude that strict adherence to a well-founded and structured treatment protocol based on clinical experience is mandatory in providing efficient, appropriate, and successful treatment to a relatively large group of patients who sustain various degrees of maxillofacial injuries during a short period of time. PMID:23449809

  4. Penetrating injuries of the abdominal inferior vena cava.

    PubMed Central

    Degiannis, E.; Velmahos, G. C.; Levy, R. D.; Souter, I.; Benn, C. A.; Saadia, R.

    1996-01-01

    This is a retrospective study of 74 patients with penetrating injuries of the abdominal inferior vena cava; the cause of injury was gunshot in 91% and stabbing in 9%. Of the patients, 77% underwent lateral venorrhaphy, 5% underwent infrarenal ligation of the inferior vena cava (IVC), and 18% died perioperatively before any caval repair could be carried out. There was an overall perioperative mortality of 39%. Persistent shock, the site of the venous injury, particularly in the retrohepatic position, and the number of associated vascular injuries were directly related to mortality. Irrespective of the improvements in resuscitation and the various operative methods available, penetrating trauma of the abdominal IVC remains a life-threatening injury. PMID:8943628

  5. New technique for treating abdominal surgical site infection using CT woundgraphy and NPWT: A case report

    PubMed Central

    Ito, Eisaku; Yoshida, Masashi; Nakashima, Keigo; Suzuki, Norihiko; Imakita, Tomonori; Tsutsui, Nobuhiro; Ohdaira, Hironori; Kitajima, Masaki; Suzuki, Yutaka

    2016-01-01

    Introduction Negative pressure wound therapy (NPWT) for abdominal surgical site infection (SSI) is becoming increasingly common, although enterocutaneous fistula (ECF) has been reported as a complication. To avoid ECF, we used computed tomography (CT) woundgraphy to evaluate the relationship between the wound and the intestine, and then safely treated the abdominal SSI with NPWT. Case presentation Following a laparoscopic intersphincteric resection for low rectal neuroendocrine tumor and covering ileostomy, a 59-year-old woman underwent stoma closure. Six days after surgery, we diagnosed SSI. We suspected ECF, because the wound was deep and the pus resembled enteric fluid. However, CT woundgraphy showed that the wound was separated from the abdominal cavity and the intestine by the abdominal rectus muscle. Accordingly, we performed NPWT. SSI was cured and the wound was well granulated. Twenty-three days after surgery, the patient was discharged. Eventually, the wound was completely epithelialized. Discussion Although successful NPWT has been reported for open abdominal wounds, ECF is a common complication. ECF can be prevented by separating the wound from the intestine by the omentum or muscle fascia, protecting the intestinal serosa during surgery, and applying low vacuum pressure. The relationships among the wound, the fascia, and the intestine must be evaluated before abdominal SSI treatment. One good method is CT woundgraphy, which evaluates wound extent and depth, closure of muscle fascia, and the relationship between the wound and the intestine. Conclusion We report a case of CT woundgraphy before NPWT for abdominal SSI. CT woundgraphy is a good candidate for evaluating wound condition. PMID:27002290

  6. Characteristics of gunshot sound displays by North Atlantic right whales in the Bay of Fundy.

    PubMed

    Parks, Susan E; Hotchkin, Cara F; Cortopassi, Kathryn A; Clark, Christopher W

    2012-04-01

    North Atlantic right whales (Eubalaena glacialis) produce a loud, broadband signal referred to as the gunshot sound. These distinctive sounds may be suitable for passive acoustic monitoring and detection of right whales; however, little is known about the prevalence of these sounds in important right whale habitats, such as the Bay of Fundy. This study investigates the timing and distribution of gunshot sound production on the summer feeding grounds using an array of five marine acoustic recording units deployed in the Bay of Fundy, Canada in mid-summer 2004 and 2005. Gunshot sounds were common, detected on 37 of 38 recording days. Stereotyped gunshot bouts averaged 1.5 h, with some bouts exceeding 7 h in duration with up to seven individuals producing gunshots at any one time. Bouts were more commonly detected in the late afternoon and evening than during the morning hours. Locations of gunshots in bouts indicated that whales producing the sounds were either stationary or showed directional travel, suggesting gunshots have different communication functions depending on behavioral context. These results indicate that gunshots are a common right whale sound produced during the summer months and are an important component in the acoustic communication system of this endangered species.

  7. Morphoscopic analysis of experimentally produced bony wounds from low-velocity ballistic impact.

    PubMed

    Kieser, Jules A; Tahere, Joy; Agnew, Caitlin; Kieser, David C; Duncan, Warwick; Swain, Michael V; Reeves, Matthew T

    2011-12-01

    Understanding how bone behaves when subjected to ballistic impact is of critical importance for forensic questions, such as the reconstruction of shooting events. Yet the literature addressing microscopic anatomical features of gunshot wounds to different types of bone is sparse. Moreover, a biomechanical framework for describing how the complex architecture of bone affects its failure during such impact is lacking. The aim of this study was to examine the morphological features associated with experimental gunshot wounds in slaughtered pig ribs. We shot the 4th rib of 12 adult pigs with .22 mm subsonic bullets at close range (5 cm) and examined resultant wounds under the light microscope, scanning electron microscope SEM and micro tomograph μCT. In all cases there was a narrow shot channel followed by spall region, with evidence of plastic deformation with burnishing of the surface bone in the former, and brittle fracture around and through individual Haversian systems in the latter. In all but one case, the entrance wounds were characterized by superficially fractured cortical bone in the form of a well-defined collar, while the exit wounds showed delamination of the periosteum. Inorganic residue was evident in all cases, with electron energy dispersive spectroscopy EDS confirming the presence of carbon, phosphate, lead and calcium. This material appeared to be especially concentrated within the fractured bony collar at the entrance. We conclude that gunshot wounds in flat bones may be morphologically divided into a thin burnished zone at the entry site, and a fracture zone at the exit.

  8. Abdominal Aortic Aneurysm (AAA)

    MedlinePlus

    ... Resources Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis ... aortic aneurysm treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, ...

  9. Absorbable mesh and topical negative pressure therapy for closure of abdominal dehiscence with exposed bowel.

    PubMed

    Chuo, C B; Thomas, S S

    2008-11-01

    Permacol mesh is a porcine dermis-derived biomaterial used for the repair of abdominal incisional and inguinal hernia. It has been found to be a safe and effective alternative to non-absorbable mesh for application over exposed bowel. This mesh has also been successfully applied over contaminated abdominal wound beds and around stomas. Topical negative pressure therapy has been used for the management of wound complications after surgical implantation of Permacol mesh. We describe our experience with the combined use of Permacol mesh and simultaneous application of topical negative pressure therapy to aid wound contraction and granulation in a patient with abdominal dehiscence and exposed bowel.

  10. [Surgical care for the wounded in an armed conflict: the organization and support of first aid, prehospital and initial medical care (1)].

    PubMed

    Efimenko, N A; Gumanenko, E K; Samokhvalov, I M; Trusov, A A

    1999-06-01

    The article is devoted to surgical care organization to the battle casualties in Northern Caucasus, analysis of size and structure of "sanitary losses" (wounded in actions), questions of rendering first aid, battalion medical specialist aid and initial physician care. Gunshot wounds prevailed (64.1%) in the structure of battle surgical casualties. The blunt traumas and non-gunshot injuries have made of 33.2%, burns--4.1%, frost-bites--1.3%. The efficiency of medical care in this armed conflict is investigated on the own experience and retrospective analysis of graduated care to the 1030 casualties. Significance of duly rendering of the first aid to battle casualties is shown: the morality in this group had made 1.3%. Among wounded, which the first aid did not appear, the morality was of 7.0%.

  11. Historical overview of wound ballistics research.

    PubMed

    Maiden, Nick

    2009-01-01

    Ballistics involves the study of the scientific properties of projectiles, their behavior and their terminal effects on biological tissues and other materials. Wound ballistics deals with the analysis of injuries caused by projectiles and the behavior of projectiles within human or other biological tissues. The nineteenth century witnessed the development of both of these areas with Kocher's hydrodynamic theory and the understanding of the significance of bullet deformation in causing tissue injury. The degree of traumatic disruption of tissues and organs was also related to direct energy transfer from projectiles. While subsequent research has concentrated on elucidating further mechanisms of injury, the exact cause of remote tissue damage from high energy projectiles is still the subject of ongoing research. Much of the contemporary literature regarding wound ballistics concentrates on the forensic aspects and their application for legal purposes, in particular the investigation of shooting scenes. There have been many advances in this area, particularly in relation to the identification of various types of gunshot wounds and how their appearance can be used to establish if a shooting was accidental, deliberate (homicidal) or self inflicted (suicidal).

  12. [Current concepts of the mechanisms of formation of gunshot fractures].

    PubMed

    Pigolkin, Iu I; Dubrovin, I A; Leonov, S V; Mikhaĭlenko, A V; Dubrovin, A I; Zotkin, D A

    2013-01-01

    The mechanisms of formation of gunshot fractures in flat bones inflicted by a semispherical bullet were investigated using expert and experimental materials. The process of crack formation was considered in terms of the Hertzian contact problem and the Hill-Johnson model. It was shown that the fracture develops as a result of combination of stresses and strains in the bone tissue leading to the formation of a hydrostatic nucleus prior to tissue fragmentation. Dynamic fluctuations (waves) generated in the zone of hydrostatic compression resulting from the gunshot injury propagate with the velocity of sound from the nucleus in the direction of the bullet movement. According to the Hill-Johnson model, the waves propagate in the direction of the impact within a parabolically expanding space; this accounts for the mechanism of formation of parabolic cracks and the specific shape of the defect that the bullet produces in the flat bones. The dynamic load applied by means of an indentor forms at a higher rate than the velocity of sound in the affected material. It gives reason to consider the effect of a bullet moving with the speed of 250 m/s as quasi-static loading. The results obtained in this study make a contribution to the theory of impact effect of a bullet and provide a deeper insight into the physical nature of the direct and sideway action of a gunshot projectile. Moreover, they explain the cause behind the widening of the outlet part of the perforating fracture in the flat bones. PMID:25474911

  13. Potential uses of lead isotope ratios in gunshot cases.

    PubMed

    Keisch, B; Callahan, R C

    1978-05-01

    The determination of lead isotope ratios in 14 bullets, and in material taken from 9 hand swabs and 5 primers shows that there are potentially valuable forensic uses for such a method. While a more complete study is required, this method could possibly be used to prove (or disprove) relatiohships between bullets and manufacturers, weapons, or persons firing the weapons. Sample size requirements (1 microgram or less) are such that damaged or fragmented bullets, or minute particles therefrom, may be used for the required analyses. An experiment showed that gunshot residue from a test-fired weapon was detectable even after washing the hands.

  14. Bacterial Wound Culture

    MedlinePlus

    ... Home Visit Global Sites Search Help? Bacterial Wound Culture Share this page: Was this page helpful? Also known as: Aerobic Wound Culture; Anaerobic Wound Culture Formal name: Culture, wound Related ...

  15. The contributions of Alexis Carrel to the management of contaminated wounds.

    PubMed

    Limjoco, U R; Landon, C W; Ragland, J J

    1995-04-01

    Wound care through the ages has ranged from good to bad, and at times has been disgusting, with little scientific approach. von Eiselsberg's dictum of no touch for military wounds proved disastrous to patients with gunshot and shrapnel wounds in the First World War. Alexis Carrel, a brilliant experimental surgeon, spearheaded the research that led to the development and application of débridement and irrigation for combat wounds. Early in his career, Carrel reported on a miraculous cure that he had observed in Lourdes, France. However, this report resulted in a strained professional environment in his homeland of France, which persisted in spite of his subsequent moves to Canada and then to the United States. There he was awarded the Nobel Prize for Physiology and Medicine.

  16. Urban gunshot and sniper location: technologies and demonstration results

    NASA Astrophysics Data System (ADS)

    Lewis, Glynn; Shaw, Scott; Crowe, Michael; Cranford, Clay; Torvik, Kevin; Scharf, Peter; Stellingworth, Bob

    2002-08-01

    The Law Enforcement and Military technology development communities have a growing common interest in the technologies associated with gunshot detection and localization. These common interests include urban warfare, community-oriented policing and sniper location. Technologies of interest include those associated with muzzle blast and bullet shockwave detection and the inter-netting of these acoustic sensors with electro-optic sensors. To date, no one sensor technology has proven totally effective for a complete solution. PSI has a muzzle blast detection and localization product which is wireless, highly mobile and reconfigurable, with a user-friendly laptop processor and display unit, which is currently being demonstrated in two different implementations: 1) A one-year, and on-going urban gunshot detection system installed in Austin, Texas, that began July 2001; and 2) A counter sniper system demonstration conducted at both the Aberdeen Proving Grounds and at an Israeli Defense Force firing range in the second half of the year in 2001. The former topic is under the auspices of a National Institute of Justice Cooperative Agreement with PSI and the Austin Police Department, and the latter topic was managed by the Army Research Laboratory and co-funded by DARPA/ATO and PSI. This paper will discuss successful aspects of the demonstrations to date, operational conclusions, and the development directions indicated for the future.

  17. [Gunshot or blast injuries of the hand. Principles of treatment].

    PubMed

    Kollig, E; Franke, A

    2012-07-01

    Gunshot injuries to the hand are rare in Central Europe. As a result of their special trauma morphology they are a serious threat to the functional integrity of the hand and often lead to a loss of function which can be associated with a permanent unfitness to work or disability. Blast injuries to the hand are more common in this part of the world and are usually caused by the inappropriate use of fireworks. This trauma entity is associated with a number of special kinetic features and effects which have therapeutic consequences and should therefore be discussed separately. As a result of the low incidence of these specific types of injuries in times of peace, experience-based expertise is unlikely to be available. The management of gunshot injuries to the hand is a particular challenge to hand surgeons who must have specialist knowledge and skills in order to achieve an optimum outcome. This applies even more so to the treatment of blast injuries to the hand which are associated with far more complex injury patterns. As a rule blast injuries are associated with a high risk of complications and require a rapid assessment and rigorous management of all damaged structures similar to approaches used for infections of the hand. Illustrated by several cases which have been treated at our institution the basic aspects of the development and morphology of these injuries are discussed as well as different treatment options, algorithms and possible treatment outcomes. PMID:22772439

  18. Variations in recorded acoustic gunshot waveforms generated by small firearms.

    PubMed

    Beck, Steven D; Nakasone, Hirotaka; Marr, Kenneth W

    2011-04-01

    Analysis of recorded acoustic gunshot signals to determine firearm waveform characteristics requires an understanding of the impulsive signal events, how the waveforms vary among different sources, and how the waveforms are affected by the environment and the recording system. This paper presents empirical results from waveforms produced by different small firearms and an analysis of their variations under different and controlled conditions. Acoustic signals were generated using multiple firearm makes and models firing different ammunition types. Simultaneous recordings from the microphones located at different distances from the source and at different azimuth angles (from the line-of-fire) were used to study source characteristics and sound propagation effects. The results indicate that recorded gunshot waveforms generally consist of multiple acoustic events, and these are observable depending on the received distance and azimuth angle. The source blast size, microphone distance, and microphone azimuth angle are the primary factors affecting the recorded muzzle blast characteristics. Ground or object reflections and ballistic shockwaves and their reflections can interfere with the muzzle blast waveform and its measurements. This experiment confirmed and quantified the wide range of correlation results between waveforms recorded from different source, microphone distance, and microphone angle configurations. PMID:21476632

  19. Colocutaneous fistula management in a dehisced wound: a case study.

    PubMed

    Reed, Terri; Economon, Diana; Wiersema-Bryant, Laurel

    2006-04-01

    A fistula is an abnormal opening between two or more organs or structures. Wound drainage containment is a key component of nonsurgical fistula management and may include pouches, skin barriers, transparent dressings, troughing procedures, saddle bagging, bridging, and condom and suction catheters used in combination with complex or routine pouching. Following extensive abdominal surgery, the wound of a 50-year-old woman dehisced and a colocutaneous fistula formed inside the wound. The wound containing the fistula, which was draining liquid stool, was too large for existing commercial pouching systems. When initial management efforts, including negative pressure wound therapy, failed to achieve containment goals, clinicians adapted the negative pressure wound therapy dressing to surround the fistula, which helped facilitate therapy while providing a platform for an ostomy appliance to contain the fistula drainage. The system was changed every 2 days until discharge. The wound and fistula management combination improved patient comfort and mobility, facilitated healing, and reduced patient dietary restrictions.

  20. Wounding effects of the AK-47 rifle used by Patrick Purdy in the Stockton, California, schoolyard shooting of January 17, 1989.

    PubMed

    Fackler, M L; Malinowski, J A; Hoxie, S W; Jason, A

    1990-09-01

    The limited disruption produced in tissue simulant by the rifle and bullets used in the Stockton, California, schoolyard shooting is entirely consistent with the autopsy reports on the five children who died of their wounds. It is also entirely consistent with well-documented battlefield studies and with previous tissue-simulant studies from many laboratories. It is inconsistent with many exaggerated accounts of assault-rifle wounding effects described by the media in the aftermath of this incident. This information should be documented for the historical record. However, the critical reason for correcting the misconceptions produced by media reaction to this incident is to prevent inappropriate gunshot-wound treatment.

  1. [Young man with gunshot wound (GSW)--what killed Ernst vom Rath?].

    PubMed

    Shasha, Shaul M; Eithan, Arieh; Feinsod, Moshe; Georg M, Weisz

    2013-11-01

    On the morning of November 7, 1938 vom Rath, a diplomat at the German embassy in Paris, was shot by Herschel Grynzspan, a Jewish teenager. Of the 5 shots fired, 2 hit vom Rath, one in the right shoulder and one in the abdomen. He was rushed to Alma Women's Hospital near the embassy, where emergency surgery was undertaken. Two days later his condition deteriorated rapidly and succumbed 55 hours after the shooting. It is believed that the assassination triggered the "Kristallnacht"--the organized Nazi pogrom against Jews across Germany. Based on the Alma hospital registry, autopsy findings and articles from recent years, the course of his condition and possible cause of his death are discussed. The possibility of malpractice, and even medical fraud, which led to his death are also mentioned. PMID:24416826

  2. Gunshot wound to the back of the head--self defence vs homicide.

    PubMed

    Zugibe, F T; Costello, J T; Breithhaupt, M K

    1989-01-01

    A police officer attended the scene of a burglary in progress and, following a pursuit through the house with his gun in hand, short the burglar in the back of the head. the officer pleased self-defense alleging that the burglar had whirled around holding what was perceived as a gun in this left hand and that he had reflexively pulled the trigger of his own gun. When he examined the body, a black yarmulke was present near the outstretched hand of the burglar. The results of a reconstruction were consistent with the details of the police officer's deposition. PMID:2794916

  3. Executive amnesia in a patient with pre-frontal damage due to a gunshot wound.

    PubMed

    de Oliveira-Souza, R; Moll, J; Moll, F T; de Oliveira, D L

    2001-01-01

    This paper reports the case of a young patient with extensive pre-frontal damage in whom we tested the hypothesis that intensive training improves executive performance as assessed by the Wisconsin Card Sorting Test (WCST). As long as her declarative memory, complex perceptual abilities and global cognitive status were spared, we surmised that any deficit in executive learning would have occurred in relative isolation. We showed that her abnormal performance on the WCST, both on the standard as well as on the post-instruction condition, was due to an impairment of shifting attention across perceptual dimensions (extra-dimensional). In contrast, her ability to shift attention within perceptual categories (intra-dimensional) was spared, as were her declarative memory, object and visuospatial perception, oral language comprehension and praxis (ideomotor, tool use and constructional). This case supports the hypothesis that executive amnesia is a type of amnesic disorder distinct from the classic amnesic syndrome due to mamillo-temporomedial damage. As such, it is probably closely related to procedural learning and may depend on the same fronto-subcortical loops that mediate the actual execution of behaviour.

  4. [Treatment methods of atypical gunshot wounds to the head--case reports].

    PubMed

    Mielniczek, Paweł; Zieliński, Grzegorz; Koziarski, Andrzej

    2016-05-01

    Due to a high mortality rate, headshot injuries pose serious diagnostic and clinical problems. In this work, we wanted to describe four atypical headshot injuries. The first patient with a headshot injury using a nail gun mishap; the second one after a headshot injury, as a result of attempted murder (the bullet came to a parasagittal halt in the left parietal area); the third victim, after a suicide attempt (the bullet was removed from clivus area, below the pituitary gland); in the case of the fourth patient, after shooting himself with a self-constructed weapon in the chin, the metal body was surgically removed - a bearing pellet from the corpus callosum. Males dominate among victims of headshot injuries. Alcohol is one of the elements that facilitate suicidal behaviour. Anti-spasm, antibacterial, anti-tetanus prophylaxes are incredibly important. In some cases, the metallic body does not have to be removed from the brain. Pulmonary embolism can be a cause of death after 7 days from injury. PMID:27234864

  5. [Treatment methods of atypical gunshot wounds to the head--case reports].

    PubMed

    Mielniczek, Paweł; Zieliński, Grzegorz; Koziarski, Andrzej

    2016-05-01

    Due to a high mortality rate, headshot injuries pose serious diagnostic and clinical problems. In this work, we wanted to describe four atypical headshot injuries. The first patient with a headshot injury using a nail gun mishap; the second one after a headshot injury, as a result of attempted murder (the bullet came to a parasagittal halt in the left parietal area); the third victim, after a suicide attempt (the bullet was removed from clivus area, below the pituitary gland); in the case of the fourth patient, after shooting himself with a self-constructed weapon in the chin, the metal body was surgically removed - a bearing pellet from the corpus callosum. Males dominate among victims of headshot injuries. Alcohol is one of the elements that facilitate suicidal behaviour. Anti-spasm, antibacterial, anti-tetanus prophylaxes are incredibly important. In some cases, the metallic body does not have to be removed from the brain. Pulmonary embolism can be a cause of death after 7 days from injury.

  6. PreFix™ external fixator used to treat a floating shoulder injury caused by gunshot wound.

    PubMed

    Vogels, J; Pommier, N; Cursolle, J-C; Belin, C; Tournier, C; Durandeau, A

    2014-10-01

    Open fractures of the shoulder are extremely rare, and their treatment is a major challenge for surgeons. Only cases encountered in military settings have been reported thus far. Such fractures are often the result of ballistic trauma, which causes extensive damage to both bony and soft tissues. Since these injuries are associated with a high risk of infection and the presence of comminuted fractures, external fixation is necessary for repair. Use of external fixators and revascularization techniques has reduced the number of cases requiring shoulder amputation or disarticulation. Injury to the proximal extremity of the humerus, acromion, and clavicle further complicates the treatment. No published studies have described the assembly of external fixators for fractures in the scapular region with significant bone loss. In addition, no cases have been described in civilian settings. However, with an increase in urban violence and the traffic of illegal arms, civilian surgeons are now encountering an increasing number of patients with these injuries. In this report, we not only present a rare case of floating shoulder injury in a civilian setting but also provide an overview of the existing treatment strategies for this type of trauma, with special focus on the use of external fixators in elective shoulder arthrodesis and on military cases. PMID:25267396

  7. [Possibilities of energy augmentation of pellets shot from ASG replicas and gunshot wounds].

    PubMed

    Golema, Wojciech; Jurek, Tomasz; Thannhäuser, Agata; Kawecki, Jerzy; Trnka, Jakub

    2011-01-01

    In this paper, the authors review the types of air soft gun replicas depending on the type of drive and ammunition, showing the possibilities of altering the M4A1 rifle replica's technical parameters and the effect of such modifications on initial energy of the projectile. A PJ4 CQB NAVY replica's inner barrel, spring, motor and cylinder kit were replaced. Subsequently, the muzzle velocity was determined and compared to the initial muzzle velocity. This example showed that amateur modifications can greatly increase the initial energy of the pellet. The authors suggest that especially in terms of determining the exposure to direct danger of death or grave detriment to health, the manufacturer's data about pellet energy should not be taken without question, but one should strive for an individual assessment of the ASG replica constituting the evidence.

  8. [Peculiarities of forensic medical expertise of gunshot wounds inflicted through a bulletproof vest].

    PubMed

    Ozertskovskiĭ, L B; Tiurin, M V; Denisov, A V

    2013-01-01

    A series of experimental studies was conducted with the object of elucidating the mechanisms of the bullet after-penetration effect produced by a handgun shot into the armoured vest with special reference to the changes developing in the space behind the barrier. The application of the pulsed radiographic technique revealed a transient cavity the presence of which accounts for the injuries to soft tissues, bones, and internal organs in the projection of the bullet impact without damage to the armour plates.

  9. A medical history of Governor John B. Connally and his gunshot wounds.

    PubMed

    Li, George Z; Duke, James H; Pappas, Theodore N

    2015-11-01

    : On November 22, 1963, the Governor of Texas, John Connally, was injured during the assassination of President John F. Kennedy. Multiple authors have documented President Kennedy's injuries, the attempted resuscitation, and the controversies surrounding these events. However, the injuries sustained by Governor Connally have been overlooked by historians predominantly because of the extraordinary importance of the presidential assassination and its impact on the national consciousness. This review discusses the governor's political life, the mechanism of injury, his medical care, and the role the injuries had on his subsequent public life. PMID:26496116

  10. Patients with Glasgow Coma Scale scores 3, 4, 5 after gunshot wounds to the brain.

    PubMed

    Kaufman, H H; Levy, M L; Stone, J L; Masri, L S; Lichtor, T; Lavine, S D; Fitzgerald, L F; Apuzzo, M L

    1995-10-01

    Even this information is only partial. To study fully the effects of treatment would require optimal care at all points from time of injury, including rapid prehospital resuscitation, rapid transport to an optimally equipped and staffed hospital, immediate evaluation and treatment of the initial injury and all complications, rapid and comprehensive rehabilitation, and supportive and flexible home and work settings for the patient on discharge. Patients would need to be stratified for premorbid characteristics, including intelligence, personal traits, and training. Prolonged follow-up, possibly for several years, would be required to determine true outcome. No current study contains sufficient numbers of patients treated optimally and studied for prolonged periods, but this should be done. One way of looking at such patients is to decide that many should be treated to salvage a few. The other way of looking at them is that so many must receive care, at great emotional and economic cost to themselves and others, that such treatment is inappropriate for any of them. Treating all such patients would be a major undertaking. If most of these patients were treated vigorously, a great proportion of them would still die but probably not for a number of days. During this period, their families would be under extreme stress. Once stabilized and receiving ongoing care, some patients would enter a permanent vegetative state and survive for prolonged periods until their prognosis was clear and care was withdrawn, again causing family stress as well as high cost. Some would likely survive although impaired. The charges and real costs of care for all these patients would be tremendous. The question therefore arises as to how to decide what to do about caring for a large group of patients whose maximal care would be costly in emotional and financial terms, particularly at a time when it is recognized that resources for medical care are going to be limited. When discussing such patients as a group with a view toward developing practice guidelines, many considerations must be brought to bear. One consideration is the certainty of the prognosis in both a quantitative and a qualitative sense in an individual case. It is not clear that one can be certain in patients except when there are overwhelmingly unfavorable features. As has been noted, even patients who have been shot through the geographic center of the brain and are posturing can make excellent recoveries. This would push toward aggressive treatment for many patients. Decision making must therefore be considered in terms of bioethics. The major principle-based systems of bioethics are deontologic, arising from accepted principles, and utilitarian, arising from effect on outcome. A virtue-based ethic for physicians arising from "the caring bond and the public trust" is being revived as a balance to analytical ethics. A similar orientation from the point of view of patients is communitarian ethics, that is asking for only what is reasonable and not so much as might harm others. Some of the issues to be considered include the sanctity of life while taking into account the criteria for life--vegetative function versus some level of mental function. One must also review each decision from the viewpoints of all the parties involved--patients, family and friends, physicians, and society--in the context of a heterogeneous society in which individual rights and tolerance enforced by law are primary features. In the patients' terms, there is a desire and right to medical care to maintain a healthy productive life. Even if impaired to some extent, patients may still have an interest in living. Balancing benefits and burdens of life is a complex problem. There is also the right, based on patients' values, to refuse care if there is the wish not to take a chance of having a significantly compromised existence. Such declaration before injury should be honored...

  11. Myositis ossificans circumscripta, secondary to high-velocity gunshot and fragment wound that causes sciatica.

    PubMed

    Gokkus, Kemal; Sagtas, Ergin; Suslu, Feride Ekimler; Aydin, Ahmet Turan

    2013-10-17

    This report concerns an unusual cause of sciatica. The case presented is of a young man with myositis ossificans that resulted in sciatica and was treated with en bloc excision and low-dose radiotherapy and indomethacine. The aim of this study was to explain the different diagnostic properties of myositis ossificans around the hip and non-classic causes of sciatica.

  12. Prehospital Management of Gunshot Patients at Major Trauma Care Centers: Exploring the Gaps in Patient Care

    PubMed Central

    Norouzpour, Amir; Khoshdel, Ali Reza; Modaghegh, Mohammad-Hadi; Kazemzadeh, Gholam-Hossein

    2013-01-01

    Background Prehospital management of gunshot-wounded (GW) patients influences injury-induced morbidity and mortality. Objectives To evaluate prehospital management to GW patients emphasizing the protocol of patient transfer to appropriate centers. Patients and Methods This prospective study, included all GW patients referred to four major, level-I hospitals in Mashhad, Iran. We evaluated demographic data, triage, transport vehicles of patients, hospitalization time and the outcome. Results There were 66 GW patients. The most affected body parts were extremities (60.6%, n = 40); 59% of cases (n = 39) were transferred to the hospitals with vehicles other than an ambulance. Furthermore, 77.3% of patients came to the hospitals directly from the site of event, and 22.7% of patients were referred from other medical centers. EMS action intervals from dispatchers to scene departure was not significantly different from established standards; however, arrival to hospital took longer than optimal standards. Additionally, time spent at emergency wards to stabilize vital signs was significantly less in patients who were transported by EMS ambulances (P = 0.01), but not with private ambulances (P = 0.47). However, ambulance pre-hospital care was not associated with a shorter hospital stay. Injury Severity was the only determinant of hospital stay duration (β = 0.36, P = 0.01) in multivariate analysis. Conclusions GW was more frequent in extremities and the most patients were directly transferred from the accident site. EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance. Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay. This showed that upgrade of ambulance equipment and training of private ambulance personnel may be needed. PMID:24350154

  13. [Ultrastructural characteristic of gunpowder charge remains in forensic medical examination of gunshot bullet injuries].

    PubMed

    Kharin, G M; Gubeeva, E G; Aleksandrov, V N; Osin, Iu N

    2008-01-01

    Particles of 3 different marks of gunpowder, withdrawing from experimental gunshot injuries, were examined with scanning electronic microscopy. Features of ultrastructure, making possible to differentiate gunpowder of studied marks, were detected.

  14. Metal dust deposition in a shotgun wound associated with barrel modification.

    PubMed

    Williams, Andrew S; Bowes, Matthew J

    2016-03-01

    Contact-range gunshot wounds commonly demonstrate deposition of black soot in and around the wound. Deposition of other visible pigments originating from the firearm has not been specifically described. In the current case, an adult male was found dead adjacent to a shotgun fixed in a vice grip with a modified, shortened barrel. A handheld, powered, metal grinding wheel was nearby. Autopsy revealed an intraoral gunshot wound, including soot deposition in and around the mouth and within the wound track. In addition, there was a peculiar, gray, lustrous film on the lips, gingiva, and anterior teeth. The material was concentrated around the most severe areas of injury in the anterior mouth and easily rubbed off with a cotton swab. It was not visualized in the rest of the mouth and not present in the larynx, or the esophagus. Overall, our opinion is that this unique, gray, lustrous film represents deposition of fine metallic dust that accumulated in the barrel of the shotgun during its modification with the grinding wheel. This type of unique pigment deposition should be recognized by forensic pathologists as possibly being related to the discharge of a firearm with a recently modified barrel or other cause for fine metallic dust accumulation within the barrel. Depending on the circumstances of the case, collection of samples of such metal dust deposits could be indicated for subsequent analysis. PMID:26782960

  15. Metal dust deposition in a shotgun wound associated with barrel modification.

    PubMed

    Williams, Andrew S; Bowes, Matthew J

    2016-03-01

    Contact-range gunshot wounds commonly demonstrate deposition of black soot in and around the wound. Deposition of other visible pigments originating from the firearm has not been specifically described. In the current case, an adult male was found dead adjacent to a shotgun fixed in a vice grip with a modified, shortened barrel. A handheld, powered, metal grinding wheel was nearby. Autopsy revealed an intraoral gunshot wound, including soot deposition in and around the mouth and within the wound track. In addition, there was a peculiar, gray, lustrous film on the lips, gingiva, and anterior teeth. The material was concentrated around the most severe areas of injury in the anterior mouth and easily rubbed off with a cotton swab. It was not visualized in the rest of the mouth and not present in the larynx, or the esophagus. Overall, our opinion is that this unique, gray, lustrous film represents deposition of fine metallic dust that accumulated in the barrel of the shotgun during its modification with the grinding wheel. This type of unique pigment deposition should be recognized by forensic pathologists as possibly being related to the discharge of a firearm with a recently modified barrel or other cause for fine metallic dust accumulation within the barrel. Depending on the circumstances of the case, collection of samples of such metal dust deposits could be indicated for subsequent analysis.

  16. Image-guided ureteral reconstruction using rendezvous technique for complex ureteric transection after gunshot injuries

    PubMed Central

    Arabi, Mohammad; Mat’hami, Abdulaziz; Said, Mohammad T.; Bulbul, Muhammad; Haddad, Maurice; Al-Kutoubi, Aghiad

    2016-01-01

    Management of complex ureteric transection poses a significant clinical challenge, particularly after gunshot injuries due to marked distortion of anatomy and associated tissue loss. We report two cases of total ureteric transection due to gunshot injury successfully repaired using fluoroscopy-guided rendezvous procedure and double J stent placement. This minimally invasive approach may offer a safe and effective technique to repair complete ureteral transection and obviate the need for complex surgical procedures. PMID:26955601

  17. Field kit and method for testing for the presence of gunshot residue

    DOEpatents

    Rodacy, Philip J.; Walker, Pamela K.

    2003-09-02

    A field test kit for gunshot residue comprises a container having at least compartments separated by a barrier. A surface is tested by wiping it with a swab and placing the swab in a first compartment. The barrier is then breached, permitting reagent in the second compartment to flow onto the swab. The first compartment is transparent, and a color change will be observed if the reagent reacts with gunshot residue.

  18. A comparison between digital radiography, computed tomography, and magnetic resonance in the detection of gunshot residues in burnt tissues and bone.

    PubMed

    Amadasi, Alberto; Borgonovo, Simone; Brandone, Alberto; Di Giancamillo, Mauro; Cattaneo, Cristina

    2014-05-01

    The radiological search for GSR is crucial in burnt material although it has been rarely tested. In this study, thirty-one bovine ribs were shot at near-contact range and burnt to calcination in an oven simulating a real combustion. Computed tomography (CT) and magnetic resonance (MR) were performed before and after carbonization and compared with former analyses with DR (digital radiography); thus comparing the assistance, the radiological methods can provide in the search for GSR in fresh and burnt bone. DR demonstrated the greatest ability in the detection of metallic residues, CT showed lower abilities, while MR showed a high sensitivity only in soft tissues. Thus, DR can be considered as the most sensitive method in the detection of GSR in charred bones, whereas CT and MR demonstrated much less reliability. Nonetheless, the MR ameliorates the analysis of gunshot wounds in other types of remains with large quantities of soft tissues.

  19. Spino-renal fistula due to gunshot injury.

    PubMed

    Alsharef, M M; Christopher, N; Fourie, T

    2011-07-01

    A 22-year-old female patient was treated for spino-renal fistula as a result of a high-velocity gunshot injury to her abdomen. The patient presented with meningeal signs, a headache and right monoparesis. A CT scan of her abdomen revealed a leak of contrast from the right kidney into the perirenal space and tracking further into the thecal sac. An MRI scan showed a stable fracture of L3 with slight compression of the thecal sac and features of cord contusion caused by the shockwave of the bullet. To the best of our knowledge a spino-renal fistula of traumatic origin has not previously been reported in the English language literature.

  20. Use of luminescent gunshot residues markers in forensic context.

    PubMed

    Weber, I T; Melo, A J G; Lucena, M A M; Consoli, E F; Rodrigues, M O; de Sá, G F; Maldaner, A O; Talhavini, M; Alves, S

    2014-11-01

    Chemical evaluation of gunshot residues (GSR) produced by non-toxic lead-free ammunition (NTA) has been a challenge to forensic analyses. Our group developed some luminescent markers specific to the detection of GSR. Here, we evaluated the performance of selected markers in experiments that mimic forensic context and/or routines in which luminescent characteristics would be very useful. We evaluated the influence of markers' addition on the bullet's speed, the rate of shot failure (i.e., when the cartridge case is not fully ejected and/or a new ammunition is not automatically replaced in the gun chamber) as a function of marker percentage, the possibility of collecting luminescent gunshot residue (LGSR) in unconventional locations (e.g. the shooters' nostrils), the LGSR lifetime after hand washing, the transfer of LGSR to objects handled by the shooter, and the dispersion of LGSR at the crime scene and on simulated victims. It was observed that high amounts of marker (10 wt%) cause high rates of failure on pistols, as well as a substantial decrease in bullet speed. However, the use of 2 wt% of marker minimizes these effects and allows LGSR detection, collection and analysis. Moreover, in all conditions tested, markers showed high performance and provided important information for forensic analyses. For instance, the LGSR particles were found on the floor, ranging from 0 to 9.4 m away from the shooter, on the door panel and seats after a car shooting experiment, and were found easily on a pig leg used to simulate a victim. When a selective tagging was done, it was possible to obtain positive or negative correlation between the victim and shooter. Additionally LGSR possesses a fairly long lifetime (9 h) and good resistance to hand washing (up to 16 washes).

  1. Use of luminescent gunshot residues markers in forensic context.

    PubMed

    Weber, I T; Melo, A J G; Lucena, M A M; Consoli, E F; Rodrigues, M O; de Sá, G F; Maldaner, A O; Talhavini, M; Alves, S

    2014-11-01

    Chemical evaluation of gunshot residues (GSR) produced by non-toxic lead-free ammunition (NTA) has been a challenge to forensic analyses. Our group developed some luminescent markers specific to the detection of GSR. Here, we evaluated the performance of selected markers in experiments that mimic forensic context and/or routines in which luminescent characteristics would be very useful. We evaluated the influence of markers' addition on the bullet's speed, the rate of shot failure (i.e., when the cartridge case is not fully ejected and/or a new ammunition is not automatically replaced in the gun chamber) as a function of marker percentage, the possibility of collecting luminescent gunshot residue (LGSR) in unconventional locations (e.g. the shooters' nostrils), the LGSR lifetime after hand washing, the transfer of LGSR to objects handled by the shooter, and the dispersion of LGSR at the crime scene and on simulated victims. It was observed that high amounts of marker (10 wt%) cause high rates of failure on pistols, as well as a substantial decrease in bullet speed. However, the use of 2 wt% of marker minimizes these effects and allows LGSR detection, collection and analysis. Moreover, in all conditions tested, markers showed high performance and provided important information for forensic analyses. For instance, the LGSR particles were found on the floor, ranging from 0 to 9.4 m away from the shooter, on the door panel and seats after a car shooting experiment, and were found easily on a pig leg used to simulate a victim. When a selective tagging was done, it was possible to obtain positive or negative correlation between the victim and shooter. Additionally LGSR possesses a fairly long lifetime (9 h) and good resistance to hand washing (up to 16 washes). PMID:25305530

  2. Dietary peptides improve wound healing following surgery.

    PubMed

    Roberts, P R; Black, K W; Santamauro, J T; Zaloga, G P

    1998-03-01

    To determine if peptide-based enteral diets improve wound healing when compared to amino acid-based diets, a prospective randomized study was conducted using 38 male Sprague-Dawley rats. Following placement of a standardized abdominal wound, 20 animals were randomized to an isonitrogenous peptide-based (PEP) versus amino acid-based diet (AA) for 10 d. In addition, 18 animals were randomized to an amino acid-based diet supplemented with the peptide carnosine (CARN) or its constituent amino acids (Control). Diets were administered through small bowel feeding tubes. Wound bursting pressure was significantly higher in the PEP animals compared to the AA animals (179+/-9 versus 138+/-12 mmHg; P=0.02). In addition, wound bursting pressure was significantly greater in the CARN animals compared to the Control animals (143+/-10 versus 116+/-8 mmHg; P=0.005). Peptide-based enteral diets improve wound healing when compared to nonpeptide generating amino acid-based diets. We also conclude that the dietary peptide carnosine represents a dietary peptide that improves wound healing when administered as part of a complete enteral formula. This effect on wound healing may be clinically relevant because carnosine is not found in most enteral formulas.

  3. How wounds heal

    MedlinePlus

    ... How scrapes heal; How puncture wounds heal; How burns heal; How pressure sores heal; How lacerations heal ... from germs. Not all wounds bleed. For example, burns, some puncture wounds, and pressure sores do not ...

  4. Abdominal cerebrospinal fluid pseudocysts.

    PubMed

    Erşahin, Y; Mutluer, S; Tekeli, G

    1996-12-01

    Abdominal cerebrospinal fluid pseudocyst in an infrequent complication of ventriculoperitoneal (VP) shunts. We reviewed ten patients with abdominal pseudocyst. There were five girls and five boys, aged between 4 months and 14 years. The number of shunt procedures prior to the presentation varied between one and five. Only one patient had had a previous shunt infection. No patients had undergone prior abdominal surgery other than VP shunting. The time from the last shunting procedure to the development of abdominal pseudocyst ranged from 3 weeks to 5 years. Presenting symptoms and signs were mainly related to abdominal complaints in all patients. Three patients also had signs of shunt malfunction. The diagnosis was made by ultrasound in all patients. Shunt infection was determined in six patients. Repositioning if the peritoneal catheter seemed to have a higher rate of recurrence. The diagnosis of abdominal pseudocyst should be considered in VP-shunted patients presenting with abdominal complaints.

  5. Abdominal Circulatory Interactions.

    PubMed

    Dagar, Gaurav; Taneja, Amit; Nanchal, Rahul S

    2016-04-01

    The abdominal compartment is separated from the thoracic compartment by the diaphragm. Under normal circumstances, a large portion of the venous return crosses the splanchnic and nonsplanchnic abdominal regions before entering the thorax and the right side of the heart. Mechanical ventilation may affect abdominal venous return independent of its interactions at the thoracic level. Changes in pressure in the intra-abdominal compartment may have important implications for organ function within the thorax, particularly if there is a sustained rise in intra-abdominal pressure. It is important to understand the consequences of abdominal pressure changes on respiratory and circulatory physiology. This article elucidates important abdominal-respiratory-circulatory interactions and their clinical effects. PMID:27016167

  6. Advanced techniques in abdominal surgery.

    PubMed Central

    Monson, J R

    1993-01-01

    Almost every abdominal organ is now amenable to laparoscopic surgery. Laparoscopic appendicectomy is a routine procedure which also permits identification of other conditions initially confused with an inflamed appendix. However, assessment of appendiceal inflammation is more difficult. Almost all colonic procedures can be performed laparoscopically, at least partly, though resection for colonic cancer is still controversial. For simple patch repair of perforated duodenal ulcers laparoscopy is ideal, and inguinal groin hernia can be repaired satisfactorily with a patch of synthetic mesh. Many upper abdominal procedures, however, still take more time than the open operations. These techniques reduce postoperative pain and the incidence of wound infections and allow a much earlier return to normal activity compared with open surgery. They have also brought new disciplines: surgeons must learn different hand-eye coordination, meticulous haemostasis is needed to maintain picture quality, and delivery of specimens may be problematic. The widespread introduction of laparoscopic techniques has emphasised the need for adequate training (operations that were straight-forward open procedures may require considerable laparoscopic expertise) and has raised questions about trainee surgeons acquiring adequate experience of open procedures. Images FIG 9 p1347-a p1347-b p1349-a p1350-a p1350-b PMID:8257893

  7. Monitoring combat wound healing by IR hyperspectral imaging

    NASA Astrophysics Data System (ADS)

    Howle, Chris R.; Spear, Abigail M.; Gazi, Ehsan; Crane, Nicole J.

    2016-03-01

    In recent conflicts, battlefield injuries consist largely of extensive soft injuries from blasts and high energy projectiles, including gunshot wounds. Repair of these large, traumatic wounds requires aggressive surgical treatment, including multiple surgical debridements to remove devitalised tissue and to reduce bacterial load. Identifying those patients with wound complications, such as infection and impaired healing, could greatly assist health care teams in providing the most appropriate and personalised care for combat casualties. Candidate technologies to enable this benefit include the fusion of imaging and optical spectroscopy to enable rapid identification of key markers. Hence, a novel system based on IR negative contrast imaging (NCI) is presented that employs an optical parametric oscillator (OPO) source comprising a periodically-poled LiNbO3 (PPLN) crystal. The crystal operates in the shortwave and midwave IR spectral regions (ca. 1.5 - 1.9 μm and 2.4 - 3.8 μm, respectively). Wavelength tuning is achieved by translating the crystal within the pump beam. System size and complexity are minimised by the use of single element detectors and the intracavity OPO design. Images are composed by raster scanning the monochromatic beam over the scene of interest; the reflection and/or absorption of the incident radiation by target materials and their surrounding environment provide a method for spatial location. Initial results using the NCI system to characterise wound biopsies are presented here.

  8. [Provision of medical care to the wounded with craniocerebral injuries at stages of medical evacuation in mountains and desert areas].

    PubMed

    Orlov, V P

    2015-01-01

    The author shows that surgery with craniocerebral injuries should be fully performed at the stage of specialized medical care. Wounded have to be evacuated not earlier than 5-7 days after surgery with the mandatory use of a special air transport ("Scalpel" or "Spasatel"), accompanied by Anaesthetist. In the absence of the possibility of surgery in 5-7 days at this stage the wounded have to be evacuated by air to the center hospitals. On the stage there are only patients requiring specialized care because of health reasons. Wounded with gunshot wounds of the soft tissues of the head, and those with mild forms of brain damage during the explosive and combat injury (concussion, mild brain contusion) can be evacuated by air transport accompanied by a doctor or paramedic at any period of time after the injury (trauma).

  9. Factors which influence the risk of wound infection in trauma patients.

    PubMed

    Weigelt, J A; Haley, R W; Seibert, B

    1987-07-01

    Surgical wound infections following traumatic injury remain a source of morbidity and mortality. A simple system for estimating the risk of infectious complications was evaluated in 949 trauma patients requiring operative therapy. The majority of cases were caused by penetrating trauma (784). Truncal, neck, and extremity procedures were included. The overall wound infection rate was 7%. Infection rates were related to amount of bacterial contamination and mechanism of injury. Age, type of antibiotics, and delay time from injury to operation were not risk factors for any injury type. Wound classification, shock, blood loss, number of organs injured, and operative time were significant risk factors, but had different effects on infection rate related to injury type. Multivariate analysis revealed no significant infectious risk factors for stabwounds. Significant factors were wound class (p = 0.02) and shock (p = 0.001) for gunshot wounds, wound class (p = 0.03) and number of organs injured (p = 0.01) for blunt trauma, and blood loss (p = 0.01) for shotgun wounds. This classification system can be used to review outcome and compare trauma patient populations for infectious morbidity in a more uniform fashion.

  10. [Wounded patients transportation during peace enforcement operation in Georgia (August 2008)].

    PubMed

    Kotenko, P K; Pak, R V; Golovinova, V Iu

    2014-09-01

    The article highlights the analysis of wounded movement during peace enforcement operation in Georgia (August 2008). 72% of incoming patients were walking wounded; 97,5% male patients, 2,5% female patients; per cent of combat surgery pathology - 90,2% including combat surgical trauma 83,2%, general surgical diseases - 7%, combat therapeutic pathology - 9,8%; leading gunshot traumas in walking wounded are lower extremities injuries - 33,6%, upper extremities injuries - 27,9% (in total 61,5%), head injuries - 25,4%. Within combat therapeutic pathology walking wounded suffered from the following classes of diseases/sicknesses - I class - 35,7%, XII class - 14,3%, V class - 10,7%. 236 military hospitals (In Vladikavkaz) had admitted 71,2% of walking wounded (of incoming traffic), 1458 military hospitals (in Mozdok) had admitted 91,7% of walking wounded from front traffic, flank traffic was 100%. 49, 7% of patients finished the treatment in military hospitals of zone level, 47,9% of patients - in hospitals of district level, 2,4% of patients - in central hospitals. The,average duration of the treatment of walking wounded in hospitals of zone level consisted 16,9±0,7 days, no lethal outcomes were registered. PMID:25546962

  11. [Penetrating injuries of the abdomen. Results of two classical and selective attitudes in the management of 249 wounds].

    PubMed

    el Idrissi, H D; Kafih, M; Ajbal, M; Ridaï, M; Sarf, I; Salmi, A; Almou, M; Zerouali, N O

    1994-01-01

    The systematic surgical exploration of each abdominal penetrating wound allows an exact out-come of lesions and an adequate treatment without delay. But these advantages are made upon a possibly 30% negative laparotomy. The selective attitude in the management of these abdominal's wounds has permitted to decrease this rate to 5% with a risk of secondary operation for non primary detected lesions in 5%. Our attitude toward 249 penetrative abdominal's wounds was classic and selectable respectively from 86 to 89 and 90 to 93. The results has confirmed the literature's date and especially has shown no significant difference between the two attitude concerning the morbidity and the mortality.

  12. Organic gunshot residues: Observations about sampling and transfer mechanisms.

    PubMed

    Gassner, Anne-Laure; Ribeiro, Cristina; Kobylinska, Joanna; Zeichner, Arie; Weyermann, Céline

    2016-09-01

    This work aimed at studying the sampling, storage, transfer and persistence of organic gunshot residue (OGSR), mainly stabilizers, using liquid chromatography hyphenated to mass spectrometry. Collection using swabs and stubs was compared through sequential sampling in terms of amount of residues left on the hand of a shooter. While stubs collected nearly all residues, swabs left about 50% of the residues on the hands. Moreover, the study of storage conditions after sampling showed that stubs were more stable than swabs and could be held at room temperature without significant compound loss up to 2weeks. Then, shooting experiments were performed to evaluate transfer of OGSR. It was not possible to differentiate different brands of ammunition based on a single compound concentration. Moreover, a memory effect was identified when different ammunition was shot using the same firearm. Finally, various exposed skin surfaces and hair as well as clothing were sampled to estimate what surfaces might be the best targets for OGSR sampling by comparing results just after discharge and 2h after discharging a pistol. The results indicated that OGSR were more rapidly lost from hands than from clothing. Moreover, it was shown that the face and hair of a suspect might be contaminated through secondary transfer. Thus, OGSR might remain longer on other skin surfaces, hair and clothing than on the hands of a suspect. As a consequence, sampling should also include clothing, hair and face. PMID:27379755

  13. Firework displays as sources of particles similar to gunshot residue.

    PubMed

    Grima, Matthew; Butler, Mark; Hanson, Robert; Mohameden, Ahmed

    2012-03-01

    In light of past research being targeted to find specific particles which may be similar to gunshot residue (GSR), this project was formulated to detect any possible particulate by random particle fallout onto substrates at firework displays and to assess the impact this may have on GSR evidence. Firework residue was collected at a display site, from amongst spectators as well as from the author's hair 90min after the display. SEM-EDX analysis has detected such particulate in all three scenarios, with the firework particle population at large providing a solid ground for discrimination from GSR. Wind dispersal was found to decrease the particle population and subsequently, the latter's discriminatory power. Some particles, if treated individually were found to be indistinguishable from GSR. Findings also include residues which may mimic strontium based GSR as well as GSR which may be mixed with that from previous firings. The continuous changes made to primer and propellant compositions by manufacturers also call for greater consideration when classifying particles as originating from pyrotechnic devices. Furthermore, authorities such as police forces should be made more aware about the incidence of such particle transfer in firework related periods.

  14. Firework displays as sources of particles similar to gunshot residue.

    PubMed

    Grima, Matthew; Butler, Mark; Hanson, Robert; Mohameden, Ahmed

    2012-03-01

    In light of past research being targeted to find specific particles which may be similar to gunshot residue (GSR), this project was formulated to detect any possible particulate by random particle fallout onto substrates at firework displays and to assess the impact this may have on GSR evidence. Firework residue was collected at a display site, from amongst spectators as well as from the author's hair 90min after the display. SEM-EDX analysis has detected such particulate in all three scenarios, with the firework particle population at large providing a solid ground for discrimination from GSR. Wind dispersal was found to decrease the particle population and subsequently, the latter's discriminatory power. Some particles, if treated individually were found to be indistinguishable from GSR. Findings also include residues which may mimic strontium based GSR as well as GSR which may be mixed with that from previous firings. The continuous changes made to primer and propellant compositions by manufacturers also call for greater consideration when classifying particles as originating from pyrotechnic devices. Furthermore, authorities such as police forces should be made more aware about the incidence of such particle transfer in firework related periods. PMID:22325911

  15. Nano characterization of gunshot residues from Brazilian ammunition.

    PubMed

    Melo, Lis G A; Martiny, Andrea; Pinto, André L

    2014-07-01

    Gunshot residues (GSR) from a total of nine different caliber ammunitions produced in Brazil were analyzed and characterized by transmission (TEM) and scanning electron microscopy (SEM). GSR particles are composed of spherical particles of several micrometers of diameter containing distinct amounts of lead, barium and antimony, along with other organic and inorganic elements arising from the primer, gunpowder, the gun and the bullet itself. This study was carried out to obtain additional information on the properties of GSR nanoparticles originated from different types of regular ammunition produced in Brazil by CBC. Besides the SEM, we have used a TEM, exploring its high magnification capability and ability to explore internal structure and chemical composition of submicron particles. We observed that CBC ammunition generated smaller particles than usually reported for other ammunitions and that the three component particles are not a majority. TEM analysis revealed that GSR are partially composed of sub-micron particles as well. The electron diffraction pattern from these particles confirmed them to be mainly composed of lead oxides crystalline nanoparticles that may be agglomerated into larger particles. Energy dispersive X-ray spectroscopy revealed that most of them were composed of two elements, especially PbSb. Ba was not a common element found in the nanoparticles.

  16. Management of civilian gunshot injuries to the hip.

    PubMed

    Long, W T; Brien, E W; Boucree, J B; Filler, B; Stark, H H; Dorr, L D

    1995-01-01

    The orthopedic surgeon at a civilian trauma center is likely to encounter a gunshot injury to the hip. The nonmilitary literature regarding this injury gives few guidelines regarding an appropriate diagnostic evaluation or the indication for arthrotomy. We found that the best diagnostic test to detect joint penetration was hip aspiration followed by an arthrogram. Selected cases can be treated successfully with antibiotic therapy without an arthrotomy. These cases involve a low-velocity missile that passes through the joint, causes minimal bone disruption, and is free of bowel contaminants. If an arthrotomy is not performed, the physician must follow the patient with repeated physical examinations, complete blood counts, and a hip aspiration whenever infection is suspected. All transbdominal hip injuries require an immediate arthrotomy. In this series, bullets left in contact with joint fluid resulted in joint destruction or infection. Each patient with a displaced femoral neck fracture had a poor outcome with internal fixation. Hip arthroplasty or fusion should be considered as elective procedures for definitive management of these injuries.

  17. [Peak sound pressure levels of gunshots from starter's pistols].

    PubMed

    Rothschild, M A; Dieker, L; Prante, H; Maschke, C

    1998-12-01

    Starter's pistols are often bought for self-defense, but can also be used for criminal activities (e.g. assaults, etc.). When a starter's pistol is loaded with blank cartridges and is fired, a powerful shooting noise results. The level of the noise produced is high enough to cause acoustic trauma. For legal examinations and giving an expert opinion further information is needed about the power of such noise. We examined how high peak sound pressure levels were of the gunshots of blank cartridges and whether there existed any directional characteristics from the noise emissions. In all, 15 different models of starter's pistols of 8 different calibres were examined. In addition to blank cartridges, 8 mm tear gas cartridges were also examined. Four transducers were situated in the horizontal plane around the muzzle: 0 degree (shooting direction), 45 degrees, 90 degrees, and 180 degrees (towards the firer). The distances between the transducers and the muzzle were 25 cm, 50 cm, 100 cm, and 200 cm. At a distance of 1 m and in the 0 degree shooting direction the peak sound pressure levels of nearly all weapons tested exceeded 160 dB. At a shooting distance of 25 cm the peak sound pressure levels reached 181 dB. In addition, we observed a directional characteristic concerning the emission of noise: pistols produced higher peak sound pressure levels to the front than backwards towards the firer. PMID:10023593

  18. Measurement of effective atomic number of gunshot residues using scattering of gamma rays

    NASA Astrophysics Data System (ADS)

    Yılmaz, Demet; Turşucu, Ahmet; Uzunoğlu, Zeynep; Korucu, Demet

    2014-09-01

    Better understanding of gunshot residues and the major elemental composition would be valuable to forensic scientists for their analysis work and interpretation of results. In the present work, the effective atomic numbers of gunshot residues (cartridge case, bullet core, bullet jacket and gunpowder) were analyzed using energy dispersive X-ray analysis (EDX). The scattering of 59.54 keV gamma rays is studied using a high-resolution HPGe detector. The experiment is performed on various elements with atomic number in the 4≤Z≤82. The intensity ratio of coherent to Compton scattered peaks, corrected for photo-peak efficiency of gamma detector and absorption of photons in the sample and air, is plotted as a function of atomic number and constituted a best-fit-curve. From this fit-curve, the respective effective atomic numbers of gunshot residues are determined.

  19. A Retained Bullet in Pericardial Sac: Penetrating Gunshot Injury of the Heart

    PubMed Central

    Kaya, Adnan; Caliskan, Emine; Tatlisu, Mustafa Adem; Hayiroglu, Mert Ilker; Tekessin, Ahmet Ilker; Cakilli, Yasin; Avsar, Sahin; Oz, Ahmet; Uzman, Osman

    2016-01-01

    Penetrating cardiac trauma is rarely seen but when present there is a short time lag to keep the patients alive. Cardiac gunshot injuries are exceptional and it occurs mostly during interpersonal disagreements casualties or a mistakenly fired gun nowadays. Here we present a case of cardiac gunshot injury from the war of Kobani, Syria. The patient was mistakenly diagnosed to have a sole bullet in the left shoulder while he had a penetrating cardiac trauma with a bullet in the heart and pericardial effusion possibly giving rise to pericardial tamponade. Luckily the cardiac gunshot injury was noticed one day later and the patient was referred to a tertiary hospital. Intrapericardial bullet was conservatively followed up. The patient was discharged one week later after resection of the bullet in the shoulder. PMID:26977324

  20. Biofilms in chronic wounds.

    PubMed

    James, Garth A; Swogger, Ellen; Wolcott, Randall; Pulcini, Elinor deLancey; Secor, Patrick; Sestrich, Jennifer; Costerton, John W; Stewart, Philip S

    2008-01-01

    Chronic wounds including diabetic foot ulcers, pressure ulcers, and venous leg ulcers are a worldwide health problem. It has been speculated that bacteria colonizing chronic wounds exist as highly persistent biofilm communities. This research examined chronic and acute wounds for biofilms and characterized microorganisms inhabiting these wounds. Chronic wound specimens were obtained from 77 subjects and acute wound specimens were obtained from 16 subjects. Culture data were collected using standard clinical techniques. Light and scanning electron microscopy techniques were used to analyze 50 of the chronic wound specimens and the 16 acute wound specimens. Molecular analyses were performed on the remaining 27 chronic wound specimens using denaturing gradient gel electrophoresis and sequence analysis. Of the 50 chronic wound specimens evaluated by microscopy, 30 were characterized as containing biofilm (60%), whereas only one of the 16 acute wound specimens was characterized as containing biofilm (6%). This was a statistically significant difference (p<0.001). Molecular analyses of chronic wound specimens revealed diverse polymicrobial communities and the presence of bacteria, including strictly anaerobic bacteria, not revealed by culture. Bacterial biofilm prevalence in specimens from chronic wounds relative to acute wounds observed in this study provides evidence that biofilms may be abundant in chronic wounds.

  1. [Traumatic and iatrogenic lesions of abdominal vessels].

    PubMed

    Farah, I; Tarabula, P; Voirin, L; Magne, J L; Delannoy, P; Gattaz, F; Guidicelli, H

    1997-01-01

    Gravity of abdominal vessels traumatisms is secondary to multiple factors. It depends on the type of injured vessels, aetiology and associated lesions. Between September 1984 and March 1995, 22 abdominal vessel traumatisms in 16 patients (mean age: 39 years) were treated. At surgical exploration, 4 aortic and 2 renal vein lesions, 7 iliac artery and 3 renal artery contusions, 2 superior mesenteric artery dissections; 3 infra-renal vena cava ruptures and 1 superior mesenteric vein dilaceration were found. All lesions were caused by penetrant wounds secondary to firearm or blade injury or secondary to injuries due to ski or traffic accidents. In 5 cases, lesions were iatrogenic. There was no mortality in the post-operative period, 14 patients out of the 16 patients operated on have been followed during a period from 1 to 120 months.

  2. Abdominal aortic aneurysm.

    PubMed

    Keisler, Brian; Carter, Chuck

    2015-04-15

    Abdominal aortic aneurysm refers to abdominal aortic dilation of 3.0 cm or greater. The main risk factors are age older than 65 years, male sex, and smoking history. Other risk factors include a family history of abdominal aortic aneurysm, coronary artery disease, hypertension, peripheral artery disease, and previous myocardial infarction. Diagnosis may be made by physical examination, an incidental finding on imaging, or ultrasonography. The U.S. Preventive Services Task Force released updated recommendations for abdominal aortic aneurysm screening in 2014. Men 65 to 75 years of age with a history of smoking should undergo one-time screening with ultrasonography based on evidence that screening will improve abdominal aortic aneurysm-related mortality in this population. Men in this age group without a history of smoking may benefit if they have other risk factors (e.g., family history of abdominal aortic aneurysm, other vascular aneurysms, coronary artery disease). There is inconclusive evidence to recommend screening for abdominal aortic aneurysm in women 65 to 75 years of age with a smoking history. Women without a smoking history should not undergo screening because the harms likely outweigh the benefits. Persons who have a stable abdominal aortic aneurysm should undergo regular surveillance or operative intervention depending on aneurysm size. Surgical intervention by open or endovascular repair is the primary option and is typically reserved for aneurysms 5.5 cm in diameter or greater. There are limited options for medical treatment beyond risk factor modification. Ruptured abdominal aortic aneurysm is a medical emergency presenting with hypotension, shooting abdominal or back pain, and a pulsatile abdominal mass. It is associated with high prehospitalization mortality. Emergent surgical intervention is indicated for a rupture but has a high operative mortality rate. PMID:25884861

  3. Exploration of mXRF analysis of gunshot residue from cartridge cases

    NASA Astrophysics Data System (ADS)

    Janssen, Martin; Stamouli, Amalia; Knijnenberg, Alwin

    2015-10-01

    During the reconstruction of a shooting incident, several analytical techniques are at the disposal of forensic scientists. The Netherlands Forensic Institute is exploring the opportunities in which mXRF can be used to obtain information in these reconstructions. In this paper the possibilities of using the 2D-mXRF instrument as a screening tool are explored. Primarily the focus is on using mXRF to obtain information regarding the elemental composition of gunshot residue from cartridge cases. Secondly, the possibilities of using the 2D-mXRF instrument to, quickly and easily, set up databases for gunshot residue analysis are investigated.

  4. [A sign of the rotational impact of the gunshot projectile on the flat bone].

    PubMed

    Leonov, S V

    2014-01-01

    The objective of the present work was to study the mechanisms of formation of the gunshot fracture of the flat bones with special reference to the translational and rotational motion of the projectile. A total of 120 real and experimental injuries of this type were available for the investigation with the use of simulation by the finite-elemental analysis. A set of morphological features has been identified that make it possible to determine the direction of rotation of the gunshot projectile. PMID:25764858

  5. Prosthetics and Techniques in Repair of Animal's Abdominal Wall

    PubMed Central

    Karrouf, Gamal; Zaghloul, Adel; Abou-Alsaud, Mohamed; Barbour, Elie; Abouelnasr, Khaled

    2016-01-01

    The management of abdominal wall repair continues to present a challenging problem, especially in the repair of major defects. Many abdominal wall defects can be repaired by primary closure; however, if the defect is large and there is a tension on the closure of the wound, the use of prosthetic materials becomes indispensable. Many studies have been performed with various materials and implant techniques, without the comparison of their degrees of success, based on sound meta-analysis and/or inclusive epidemiologic studies. This review covered the effectiveness of recent advances in prosthetic materials and implant procedures used in repair of abdominal wall, based on biomechanical properties and economic aspects of reconstructed large abdominal wall defects and hernias in animals. The presented results in this review helped to reach treatment algorithms that could maximize outcomes and minimize morbidity. PMID:27293982

  6. Advanced Gastric Cancer Perforation Mimicking Abdominal Wall Abscess

    PubMed Central

    Cho, Jinbeom; Park, Ilyoung; Lee, Dosang; Sung, Kiyoung; Baek, Jongmin

    2015-01-01

    Surgeons occasionally encounter a patient with a gastric cancer invading an adjacent organ, such as the pancreas, liver, or transverse colon. Although there is no established guideline for treatment of invasive gastric cancer, combined resection with radical gastrectomy is conventionally performed for curative purposes. We recently treated a patient with a large gastric cancer invading the abdominal wall, which was initially diagnosed as a simple abdominal wall abscess. Computed tomography showed that an abscess had formed adjacent to the greater curvature of the stomach. During surgery, we made an incision on the abdominal wall to drain the abscess, and performed curative total gastrectomy with partial excision of the involved abdominal wall. The patient received intensive treatment and wound management postoperatively with no surgery-related adverse events. However, the patient could not receive adjuvant chemotherapy and expired on the 82nd postoperative day. PMID:26468420

  7. [Abdominal compartment syndrome].

    PubMed

    Pottecher, T; Segura, P; Launoy, A

    2001-04-01

    French physicians dealing with abdominal emergencies are not very familiar with the abdominal compartment syndrome (ACS). Increased abdominal pressure has deleterious consequences on local (intestine, liver, kidney) circulation, leading to death in the absence of correct treatment. Abdominal trauma and ruptured aortic aneurism are the main causes of ACS. Clinical presentation may be misleading: respiratory failure, oliguria or circulatory symptoms are often predominant. Abdominal palpation is inefficient for evaluating intra-abdominal pressure (IAP); only measurement of cystic pressure allows precise evaluation of IAP. Abdominal decompression is the treatment of choice. It must be performed as soon as IAP exceeds 25 mmHg. The procedure may be risky with a high incidence of severe complications when ischaemic territories are reperfused. Recent data underline the importance of compensation of hypovolemia before decompression. Abdominal closure may necessitate various techniques (aponevrotomy, Bogota bags, etc.). At any rate, IAP must remain low at the end of the procedure. In case of suspicion of ACS, early measurement of IAP is mandatory. If pressure is over 25 mmHg, a decompressive procedure must be initiated. PMID:11340703

  8. [Semeiotics of abdominal tuberculosis].

    PubMed

    Guseĭnov, G K; Ramazanova, A M; Guseĭnov, A G

    1984-01-01

    Examination of 119 patients with abdominal tuberculosis permitted the description of the characteristic semiotics of the illness. Today the patients with abdominal tuberculosis are mainly women of child-bearing age with a long-term tuberculosis catamnesis and intoxication, with a history of tuberculosis of different sites, those suffering from tuberculosis or its sequels at present (64%), those with pains (94%), discomfort or swelling of the abdomen (79%), malfunction of the gastrointestinal tract (65%), weight loss (86%), malnutrition (72%), anemia (63%), not infrequently with inflammatory induration (43%) or ascites in the abdominal cavity (39%). In addition to this characteristic semiotics, the patients with abdominal tuberculosis may demonstrate the most different and unexpected symptoms up to acute abdomen (23%). To make differential diagnosis of abdominal tuberculosis, one has often to resort to diagnostic laparotomy, laparoscopy, Koch's test and to trial therapy.

  9. [Frangible bullets: wounding capability and clinical aspects of their use].

    PubMed

    Komenda, J; Hejna, P; Rydlo, M; Novak, M; Krajsa, J; Racek, F

    2012-04-01

    The article deals with basic characteristics of the frangible bullets and it documents a very specific behaviour of chosen types of these bullets in testing blocks as a substitute materials of alive tissues. The frangible bullets have several important advantages compared to the classical sorts of firearms bullets. The highest benefit could be seen especially in the limited penetrating capability and very low ricochet hazard connected with the use of these bullets. The absence of poisonous elements in the material of frangible bullets (for instance lead) is highly appreciated from the ecology reasons nowadays as well. The cartridges assembled with frangible bullets are used most of all for the practise reasons by law enforcement units, but can be used very effectively also in combat situations. Results of own shooting experiments confirm that the wound potential of bullet can be changed in a very large extent with the change of the manufacturing technology and the bullets geometry. Newly developed frangible bullets and the already manufactured bullets available on the market are characterized by very specific terminal ballistic features. Some frangible bullets behave in a comparable way to full metal jacketed bullets while penetrating soft tissues. Another frangible bullets of different designs fragment to the pieces in soft tissues and cause very serious wounds with persistent effects. The usage of frangible bullets and a potential risk of misuse of this specific sort of ammunition require also new approaches in the medicine for the treatment of the gunshot wounds.

  10. Image guided surgery in the management of craniocerebral gunshot injuries

    PubMed Central

    Elserry, Tarek; Anwer, Hesham; Esene, Ignatius Ngene

    2013-01-01

    Background: A craniocerebral trauma caused by firearms is a complex injury with high morbidity and mortality. One of the most intriguing and controversial part in their management in salvageable patients is the decision to remove the bullet/pellet. A bullet is foreign to the brain and, in principle, should be removed. Surgical options for bullet extraction span from conventional craniotomy, through C-arm-guided surgery to minimally invasive frame or frameless stereotaxy. But what is the best surgical option? Methods: We prospectively followed up a cohort of 28 patients with cranio-cerebral gunshot injury (CCHSI) managed from January to December 2012 in our department of neurosurgery. The missiles were extracted via stereotaxy (frame or frameless), C-arm-guided, or free-hand-based surgery. Cases managed conservatively were excluded. The Glasgow Outcome Score was used to assess the functional outcome on discharge. Results: Five of the eight “stereotactic cases” had an excellent outcome after missile extraction while the initially planned stereotaxy missed locating the missile in three cases and were thus subjected to free hand craniotomy. Excellent outcome was obtained in five of the nine “neuronavigation cases, five of the eight cases for free hand surgery based on the bony landmarks, and five of the six C-arm-based surgery. Conclusion: Conventional craniotomy isn’t indicated in the extraction of isolated, retained, intracranial firearm missiles in civilian injury but could be useful when the missile is incorporated within a surgical lesion. Stereotactic surgery could be useful for bullet extraction, though with limited precision in identifying small pellets because of their small sizes, thus exposing patients to same risk of brain insult when retrieving a missile by conventional surgery. Because of its availability, C-arm-guided surgery continues to be of much benefit, especially in emergency situations. We recommend an extensive long-term study of these

  11. Using Gunshot Detection Systems to Fight Explosive Fishing Practices

    NASA Astrophysics Data System (ADS)

    Showen, R. L.; Dunson, J. C.; Woodman, G.; Christopher, S.; Wilson, S.

    2015-12-01

    Blast fishing (using explosives to catch fish) causes extensive damage to coral reefs, especially in the Coral Triangle in Southeast Asia. Subsistence fishermen and larger consortiums, often with criminal links, throw an explosive into a school of fish, killing all sea life within range. This unsustainable practice is becoming more prevalent, and threatens the protein supply of as many as a billion people. Ending blast fishing will require combined technical and societal methods aimed at both deterring the practice, and catching those responsible. Our work aims to significantly improve enforcement. We are re-purposing SST's ShotSpotter gunshot detection system, (trusted and valued by police around the world), substituting hydrophones for the present microphones. Using multilateration and trained human reviewers, the system can give prompt blast alerts, location data, and acoustic waveforms to law enforcement officials. We hope to establish a prototype system in Malaysia in 2015, and have already secured governmental approvals for installation and tests with local law enforcement. The Scubazoo media firm in Malaysia is working with resorts, dive operations, and celebrity sponsors, and is planning to produce videos to illustrate the severity of the problem to both governments and the public. Because there is little hard data concerning the prevalence of blast fishing in either marine protected areas or open waters, the system can also indicate to the world the actual blast rates and patterns of use. The Teng Hoi environmental NGO in Hong Kong showed in 2004 that acoustic waves from typical bombs propagate on the order of 20 km, so an underwater locator system with a small number of sensors can feasibly cover a sizable coral region. Our present plans are to mount sensors on piers, buoys, and boats, but if possible we would also like to integrate with other existing acoustic arrays to strengthen the fight against blast fishing.

  12. Craniocerebral Gunshot Injuries; A Review of the Current Literature

    PubMed Central

    Alvis-Miranda, Hernando Raphael; M. Rubiano, Andres; Agrawal, Amit; Rojas, Alejandro; Moscote-Salazar, Luis Rafael; Satyarthee, Guru Dutta; Calderon-Miranda, Willem Guillermo; Hernandez, Nidia Escobar; Zabaleta-Churio, Nasly

    2016-01-01

    Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately, more   prevalent condition in developing countries, with major armed conflicts which is still persisting, since the main trigger is violence at the national or state level. Management goals of CGI should focus on aggressive resuscitation and correction of coagulopathy; those with stable vital signs should undergo CT scan head at the earliest possible opportunity. Neuroimaging is vital for   planning of surgical management, especially to determine the type of surgery, routes of the approach to the surgical target area and  extraction of the impacted foreign bodies, however, surgical management is not always indicated. Although subset of such cases may be managed even with non-surgical management. The treatment comprises of immediate life salvaging resuscitative measures including control of the  persistent bleeding, care of associated injury, management of raised intracranial pressure, prevention of cerebrospinal fistula formation by primary watertight dural repair and  prevention of infection, through extensive debridement of contaminated, macerated or ischemic tissues; preservation of nervous tissue and restoration of anatomic structures through the hermetic sealing of dural and scalp defect. Recently, only few studies of craniocerebral penetrating injuries are published that too involving smaller patients sample sizes; although classic studies in the military and civil situation noticed associated relatively very high mortality and morbidity and psychological as well as economic impact on the   affected individual, the family and the health system in providing ongoing care to the sufferers and society at large.  Currently various measures are advocated with aim to reduce the incidence of CGI especially in civilian populations. It is highly necessary and immensely urgent to promote research in a neurocritical care of CGI to

  13. [Inflammatory abdominal aortic aneurysm].

    PubMed

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  14. Wound healing and treating wounds: Chronic wound care and management.

    PubMed

    Powers, Jennifer G; Higham, Catherine; Broussard, Karen; Phillips, Tania J

    2016-04-01

    In the United States, chronic ulcers--including decubitus, vascular, inflammatory, and rheumatologic subtypes--affect >6 million people, with increasing numbers anticipated in our growing elderly and diabetic populations. These wounds cause significant morbidity and mortality and lead to significant medical costs. Preventative and treatment measures include disease-specific approaches and the use of moisture retentive dressings and adjunctive topical therapies to promote healing. In this article, we discuss recent advances in wound care technology and current management guidelines for the treatment of wounds and ulcers.

  15. Surgical wound infection - treatment

    MedlinePlus

    ... wounds heal, you may have a wound VAC (Vacuum Assisted Closure) dressing. It increases blood flow in ... helps with healing. This is a negative pressure (vacuum) dressing. There is a vacuum pump, a foam ...

  16. [Standardized wound documentation of chronic wounds].

    PubMed

    Deutschle, G; Coerper, S; Witte, M; Becker, H D

    1999-01-01

    Owing to the long periods of treatment and multi-factoral etiology of chronic wounds, standardized wound documentation is necessary to enable judgement of the course of healing. We have developed a documentation system which permits a standardized assessment of chronic wounds by means of defined parameters and graded divisions. Besides containing the diagnostic and therapeutic measures which have been carried out, the documentation should also contain parameters of wound healing. These are the following: wound localisation, size of wound, degree of injury, infection, and wound morphology. Planimetry and photographic documentation complete the documentation. Thus a documented course of healing can be presented, which enables rapid retrospective analysis and, if needed, a change in therapeutic approach at an early stage. This complete, exact documentation is required by modern administration of justice and is a protection against the reversal of the onus of proof in lawsuits. The extent of documentation can be adapted to the individual needs of the institution responsible for treatment. However, a minimal amount of documentation should always include localisation of the wound, size, the diagnostic and therapeutic measures, and complications if any. PMID:10436529

  17. Analysis of gunshot residues as trace in nasal mucus by GFAAS.

    PubMed

    Aliste, Marina; Chávez, Luis Guillermo

    2016-04-01

    When a gun is fired, the majority of gunshot residues are deposited on the shooter's hands. But these residues disappear through contact with surfaces or washing. Therefore, the maximum time frame to find GSR on a suspect's hands is 8h. The mucus, inside of a nostril, forms a surface layer where they are trapped foreign particles. In this way, mucus inside of a gunshot suspect's nostrils could act like an adhesive medium to stick on it gaseous particles from a gunshot. In this study, the presence of GSR in nasal mucus and its residence time is examined. A new procedure for the sampling of possible gunshot residue accumulated in the nasal mucus is designed. Samples are taken with cotton swabs moistened with a solution of EDTA and, after an acid digestion, are analysed by graphite furnace atomic absorption spectrometry. In addition, samples of hands are taken for comparison purposes. GSR recovery has been successful. The concentration of GSR in nasal mucus is found to be lower than on the hands, but with a longer residence time. Thus, it is possible to expand the sampling time of a suspect also, as nasal mucus cannot be contaminated by handling weapons.

  18. Acoustic sensor planning for gunshot location in national parks: a pareto front approach.

    PubMed

    González-Castaño, Francisco Javier; Alonso, Javier Vales; Costa-Montenegro, Enrique; López-Matencio, Pablo; Vicente-Carrasco, Francisco; Parrado-García, Francisco J; Gil-Castiñeira, Felipe; Costas-Rodríguez, Sergio

    2009-01-01

    In this paper, we propose a solution for gunshot location in national parks. In Spain there are agencies such as SEPRONA that fight against poaching with considerable success. The DiANa project, which is endorsed by Cabaneros National Park and the SEPRONA service, proposes a system to automatically detect and locate gunshots. This work presents its technical aspects related to network design and planning. The system consists of a network of acoustic sensors that locate gunshots by hyperbolic multi-lateration estimation. The differences in sound time arrivals allow the computation of a low error estimator of gunshot location. The accuracy of this method depends on tight sensor clock synchronization, which an ad-hoc time synchronization protocol provides. On the other hand, since the areas under surveillance are wide, and electric power is scarce, it is necessary to maximize detection coverage and minimize system cost at the same time. Therefore, sensor network planning has two targets, i.e., coverage and cost. We model planning as an unconstrained problem with two objective functions. We determine a set of candidate solutions of interest by combining a derivative-free descent method we have recently proposed with a Pareto front approach. The results are clearly superior to random seeding in a realistic simulation scenario.

  19. [Treatment of ununited open and gunshot fractures of the leg bones complicated by osteomyelitis].

    PubMed

    Kravchuk, V I

    1980-03-01

    The experience of the treatment of 107 patients with nonunited open and gunshot fractures of the crus bone complicated by osteomyelitis is described. In 100 patients osteomyelitis was liquidated, in 97 patients consolidation of bone fragments was achieved, the supporting ability and joint movements were restored.

  20. Acoustic Sensor Planning for Gunshot Location in National Parks: A Pareto Front Approach

    PubMed Central

    González-Castaño, Francisco Javier; Alonso, Javier Vales; Costa-Montenegro, Enrique; López-Matencio, Pablo; Vicente-Carrasco, Francisco; Parrado-García, Francisco J.; Gil-Castiñeira, Felipe; Costas-Rodríguez, Sergio

    2009-01-01

    In this paper, we propose a solution for gunshot location in national parks. In Spain there are agencies such as SEPRONA that fight against poaching with considerable success. The DiANa project, which is endorsed by Cabaneros National Park and the SEPRONA service, proposes a system to automatically detect and locate gunshots. This work presents its technical aspects related to network design and planning. The system consists of a network of acoustic sensors that locate gunshots by hyperbolic multi-lateration estimation. The differences in sound time arrivals allow the computation of a low error estimator of gunshot location. The accuracy of this method depends on tight sensor clock synchronization, which an ad-hoc time synchronization protocol provides. On the other hand, since the areas under surveillance are wide, and electric power is scarce, it is necessary to maximize detection coverage and minimize system cost at the same time. Therefore, sensor network planning has two targets, i.e., coverage and cost. We model planning as an unconstrained problem with two objective functions. We determine a set of candidate solutions of interest by combining a derivative-free descent method we have recently proposed with a Pareto front approach. The results are clearly superior to random seeding in a realistic simulation scenario. PMID:22303135

  1. [The reconstruction of gunshot circumstances by means of situational forensic medical expertise].

    PubMed

    Kolkutin, V V; Makarov, I Iu; Evteeva, I A

    2012-01-01

    The authors discuss the objective potential of situational forensic medical expertise for the determination of the direction and the distance of a gunshot as well as the position of the gun in the shooter's hand. The use of fundamental theoretical propositions determining the essence of the form of expertise being considered is illustrated by an example from forensic medical practice.

  2. Physical components of soft-tissue ballistic wounding and their involvement in the generation of blood backspatter.

    PubMed

    Davidson, Peter L; Taylor, Michael C; Wilson, Suzanne J; Walsh, Kevan A J; Kieser, Jules A

    2012-09-01

    Gunshot backspatter comprises biological material expelled backward through bullet entry holes. Crime scene investigators analyze backspatter patterns to infer wounding circumstances. An understanding of the mechanism of backspatter generation, and the relationship between spatter patterns and bullet and tissue characteristics, would enhance the predictive value of such analysis. We examined soft-tissue ballistic wounding responses to determine the underlying components and how these might be relevant to the generation of backspatter. We identified five mechanistic components to ballistic wounding (elastic, viscous, crushing, cutting, and thermal), each related to mechanical disciplines (respectively, solid mechanics, fluid mechanics, fracture mechanics, rheology, and thermodynamics). We identified potential roles for these five components in backspatter formation and provide a scenario whereby a sequence of events incorporating these components could lead to backspatter generation and expulsion. This research provides a framework for the mathematical representation, and subsequent computational predictive modeling, of backspatter generation and pattern formation.

  3. Abdominal Drainage Following Appendectomy and Cholecystectomy

    PubMed Central

    Stone, H. Harlan; Hooper, C. Ann; Millikan, William J.

    1978-01-01

    Consecutive patients undergoing emergency appendectomy (283) or urgent cholecystectomy (51) were prospectively studied for the development of post-operative incisional or peritoneal sepsis. Severity of the original peritoneal infection was carefully recorded, while use of a Penrose dam to drain the peritoneum was randomized according to pre-assigned hospital number. Both aerobic and anaerobic cultures were taken from the abdomen at the time of operation as well as from all postoperative infectious foci. Results demonstrated no essential differences in incidence of wound and peritoneal infection following appendectomy for simple or suppurative appendicitis (187) or following cholecystectomy for acute cholecystitis (51). However, with gangrenous or perforative appendicitis (94), incisional and intra-abdominal infection rates were 43% and 45%, respectively, when a drain was used; yet only 29 and 13%, respectively, without a drain. These latter differences were significant (p < 0.001). In addition, intra-abdominal abscesses were three times as likely to drain through the incision than along any tract provided by the rubber conduit. Cultures revealed that hospital pathogens accounted for a greater proportion of wound and peritoneal sepsis after cholecystectomy and appendectomy for simple or suppurative appendicitis if a drain had been inserted than if managed otherwise. By contrast, a mixed bacterial flora was responsible for most infections following appendectomy for gangrenous or perforated appendicitis, irrespective as to use of a drain. PMID:646499

  4. Abdominal ultrasound (image)

    MedlinePlus

    Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X-ray, MRI, ... it has its place as a diagnostic tool. Ultrasound scans use high frequency sound waves to produce ...

  5. Ultrasonographic assessment of standing laparotomy wound healing in dairy cows.

    PubMed

    Buczinski, S; Bourel, C; Bélanger, A M

    2012-08-01

    The surgical wounds of 40 cows with a standing clean laparotomy were assessed 10-15 days after surgery. The abdominal wall thickness on the upper (w1), the middle (w2) and the lower (w3) third of the wound (and the contralateral flank n1, n2, and n3), the presence of edema, cavitary lesion, capsulated lesion, or visualization of shadow artifact in the wound were assessed ultrasonographically. On day 30, wound healing status (normal or surgical site infection (SSI)) was determined. Five out of 39 cows (12.8%) had SSI. A significant positive correlation was found between w3 and edema (p<0.01; r=0.44), w3/n3 and edema (p<0.05; r=0.32), w3 and pain on wound palpation (p<0.01; r=0.41); w3/n3 and the presence of pain (p<0.002; r=0.49) and w2/n2 and pain when palpating the wound (p<0.05; r=0.33). No association was found between the ultrasonographic evidence of edema and SSI (p=0.10), cavitary lesion and SSI (p=0.65), encapsulated lesion and SSI (p=1), and shadow artefact and SSI (p=1). The wound ultrasonography 10-15 days after surgery was not predictive of abnormal wound healing.

  6. [Experimental stab wound].

    PubMed

    Hirt, Miroslav; Vorel, František; Zelený, Michal

    2015-01-01

    Stab wounds caused by knives and daggers are usually of different appearances. The knife wound has one edge sharp while the second one is blunt. The wound caused by blow of dagger has both edges sharp. The forensic expert must very often decide whether the knife or dagger was used. The aim of this experimental work was to show how a single-edged knife penetrates the skin and causes the wound typical for the double-edged dagger. The fact was verified. The wound typical for dagger can be found if the knife is used only according to the scheme. The forensic expert can say that a one cutting edge knife was used if the one edge of wound is squared and the other one is sharp. If the both of them are sharp, forensic expert must be very careful in his decision.Key words: stab wounds - knife - dagger - forensic expertise. PMID:25671417

  7. Biofilm in wound care.

    PubMed

    Rajpaul, Kumal

    2015-03-01

    A biofilm can be described as a microbial colony encased in a polysaccharide matrix which can become attached to a wound surface. This can affect the healing potential of chronic wounds due to the production of destructive enzymes and toxins which can promote a chronic inflammatory state within the wound. Biofilms can be polymicrobial and can result in delayed wound healing and chronic wound infection resistant to antibiotics, leading to prolonged hospitalisation for some patients. There appears to be a correlation between biofilms and non-healing in chronic wounds. It is suggested that biofilms are a major player in the chronicity of wounds. They are a complex concept to diagnose and management needs to be multifactorial.

  8. Wet wound healing.

    PubMed

    Vranckx, Jan J; Slama, Jaromir; Preuss, Stefan; Perez, Norvin; Svensjö, Tor; Visovatti, Scott; Breuing, Karl; Bartlett, Richard; Pribaz, Julian; Weiss, Denton; Eriksson, Elof

    2002-12-01

    Wound treatment in a flexible transparent chamber attached to the perimeter of the wound and containing a liquid has been extensively tested in preclinical experiments in pigs and found to offer several advantages. It protects the wound; the liquid medium or saline in the chamber provides in vivo tissue culture-like conditions; and antibiotics, analgesics, and various molecules can be delivered to the wound through the chamber. The wound chamber causes no injury to the wound itself or to the surrounding intact skin. Topical delivery of, for instance, antibiotics can provide very high concentrations at the wound site and with a favorable direction of the concentration gradient. A series of 28 wounds in 20 patients were treated with a wound chamber containing saline and antibiotics. Most patients had significant comorbidity and had not responded to conservative or surgical management with débridement and delayed primary closure or skin grafts. Six wounds had foreign bodies present; four of these were joint prostheses. Seven patients were on corticosteroids for rheumatoid arthritis, lupus, or chronic obstructive pulmonary disease, and four patients had diabetes. Most patients were treated with the wound chamber in preparation for a delayed skin graft or flap procedure, but one was treated with a wound chamber until the wound healed. Twenty-five of the wounds (89 percent) healed, and five wounds (18 percent) required additional conservative management after the initial chamber treatment and grafting procedure. Of the three wounds that did not heal, one healed after additional chamber treatment, one had a skin graft that did not take, and one required reamputation at a higher level. Antibiotic delivery was less than one intravenous dose daily, which avoided the potential for systemic absorption to toxic levels. Antibiotics such as vancomycin and gentamicin could be used in concentrations of up to 10,000 times the minimal inhibitory concentration. Forty-eight hours

  9. Abdominal emergencies in pediatrics.

    PubMed

    Coca Robinot, D; Liébana de Rojas, C; Aguirre Pascual, E

    2016-05-01

    Abdominal symptoms are among the most common reasons for pediatric emergency department visits, and abdominal pain is the most frequently reported symptom. Thorough history taking and physical examination can often reach the correct diagnosis. Knowing the abdominal conditions that are most common in each age group can help radiologists narrow the differential diagnosis. When imaging tests are indicated, ultrasonography is usually the first-line technique, enabling the diagnosis or adding relevant information with the well-known advantages of this technique. Nowadays, plain-film X-ray studies are reserved for cases in which perforation, bowel obstruction, or foreign body ingestion is suspected. It is also important to remember that abdominal pain can also occur secondary to basal pneumonia. CT is reserved for specific indications and in individual cases, for example, in patients with high clinical suspicion of abdominal disease and inconclusive findings at ultrasonography. We review some of the most common conditions in pediatric emergencies, the different imaging tests indicated in each case, and the imaging signs in each condition.

  10. Wound care in horses.

    PubMed

    Caston, Stephanie S

    2012-04-01

    Care of equine wounds in the field can be a challenging endeavor. Many times, wound care is complicated by chronicity or by prior inappropriate care in addition to the great degree of tissue trauma that occurred when the horse was wounded. Recognizing involvement of synovial structures, loss of skin, and damage to bone are critical in the initial examination of wounds and will guide future care. Education of clients is also important in that preparing them for possible outcomes during healing may help improve compliance and proper treatment of wound. Owners and trainers often perform much of the daily care and monitoring of equine wounds and thus can greatly assist or impede the progress. Bandaging is important to management of equine wounds-especially on the limbs-and is sometimes overlooked because of its labor-intensive nature and the desire for a spray, ointment, or salve that will heal the wound. The practitioner that improves and utilizes his or her understanding of the wound-healing process in concert with his or her knowledge of local anatomy will be the one who is best equipped to care for wounds in ambulatory practice.

  11. Current concepts in wound management and wound healing products.

    PubMed

    Davidson, Jacqueline R

    2015-05-01

    Current concepts in wound management are summarized. The emphasis is on selection of the contact layer of the bandage to promote a moist wound environment. Selection of an appropriate contact layer is based on the stage of wound healing and the amount of wound exudate. The contact layer can be used to promote autolytic debridement and enhance wound healing.

  12. [The role of laparoscopy in emergency abdominal surgery].

    PubMed

    Balén, E; Herrera, J; Miranda, C; Tarifa, A; Zazpe, C; Lera, J M

    2005-01-01

    Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV). In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are excellent and better than open surgery (less infection of the wound, complications, hospital stay and postoperative pain). A detailed explanation is given of the basic aspects of the surgical technique in the most frequent procedures of emergency laparoscopy.

  13. [Abdominal actinomycosis: four cases].

    PubMed

    Ghannouchi Jaafoura, N; Kaabia, N; Khalifa, M; Ben Jazia, I; Hachfi, W; Braham, A; Letaief, A; Bahri, F

    2008-12-01

    The abdominal actinomycosis (AA) is a rare and often unrecognised suppurative chronic illness. It is caused by an anaerobic Gram positive bacteria, Actinomyces israelii. Abdominal actinomycosis is responsible for pseudotumoral syndrome often leading, to a large and mutilating surgery whereas a prolonged treatment by antibiotics would have permitted to cure the disease. The diagnosis is obtained generally from anatomopathologic exam. We report four cases of abdominal actinomycosis being revealed by a pseudotumoral syndrome. The diagnosis was only made after surgery. In spite of an active treatment by antibiotics during several months, two of our patients had a relapse of the infectious process. These four observations confirm the diagnostic and therapeutic difficulties previously reported by other authors.

  14. Use of absorbable mesh as an aid in abdominal wall closure in the emergent setting.

    PubMed

    Buck, J R; Fath, J J; Chung, S K; Sorensen, V J; Horst, H M; Obeid, F N

    1995-08-01

    A surgeon has many options available to aid in the closure of abdominal wall defects in the elective setting. In the emergent setting, active infection or contamination increases the likelihood of infection of permanent prosthetic material and limits the surgical options. In such settings, we have used absorbable mesh (Dexon) as an adjunct to fascial closure until the acute complications resolve. To evaluate the effectiveness of this technique, we reviewed the outcome of such closures in 26 critically ill patients. Between July 1987 and June 1993, 26 patients were identified who had placement of absorbable mesh as part of an emergent laparotomy at a major urban trauma center. Through a retrospective chart review, the incidence of complications and outcome of the closure were tabulated. Seven patients were initially operated on for trauma. Two of the patients had mesh placement at their initial procedure secondary to fascial loss from trauma. The remainder of the patients hd mesh placement during a subsequent laparotomy for complications related to their initial procedure. Indications for these laparotomies included combinations of wound dehiscence, intra-abdominal abscess, anastomotic disruption, and perforation. Mesh placement in patients with intra-abdominal infection created effectively open abdominal wounds that allowed continued abdominal drainage, but required extensive wound care. Despite the absorbable nature of the mesh and often prolonged hospital stay in these ill patients, none of them required reoperation for dehiscence, recurrence of intra-abdominal abscess, or infection of the mesh.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. [Advances in wound care].

    PubMed

    Raffoul, Wassim

    2008-03-01

    Wound care made great progress during last years related to several factors. The first is an awakening of the importance of wounds. The progress made in the comprehension of the physiopathology of wounds led to innovations in all stages of this complex process which is the wound healing. Autologus platelet concentrate producing growth factors are in use to stimulate the first phase of the healing. The second phase which is the phase of proliferation and secretion is currently better managed with new categories of bandages which are true local treatments. The nutrition became one of the pillars of wound treatments especially among old patients. The reconstructive surgery took great steps since the physiology and the vascular anatomy of the skin and soft tissues are better known. Finally the bio-engineering has entered the treatment of the wound there is more than 20 years ago and methods have improved and become more reliable.

  16. Dressings for chronic wounds.

    PubMed

    Powers, Jennifer Gloeckner; Morton, Laurel M; Phillips, Tania J

    2013-01-01

    Covering wounds, acute and chronic, is one of the most fundamental activities of any medical practitioner. Although wound dressings primarily serve to contain the "good" and keep out the "bad," research has characterized more specifically the sophisticated interaction between the human wound bed and its dressing counterpart. Wound dressings for today's chronic wounds come in many flavors, ranging from the classic types of moisture-retentive dressings to silver-coated varieties to biologic dressings serving as skin substitutes. Moisture-retentive dressing types include foams, films, hydrogels, hydrocolloids, and alginates. Appropriate use of these dressings can help to keep the wound bed moist, which allows for epithelial migration, angiogenesis, retention of growth factors, autolytic debridement, and maintenance of electrical gradients. PMID:23742280

  17. The Acute Abdominal Aorta.

    PubMed

    Mellnick, Vincent M; Heiken, Jay P

    2015-11-01

    Acute disorders of the abdominal aorta are potentially lethal conditions that require prompt evaluation and treatment. Computed tomography (CT) is the primary imaging method for evaluating these conditions because of its availability and speed. Volumetric CT acquisition with multiplanar reconstruction and three-dimensional analysis is now the standard technique for evaluating the aorta. MR imaging may be useful for select applications in stable patients in whom rupture has been excluded. Imaging is indispensable for diagnosis and treatment planning, because management has shifted toward endoluminal repair. Acute abdominal aortic conditions most commonly are complications of aneurysms and atherosclerosis. PMID:26526434

  18. Normoxic wound fluid contains high levels of vascular endothelial growth factor.

    PubMed Central

    Howdieshell, T R; Riegner, C; Gupta, V; Callaway, D; Grembowicz, K; Sathyanarayana; McNeil, P L

    1998-01-01

    OBJECTIVE: To examine the temporal integration of vascular endothelial growth factor (VEGF), which has been shown to be present in wound fluid, with the putatively related processes of wound fluid oxygen content, wound angiogenesis, and granulation tissue formation. SUMMARY BACKGROUND DATA: During cutaneous wound repair, new tissue formation starts with reepithelialization and is followed by granulation tissue formation, including neutrophil and macrophage accumulation, fibroblast ingrowth, matrix deposition, and angiogenesis. Because angiogenesis and increased vascular permeability are characteristic features of wound healing, VEGF may play an important role in tissue repair. METHODS: A ventral hernia, surgically created in the abdominal wall of female swine, was repaired using silicone sheeting and skin closure. Over time, a fluid-filled wound compartment formed, bounded by subcutaneous tissue and omentum. Ultrasonography was performed serially to examine the anatomy and dimensions of the subcutaneous tissue and wound compartment. Serial wound fluid samples, obtained by percutaneous aspiration, were analyzed for PO2, PCO2, pH, and growth factor concentrations. RESULTS: Three independent assays demonstrate that VEGF protein is present at substantially elevated levels in a wound fluid associated with the formation of abdominal granulation tissue. However, the wound fluid is not hypoxic at any time. Serial sampling reveals that transforming growth factor beta-1 protein appears in the wound fluid before VEGF. CONCLUSIONS: The results suggest that VEGF is a prominent regulator of wound angiogenesis and vessel permeability. A factor other than hypoxia, perhaps the earlier appearance of another growth factor, transforming growth factor beta-1, may positively regulate VEGF appearance in the wound fluid. Images Figure 1. Figure 2. Figure 3. Figure 5. Figure 7. PMID:9833810

  19. Matching biological mesh and negative pressure wound therapy in reconstructing an open abdomen defect.

    PubMed

    Caviggioli, Fabio; Klinger, Francesco Maria; Lisa, Andrea; Maione, Luca; Forcellini, Davide; Vinci, Valeriano; Codolini, Luca; Klinger, Marco

    2014-01-01

    Reconstruction of open abdominal defects is a clinical problem which general and plastic surgeons have to address in cooperation. We report the case of a 66-year-old man who presented an abdominal dehiscence after multiple laparotomies for a sigmoid-rectal adenocarcinoma that infiltrated into the abdominal wall, subsequently complicated by peritonitis and enteric fistula. A cutaneous dehiscence and an incontinent abdominal wall resulted after the last surgery. The abdominal wall was reconstructed using a biological porcine cross-linked mesh Permacol (Covidien Inc., Norwalk, CT). Negative Pressure Wound Therapy (NPWT), instead, was used on the mesh in order to reduce wound dimensions, promote granulation tissue formation, and obtain secondary closure of cutaneous dehiscence which was finally achieved with a split-thickness skin graft. Biological mesh behaved like a scaffold for the granulation tissue that was stimulated by the negative pressure. The biological mesh was rapidly integrated in the abdominal wall restoring abdominal wall continence, while the small dehiscence, still present in the central area, was subsequently covered with a split-thickness skin graft. The combination of these different procedures led us to solve this complicated case obtaining complete wound closure after less than 2 months.

  20. Innovation and wound healing.

    PubMed

    Harding, Keith

    2015-04-01

    Innovation in medicine requires unique partnerships between academic research, biotech or pharmaceutical companies, and health-care providers. While innovation in medicine has greatly increased over the past 100 years, innovation in wound care has been slow, despite the fact that chronic wounds are a global health challenge where there is a need for technical, process and social innovation. While novel partnerships between research and the health-care system have been created, we still have much to learn about wound care and the wound-healing processes.

  1. Telemedicine for wound management.

    PubMed

    Chittoria, Ravi K

    2012-05-01

    The escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer) and real-time transmission (synchronous transfer, e.g. video conference), are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process.

  2. An eye for a lost eye: A case of self-inflicting gunshot injury

    PubMed Central

    Kar, Indu Bhusan; Kar, Rosalin; Mishra, Niranjan; Singh, Akhilesh Kumar

    2014-01-01

    Maxillofacial defects due to gunshot injuries can have detrimental functional and psychological effects on the patient. These occur predominantly in young males, although all are at risk. Military, civil, accidental or self-inflicted injuries employing guns of varying caliber and ballistic properties may produce a defect or deformity which encompasses the entire spectrum of reconstructive surgery. Patients with facial defects have major difficulties to re-establish their mastication, speech, soft-tissue projections and therefore social integration. Successful prosthetic rehabilitation is crucial for better quality of life in case of large facial deformities. We present a case of 24-year-old male with gunshot injury to the left side face leading damage to the eye, which was rehabilitated with oculo-facial prosthesis. PMID:25298724

  3. Hyperspectral characterization of an in vitro wound model

    NASA Astrophysics Data System (ADS)

    Randeberg, Lise L.; Hegstad, Janne-Lise; Paluchowski, Lukasz; Milanič, Matija; Pukstad, Brita S.

    2014-03-01

    Wound healing is a complex process not fully understood. There is a need of better methods to evaluate the different stages of healing, and optical characterization is a promising tool in this respect. In this study hyperspectral imaging was employed to characterize an in vitro wound model. The wound model was established by first cutting circular patches of human abdominal skin using an 8mm punch biopsy tool, and then creating dermal wounds in the center of the skin patches using a 5mm tool. The wounds were incubated in medium with 10% serum and antibiotics. Hyperspectral images were collected every three days using a push broom hyper spectral camera (Hyspex VNIR1600). The camera had a spectral resolution of 3.7 nm and was fitted with a close up lens giving a FOV of 2.5 cm and a spatial resolution of 29 micrometer. Samples for histology were collected throughout the measurement period, which was 21 days in total. Data were processed in ENVI and Matlab. A successful classification based on hyperspectral imaging of the implemented model is presented. It was not possible to see the healing zone in the in vitro model with the naked eye without dying. The hyperspectral results showed that newly formed epithelium could be imaged without any additional contrast agents or dyes. It was also possible to detect non-viable tissue. In vitro wound models and hyperspectral imaging can thus be employed to gain further insight in the complicated process of healing in different kinds of wounds.

  4. The role of maxillofacial radiologists in gunshot injuries: a hypothesized missile trajectory in two case reports

    PubMed Central

    Sansare, K; Khanna, V; Karjodkar, F

    2011-01-01

    Gunshot injuries are an emerging form of trauma that oral radiologists increasingly have to deal with. There are two main types of gunshot injuries: high-velocity and low-velocity bullet injuries. The outcome of high-velocity gunshot injury is usually fatal; however, a non-fatal low-velocity injury to the maxillofacial region is more likely to be encountered by the oral and maxillofacial radiologist. It is therefore important to up-to-date knowledge of ballistic science and its implications in the field of maxillofacial radiology. The ability of oral and maxillofacial radiologists to predict the missile trajectory will aid the assessment and localization of the damage caused by the bullet and its splinters. Predicting the missile trajectory may also be of help to law enforcement agencies and forensic scientists in determining the type of firearm used and direction of fire. This article, which examines two cases, attempts to highlight to the oral radiologist this emerging form of trauma and its implications. PMID:21159916

  5. Quantifying gunshot residues in cases of suicide: Implications for evaluation of suicides and criminal shootings.

    PubMed

    Lucas, Nick; Cook, Michael; Wallace, James; Kirkbride, K Paul; Kobus, Hilton

    2016-09-01

    Gunshot residue (GSR) is a valuable form of forensic trace evidence in the investigation of firearms-related suicide and crime. In order to ensure that such evidence is given appropriate evidential weighting when it comes to case investigations, the dynamics of the deposition and distribution of GSR must be understood. As the activity of the subject after firing is a major factor in the retention of GSR, cases of suicide involving a firearm provide an opportunity to assess GSR distribution where post-shooting activity is not an issue, assuming the subject had not been moved. Seventy-one cases of suicide by gunshot in South Australia between 1998 and 2014 were examined to collect data on firearm type, calibre, and gunshot residue test results. Overall, 47% of cases were found to produce GSR results that were not of high probative value, even though it was known that the shooter had fired a firearm. Of particular interest were cases involving 0.22 rimfire ammunition, for which characteristic particles are not expected due to lack of antimony present in the primer. Despite this, 64% of these cases resulted in the detection of antimony-containing, three-component particles. PMID:27348466

  6. Chemical and physical characterisation of welding fume particles for distinguishing from gunshot residue.

    PubMed

    Brożek-Mucha, Zuzanna

    2015-09-01

    Spherical particles produced by firearms loaded with a traditional ammunition reveal characteristic elemental contents and so their identification may provide a significant evidence in criminal investigations. With the advent of modern technologies in manufacturing ammunition, which replace toxic compounds of lead, antimony and barium in the primer mixture by elements and compounds such as powdered aluminium, titanium, amorphous boron or calcium silicide, differentiation between gunshot residue and morphologically similar particles originating from other anthropogenic or natural sources becomes more difficult. This work provides a chemical and morphological characterisation of welding fume particles originating from both the core and the covering of electrodes used in popular manners of welding steel and aluminium alloy constructions. With the use of scanning electron microscopy and energy dispersive X-ray spectrometry it has been established that single spherules containing aluminium, titanium or a set of such elements as aluminium, silicon, potassium and calcium may occur in result of welding processes, however, they are accompanied by great numbers of iron and iron oxide spherules. Thus, with this analytical method a population of welding particles can be distinguished from a population of gunshot residue originating from a modern type of ammunition, but a special care has to be taken when assessing the evidential value of single or few spherules consisting from light elements being detected in result of the search for gunshot residue for forensic purposes. PMID:26188699

  7. Complex reconstruction of facial deformity and function after severe gunshot injury: one case report

    PubMed Central

    Wang, Weijian; Duan, Jianmin; Wang, Qiao; Kuang, Wei

    2015-01-01

    In this report, we described clinical outcomes of a multi-stage surgery integrating multiple techniques in restoration of facial morphology and function of a 17-year-old boy with severe gunshot injuries. This multi-stage surgery was applied in treatment of one rare case of gunshot-caused complicated facial deformities involving most parts of the face (labrum, left nose wing, nasal columella, nasal septum, maxillary alveolar process, hard palate, soft palate, bilateral maxillary bones, left zygoma, suborbital bone defects) and clinical efficacy upon restoring facial form and function were retrospectively evaluated. The patient was diagnosed with massive facial defects and deformities caused by gunshot, which led to feeding difficulty, severe articulation disorders and serious facial disfigurement. To reconstruct facial form and restore functions of mastication and articulation, multiple examinations and surgical procedures including mirror imaging, rapid prototyping technique, porous titanium implants, microscopic surgical technique, dental implants, osteomyocutaneous flap, muscular flap, shifting and repairing of adjacent tissue flaps and free bone graft reconstruction were undertaken. Postoperatively, reconstruction of severe facial disfigurement and restoring basic functions including articulation and feeding for the first time and relatively sound clinical outcomes have been obtained, which may add clinical evidence to the treatment of similar cases of severe facial deformities. PMID:25785151

  8. Long-term administration of magnesium after acoustic trauma caused by gunshot noise in guinea pigs.

    PubMed

    Abaamrane, L; Raffin, F; Gal, M; Avan, P; Sendowski, I

    2009-01-01

    In a previous study we observed that a 7-day post-trauma magnesium treatment significantly reduced auditory threshold shifts measured 7 days after gunshot noise exposure. However this improvement was only temporary, suggesting that it could be potentially beneficial to prolong this treatment. The aim of the present study was to evaluate the efficacy of a long-term (1 month) magnesium treatment after an impulse noise trauma, in comparison with either a 7-day magnesium treatment, an administration of methylprednisolone (conventional treatment), or a placebo (NaCl). Guinea pigs were exposed to impulse noise (three blank gunshots, 170 dB SPL peak). They received one of the four treatments, 1 h after the noise exposure. Auditory function was explored by recording the auditory brainstem response (ABR) and measuring the distortion product otoacoustic emissions (DPOAE) over a 3-month recovery period after the gunshot exposure. The functional hearing study was supplemented by a histological analysis. The results showed that a 1-month treatment with magnesium was the most effective treatment in terms of hair cell preservation. The DPOAE confirmed this effectiveness. Methylprednisolone accelerated recovery but its final efficacy remained moderate. It is probable that magnesium acts on the later metabolic processes that occur after noise exposure. Multiple mechanisms could be involved: calcium antagonism, anti-ischaemic effect or NMDA channel blockage. Regardless of the specific mechanism, a 1-month treatment with magnesium clearly attenuates NIHL, and presents the advantage of being safe for use in humans. PMID:19084059

  9. Screening for Abdominal Aortic Aneurysm

    MedlinePlus

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) ... final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final recommendation statement applies to adults ages ...

  10. Abdominal Pain, Long-Term

    MedlinePlus

    MENU Return to Web version Abdominal Pain, Long-term See complete list of charts. Ongoing or recurrent abdominal pain, also called chronic pain, may be difficult to diagnose, causing frustration for ...

  11. Understanding methods of wound debridement.

    PubMed

    Atkin, Leanne

    Autolytic debridement describes the body's natural method of wound-bed cleansing, helping it to prepare the wound bed for healing. In acute wounds, autolytic debridement occurs automatically and often does not require intervention, as during the inflammatory stage of a wound, neutrophils and macrophages digest and removes devitalised tissue, cell debris and contaminants, clearing the wound of any cellular barriers to healing. In chronic wounds, by contrast, healing is often delayed, frequently because of inadequate debridement. The autolytic process becomes overwhelmed by high levels of endotoxins released from damaged tissue (Broadus, 2013). Therefore wound debridement becomes an integral part of chronic-wound management and practitioners involved in wound care must be fully competent at wound-bed assessment and have an awareness of the options available for debridement. This article will review wound-bed assessment, highlighting variations in devitalised tissue, and explore options available for wound debridement, taking into consideration patients’ pain and quality of life.

  12. Debridement of the noninfected wound.

    PubMed

    Cornell, Rhonda S; Meyr, Andrew J; Steinberg, John S; Attinger, Christopher E

    2010-01-01

    The utility of wound debridement has expanded to include the management of all chronic wounds, even in the absence of infection and gross necrosis. Biofilms, metalloproteases on the wound base, and senescent cells at the wound edge irreversibly change the physiologic features of wound healing and contribute to a pathologic, chronic inflammatory environment. The objective of this review is to provide surgeons with a basic understanding of the processes of debridement in the noninfected wound.

  13. Surgical wound care - open

    MedlinePlus

    Surgical incision care; Open wound care ... your wound again with sutures, you need to care for it at home, since it may take ... Your health care provider will tell you how often to change your dressing . To prepare for the dressing change: Clean your ...

  14. Saliva and wound healing.

    PubMed

    Brand, Henk S; Veerman, Enno C I

    2013-01-01

    Wounds in the oral cavity heal faster and with less scarring than wounds in other parts of the body. One of the factors implicated in this phenomenon is the presence of saliva, which promotes the healing of oral wounds in several ways. Saliva creates a humid environment, which improves the survival and functioning of inflammatory cells that are crucial for wound healing. Furthermore, saliva contains a variety of proteins that play a role in the various stages of the intraoral wound healing. Tissue factor, present in salivary exosomes, accelerates the clotting of blood dramatically. The subsequent proliferation of epithelial cells is promoted by growth factors in saliva, especially epidermal growth factor. The importance of secretory leucocyte protease inhibitor is demonstrated by the observation that in the absence of this salivary protein, oral wound healing is considerably delayed. Members of the salivary histatin family promote wound closure in vitro by enhancing cell spreading and cell migration. Cell proliferation is not enhanced by histatin. Cyclization of histatin increased its biological activity approximately 1,000-fold compared to linear histatin. These studies suggest that histatins could potentially be used for the development of new wound healing medications.

  15. Postoperative fistula of the abdominal wall after laparascopic cholecystectomy due to lost gallstones.

    PubMed

    Weiler, H; Grandel, A

    2002-06-01

    Abdominal fistula caused by cholesterol gallstones, which remained in the abdominal wall after laparascopic cholecystectomy: a laparascopic cholecystectomy was performed in a 60-years-old man who was diagnosed as acute necrosing cholecystitis due to cholecystolithiasis. After removal of the gallbladder using an Endocath some gallstones remained in the excision channel of the abdominal wall. Therefore, a fistula developed in the excision channel postoperatively. As the wound healing was disturbed an investigation of the abdominal wall was performed by ultrasound. In the former excision channel several small, oval, formations with high echogenicity and faint ultrasound shadows were detected, corresponding to additional gallstones. After excision of granulation tissue and removal of the cholesterol stones, complete healing of the fistula in the abdominal wall was achieved. PMID:12044854

  16. Treatment Experience of Severe Abdominal Infection after Orthotopic Liver Transplantation

    PubMed Central

    Wang, Y-G; Wu, J-S; Jiang, B; Wang, J-H; Liu, C-P; Peng, C; Tian, B-Z

    2015-01-01

    ABSTRACT This study aims to investigate the causes and treatment experience of severe abdominal infection after orthotopic liver transplantation. Clinical data were retrospectively analysed in perioperative severe abdominal infection of 186 orthotopic liver transplantation cases from March 2004 to November 2011. Among the 186 patients, 16 cases had severe abdominal infection: five cases had bile duct anastomotic leakage-inducing massive hydrops and infection under liver interstice, 10 cases had extensive bleeding of surgical wound leading to massive haematocele and infection around the liver, and one case had postoperative lower oesophageal fistula leakage causing massive hydrops and infection under the left diaphragm. After definite diagnosis, 12 cases underwent surgery within three days, with no death. Among the four cases that underwent surgery three days after diagnosis, one case died of multiple-organ failure five days after abdominal cavity exploration, which was performed 21 days after liver transplantation. Severe abdominal infections after liver transplantation were the most common causes of death in perioperative liver transplantation. Comprehensive treatment with efficacious antibiotics, multiple-organ support, controlled surgical removal of the lesion, and adequate drainage establishment was the key to the entire treatment. PMID:26426173

  17. The ``gunshot'' sound produced by male North Atlantic right whales and its potential function in reproductive advertisement

    NASA Astrophysics Data System (ADS)

    Parks, Susan E.; Hamilton, Philip; Kraus, Scott D.; Tyack, Peter L.

    2001-05-01

    North Atlantic right whales (Eubalaena glacialis) commonly use sound to mediate social interactions between individuals. Surface active groups (SAGs) are the most commonly observed social interaction on the summer feeding grounds. These groups are typically composed of an adult female with two or more males engaged in social behavior at the surface. Several distinct types of sounds have been recorded from these groups. One sound commonly recorded from these groups is a brief broadband sound, referred to as a gunshot sound because it sounds like a rifle being fired. This sound has been recorded in the Bay of Fundy, Canada from both lone whales (N=9) and social SAGs (N=49). Those lone whales producing gunshot sounds whose sex could be determined (N=9) were all mature males. In surface active groups, the rate of production of gunshot sounds was weakly correlated with the total number of males present in the group. Given the behavioral contexts of gunshot sound production by male whales, gunshots probably function in a reproductive context as an agonistic signal directed toward other males, an advertisement signal to attract females, or a combination of the two functions.

  18. [The clinical biomechanical interpretation of gunshot wounds. The general problems (IV). The propedeutic ABCs of the terminal ballistics].

    PubMed

    Marini, F; Radin, S; Manganelli, F; Carolo, F; Malagutti, D; Prati, G; Massari, S; Tosi, D; Giarolli, M; Tenci, A

    1990-01-01

    If we want to enunciate the damaging potential of a bullet fired from a gun we have to express ourselves right from the outset in terms of destructive work, that is to say not only destruction of the structures the bullet passes through, but also, above all, destruction of the homeostatic condition. In modern terms, this is particularly true of the abdomen, which, in perspective, above and beyond any direct involvement, is a candidate for an interesting role. As regards the translation of this destructive force in mathematical language, formulae are proposed in kilogram-meters, feet per second and Joules. A basic factor in external ballistics, quite apart from the actual forces involved, is the trajectory in space, the hyperbola, though we should also reflect on the problem of resistance, which has such a considerable effect on the behaviour of the "ideal" bullet in the atmosphere (the smallest calibre for a given mass, with the attempt to rid itself of its forced subordination to the calibre of the barrel). This leads us on to the subsequent concept of the "ballistic coefficient" and, in itself definitively established the basic assumptions of terminal ballistics.

  19. Management of complex abdominal wall defects using acellular porcine dermal collagen.

    PubMed

    Chavarriaga, Luis Felipe; Lin, Edward; Losken, Albert; Cook, Michael W; Jeansonne, Louis O; White, Brent C; Sweeney, John F; Galloway, John R; Davis, S Scott

    2010-01-01

    Multiple techniques have been used for the repair of complex abdominal wall defects after recurrent incisional hernias with varying rates of success. Primary repair has been associated with high recurrence rates, and prosthetic mesh placement is contraindicated in contaminated surgical fields. The development of biologic prostheses has changed the approach to these difficult problems. This study evaluates the management of complex abdominal wall defects using acellular porcine dermal collagen. Between August 2006 and May 2007, 18 patients underwent abdominal wall reconstruction for complex defects with acellular porcine dermal collagen (CollaMend; Bard Inc., Warwick, RI). Patient demographics, preoperative risk factors, previous herniorrhaphy attempts, postoperative complications, recurrences, and long-term results were retrospectively reviewed. Records were reviewed at a mean follow up of 7.3 months; the recurrence rate was 44.4 per cent. A total of 38.9 per cent (seven of 18) developed a postoperative wound complications, including infection in 22.2 per cent (four of 18). All of the patients with infection required prosthesis removal as a result of encapsulation rather than incorporation of the biologic prosthesis. Acellular porcine dermal collagen has the potential for reconstruction of abdominal wall defects with postoperative wound occurrences comparable with other biologic materials. Encapsulation of the material was a major problem in cases with wound infection that required graft removal rather than local wound measures. Hernia recurrence and dehiscence of the graft were problems in noncompromised surgical fields.

  20. Lateral Abdominal Wall Reconstruction

    PubMed Central

    Baumann, Donald P.; Butler, Charles E.

    2012-01-01

    Lateral abdominal wall (LAW) defects can manifest as a flank hernias, myofascial laxity/bulges, or full-thickness defects. These defects are quite different from those in the anterior abdominal wall defects and the complexity and limited surgical options make repairing the LAW a challenge for the reconstructive surgeon. LAW reconstruction requires an understanding of the anatomy, physiologic forces, and the impact of deinnervation injury to design and perform successful reconstructions of hernia, bulge, and full-thickness defects. Reconstructive strategies must be tailored to address the inguinal ligament, retroperitoneum, chest wall, and diaphragm. Operative technique must focus on stabilization of the LAW to nonyielding points of fixation at the anatomic borders of the LAW far beyond the musculofascial borders of the defect itself. Thus, hernias, bulges, and full-thickness defects are approached in a similar fashion. Mesh reinforcement is uniformly required in lateral abdominal wall reconstruction. Inlay mesh placement with overlying myofascial coverage is preferred as a first-line option as is the case in anterior abdominal wall reconstruction. However, interposition bridging repairs are often performed as the surrounding myofascial tissue precludes a dual layered closure. The decision to place bioprosthetic or prosthetic mesh depends on surgeon preference, patient comorbidities, and clinical factors of the repair. Regardless of mesh type, the overlying soft tissue must provide stable cutaneous coverage and obliteration of dead space. In cases where the fasciocutaneous flaps surrounding the defect are inadequate for closure, regional pedicled flaps or free flaps are recruited to achieve stable soft tissue coverage. PMID:23372458

  1. Abdominal SPECT imaging

    SciTech Connect

    Van Heertum, R.L.; Brunetti, J.C.; Yudd, A.P.

    1987-07-01

    Over the past several years, abdominal single photon emission computed tomography (SPECT) imaging has evolved from a research tool to an important clinical imaging modality that is helpful in the diagnostic assessment of a wide variety of disorders involving the abdominal viscera. Although liver-spleen imaging is the most popular of the abdominal SPECT procedures, blood pool imaging is becoming much more widely utilized for the evaluation of cavernous hemangiomas of the liver as well as other vascular abnormalities in the abdomen. Adjunctive indium leukocyte and gallium SPECT studies are also proving to be of value in the assessment of a variety of infectious and neoplastic diseases. As more experience is acquired in this area, SPECT should become the primary imaging modality for both gallium and indium white blood cells in many institutions. Renal SPECT, on the other hand, has only recently been used as a clinical imaging modality for the assessment of such parameters as renal depth and volume. The exact role of renal SPECT as a clinical tool is, therefore, yet to be determined. 79 references.

  2. Abdominal emergencies during pregnancy.

    PubMed

    Bouyou, J; Gaujoux, S; Marcellin, L; Leconte, M; Goffinet, F; Chapron, C; Dousset, B

    2015-12-01

    Abdominal emergencies during pregnancy (excluding obstetrical emergencies) occur in one out of 500-700 pregnancies and may involve gastrointestinal, gynecologic, urologic, vascular and traumatic etiologies; surgery is necessary in 0.2-2% of cases. Since these emergencies are relatively rare, patients should be referred to specialized centers where surgical, obstetrical and neonatal cares are available, particularly because surgical intervention increases the risk of premature labor. Clinical presentations may be atypical and misleading because of pregnancy-associated anatomical and physiologic alterations, which often result in diagnostic uncertainty and therapeutic delay with increased risks of maternal and infant morbidity. The most common abdominal emergencies are acute appendicitis (best treated by laparoscopic appendectomy), acute calculous cholecystitis (best treated by laparoscopic cholecystectomy from the first trimester through the early part of the third trimester) and intestinal obstruction (where medical treatment is the first-line approach, just as in the non-pregnant patient). Acute pancreatitis is rare, usually resulting from trans-ampullary passage of gallstones; it usually resolves with medical treatment but an elevated risk of recurrent episodes justifies laparoscopic cholecystectomy in the 2nd trimester and endoscopic sphincterotomy in the 3rd trimester. The aim of the present work is to review pregnancy-induced anatomical and physiological modifications, to describe the main abdominal emergencies during pregnancy, their specific features and their diagnostic and therapeutic management.

  3. Abdominal trauma by ostrich

    PubMed Central

    Usurelu, Sergiu; Bettencourt, Vanessa; Melo, Gina

    2015-01-01

    Introduction Ostriches typically avoid humans in the wild, since they correctly assess humans as potential predators, and, if approached, often run away. However, ostriches may turn aggressive rather than run when threatened, especially when cornered, and may also attack when they feel the need to defend their offspring or territories. Presentation of case A 71-year-old male patient presented with intra abdominal injury sustained from being kicked in the abdominal wall by an ostrich. During laparotomy, were found free peritoneal effusion and perforation of the small intestine. Discussion The clinical history and physical examination are extremely important for diagnostic and therapeutic decision making. CT-scan is the most accurate exam for making diagnosis. Surgery is the treatment of choice, and is always indicated when there is injury to the hollow viscera. In general it is possible to suture the defect. Conclusion In cases of blunt abdominal trauma by animals is necessary to have a low threshold of suspicion for acute abdomen. PMID:25685344

  4. [Types of abdominal war injuries in relation to colonic injuries analyzed during 2 war years of treatment at the Clinic for Abdominal Surgery in Sarajevo].

    PubMed

    Tanović, Haris

    2003-01-01

    The basic characteristics of war in Sarajevo are occasional shelling, sniper fire, unexpected shelling and a lack of a front line in the classic sense of the word. The extent of the wound is the key factor in deciding how the patient is to be treated. A primary contamination of this kind of wound has all the conditions to turn into a manifest infection. The abdomen wounds, because of their severity and direct threat to life, are among the most dangerous wounds altogether. They make up on average 10% of all war wounds and the mortality of these patients by today's literature is high, about 6%. The aims of this paper are to show which organs in the abdomen are wounded and what is their relationship to the wounding of the colon, and to show what is the relation between multiple and isolated wounding of the abdomen. During the years 1992 and 1993, 1106 patients with war wounds were treated at the clinic for the abdominal surgery. From that number 71 patients were treated with explorative laparotomy. The large intestine was injured in 274 patients while 221 patients had injuries of the small intestine. An injury of the liver was found in 165 cases. The gall bladder was injured in 18 cases. The stomach was injured in 324 patients. The pancreas was damaged in 72 patients. There were 94 cases of injured spleens. The kidneys were wounded in 30 cases. In 40 cases there was bleeding from the retroperitoncum. Treatment of the omentumen was carried out in 753 patients. The number of patients who did not survive is 135 of which 44 had an injury of the large intestine. A retrospective analysis data shows that the number of multiple wounds makes up over 98% of all wounds. Isolated wounds of abdominal organs are found in less than 2% of all cases. The increase mortality in our research can be explained greater energy of the projectiles which amplify the acceleration at asphalt surfaces which product the greater destructions of the tissue and the massiveness of the injuries.

  5. Superficial Wound Swabbing

    PubMed Central

    Schmohl, Michael; Beckert, Stefan; Joos, Thomas O.; Königsrainer, Alfred; Schneiderhan-Marra, Nicole; Löffler, Markus W.

    2012-01-01

    OBJECTIVE In diabetic foot ulcers, wound fluid inflammatory mediators have previously been proposed as surrogate markers for nonhealing. However, currently available wound fluid sampling techniques are not suitable for clinical practice due to low levels of exudate and a high logistical effort. The aim of this investigation was to assess 1) the technique of superficial wound swabbing for harvesting wound fluid; and 2) the quality of the collected fluid for immunoassay analysis of inflammatory mediators. RESEARCH DESIGN AND METHODS Both nylon-flocked swabs and film dressings were used to collect wound fluid from foot ulcers of diabetic patients. In randomly selected patients, levels of wound fluid inflammatory mediators and matrix metalloproteases were determined using multiplexed bead-based sandwich immunoassays with respect to both sampling methods. Wound fluid spike-in experiments were performed to evaluate the impact of different sample processing protocols on subsequent immunoassay analysis. RESULTS Using the swabbing technique, a median amount of 40 µL (2–120 µL) wound exudate was collected, which allowed the measurement of several multiplex panels. Comparing both sampling methods, a similar qualitative protein recovery was observed with a trend to analyte enrichment by swabbing. Sample processing using swabs did not affect analyte recovery, with the exception of interleukin (IL)-8, thymus and activation-regulated chemokine, IL-17A, interferon-γ–induced protein 10, and IL-4. CONCLUSIONS The quality of wound fluid collected by superficial swabbing is not inferior to the current standard technique. Combined with subsequent bead-based sandwich immunoassay analysis, this new method offers a noninvasive technique, suitable for daily clinical routines, for assessment of inflammatory activity in diabetic foot ulcers. PMID:22837363

  6. Postoperative infection of an abdominal mesh due to methicillin resistant Staphylococcus aureus - a case report.

    PubMed

    Ashok, R; Anuradha, K; Babu, S S; Bheerappa, N; Sastry, R A; Lakshmi, V

    2004-01-01

    Methicillin resistant Stephylococcus aureus (MRSA) infection has now become a major problem in hospitals. We present a case of postoperative infection MRSA where the primary source of the infection was found to be an abdominal mesh that was used to reinforce the abdominal wall. After one year of surgery, the patient developed wound dehiscence and discharge. MRSA was isolated from the wound, mesh, external nares, throat and axilla. Initially she was started on clindamycin and discharged from the hospital. After 5 months, patient came back to the hospital with infection at the same site. The patient was then treated with vancomycin and MRSA clearance. She responded to the treatment with complete healing of the wound and clearance of MRSA.

  7. Does the declining lethality of gunshot injuries mask a rising epidemic of gun violence in the United States?

    PubMed

    Jena, Anupam B; Sun, Eric C; Prasad, Vinay

    2014-07-01

    Recent mass shootings in the U.S. have reignited the important public health debate concerning measures to decrease the epidemic of gun violence. Editorialists and gun lobbyists have criticized the recent focus on gun violence, arguing that gun-related homicide rates have been stable in the last decade. While true, data from the U.S. Centers for Disease Control and Prevention also demonstrate that although gun-related homicide rates were stable between 2002 and 2011, rates of violent gunshot injuries increased. These seemingly paradoxical trends may reflect the declining lethality of gunshot injuries brought about by surgical advances in the care of the patient with penetrating trauma. Focusing on gun-related homicide rates as a summary statistic of gun violence, rather than total violent gunshot injuries, can therefore misrepresent the rising epidemic of gun violence in the U.S.

  8. Best practice in wound assessment.

    PubMed

    Benbow, Maureen

    2016-03-01

    Accurate and considered wound assessment is essential to fulfil professional nursing requirements and ensure appropriate patient and wound management. This article describes the main aspects of holistic assessment of the patient and the wound, including identifying patient risk factors and comorbidities, and factors affecting wound healing to ensure optimal outcomes.

  9. On the prevalence of gunshot residue in selected populations - an empirical study performed with SEM-EDX analysis.

    PubMed

    Brożek-Mucha, Zuzanna

    2014-04-01

    The study was designed to obtain a comprehensive view on the prevalence of gunshot residue and the factors influencing their dispersion. 273 specimens collected from people of various professions, representing both users and non-users of firearms, as well as from the interior of a forensic laboratory were examined for the presence of gunshot residue. In specimens taken from hands of 100 people declaring no contact with firearms only one spherical particle containing lead, antimony and barium was found. Numbers of particles found in specimens collected from hands of 50 shooters varied from zero to numbers greater than 100 and were strongly correlated with the time interval between last shooting and collecting specimens. Within the first 4h after shooting particles are being lost from the shooter's hands, and so transferred from shooters to their environment. Thus, the relatives of five hunters were examined during both the close and open hunting seasons to trace the potential secondary transfer in practice. Using the criterion of low risk of contamination with gunshot residue, i.e. 5h after last handling a gun, only few specimens were encountered among these collected from hands of firearm users that contained characteristic particles and these occurred in small numbers. Frequent shooters, e.g. shooting instructors or firearm examiners, formed a class for themselves of high risk of contamination with gunshot residue. As a result of continuous monitoring of the laboratory (55 specimens examined so far), where the examinations of gunshot residue are being carried out, it has been proved that the laboratory is free from contamination and so confirmed the usefulness of protocols worked out. The obtained information provided empirical bases to the minimisation of the risk of contamination of the evidence as well as for the evaluation of the analytical findings in the expertise on gunshot incidents.

  10. Effectively managing wound exudate.

    PubMed

    Chamanga, Edwin

    2015-09-01

    The management of wound exudate remains a clinical challenge despite technological advances in products with better exudate-handling capacities. This clinical challenge is occasionally encountered when thick exudate (viscous exudate) is present, and when most modern dressings do not possess the capabilities to manage the viscosity while enabling exudate absorption. Maceration to the peri-wound area poses another challenge, irrespective of the number of topical barrier application products on the market and the innovation of dressing products that lock exudate away or those that encourage vertical wicking. In addition to all the above, in clinical practice, the assessment and documentation of wound exudate remains sporadic, leading to the challenges of effective wound exudate dressing selection and cost-effective dressings.

  11. [Saliva and wound healing].

    PubMed

    Veerman, E C I; Oudhoff, M J; Brand, H S

    2011-05-01

    The oral mucosa is frequently exposed to mechanical forces, which may result in tissue damage. Saliva contributes to the repair of the oral mucosa in several ways. In the first place, it creates a humid environment to improve the function of inflammatory cells. During the last few years, it has been shown that saliva also contains a large number of proteins with a role in wound healing. Saliva contains growth factors, especially Epidermal Growth FACTOR, which promotes the proliferation of epithelial cells. Trefoil factor 3 and histatin promote the process of wound closure. The importance of Secretory Leucocyte Protease Inhibitor is demonstrated by the fact that in the absence of this salivary protein, oral wound healing is considerably delayed. Understanding these salivary proteins opens the way for the development of new wound healing medications.

  12. Prevent Bite Wounds

    MedlinePlus

    ... Health Issues Conditions Abdominal ADHD Allergies & Asthma Autism Cancer Chest & Lungs Chronic Conditions Cleft & Craniofacial Developmental Disabilities Ear Nose & Throat Emotional Problems Eyes Fever From Insects or Animals Genitals and Urinary Tract Glands & Growth ...

  13. Prosthodontic Rehabilitation of Accidental Maxillofacial Gunshot Injury Using Dental Implants: A Five Year Follow-Up Clinical Report

    PubMed Central

    Balla, Vinod; Daniel, Angleena Y

    2016-01-01

    Gunshot injuries to the face can have serious aesthetic, functional, and psychological consequences. The incapacitating nature of maxillofacial defects makes reconstruction of the maxilla and mandible challenging, owing to multiple surgeries and extensive rehabilitation phase. Outcome of prosthodontic treatment is one of the important parameters by which a patient measures the success of rehabilitation. A 5-year follow-up of comprehensive surgical and prosthodontic reconstruction of a gunshot injury using dental implants is described. This case report illustrates the contribution of immediate dental implants with proper oral hygiene follow-up as an effective treatment modality in restoring a patient to near normal function and aesthetics. PMID:27790591

  14. Gentamicin-impregnated collagen sponge for preventing sternal wound infection after cardiac surgery.

    PubMed

    Kozioł, Małgorzata; Targońska, Sylwia; Stążka, Janusz; Kozioł-Montewka, Maria

    2014-03-01

    The frequency of sternal wound infection (SWI) after cardiac surgery ranges from 0.5% to 8% and is associated with significant morbidity, mortality, and treatment cost. Perioperative antibiotic prophylaxis is not sufficient to fully prevent the contamination of the surgical access site. One of the most effective methods for the prevention of wound infection seems to be the use of gentamicin-impregnated collagen sponge, which is successfully used in abdominal and orthopedic surgery. Surgically implantable topical antibiotics can reduce wound infection in cardiac patients as well, but the efficacy of SWI prevention in cardiac surgery still raises many questions.

  15. Phytochemicals in Wound Healing

    PubMed Central

    Thangapazham, Rajesh L.; Sharad, Shashwat; Maheshwari, Radha K.

    2016-01-01

    Significance: Traditional therapies, including the use of dietary components for wound healing and skin regeneration, are very common in Asian countries such as China and India. The increasing evidence of health-protective benefits of phytochemicals, components derived from plants is generating a lot of interest, warranting further scientific evaluation and mechanistic studies. Recent Advances: Phytochemicals are non-nutritive substances present in plants, and some of them have the potential to provide better tissue remodeling when applied on wounds and to also act as proangiogenic agents during wound healing. Critical Issues: In this review, we briefly discuss the current understanding, important molecular targets, and mechanism of action(s) of some of the phytochemicals such as curcumin, picroliv, and arnebin-1. We also broadly review the multiple pathways that these phytochemicals regulate to enhance wound repair and skin regeneration. Future Directions: Recent experimental data on the effects of phytochemicals on wound healing and skin regeneration establish the potential clinical utility of plant-based compounds. Additional research in order to better understand the exact mechanism and potential targets of phytochemicals in skin regeneration is needed. Human studies a2nd clinical trials are pivotal to fully understand the benefits of phytochemicals in wound healing and skin regeneration. PMID:27134766

  16. Nutrition and Chronic Wounds

    PubMed Central

    Molnar, Joseph Andrew; Underdown, Mary Jane; Clark, William Andrew

    2014-01-01

    Significance: Nutrition is one of the most basic of medical issues and is often ignored as a problem in the management of our chronic wound patients. Unfortunately, malnutrition is widespread in our geriatric patients even in nursing homes in developed countries. Attention to basic nutrition and providing appropriate supplements may assist in the healing of our chronic wounds. Recent Advances: Recent research has revealed the epidemiology of malnutrition in developed countries, the similarities to malnutrition in developing countries, and some of the physiologic and sociologic causes for this problem. More information is now available on the biochemical effects of nutrient deficiency and supplementation with macronutrients and micronutrients. In some cases, administration of isolated nutrients beyond recommended amounts for healthy individuals may have a pharmacologic effect to help wounds heal. Critical Issues: Much of the knowledge of the nutritional support of chronic wounds is based on information that has been obtained from trauma management. Due to the demographic differences of the patients and differences in the physiology of acute and chronic wounds, it is not logical to assume that all aspects of nutritional support are identical in these patient groups. Before providing specific nutritional supplements, appropriate assessments of patient general nutritional status and the reasons for malnutrition must be obtained or specific nutrient supplementation will not be utilized. Future Directions: Future research must concentrate on the biochemical and physiologic differences of the acute and chronic wounds and the interaction with specific supplements, such as antioxidants, vitamin A, and vitamin D. PMID:25371850

  17. Nutrition and Chronic Wounds.

    PubMed

    Molnar, Joseph Andrew; Underdown, Mary Jane; Clark, William Andrew

    2014-11-01

    Significance: Nutrition is one of the most basic of medical issues and is often ignored as a problem in the management of our chronic wound patients. Unfortunately, malnutrition is widespread in our geriatric patients even in nursing homes in developed countries. Attention to basic nutrition and providing appropriate supplements may assist in the healing of our chronic wounds. Recent Advances: Recent research has revealed the epidemiology of malnutrition in developed countries, the similarities to malnutrition in developing countries, and some of the physiologic and sociologic causes for this problem. More information is now available on the biochemical effects of nutrient deficiency and supplementation with macronutrients and micronutrients. In some cases, administration of isolated nutrients beyond recommended amounts for healthy individuals may have a pharmacologic effect to help wounds heal. Critical Issues: Much of the knowledge of the nutritional support of chronic wounds is based on information that has been obtained from trauma management. Due to the demographic differences of the patients and differences in the physiology of acute and chronic wounds, it is not logical to assume that all aspects of nutritional support are identical in these patient groups. Before providing specific nutritional supplements, appropriate assessments of patient general nutritional status and the reasons for malnutrition must be obtained or specific nutrient supplementation will not be utilized. Future Directions: Future research must concentrate on the biochemical and physiologic differences of the acute and chronic wounds and the interaction with specific supplements, such as antioxidants, vitamin A, and vitamin D.

  18. Combat Wound Initiative program.

    PubMed

    Stojadinovic, Alexander; Elster, Eric; Potter, Benjamin K; Davis, Thomas A; Tadaki, Doug K; Brown, Trevor S; Ahlers, Stephen; Attinger, Christopher E; Andersen, Romney C; Burris, David; Centeno, Jose; Champion, Hunter; Crumbley, David R; Denobile, John; Duga, Michael; Dunne, James R; Eberhardt, John; Ennis, William J; Forsberg, Jonathan A; Hawksworth, Jason; Helling, Thomas S; Lazarus, Gerald S; Milner, Stephen M; Mullick, Florabel G; Owner, Christopher R; Pasquina, Paul F; Patel, Chirag R; Peoples, George E; Nissan, Aviram; Ring, Michael; Sandberg, Glenn D; Schaden, Wolfgang; Schultz, Gregory S; Scofield, Tom; Shawen, Scott B; Sheppard, Forest R; Stannard, James P; Weina, Peter J; Zenilman, Jonathan M

    2010-07-01

    The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. Additional clinical trials include the prospective use of clinical data, serum and wound biomarkers, and wound gene expression profiles to predict wound healing/failure and additional clinical patient outcomes following combat-related trauma. These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care. PMID:23634474

  19. Infection in conflict wounded

    PubMed Central

    Eardley, W. G. P.; Brown, K. V.; Bonner, T. J.; Green, A. D.; Clasper, J. C.

    2011-01-01

    Although mechanisms of modern military wounding may be distinct from those of ancient conflicts, the infectious sequelae of ballistic trauma and the evolving microbial flora of war wounds remain a considerable burden on both the injured combatant and their deployed medical systems. Battlefield surgeons of ancient times favoured suppuration in war wounding and as such Galenic encouragement of pus formation would hinder progress in wound care for centuries. Napoleonic surgeons eventually abandoned this mantra, embracing radical surgical intervention, primarily by amputation, to prevent infection. Later, microscopy enabled identification of microorganisms and characterization of wound flora. Concurrent advances in sanitation and evacuation enabled improved outcomes and establishment of modern military medical systems. Advances in medical doctrine and technology afford those injured in current conflicts with increasing survivability through rapid evacuation, sophisticated resuscitation and timely surgical intervention. Infectious complications in those that do survive, however, are a major concern. Addressing antibiotic use, nosocomial transmission and infectious sequelae are a current clinical management and research priority and will remain so in an era characterized by a massive burden of combat extremity injury. This paper provides a review of infection in combat wounding from a historical setting through to the modern evidence base. PMID:21149356

  20. Prontosan wound irrigation and gel: management of chronic wounds.

    PubMed

    Horrocks, Ann

    Chronic wounds present a challenge that is costly in terms of quality of life to the patient and in financial terms for the NHS. Several factors contribute to the development of a chronic wound, in particular the influence of bacteria as a biofilm within the wound environment. Irrigating a wound with normal saline has long been advocated as the most appropriate method of wound irrigation but biofilms are now known to be resistant to this method of cleansing. A small (10 patient) evaluation of the use of Prontosan in patients whose duration of chronic wounds exceeded 1 year has demonstrated that Prontosan wound irrigation and Prontosan gel are an appropriate alternative for cleaning, moistening and decontaminating encrusted, contaminated and chronic skin wounds, and can have a dramatic influence of the quality of life for such patients. This article discusses the cause of chronicity within a wound and discusses in depth three of the ten patients in the evaluation.

  1. Characterisation of gunshot residue particles using self-consistent ion beam analysis

    NASA Astrophysics Data System (ADS)

    Bailey, M. J.; Jeynes, C.

    2009-06-01

    Individual particles of gunshot residue were studied with particle-induced X-ray emission and backscattering spectrometry using a 2.5 MeV H + beam focussed to ˜4 μm and self-consistent fitting of the data. The geometry of these spherical particles was considered in order to accurately fit the corresponding particle spectrum and therefore to quantify the trace element composition of these particles. The demonstrable self-consistency of this method allows the compositions of most residue particles to be determined unambiguously and with a higher sensitivity to trace elements than conventional methods.

  2. [Forensic medical assessment of the mechanisms of development of gunshot lesions caused by elastic destructive agents].

    PubMed

    Musin, É Kh; Roman'ko, N A; Makarov, I Iu; Kutsenko, K I

    2012-01-01

    This paper reports the results of analysis of the data obtained in experimental studies and practical expert assessments of body injuries inflicted by rubber balls for traumatic weapons. The causes accounting for the polymorphism of such injuries and the mechanisms of their development were elucidated by means of damage simulation taking into consideration the physical and dynamic properties of elastic ball-type destructive agents and the morphological structure of different anatomical regions of the human body. The results of the study may be of interest for differential diagnostics of gunshot lesions caused by elastic destructive agents.

  3. Leaking mycotic abdominal aortic aneurysm.

    PubMed

    Sing, T M; Young, N; O'Rourke, I C; Tomlinson, P

    1994-11-01

    A case of leaking mycotic abdominal aortic aneurysm is reported, with a brief review of the literature. A 58 year old female presented with shoulder and abdominal pain associated with diarrhoea, vomiting and fever with leucocytosis. Computed tomography of the abdomen showed pooling of contrast in the retroperitoneum anterior to a non-dilated abdominal aorta. There was considerable retroperitoneal blood accumulating in a mass-like lesion in the right lower abdomen and pelvis obstructing the right renal collecting system. Laparotomy revealed a 4 cm diameter saccular aneurysm of the abdominal aorta, with a 1 cm diameter neck. Culture of the thrombus grew Streptococcus pyogenes. PMID:7993259

  4. Hypnosis for functional abdominal pain.

    PubMed

    Gottsegen, David

    2011-07-01

    Chronic abdominal pain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominal pain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other somatic symptoms are easily adaptable for use with functional abdominal pain. The author discusses 2 contrasting hypnotic approaches to functional abdominal pain and provides implications for further research. These approaches may provide new insights into this common and complex disorder. PMID:21922712

  5. Chemometric classification of gunshot residues based on energy dispersive X-ray microanalysis and inductively coupled plasma analysis with mass-spectrometric detection

    NASA Astrophysics Data System (ADS)

    Steffen, S.; Otto, M.; Niewoehner, L.; Barth, M.; Bro¿żek-Mucha, Z.; Biegstraaten, J.; Horváth, R.

    2007-09-01

    A gunshot residue sample that was collected from an object or a suspected person is automatically searched for gunshot residue relevant particles. Particle data (such as size, morphology, position on the sample for manual relocation, etc.) as well as the corresponding X-ray spectra and images are stored. According to these data, particles are classified by the analysis-software into different groups: 'gunshot residue characteristic', 'consistent with gunshot residue' and environmental particles, respectively. Potential gunshot residue particles are manually checked and - if necessary - confirmed by the operating forensic scientist. As there are continuing developments on the ammunition market worldwide, it becomes more and more difficult to assign a detected particle to a particular ammunition brand. As well, the differentiation towards environmental particles similar to gunshot residue is getting more complex. To keep external conditions unchanged, gunshot residue particles were collected using a specially designed shooting device for the test shots revealing defined shooting distances between the weapon's muzzle and the target. The data obtained as X-ray spectra of a number of particles (3000 per ammunition brand) were reduced by Fast Fourier Transformation and subjected to a chemometric evaluation by means of regularized discriminant analysis. In addition to the scanning electron microscopy in combination with energy dispersive X-ray microanalysis results, isotope ratio measurements based on inductively coupled plasma analysis with mass-spectrometric detection were carried out to provide a supplementary feature for an even lower risk of misclassification.

  6. Principles of Wound Management and Wound Healing in Exotic Pets.

    PubMed

    Mickelson, Megan A; Mans, Christoph; Colopy, Sara A

    2016-01-01

    The care of wounds in exotic animal species can be a challenging endeavor. Special considerations must be made in regard to the animal's temperament and behavior, unique anatomy and small size, and tendency toward secondary stress-related health problems. It is important to assess the entire patient with adequate systemic evaluation and consideration of proper nutrition and husbandry, which could ultimately affect wound healing. This article summarizes the general phases of wound healing, factors that affect healing, and principles of wound management. Emphasis is placed on novel methods of treating wounds and species differences in wound management and healing.

  7. Principles of Wound Management and Wound Healing in Exotic Pets.

    PubMed

    Mickelson, Megan A; Mans, Christoph; Colopy, Sara A

    2016-01-01

    The care of wounds in exotic animal species can be a challenging endeavor. Special considerations must be made in regard to the animal's temperament and behavior, unique anatomy and small size, and tendency toward secondary stress-related health problems. It is important to assess the entire patient with adequate systemic evaluation and consideration of proper nutrition and husbandry, which could ultimately affect wound healing. This article summarizes the general phases of wound healing, factors that affect healing, and principles of wound management. Emphasis is placed on novel methods of treating wounds and species differences in wound management and healing. PMID:26611923

  8. Wound healing for the clinician.

    PubMed

    Zitelli, J

    1987-01-01

    Wound healing is a complex sequence of events, beginning with tissue injury, mediated by inflammation, and ending long after reepithelialization is complete. Research and controlled clinical experience have provided a better understanding so that clinicians can influence the events of healing to decrease pain, control bleeding, infection, and cosmetic result as well as speed the time for complete healing. The following is a summary of guidelines for the management of wound healing: (1) wound creation; wounds should be created with minimal necrosis of tissue in order to prevent delays in healing. Electrosurgical, cryosurgical, and laser surgical wounds heal more slowly than wounds created by scalpel excision or curettage. Electro-coagulation should be used sparingly in sutured wounds. Large lesions are best treated in a single stage rather than in divided treatments since the rate of wound healing is not proportional to the area but instead to the logarithm of the area. Thus, the total healing time is much shorter if done in a single treatment session. (2) use of drugs; corticosteroids given before or within three days of wounding in dose of prednisone 40 mg or greater will inhibit wound healing. Vitamin A topically or systemically may reverse this inhibition. Aspirin and other nonsteroidal anti-inflammatory agents are more important for their effects on platelet function and bleeding than on wound healing. (3) wound dressings; the use of occlusive dressings to promote moist wound healing is the most significant advance in wound management. Occlusive dressings shorten the time for healing, decrease pain, reduce wound contamination, and improve the cosmetic result. (4) control of wound contraction and scar formation; at the time of wound formation, guiding sutures may be helpful in wound healing by secondary intention in order to control the direction of wound contraction and prevent distortion. Intralesional steroids may be useful for hypertrophic scars and keloids

  9. Wound healing for the clinician.

    PubMed

    Zitelli, J

    1987-01-01

    Wound healing is a complex sequence of events, beginning with tissue injury, mediated by inflammation, and ending long after reepithelialization is complete. Research and controlled clinical experience have provided a better understanding so that clinicians can influence the events of healing to decrease pain, control bleeding, infection, and cosmetic result as well as speed the time for complete healing. The following is a summary of guidelines for the management of wound healing: (1) wound creation; wounds should be created with minimal necrosis of tissue in order to prevent delays in healing. Electrosurgical, cryosurgical, and laser surgical wounds heal more slowly than wounds created by scalpel excision or curettage. Electro-coagulation should be used sparingly in sutured wounds. Large lesions are best treated in a single stage rather than in divided treatments since the rate of wound healing is not proportional to the area but instead to the logarithm of the area. Thus, the total healing time is much shorter if done in a single treatment session. (2) use of drugs; corticosteroids given before or within three days of wounding in dose of prednisone 40 mg or greater will inhibit wound healing. Vitamin A topically or systemically may reverse this inhibition. Aspirin and other nonsteroidal anti-inflammatory agents are more important for their effects on platelet function and bleeding than on wound healing. (3) wound dressings; the use of occlusive dressings to promote moist wound healing is the most significant advance in wound management. Occlusive dressings shorten the time for healing, decrease pain, reduce wound contamination, and improve the cosmetic result. (4) control of wound contraction and scar formation; at the time of wound formation, guiding sutures may be helpful in wound healing by secondary intention in order to control the direction of wound contraction and prevent distortion. Intralesional steroids may be useful for hypertrophic scars and keloids

  10. [A Case of Abdominal Wall Hernia Rupture during Bevacizumab Treatment].

    PubMed

    Sugimoto, Satoshi; Miyazaki, Yasuaki; Hirose, Sou; Michiura, Toshiya; Fujita, Shigeo; Yamabe, Kazuo; Miyazaki, Satoru; Nagaoka, Makio

    2015-11-01

    A 78 -year-old man with rectal cancer underwent abdominoperineal resection of the rectum. In the postoperative period, the patient experienced wound infection, leading to an abdominal wall hernia. Two years following surgery, a rise in the serum CEA level was seen. A metastatic tumor was detected in the right lung on chest CT. VATS right lung inferior lobe segmental resection was performed. After lobectomy, the serum CEA level continued to increase. Another metastatic tumor was detected in the right lung on chest CT. Chemotherapy with capecitabine, oxaliplatin, and bevacizumab was commenced. The erosive part of the abdominal wall scar hernia extended during the nine weeks of chemotherapy. The chemotherapy was then discontinued. In the follow-up CT scan, a right pleural recurrence, local recurrence in the pelvis, and a liver metastasis were detected. Chemotherapy was re-introduced 3 years after surgery. The erosive part of the abdominal wall hernia again began to spread with chemotherapy recommencement. Four months after restarting chemotherapy, the hernia ruptured, with a loop of the small intestine protruding out of it. The patient covered this with a sheet of vinyl and was taken by the ambulance to our hospital. The erosive part of the abdominal wall hernia had split by 10 cm, and a loop of the small intestine was protruding. As ischemia of the small intestine was not observed, we replaced it into the abdominal cavity, and performed a temporary suture repair of the hernia sac. Following this, bevacizumab was discontinued, and the erosive part reduced. We performed a radical operation for abdominal wall scar hernia repair 11 weeks after the discontinuation of bevacizumab. PMID:26805294

  11. Negative pressure wound therapy with instillation: the current state of the art.

    PubMed

    Wolvos, Tom A

    2014-03-01

    Traditional negative pressure wound therapy (NPWT) has revolutionized the treatment of complex wounds for nearly 20 years. A decade ago, a modification of the original system added intermittent automated instillation of topical wound irrigation solutions to traditional negative pressure wound therapy. This combined therapy, termed negative pressure wound therapy with instillation (NPWTi), has been shown to be effective in the treatment of a variety of complex wounds. Negative pressure wound therapy with instillation has been shown to reduce bioburden and biofilms present in wounds helping heal clinically infected wounds. It has also been used with success to jump-start stalled wounds, in relieving wound pain and treating infected foreign bodies including infected orthopedic hardware and some types of exposed abdominal wall mesh. The system includes a foam dressing placed in the wound covered by a semi-occlusive drape. A tubing placed over a hole cut in the drape connects the foam dressing to a pump run by a computerized microprocessor that delivers negative pressure to the dressing and wound. A preset volume of instillation fluid is automatically delivered via the instillation tubing to the wound. The fluid is held in the foam to bathe the wound for a predetermined time period. Negative pressure is then re-started draining the irrigation fluid and any wound exudate into a collection canister. The entire sequence is automated and consists of three phases: (1) fluid instillation; (2) holding for a period of time in the wound, which is fully expanded since the negative pressure is off during this phase; and then (3) a cycle of continuous negative pressure. The entire sequence repeats itself automatically. Typically the dressing is changed three times a week. The variables involved in treating patients with negative pressure wound therapy with instillation included: the indicated wound types; the system settings; the choice of the irrigation solution and the duration

  12. [Abdominal approaches and drainages of the abdominal cavity].

    PubMed

    Hagel, C; Schilling, M

    2006-04-01

    Appropriate access to the abdominal cavity is the first and crucial step for successful abdominal surgical intervention. In planning the incision, several variables have to be considered, such as anatomy of the abdominal wall, localization of the target organ, and individual conditions (previous incisions, minimal access surgery, etc). Medial laparotomy is the preferred incision for emergency cases and ill-defined pathologies, allowing access and hence exploration to all quadrants. Transverse laparotomies give superior access to the dorsal and right aspects of the liver and cause less pain in patients unfit for regional anesthetic procedures. Draining of the abdominal cavity is used after various resective and reconstructive procedures, but there is little evidence for its use in a number of operations such as gastric, hepatic, and colorectal resections. Advantages and disadvantages of different abdominal wall incisions and drainages are discussed.

  13. Deep digital burns treated with 2 abdominal flaps: case report.

    PubMed

    Wu, Choulang; Zhou, Lichun; Zhu, Lili; Zheng, Jinman

    2013-11-01

    We present the case of a 22-year-old man with third- to fourth-degree flame burns to all fingers of the right hand. After removing the necrotic tissues and amputating the carbonized distal segments of each finger, we covered the injured thumb with a paraumbilical tubular flap and covered the other fingers with an abdominal wall marsupial flap. Fifty days after injury, all the wounds healed, and the remaining fingers were salvaged. Four months after injury, the grip strength and the first web span of the right hand was 23.6 kg and 53°, and the patient could fulfill almost all the activities of daily living.

  14. Primary closure of the abdominal wall after "open abdomen" situation.

    PubMed

    Kääriäinen, M; Kuokkanen, H

    2013-01-01

    "Open abdomen" is a strategy used to avoid or treat abdominal compartment syndrome. It has reduced mortality both in trauma and non-trauma abdominal catastrophes but also has created a challenging clinical problem. Traditionally, open abdomen is closed in two phases; primarily with a free skin graft and later with a flap reconstruction. A modern trend is to close the abdomen within the initial hospitalization. This requires multi-professional co-operation. Temporary abdominal closure methods, e.g. negative pressure wound therapy alone or combined with mesh-mediated traction, have been developed to facilitate direct fascial closure. Components separation technique, mesh reinforcement or bridging of the fascial defect with mesh and perforator saving skin undermining can be utilized in the final closure if needed. These techniques can be combined. Choice of the treatment depends on the condition of the patient and size of the fascia and skin defect, and the state of the abdominal contents. In this paper we review the literature on the closure of an open abdomen and present the policy used in our institution in the open abdomen situations.

  15. Can Abdominal Wall Reconstruction Be Safely Performed Without Drains?

    PubMed

    Ramshaw, Bruce; Dean, Jonathan; Forman, Brandie; Heidel, Eric; Gamenthaler, Andrew; Fabian, Michael

    2016-08-01

    The use of closed suction drains in the abdominal wall is a common practice in abdominal wall reconstruction (AWR) operations. Drains can be a conduit for bacteria and can cause pain and discomfort for patients after surgery. A single hernia program has implemented the principles of clinical quality improvement in an attempt to improve outcomes for hernia patients. An attempt at a process improvement was implemented to eliminate the use of drains in AWR by adapting the technique. A total of 102 patients undergoing AWR were included between 8/11 and 9/15 (49 months). Compared with the group before the attempt at eliminating the use of abdominal wall drains (8/11-9/13), the group of patients after the implementation of the attempted process improvement (9/13-9/15) had less wound and pulmonary complications, a shorter hospital stay, less time in the postanesthesia care unit, and less opioid use in the postanesthesia care unit as well as for the entire hospital stay. In this group of AWR patients, an attempt at process improvement that eliminated the use of drains led to improved outcomes. Abdominal wall drains may be able to be safely eliminated with appropriate technique adaptation for AWR. PMID:27657586

  16. [Abdominal cure procedures. Adequate use of Nobecutan Spray].

    PubMed

    López Soto, Rosa María

    2009-12-01

    Open abdominal wounds, complicated by infection and/or risk of eventration tend to become chronic and usually require frequent prolonged cure. Habitual changing of bandages develop into one of the clearest risk factors leading to the deterioration of perilesional cutaneous integrity. This brings with it new complications which draw out the evolution of the process, provoking an important deterioration in quality of life for the person who suffers this and a considerable increase in health costs. What is needed is a product and a procedure which control the risk of irritation, which protect the skin, which favor a patient's comfort and which shorten treatment requirements while lowering health care expenses. This report invites medical personnel to think seriously about the scientific rationale, and treatment practice, as to why and how to apply Nobecutan adequately, this reports concludes stating the benefits in the adequate use of this product. The objective of this report is to guarantee the adequate use of this product in treatment of complicated abdominal wounds. This product responds to the needs which are present in these clinical cases favoring skin care apt isolation and protection, while at the same time, facilitating the placement and stability of dressings and bandages used to cure wounds. In order for this to happen, the correct use of this product is essential; medical personnel must pay attention to precautions and recommendations for proper application. The author's experiences in habitual handling of this product during various years, included in the procedures for standardized cures for these wounds, corroborates its usefulness; the author considers use of this product to be highly effective while being simple to apply; furthermore, one succeeds in providing quality care and optimizes resources employed.

  17. A prospective evaluation of the risk factors for development of wound dehiscence and incisional hernia

    PubMed Central

    Yılmaz, Kerim Bora; Akıncı, Melih; Doğan, Lütfi; Karaman, Niyazi; Özaslan, Cihangir; Atalay, Can

    2013-01-01

    Objective: Post-laparotomy wound dehiscence, evantration and evisceration are important complications leading to an increase in both morbidity and mortality. Incisional hernias are frequently observed following abdominal surgeries and their occurrence is related to various local and systemic factors. This study aims to analyze the factors affecting wound healing by investigating the parameters that may cause wound dehiscence, incisional hernia, sinus formation and chronic incisional pain. Material and Methods: The records of 265 patients who underwent major abdominal surgery were analyzed. The data on patient characteristics, medication, surgical procedure type, type of suture and surgical instruments used and complications were recorded. The patients were followed up with respect to sinus formation, incisional hernia occurrence and presence of chronic incision pain. Statistical analysis was performed using SPSS 10.00 program. The groups were compared via chi-square tests. Significance was determined as p<0.05. Multi-variate analysis was done by forward logistic regression analysis. Results: 115 (43.4%) patients were female and 150 (56.6%) were male. Ninety-four (35.5%) patients were under 50 years old and 171 (64.5%) were older than 50 years. The median follow-up period was 28 months (0–48). Factors affecting wound dehiscence were found to be; creation of an ostomy (p=0.002), postoperative pulmonary problems (p=0.001) and wound infection (p=0.001). Factors leading to incisional hernia were; incision type (p=0.002), formation of an ostomy (p=0.002), postoperative bowel obstruction (p=0.027), postoperative pulmonary problems (p=0.017) and wound infection (p=0.011). Conclusion: Awareness of the factors causing wound dehiscence and incisional hernia in abdominal surgery, means of intervention to the risk factors and taking relevant measures may prevent complications. Surgical complications that occur in the postoperative period are especially related to wound

  18. How I Manage Abdominal Injuries.

    ERIC Educational Resources Information Center

    Haycock, Christine E.

    1986-01-01

    In sports, abdominal injuries occur most frequently in cycling, horseback riding, and skiing. Most involve children, not adults. Any athlete sustaining a severe blow to the abdomen should be examined. Guidelines are provided for recognizing and treating injuries to the abdominal muscles, kidneys, spleen, and liver. (Author/MT)

  19. Wound cleaning and wound healing: a concise review.

    PubMed

    Wilkins, Robert G; Unverdorben, Martin

    2013-04-01

    Chronic wounds present a significant societal burden in their cost of care, and they reduce patient quality of life. Key components of wound care include such measures as debridement, irrigation, and wound cleaning. Appropriate care removes necrotic tissue and reduces wound bioburden to enhance wound healing. Physical cleaning with debridement and irrigation is of documented efficacy. Wounds may be washed with water, saline, or Ringer's solution or cleaned with active ingredients, such as hydrogen peroxide, sodium hypochlorite, acetic acid, alcohol, ionized silver preparations, chlorhexidine, polyhexanide/betaine solution, or povidone-iodine--the majority of which are locally toxic and of limited or no proven efficacy in enhancing wound healing. Although the consensus opinion is that these topical cleaning agents should not be routinely used, recent clinical evidence suggests that polyhexanide/betaine may be nontoxic and effective in enhancing wound healing. Further well-designed studies are needed. PMID:23507692

  20. Wound cleaning and wound healing: a concise review.

    PubMed

    Wilkins, Robert G; Unverdorben, Martin

    2013-04-01

    Chronic wounds present a significant societal burden in their cost of care, and they reduce patient quality of life. Key components of wound care include such measures as debridement, irrigation, and wound cleaning. Appropriate care removes necrotic tissue and reduces wound bioburden to enhance wound healing. Physical cleaning with debridement and irrigation is of documented efficacy. Wounds may be washed with water, saline, or Ringer's solution or cleaned with active ingredients, such as hydrogen peroxide, sodium hypochlorite, acetic acid, alcohol, ionized silver preparations, chlorhexidine, polyhexanide/betaine solution, or povidone-iodine--the majority of which are locally toxic and of limited or no proven efficacy in enhancing wound healing. Although the consensus opinion is that these topical cleaning agents should not be routinely used, recent clinical evidence suggests that polyhexanide/betaine may be nontoxic and effective in enhancing wound healing. Further well-designed studies are needed.

  1. The evaluation of a new technology for gunshot residue (GSR) analysis in the field

    NASA Astrophysics Data System (ADS)

    Hondrogiannis, Ellen; Andersen, Danielle; Miziolek, Andrzej W.

    2013-05-01

    There continues to be a need for improved technology to be used in theater to quickly and accurately identify the person who shot any weapon during a terrorist attack as well as to link a suspect to the actual weapon fired during a crime. Beyond this, in areas of conflict it would be desirable to have the capability to establish the source country for weaponry and ammunition. Gunshot residue (GSR) analysis is a reasonably well-studied technology area. Recent scientific publications have reported that the residues have a rich composition of both organic and inorganic compounds. For the purposes of identifying the manufacturer or country of origin for the ammunition, the inorganic components of GSR appear to be especially promising since their presence in the propellant and primer formulations are either specific to a given chemical formula, or they represent impurities in the manufacturing process that can be unique to a manufacturer or the source country for the chemicals used for propellants and primers. The Laser Induced Breakdown Spectroscopy (LIBS) technology has already demonstrated considerable capability for elemental fingerprinting, especially for inorganic/metallic components. A number of reports have demonstrated LIBS capability in forensics for matching materials such as inks, fabrics, paper, glass, and paint. This work describes the encouraging results of an initial study to assess a new commercial field-portable (battery operated) LIBS system for GSR analysis with gunshot residues having been collected from inside cartridge casings from 3 different ammunition manufacturers.

  2. [The abdominal drop flap].

    PubMed

    Bodin, F; Liverneaux, P; Seigle-Murandi, F; Facca, S; Bruant-Rodier, C; Dissaux, C; Chaput, B

    2015-08-01

    The skin between the mastectomy scar and the future infra-mammary fold may be managed in different ways in delayed breast reconstruction using a DIEP (deep inferior epigastric perforator). Conserving this skin and positioning the flap skin paddle in the middle of the breast usually highlights skin color disparity because of two visible transition zones. Resection of the entire skin under the scar may be more aesthetic but limits direct closure possibility in case of flap failure. In order to benefit from both aesthetic result and safe surgical method, we propose the abdominal drop flap. The inferior thoracic skin flap is detached from the thoracic wall beyond the future infra-mammary fold, preserved and pushed under the breast.

  3. Wound healing and treating wounds: Differential diagnosis and evaluation of chronic wounds.

    PubMed

    Morton, Laurel M; Phillips, Tania J

    2016-04-01

    Wounds are an excellent example of how the field of dermatology represents a cross-section of many medical disciplines. For instance, wounds may be caused by trauma, vascular insufficiency, and underlying medical conditions, such as diabetes, hypertension, and rheumatologic and inflammatory disease. This continuing medical education article provides an overview of wound healing and the pathophysiology of chronic wounds and reviews the broad differential diagnosis of chronic wounds. It also describes the initial steps necessary in evaluating a chronic wound and determining its underlying etiology.

  4. Wound Management: The Occlusive Dressing

    PubMed Central

    Rheinecker, Scot B.

    1995-01-01

    Superficial wounds resulting from athletic injury are common in sports medicine. Although such wounds can be quite painful, they are usually merely inconvenient to the athlete. If improperly managed, however, superficial wounds may heal slowly and cause unnecessary scar tissue proliferation at the wound site. Scar formation causes the wound to break open frequently and puts the athlete at risk of cross-contamination by pathogenic organisms. New advances in the science of wound management strongly favor the use of occlusive dressings to increase patient comfort, increase patient compliance, decrease the risk of infection, and decrease overall healing time. Occlusion has clearly been proven to aid in the healing of superficial wounds and should be considered as a treatment alternative for wounds in the sports medicine setting. In this paper, I discuss three of the most widely used types of occlusive dressings: 1) films, 2) hydrogels, and 3) hydrocolloids. PMID:16558325

  5. Wound Healing Devices Brief Vignettes

    PubMed Central

    Anderson, Caesar A.; Hare, Marc A.; Perdrizet, George A.

    2016-01-01

    Significance: The demand for wound care therapies is increasing. New wound care products and devices are marketed at a dizzying rate. Practitioners must make informed decisions about the use of medical devices for wound healing therapy. This paper provides updated evidence and recommendations based on a review of recent publications. Recent Advances: The published literature on the use of medical devices for wound healing continues to support the use of hyperbaric oxygen therapy, negative pressure wound therapy, and most recently electrical stimulation. Critical Issue: To inform wound healing practitioners of the evidence for or against the use of medical devices for wound healing. This information will aid the practitioner in deciding which technology should be accepted or rejected for clinical use. Future Directions: To produce high quality, randomized controlled trials or acquire outcome-based registry databases to further test and improve the knowledge base as it relates to the use of medical devices in wound care. PMID:27076996

  6. Biofilms in wounds: management strategies.

    PubMed

    Rhoads, D D; Wolcott, R D; Percival, S L

    2008-11-01

    Biofilms probably induce a chronic and/or 'quiet' inflammation in the chronic wound and so delay healing. This paper reviews current strategies that can be used to suppress biofilms in chronic wounds until better options are available.

  7. Wound Drainage Culture (For Parents)

    MedlinePlus

    ... Things to Know About Zika & Pregnancy Wound Drainage Culture KidsHealth > For Parents > Wound Drainage Culture Print A A A Text Size What's in ... de heridas What It Is A wound drainage culture is a test to detect germs such as ...

  8. The History of Wound Care

    PubMed Central

    Shah, Jayesh B.

    2012-01-01

    The history of wound healing is, in a sense, the history of humankind. This brief history of wound healing has been compiled for the benefit of readers. It is amazing to see that some of the basic principles of wound healing have been known since 2000 bc. PMID:24525756

  9. Cell therapy for wound healing.

    PubMed

    You, Hi-Jin; Han, Seung-Kyu

    2014-03-01

    In covering wounds, efforts should include utilization of the safest and least invasive methods with goals of achieving optimal functional and cosmetic outcome. The recent development of advanced wound healing technology has triggered the use of cells to improve wound healing conditions. The purpose of this review is to provide information on clinically available cell-based treatment options for healing of acute and chronic wounds. Compared with a variety of conventional methods, such as skin grafts and local flaps, the cell therapy technique is simple, less time-consuming, and reduces the surgical burden for patients in the repair of acute wounds. Cell therapy has also been developed for chronic wound healing. By transplanting cells with an excellent wound healing capacity profile to chronic wounds, in which wound healing cannot be achieved successfully, attempts are made to convert the wound bed into the environment where maximum wound healing can be achieved. Fibroblasts, keratinocytes, adipose-derived stromal vascular fraction cells, bone marrow stem cells, and platelets have been used for wound healing in clinical practice. Some formulations are commercially available. To establish the cell therapy as a standard treatment, however, further research is needed.

  10. Burn Wound Infections

    PubMed Central

    Church, Deirdre; Elsayed, Sameer; Reid, Owen; Winston, Brent; Lindsay, Robert

    2006-01-01

    Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices. PMID:16614255

  11. Spiral wound extraction cartridge

    DOEpatents

    Wisted, E.E.; Lundquist, S.H.

    1999-04-27

    A cartridge device for removing an analyte from a fluid comprises a hollow core, a sheet composite comprising a particulate-loaded porous membrane and optionally at least one reinforcing spacer sheet, the particulate being capable of binding the analyte, the sheet composite being formed into a spiral configuration about the core, wherein the sheet composite is wound around itself and wherein the windings of sheet composite are of sufficient tightness so that adjacent layers are essentially free of spaces therebetween, two end caps which are disposed over the core and the lateral ends of the spirally wound sheet composite, and means for securing the end caps to the core, the end caps also being secured to the lateral ends of the spirally wound sheet composite. A method for removing an analyte from a fluid comprises the steps of providing a spirally wound element of the invention and passing the fluid containing the analyte through the element essentially normal to a surface of the sheet composite so as to bind the analyte to the particulate of the particulate-loaded porous membrane, the method optionally including the step of eluting the bound analyte from the sheet composite. 4 figs.

  12. Gingival Wound Healing

    PubMed Central

    Cáceres, M.; Martínez, C.; Oyarzún, A.; Martínez, J.

    2015-01-01

    Gingival wound healing comprises a series of sequential responses that allow the closure of breaches in the masticatory mucosa. This process is of critical importance to prevent the invasion of microbes or other agents into tissues, avoiding the establishment of a chronic infection. Wound healing may also play an important role during cell and tissue reaction to long-term injury, as it may occur during inflammatory responses and cancer. Recent experimental data have shown that gingival wound healing is severely affected by the aging process. These defects may alter distinct phases of the wound-healing process, including epithelial migration, granulation tissue formation, and tissue remodeling. The cellular and molecular defects that may explain these deficiencies include several biological responses such as an increased inflammatory response, altered integrin signaling, reduced growth factor activity, decreased cell proliferation, diminished angiogenesis, reduced collagen synthesis, augmented collagen remodeling, and deterioration of the proliferative and differentiation potential of stem cells. In this review, we explore the cellular and molecular basis of these defects and their possible clinical implications. PMID:25527254

  13. Wound care centers

    MedlinePlus

    ... at a time as it heals. Negative pressure therapy -- pulling the air out of a closed dressing, creating a vacuum. The negative pressure improves blood flow and pulls out excess fluid. Growth factor therapy -- materials produced by the body that helps wound- ...

  14. Spiral wound extraction cartridge

    DOEpatents

    Wisted, Eric E.; Lundquist, Susan H.

    1999-01-01

    A cartridge device for removing an analyte from a fluid comprises a hollow core, a sheet composite comprising a particulate-loaded porous membrane and optionally at least one reinforcing spacer sheet, the particulate being capable of binding the analyte, the sheet composite being formed into a spiral configuration about the core, wherein the sheet composite is wound around itself and wherein the windings of sheet composite are of sufficient tightness so that adjacent layers are essentially free of spaces therebetween, two end caps which are disposed over the core and the lateral ends of the spirally wound sheet composite, and means for securing the end caps to the core, the end caps also being secured to the lateral ends of the spirally wound sheet composite. A method for removing an analyte from a fluid comprises the steps of providing a spirally wound element of the invention and passing the fluid containing the analyte through the element essentially normal to a surface of the sheet composite so as to bind the analyte to the particulate of the particulate-loaded porous membrane, the method optionally including the step of eluting the bound analyte from the sheet composite.

  15. Healing Invisible Wounds

    ERIC Educational Resources Information Center

    Adams, Erica J.

    2010-01-01

    As many as 9 in 10 justice-involved youth are affected by traumatic childhood experiences. According to "Healing Invisible Wounds: Why Investing in Trauma-Informed Care for Children Makes Sense," between 75 and 93 percent of youth currently incarcerated in the justice system have had at least one traumatic experience, including sexual abuse, war,…

  16. The Wounded Spirit.

    ERIC Educational Resources Information Center

    Peretti, Frank

    2001-01-01

    This article offers a glimpse into the life of Frank Peretti, who as a child suffered abuse because of his physical disfigurement. He was bullied and physically assaulted by peers and sometimes adults. Now well known for his novels, Peretti suggests that people who cause others to suffer also suffer from a wounded spirit. (Author)

  17. Diabetic Wound Care

    MedlinePlus

    ... Feet Footwear & Products Products by Company Products by Type Foot Health Awareness Diabetes Awareness What is a Podiatrist? Today's Podiatrist Print Share RSS Home » Learn About Feet » Foot Health Information Diabetic Wound Care What is a Diabetic Foot Ulcer? ...

  18. [Pneumonia in wounded].

    PubMed

    Ovchinnikov, Iu V; Kharitonov, M A; Sadykov, R R; Shelukhin, V A; Gaĭduk, S V; Bogomolov, A B; Ivanov, V V; Dobrovol'skaia, L M

    2015-02-01

    Pneumonia is one of the common complications of wounds of any localization. Therapists are involved into the treatment of lung lesions in wounded in the ICU, in the surgical and if the patient arrives "on follow-up care,"--in the medical ward. The article analyzes the main statistical indicators reflecting the prevalence and clinical and pathogenetic characteristics of lung pathology in wounded during the Great Patriotic War, during the fighting Soviet troops in the Republic of Afghanistan, the 1st and 2nd Chechen campaign. Pneumonia as a manifestation of traumatic disease can occur in two ways. Primary pneumonia is in close connection with the pathogenetic traumatic injury. Secondary lung lesions complicate the injury at a later date and are due to the introduction of a nosocomial infection process flora. We describe the clinical picture of pneumonia in the affected, the basic pathogenesis, principles of therapy. Successful treatment of lung pathology in wounded depends on the performance of a complex of activities involving a wide range of doctors of various specialties. PMID:25920173

  19. Pseudomonas aeruginosa wound infection involves activation of its iron acquisition system in response to fascial contact

    PubMed Central

    Kim, M.; Christley, S.; Khodarev, N. N.; Fleming, I.; Huang, Y.; Chang, E.; Zaborina, O.; Alverdy, J.

    2015-01-01

    Background Wound infections are traditionally thought to occur when microbial burden exceeds the innate clearance capacity of host immune system. Here we introduce the idea that the wound environment itself plays a significant contributory role to wound infection. Methods We developed a clinically relevant murine model of soft tissue infection to explore the role of activation of microbial virulence in response to tissue factors as a mechanism by which pathogenic bacteria cause wound infections. Mice underwent abdominal skin incision and light muscle injury with a crushing forceps versus skin incision alone followed by topical inoculation of P. aeruginosa. Mice were sacrificed on postoperative day 6 and abdominal tissues analyzed for clinical signs of wound infection. To determine if specific wound tissues components induce bacterial virulence, P. aeruginosa was exposed to skin, fascia, and muscle. Results Gross wound infection due to P. aeruginosa was observed to be significantly increased in injured tissues vs non-injured (80% vs 10%) tissues (n=20/group, p<0.0001). Exposure of P. aeruginosa to individual tissue components demonstrated that fascia significantly induced bacterial virulence as judged by the production of pyocyanin, a redox-active phenazine compound known to kill immune cells. Whole genome transcriptional profiling of P. aeruginosa exposed to fascia demonstrated activation of multiple genes responsible for the synthesis of the iron scavenging molecule pyochelin. Conclusion We conclude that wound elements, in particular fascia, may play a significant role in enhancing the virulence of P. aeruginosa and may contribute to the pathogenesis of clinical wound infection. PMID:25807409

  20. Choosing a Wound Dressing Based on Common Wound Characteristics

    PubMed Central

    Dabiri, Ganary; Damstetter, Elizabeth; Phillips, Tania

    2016-01-01

    Significance: Chronic wounds are a major healthcare burden.The practitioner should have an appropriate understanding of both the etiology of the wound as well as the optimal type of dressings to use. Fundamental wound characteristics may be used to guide the practitioner's choice of dressings. The identification of optimal dressings to use for a particular wound type is an important element in facilitating wound healing. Recent Advances: Researchers have sought to design wound dressings that aim to optimize each stage in the healing process. In addition, dressings have been designed to target and kill infection-causing bacteria, with the incorporation of antimicrobial agents. Critical Issues: Chronic wounds are frequently dynamic in presentation, and the numerous wound dressings available make dressing selection challenging for the practitioner. Choosing the correct dressing decreases time to healing, provides cost-effective care, and improves patient quality of life. Future Directions: Research into the mechanisms of wound healing has enhanced our ability to heal chronic wounds at a faster rate through the use of moisture-retentive dressings. Newer dressings are incorporating the use of nanotechnology by incorporating miniature electrical sensors into the dressing. These dressings are engineered to detect changes in a wound environment and alert the patient or practitioner by altering the color of the dressing or sending a message to a smartphone. Additional investigations are underway that incorporate biologic material such as stem cells into dressings. PMID:26858913

  1. [Physiology and pathophysiology of wound healing of wound defects].

    PubMed

    Mutschler, W

    2012-09-01

    Understanding wound healing involves more than simply stating that there are the three phases of inflammation, proliferation and maturation. Wound healing is a complex series of actions, reactions and interactions among cells and mediators in a sequential and simultaneously ongoing temporal process within a spatial frame. At first this article will attempt to provide a concise summary of the events, cellular components and main influential mediators of wound healing over time. Secondly, the pathophysiology of chronic non-healing wounds is described where an imbalance of stimulating and inhibiting factors causes failure of healing. The most relevant extrinsic and intrinsic determinants are described and related to the cellular and molecular level of disturbed wound healing. A basic understanding of wound healing is a prerequisite for any prophylactic or therapeutic maneuver to maintain or re-establish wound equilibrium to give a satisfactory healing trajectory.

  2. Acute incarcerated external abdominal hernia

    PubMed Central

    Yang, Xue-Fei

    2014-01-01

    External abdominal hernia occurs when abdominal organs or tissues leave their normal anatomic site and protrude outside the skin through the congenital or acquired weakness, defects or holes on the abdominal wall, including inguinal hernia, umbilical hernia, femoral hernia and so on. Acute incarcerated hernia is a common surgical emergency. With advances in minimally invasive devices and techniques, the diagnosis and treatment have witnessed major changes, such as the use of laparoscopic surgery in some cases to achieve minimally invasive treatment. However, strict adherence to the indications and contraindications is still required. PMID:25489584

  3. Indium-111 labeled leukocytes in the evaluation of suspected abdominal abscesses.

    PubMed

    Coleman, R E; Black, R E; Welch, D M; Maxwell, J G

    1980-01-01

    Sixty-eight indium-111-labeled leukocyte imaging studies were performed in 53 patients with suspected abdominal abscesses. Twenty-nine studies gave abnoramal results. Nine wound infections were demonstrated, and 14 abscesses were correctly identified. Four studied demonstrated colonic accumulation, one of which remains unexplained, and two accessory spleens were identified. Indium-111 leukocyte imaging is a sensitive and specific study in evaluating patients with suspected abdominal abscess. Differentiation of abscess from other causes of inflammation has not been a problem. The exact role of leukocyte imaging compared with gallium-67 citrate imaging, ultrasound and computerized tomography remains to be determined.

  4. Recording and Calculating Gunshot Sound—Change of the Volume in Reference to the Distance

    NASA Astrophysics Data System (ADS)

    Nikolaos, Tsiatis E.

    2010-01-01

    An experiment was conducted in an open practice ground (shooting range) regarding the recording of the sound of gunshots. Shots were fired using various types of firearms (seven pistols, five revolvers, two submachine guns, one rifle, and one shotgun) in different calibers, from several various distances with reference to the recording sources. Both, a conventional sound level meter (device) and a measurement microphone were used, having been placed in a fixed point behind the shooting line. The sound of each shot was recorded (from the device). At the same time the signal received by the microphone was transferred to a connected computer through an appropriate audio interface with a pre-amplifier. Each sound wave was stored and depicted as a wave function. After the physic-mathematical analysis of these depictions, the volume was calculated in the accepted engineering units(Decibels or dB) of Sound Pressure Level (SPL). The distances from the recording sources were 9.60 meters, 14.40 m, 19.20 m, and 38.40 m. The experiment was carried out by using the following calibers: .22 LR, 6.35 mm(.25 AUTO), 7.62 mm Tokarev(7,62×25), 7.65 mm(.32 AUTO), 9 mm Parabellum(9×19), 9 mm Short(9×17), 9 mm Makarov(9×18), .45 AUTO, .32 S&W, .38 S&W, .38 SPECIAL, .357 Magnum, 7,62 mm Kalashnikov(7,62×39) and 12 GA. Tables are given for the environmental conditions (temperature, humidity, altitude & barometric pressure), the length of the barrel of each gun, technical characteristics of the used ammunition, as well as for the volume taken from the SLM. The data for the sound intensity were collected after 168 gunshots (158 single shot & 10 bursts). According to the results, a decreasing of the volume, equivalent to the increasing of the distance, was remarked, as it was expected. Values seem to follow the Inverse square Law. For every doubling of the distance from the sound source, the sound intensity diminishes by 5.9904±0.2325 decibels (on average). In addition, we have the

  5. Abdominal aortic feminism.

    PubMed

    Mortimer, Alice Emily

    2014-11-14

    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer.

  6. Advances in wound debridement techniques.

    PubMed

    Nazarko, Linda

    2015-06-01

    Dead and devitalised tissue interferes with the process of wound healing. Debridement is a natural process that occurs in all wounds and is crucial to healing; it reduces the bacterial burden in a wound and promotes effective inflammatory responses that encourage the formation of healthy granulation tissue (Wolcott et al, 2009). Wound care should be part of holistic patient care. Recent advances in debridement techniques include: biosurgery, hydrosurgery, mechanical debridement, and ultrasound. Biosurgery and mechanical debridement can be practiced by nonspecialist nurses and can be provided in a patient's home, thus increasing the patient's access to debridement therapy and accelerating wound healing.

  7. Office management of minor wounds.

    PubMed Central

    Gouin, S.; Patel, H.

    2001-01-01

    OBJECTIVE: To review office interventions for minor wounds not requiring sutures, such as abrasions, bites, and lacerations. QUALITY OF EVIDENCE: Most information on minor wound management comes from descriptive studies. Few comparative studies examine the effectiveness of topical antisepsis for minor wounds. Several clinical trials have demonstrated that tissue adhesives produce short- and long-term cosmetic results equivalent to those achieved with suture materials. MAIN MESSAGE: Sterile saline is the least toxic solution for wound irrigation. Chlorhexidine (2%) and povidone iodine (10%) have been the most investigated antiseptic solutions. Systemic antibiotics are unnecessary for wounds unlikely to be infected. All bite wounds require special attention. Primary closure of bite wounds is indicated in certain circumstances: less than 12-hour-old nonpuncture wounds, uninfected wounds, and low-risk lesions (such as on the face). In spite of their many advantages, skin tapes should be used for low-tension wounds only. The popularity of tissue adhesives has greatly increased. Since the advent of newer products (with increased bonding strength and flexibility), adhesives are used to manage most lacerations except those in areas of high tension (e.g., joints) and on mucosal surfaces. CONCLUSION: Minor wounds not requiring sutures can be managed easily in the office. PMID:11340758

  8. Common questions about wound care.

    PubMed

    Worster, Brooke; Zawora, Michelle Q; Hsieh, Christine

    2015-01-15

    Lacerations, abrasions, burns, and puncture wounds are common in the outpatient setting. Because wounds can quickly become infected, the most important aspect of treating a minor wound is irrigation and cleaning. There is no evidence that antiseptic irrigation is superior to sterile saline or tap water. Occlusion of the wound is key to preventing contamination. Suturing, if required, can be completed up to 24 hours after the trauma occurs, depending on the wound site. Tissue adhesives are equally effective for low-tension wounds with linear edges that can be evenly approximated. Although patients are often instructed to keep their wounds covered and dry after suturing, they can get wet within the first 24 to 48 hours without increasing the risk of infection. There is no evidence that prophylactic antibiotics improve outcomes for most simple wounds. Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years. Superficial mild wound infections can be treated with topical agents, whereas deeper mild and moderate infections should be treated with oral antibiotics. Most severe infections, and moderate infections in high-risk patients, require initial parenteral antibiotics. Severe burns and wounds that cover large areas of the body or involve the face, joints, bone, tendons, or nerves should generally be referred to wound care specialists.

  9. [ENDOVASCULAR ABDOMINAL AORTIC ANEURISM REPAIR].

    PubMed

    Maĭstrenko, D N; Generalov, M I; Tarazov, P G; Zherebtsov, F K; Osovskikh, V V; Ivanov, A S; Oleshchuk, A N; Granov, D A

    2015-01-01

    The authors analyzed the single-center experience of treatment of 72 patients with abdominal aortic aneurisms and severe accompanied pathology. The aneurisms were repaired by stent-grafts. All the patients had abdominal aortic aneurisms with the diameters from 41 to 84 mm against the background of severe somatic pathology. It was a contraindication to planned open surgery. An installation of stent-graft was successful in all 72 follow-ups. It wasn't necessary to use a conversion to open surgery. The follow-up period consisted of 44,6?2,1 months. Control ultrasound and computer tomography studies hadn't revealed an increase of aneurism sack sizes or "eakages". A reduction of abdominal aortic aneurism sizes was noted in 37 patients on 4-5% during first year after operation. The stent-graft implantation extends the possibilities of abdominal aortic aneurism treatment for patients from a high surgical risk group. PMID:26234059

  10. Functional Abdominal Pain in Children

    MedlinePlus

    ... At low doses, these medicines can be excellent pain relievers for some children. A fearful, anxious, or depressed child however should be fully assessed by a psychiatrist or psychologist. Some psychological treatments that help children cope with functional abdominal pain ...

  11. Filament wound structure and method

    DOEpatents

    Dritt, William S.; Gerth, Howard L.; Knight, Jr., Charles E.; Pardue, Robert M.

    1977-01-01

    The present invention relates to a filament wound spherical structure comprising a plurality of filament band sets disposed about the surface of a mandrel with each band of each set formed of a continuous filament circumferentially wound about the mandrel a selected number of circuits and with each circuit of filament being wound parallel to and contiguous with an immediate previously wound circuit. Each filament band in each band set is wound at the same helix angle from the axis of revolution of the mandrel and all of the bands of each set are uniformly distributed about the mandrel circumference. The pole-to-equator wall thickness taper associated with each band set, as several contiguous band sets are wound about the mandrel starting at the poles, is accumulative as the band sets are nested to provide a complete filament wound sphere of essentially uniform thickness.

  12. Reconstructive challenges in war wounds

    PubMed Central

    Bhandari, Prem Singh; Maurya, Sanjay; Mukherjee, Mrinal Kanti

    2012-01-01

    War wounds are devastating with extensive soft tissue and osseous destruction and heavy contamination. War casualties generally reach the reconstructive surgery centre after a delayed period due to additional injuries to the vital organs. This delay in their transfer to a tertiary care centre is responsible for progressive deterioration in wound conditions. In the prevailing circumstances, a majority of war wounds undergo delayed reconstruction, after a series of debridements. In the recent military conflicts, hydrosurgery jet debridement and negative pressure wound therapy have been successfully used in the preparation of war wounds. In war injuries, due to a heavy casualty load, a faster and reliable method of reconstruction is aimed at. Pedicle flaps in extremities provide rapid and reliable cover in extremity wounds. Large complex defects can be reconstructed using microvascular free flaps in a single stage. This article highlights the peculiarities and the challenges encountered in the reconstruction of these ghastly wounds. PMID:23162233

  13. Abdominal ultrasonography, 2nd Ed

    SciTech Connect

    Goldberg, B.B.

    1984-01-01

    This volume is a new and updated edition of an extensively illustrated text and reference on the capabilities and imaging of gray scale ultrasonography for each major abdominal organ. Each major organ system is treated separately, including liver, gallbladder and bile ducts, pancreas, kidney, retroperitoneum, abdominal vasculature, and more. There are over 500 illustrations and ten pages of full color plates for cross sectional anatomy.

  14. Early attack reaction sensor (EARS), a man-wearable gunshot detection system

    NASA Astrophysics Data System (ADS)

    Chang, Jay; Mendyk, William; Thier, Lisa; Yun, Paul; LaRow, Andy; Shaw, Scott; Schoenborn, William

    2006-05-01

    The Early Attack Reaction Sensor (EARS) is a modified passive acoustic system that detects gunshots (muzzle blast and/or shockwave) to provide the user with relative azimuth and range of sniper fire via both audio alert and visual display. The EARS system consists of a microphone array in a small planar configuration and an equivalently sized Digital Signal Processing board, which is interfaced to a PDA via a PCMCIA slot. Hence, configuration easily provides portability. However, the system is being repackaged for man-wearable and vehicle mount applications. The EARS system in a PDA configuration has been tested in open fields at up to 500 meters range and has provided useable bearing and range information against the sniper rounds. This paper will discuss EARS system description, various test results, and EARS system capabilities and limitations.

  15. Detection of gunshot residue on dark-colored clothing prior to chemical analysis.

    PubMed

    Kersh, Kyla L; Childers, James M; Justice, Dale; Karim, Greg

    2014-05-01

    Detection of gunshot residue (GSR) is an arduous task for investigators. It is often accomplished with chemical tests, which can reveal elements and ions indicating the presence of GSR, but are likely to cause physical alteration to the pattern. In this study, the Spex Forensics Mini-CrimeScope MCS 400, along with 16 accompanying wavelength filters, was applied to various GSR patterns and target types. Three dark shirt materials, four ammunition calibers, and eight ammunition manufacturers, along with the primer residue of the different manufacturer ammunitions were tested. Results indicate the alternate light source wavelength of 445 nm to be the optimal setting. In addition, target material plays a large role in the preservation of GSR patterns as particles burn. Furthermore, it can be extrapolated that residue, observed from a full round and firing distance of six inches, is mostly composed of unburnt gunpowder residue, not primer residue.

  16. Identifying wound prevalence using the Mobile Wound Care program.

    PubMed

    Walker, Judi; Cullen, Marianne; Chambers, Helen; Mitchell, Eleanor; Steers, Nicole; Khalil, Hanan

    2014-06-01

    Measuring the prevalence of wounds within health care systems is a challenging and complex undertaking. This is often compounded by the clinicians' training, the availability of the required data to collect, incomplete documentation and lack of reporting of this type of data across the various health care settings. To date, there is little published data on wound prevalence across regions or states. This study aims to identify the number and types of wounds treated in the Gippsland area using the Mobile Wound Care (MWC™) program. The MWC program has enabled clinicians in Gippsland to collect data on wounds managed by district nurses from four health services. The main outcomes measured were patient characteristics, wound characteristics and treatment characteristics of wounds in Gippsland. These data create several clinical and research opportunities. The identification of predominant wound aetiologies in Gippsland provides a basis on which to determine a regional wound prospective and the impact of the regional epidemiology. Training that incorporates best practice guidelines can be tailored to the most prevalent wound types. Clinical pathways that encompass the Australian and New Zealand clinical practice guidelines for the management of venous leg ulcers can be introduced and the clinical and economical outcomes can be quantitatively measured. The MWC allows healing times (days) to be benchmarked both regionally and against established literature, for example, venous leg ulcers.

  17. Wound Microbiology and Associated Approaches to Wound Management

    PubMed Central

    Bowler, P. G.; Duerden, B. I.; Armstrong, D. G.

    2001-01-01

    The majority of dermal wounds are colonized with aerobic and anaerobic microorganisms that originate predominantly from mucosal surfaces such as those of the oral cavity and gut. The role and significance of microorganisms in wound healing has been debated for many years. While some experts consider the microbial density to be critical in predicting wound healing and infection, others consider the types of microorganisms to be of greater importance. However, these and other factors such as microbial synergy, the host immune response, and the quality of tissue must be considered collectively in assessing the probability of infection. Debate also exists regarding the value of wound sampling, the types of wounds that should be sampled, and the sampling technique required to generate the most meaningful data. In the laboratory, consideration must be given to the relevance of culturing polymicrobial specimens, the value in identifying one or more microorganisms, and the microorganisms that should be assayed for antibiotic susceptibility. Although appropriate systemic antibiotics are essential for the treatment of deteriorating, clinically infected wounds, debate exists regarding the relevance and use of antibiotics (systemic or topical) and antiseptics (topical) in the treatment of nonhealing wounds that have no clinical signs of infection. In providing a detailed analysis of wound microbiology, together with current opinion and controversies regarding wound assessment and treatment, this review has attempted to capture and address microbiological aspects that are critical to the successful management of microorganisms in wounds. PMID:11292638

  18. Abdominal emergencies in the geriatric patient

    PubMed Central

    2014-01-01

    Abdominal pain is one of the most frequent reasons that elderly people visit the emergency department (ED). In this article, we review the deadliest causes of abdominal pain in this population, including mesenteric ischemia, abdominal aortic aneurysm, and appendicitis and potentially lethal non-abdominal causes. We also highlight the pitfalls in diagnosing, or rather misdiagnosing, these clinical entities. PMID:25635203

  19. Timing of Pars Plana Vitrectomy in Management of Gunshot Perforating Eye Injury: Observational Study

    PubMed Central

    Ghoraba, Hammouda Hamdy; Mansour, Hosam Osman; Abdelfattah, Haithem Mamon; Elgemai, Emad Mohamed

    2016-01-01

    The aim of this study is to report the difference in either anatomical or functional outcome of vitreoretinal intervention in cases of gunshot perforating eye injury if done 2–4 weeks or after the 4th week after the original trauma. Patients were treated with pars plana vitrectomy and silicon oil. Surgeries were performed in the period from February 2011 until the end of December 2014. 253 eyes of 237 patients were reviewed. 46 eyes were excluded. 207 eyes of 197 patients were analyzed. The included eyes were classified based on the timing of vitrectomy in relation to the initial trauma into two groups: 149 eyes (the first group) operated on between the 3rd and the 4th week and 58 eyes (the second group) operated on after the 4th week after the trauma. Following one surgical intervention, in the first group, attached retina was achieved in 93.28% of patients. In the second group, attached retina was achieved in 96.55% of patients. All RD cases could be attached by a second surgery. Visual acuity improved in 81.21% of patients, did not change in 15.43% of patients, and declined in 3.35% of patients. In the second group, visual acuity improved in 81.03% of patients, did not change in 12.06% of patients, and worsened in 6.89% of patients. There was no statistically significant difference between the two groups in either anatomical or functional results. We recommend interfering before the 5th week after the trauma as retinal detachment is encountered more in cases operated on after the 4th week. The visual outcome depends on the site of entry and exit (the route of gunshot). PMID:27781127

  20. An optimized computed tomography protocol for metallic gunshot head trauma in a seal model.

    PubMed

    Fraga-Manteiga, Eduardo; Shaw, Darren J; Dennison, Sophie; Brownlow, Andrew; Schwarz, Tobias

    2014-01-01

    Computed tomography (CT) is commonly used to assess animals with head trauma. However, strongly attenuating objects such as metallic gunshot cause artifacts that may make accurate localization of shrapnel pieces difficult. The purpose of this study was to develop an optimized CT protocol for minimizing metal artifacts in an animal model of gunshot head trauma. A cadaver head of a stranded Gray seal (Halichoerus grypus) was shot post-mortem with a 0.223-inch caliber rifle. The head was frozen, thawed, and scanned using a multislice CT scanner and protocols with varying acquisition and reconstruction parameters. Scans were acquired with and without use of the scanner's proprietary Extended CT Scale (ECTS) mode and beam hardening reduction (Posterior Fossa Optimization [PFO]) filter. Window/level display settings were also varied. For each protocol and each of five selected metallic shrapnel pieces, a single observer measured combined metal halo artifact and shrapnel area using a hand-traced region of interest. The number of hypo- and hyper-attenuating streak artifacts was also recorded. Measurements were repeated for three different reading sessions. Metal CT artifacts were minimized with a high-frequency image reconstruction algorithm and a wide window setting. Further artifact reduction was achieved with a proprietary ECTS raw data reconstruction technique and a very wide window. This enabled a more confident evaluation of surrounding bone. On the other hand, these techniques are unfortunately not effective under conditions of soft tissue evaluation. Increasing tube voltage and use of a proprietary PFO filter did not yield a significant reduction in metal artifacts. PMID:25184173

  1. Investigation of gunshot residue patterns using milli-XRF-techniques: first experiences in casework

    NASA Astrophysics Data System (ADS)

    Schumacher, Rüdiger; Barth, Martin; Neimke, Dieter; Niewöhner, Ludwig

    2010-06-01

    The investigation of gunshot residue (GSR) patterns for shooting range estimation is usually based on visualizing the lead, copper, or nitrocellulose distributions on targets like fabric or adhesive tape by chemographic color tests. The method usually provides good results but has its drawbacks when it comes to the examination of ammunition containing lead-free primers or bloody clothing. A milli-X-ray fluorescence (m-XRF) spectrometer with a large motorized stage can help to circumvent these problems allowing the acquisition of XRF mappings of relatively large areas (up to 20 x 20 cm) in millimeter resolution within reasonable time (2-10 hours) for almost all elements. First experiences in GSR casework at the Forensic Science Institute of the Bundeskriminalamt (BKA) have shown, that m-XRF is a useful supplementation for conventional methods in shooting ranges estimation, which helps if there are problems in transferring a GSR pattern to secondary targets (e.g. bloody or stained garments) or if there is no suitable color test available for the element of interest. The resulting elemental distributions are a good estimate for the shooting range and can be evaluated by calculating radial distributions or integrated count rates of irregular shaped regions like pieces of human skin which are too small to be investigated with a conventional WD-XRF spectrometer. Beside a mapping mode the milli-XRF offers also point and line scan modes which can also be utilized in gunshot crime investigations as a quick survey tool to identify bullet holes based on the elements present in the wipe ring.

  2. Non-fatal gunshot trauma among a sample of adolescents in Djibouti: prevalence and sociodemographic associations.

    PubMed

    Wilson, Michael L; Lewis, Erin R

    2014-01-01

    Firearm trauma is the second most common cause of serious injury among adolescents in the Republic of Djibouti. The aim of this study was to explore the sociodemographic correlates of serious injury and non-fatal gunshot trauma among adolescents in Djibouti. Using multinomial logistic regression, we compared a sample of adolescents (N = 1,711) who self-reported a non-firearm-related serious injury (n = 587) and those who reported a firearm-related injury (n = 101) with non-injured participants (n = 1,023) during a 12-month recall period. Analyses targeted demographic, behavioral, social, mental health, and family factors. After adjusting for covariates, participants reporting a non-firearm-related serious injury were more likely to report having been involved in physical fights (relative risk ratio [RRR] = 145; confidence interval [CI] = [1.04, 2.02), being bullied (RRR = 2.83; CI = [2.24, 3.56]), feeling lonely (RRR = 1.48; CI = [1.11, 1.96]), having signs of depression (RRR = 1.27; CI = [1.02, 1.58]), and be truant from school (RRR = 1.68; CI = [1.25, 2.28]). Those who reported a gunshot injury recorded being bullied (RRR = 2.83; CI = [1.77, 4.53]) and physically attacked at higher rates (RRR = 1.78; CI = [1.09, 2.89]). Serious injuries, whether firearm related or not, are important threats to adolescent health in Djibouti with potentially serious health-related correlates. More research, particularly multilevel designs, are needed to explain context-relevant factors associated with serious trauma in Djibouti. PMID:24097908

  3. Clinical characteristics of acoustic trauma caused by gunshot noise in mass rifle drills without ear protection.

    PubMed

    Moon, In Seok; Park, Sang-Yong; Park, Hyun Jin; Yang, Hoon-Shik; Hong, Sung-Jong; Lee, Won-Sang

    2011-10-01

    One of the major occupational hazards of working in military service is being subjected to intense impulse noise. We analyzed the clinical presentation of acoustic traumas, induced by mass rifle gunshot noise during military training, in unprotected patients. We evaluated 189 soldiers who had otologic symptoms after rifle shooting exercises without using any hearing protection. All soldiers had been training on the K2 rifle. We took medical histories; conducted physical examinations and hearing evaluations (pure-tone audiometry, speech audiometry, and impedence audiometry); and distributed the Newmann's Tinnitus Handicap Inventory (THI) survey. In addition, we evaluated a normal control group of 64 subjects of similar age who had never fired a rifle. In the patient group, the most common and irritating reported symptom was tinnitus (94.2%), and the average THI score in the patient group was 39.51 ± 14.87, which was significantly higher than the control group score (0.56 ± 3.94) (p < 0.001). Average outcomes of post-exposure air conduction thresholds were 21.33 ± 13.25 dB HL in the affected ears. These levels also were significantly higher than those of the control group (9.16 ± 4.07dB HL) (p < 0.001). Hearing loss was most prominent at high frequencies. An asymmetry of hearing loss related to head position during shooting was not observed. Acoustic trauma induced by gunshot noise can cause permanent tinnitus and hearing loss. Hearing protection (bilateral earplugs) and environmental reform are necessary. PMID:21936701

  4. Wound healing: part II. Clinical applications.

    PubMed

    Janis, Jeffrey; Harrison, Bridget

    2014-03-01

    Treatment of all wounds requires adequate wound bed preparation, beginning with irrigation and débridement. Complicated or chronic wounds may also require treatment adjuncts or specialized wound healing products. An extensive body of research and development has introduced novel wound healing therapies and scar management options. In this second of a two-part continuing medical education series on wound healing, the reader is offered an update on current wound healing technologies and recommendations for obtaining optimal outcomes.

  5. Some wounds are hard to heal: an interesting presentation of Ehlers-Danlos syndrome.

    PubMed

    Ryan, N; Walkden, G; Akbar, S

    2012-05-01

    A 17-year-old female patient was admitted for an elective mini laparotomy and cystectomy of the right ovary for the treatment of chronic supra-pubic abdominal pain. The procedure went without complication and she was discharged the next day. She was re-admitted a month later as an acute case with wound dehiscence. HIV serology, thyroid function, immunoglobulin, protein electrophoresis and electrolyte levels were all normal. There were no obvious signs of infection and the bacterial swabs failed to culture an organism. Despite conservative measures with regular dressing, oral antibiotics and input from the tissue viability team the wound failed to epithelialise. The wound was debrided and re-sutured a total of three times and the patient received 24 days of intravenous antibiotics. After input from various teams a diagnosis of Ehlers-Danlos syndrome was made, allowing for appropriate management and wound healing. PMID:22584739

  6. Peripheral Surgical Wounding and Age-Dependent Neuroinflammation in Mice

    PubMed Central

    Wang, Hui; Culley, Deborah J.; Marcantonio, Edward R.; Crosby, Gregory; Tanzi, Rudolph E.; Zhang, Yiying; Xie, Zhongcong

    2014-01-01

    Post-operative cognitive dysfunction is associated with morbidity and mortality. However, its neuropathogenesis remains largely to be determined. Neuroinflammation and accumulation of β-amyloid (Aβ) have been reported to contribute to cognitive dysfunction in humans and cognitive impairment in animals. Our recent studies have established a pre-clinical model in mice, and have found that the peripheral surgical wounding without the influence of general anesthesia induces an age-dependent Aβ accumulation and cognitive impairment in mice. We therefore set out to assess the effects of peripheral surgical wounding, in the absence of general anesthesia, on neuroinflammation in mice with different ages. Abdominal surgery under local anesthesia was established in 9 and 18 month-old mice. The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), Iba1 positive cells (the marker of microglia activation), CD33, and cognitive function in mice were determined. The peripheral surgical wounding increased the levels of TNF-α, IL-6, and Iba1 positive cells in the hippocampus of both 9 and 18 month-old mice, and age potentiated these effects. The peripheral surgical wounding increased the levels of CD33 in the hippocampus of 18, but not 9, month-old mice. Finally, anti-inflammatory drug ibuprofen ameliorated the peripheral surgical wounding-induced cognitive impairment in 18 month-old mice. These data suggested that the peripheral surgical wounding could induce an age-dependent neuroinflammation and elevation of CD33 levels in the hippocampus of mice, which could lead to cognitive impairment in aged mice. Pending further studies, anti-inflammatory therapies may reduce the risk of postoperative cognitive dysfunction in elderly patients. PMID:24796537

  7. [Traumatic wound botulism].

    PubMed

    Moreno, Emilia; Pannocchia, Cecilia; Carricondo, Concepción

    2014-04-01

    Botulism is a rare illness caused by a potent neurotoxin produced by the bacterium of the Clostridium family. Clostridium botulinum is the most frequent one, but Clostridium baratti and Clostridium butyricum are also neurotoxins producers. There are seven neurotoxins types, A to G; A, B, E, F and G cause human botulism. Every neurotoxin type blocks cholinergic transmission at the myoneural junction. The least frequent syndrome results from Clostridium botulinum colonization of a wound and it is clinically similar to the other botulism syndromes, but with fever due to an infected wound. Disease should be suspected in lucid patient with a symmetric descending, flaccid paralysis. This syndrome appears within the first twenty days, but it could be present for weeks or months before the disease is diagnosed. This disease is poorly known, so to be diagnosed it requires a high index of suspicion. The treatment is a supportive one; administration of the specific antitoxin must be early in order to neutralize the toxin before the debridement and cleaning of the infected wound.

  8. The Burn Wound Microenvironment

    PubMed Central

    Rose, Lloyd F.; Chan, Rodney K.

    2016-01-01

    Significance: While the survival rate of the severely burned patient has improved significantly, relatively little progress has been made in treatment or prevention of burn-induced long-term sequelae, such as contraction and fibrosis. Recent Advances: Our knowledge of the molecular pathways involved in burn wounds has increased dramatically, and technological advances now allow large-scale genomic studies, providing a global view of wound healing processes. Critical Issues: Translating findings from a large number of in vitro and preclinical animal studies into clinical practice represents a gap in our understanding, and the failures of a number of clinical trials suggest that targeting single pathways or cytokines may not be the best approach. Significant opportunities for improvement exist. Future Directions: Study of the underlying molecular influences of burn wound healing progression will undoubtedly continue as an active research focus. Increasing our knowledge of these processes will identify additional therapeutic targets, supporting informed clinical studies that translate into clinical relevance and practice. PMID:26989577

  9. Clinician perceptions of wound biofilm.

    PubMed

    Metcalf, Daniel G; Bowler, Philip G

    2016-10-01

    In wound care today, biofilm is a subject area of great interest and debate. There is an increasing awareness that biofilm exists in the majority of non-healing wounds, and that it is implicated in both recalcitrance and infection. Together with the presence of devitalised host tissue, biofilm is recognised as a component of the wound environment that requires removal to enable wound progression. However, uncertainty exists among wound care practitioners regarding confirmation of the presence of biofilm, and how best to remove biofilm from a non-healing wound. While recent efforts have been taken to assist practitioners in signs and symptoms of wound biofilm, continuing research is required to characterise and confirm wound biofilm. This research was conducted as part of a market research process to better understand the knowledge levels, experiences, clinical awareness and impact of biofilm in wound care, which was undertaken across the USA and Europe. While knowledge levels and experiences vary from country to country, certain wound characteristics were consistently associated with the presence of biofilm.

  10. Laser-induced breakdown spectroscopy for the detection of gunshot residues on the hands of a shooter

    NASA Astrophysics Data System (ADS)

    Dockery, Christopher R.; Goode, Scott R.

    2003-10-01

    Laser-induced breakdown spectroscopy (LIBS) has been used to determine whether the hands of a suspected gun user contain traces of gunshot residue. Samples are obtained by pressing adhesive tape against the skin of the suspect and analyzing the tape directly. When the suspect has fired multiple shots, or if the gun has not been cleaned, the gunshot residue provides a spectral signature that is readily apparent, but a person who has fired a single shot from a clean gun is not so easy to identify. The error rates associated with the LIBS identification of a subject who fired one shot from a clean gun have been evaluated by Monte Carlo simulation techniques, and criteria are proposed for defining a positive or a negative test result.

  11. [Unusual wound morphology after textile penetration by the automatic rifle (StG) 58. A case report].

    PubMed

    Tributsch, W; Rabl, W; Ambach, E

    1991-01-01

    Technical characteristics of the used fire-arm and ammunition, the firing range and the shot through garments of the victim are essential factors, that exercise an influence on the appearance of gunshot injuries. An exemplary case-report shall emphasize the importance of these factors. It deals with a suicidal double-shot fired from an automatic rifle by a young soldier. The wounds were localized in the left chest region and the adjacent skin was blackened by soot in a remarkable geometrical pattern, although an ammunition with a smokeless charge has been used. By means of comparative shots we have good reasons to suppose this phenomenon to be caused by rests of gun powder and pressure of the explosion gas leaved in the barrel after the first shot. The second projectile pushed out this explosion gas to the skin that had been uncovered in a star-shaped way by the first shot.

  12. Attempts to accelerate wound healing.

    PubMed

    Kasuya, Akira; Tokura, Yoshiki

    2014-12-01

    Wound healing is a well-orchestrated process, where numerous factors are activated or inhibited in a sequence of steps. Immediately after the infliction of damage, the repair of wound stars. The initial step is an inflammatory change with activation of innate immunity, which is followed by proliferation phase, including fibroplasia, angiogenesis and re-epithelialization. Pathological impairment of wound healing process may lead to persistent ulceration as seen in diabetic patients. Various signaling pathways are involved in wound healing. TGFβ/Smad pathway is a representative and well known to participate in fibroplasia, however, its comprehensive effect on wound healing is controversial. Experimental and clinical remedies have been being tried to promote wound healing. Advancement of cell engineering allows us to use stem cells and living skin equivalents.

  13. Development of a wound dressing composed of hyaluronic acid sponge containing arginine and epidermal growth factor.

    PubMed

    Matsumoto, Yasuhiro; Kuroyanagi, Yoshimitsu

    2010-01-01

    Hyaluronic acid (HA) has the ability to promote wound healing. Epidermal growth factor (EGF) is able to promote the proliferation of various cell types, in addition to epidermal cells. A novel wound dressing was designed using high-molecular-weight hyaluronic acid (HMW-HA) and low-molecular-weight hyaluronic acid (LMW-HA). Spongy sheets composed of cross-linked high-molecular-weight hyaluronic acid (c-HMW-HA) were prepared by freeze-drying an aqueous solution of HMW-HA containing a crosslinking agent. Each spongy sheet was immersed into an aqueous solution of LMW-HA containing arginine (Arg) alone or both Arg and epidermal growth factor (EGF), and were then freeze-dried to prepare two types of product. One was a wound dressing composed of c-HMW-HA sponge containing LMW-HA and Arg (c-HMW-HA/LMW-HA + Arg; Group I). The other was a wound dressing composed of c-HMW-HA sponge containing LMW-HA, Arg and EGF (c-HMW-HA/LMW-HA + Arg + EGF; Group II). The efficacy of these products was evaluated in animal tests using rats. In the first experiment, each wound dressing was applied to a full-thickness skin defect with a diameter of 35 mm in the abdominal region of Sprague-Dawley (SD) rats, leaving an intact skin island measuring 15 mm in diameter in the central area of this skin defect. Commercially available polyurethane film dressing was then applied to each wound dressing as a covering material. In the control group, the wound surface was covered with polyurethane film dressing alone. Both wound dressings (Group I and Group II) potently decreased the size of the full-thickness skin defect and increased the size of the intact skin island, when compared with the control group. The wound dressing in Group II showed particularly potent activity in increasing the distance of epithelization from the intact skin island. This suggests that EGF release from the spongy sheet serves to promote epithelization. The wound dressing in Group II enhanced early-stage inflammation after 1 week

  14. Abdominal aortic grafting for spontaneous infrarenal abdominal aortic dissection.

    PubMed

    Iwasaki, Hiroto; Shibuya, Takashi; Shintani, Takashi; Uenaka, Hisazumi; Suehiro, Shigefumi; Satoh, Hisashi

    2010-02-01

    This case report concerns a 62-year-old woman with spontaneous infrarenal abdominal aortic dissection, which developed into claudication and rest pain in the lower extremity. Multi-row detector computed tomography showed the entry site of the abdominal aortic dissection at the second lumbar artery, while the reentry site was found intraoperatively at the median sacral artery, indicating that the false lumen had progressed and compressed the true lumen. A direct approach involving grafting appears to be an effective procedure for resolving mesenteric and lower extremity hypoperfusion due to aortic dissection with a dilated false channel, even during the acute period. PMID:19879731

  15. Ten-year longitudinal study of the effect of impulse noise exposure from gunshot on inner ear function.

    PubMed

    Wu, Chun-Ching; Young, Yi-Ho

    2009-01-01

    This longitudinal study investigated how chronic gunshot noise exposure affects cochlear and saccular function in police officers who engaged in regular target shooting practice using dual protection (ear plugs plus earmuffs) for >10 years. In 1997, 20 male police officers underwent audiometry before and two weeks after shooting. Twelve of the original subjects were re-examined by audiometry coupled with vestibular evoked myogenic potential (VEMP) test in 2007. Significant deterioration of mean hearing thresholds at frequencies of 500 Hz through 4000 Hz was noted ten years later, affecting both ears. However, only the frequencies of 4000 and 6000 Hz on the left ear revealed significant difference in mean hearing thresholds compared with healthy controls. Abnormal VEMP responses were evident in nine police officers (75%), including absent VEMPs 7 and delayed VEMPs 2. In conclusion, deterioration to hearing may occur after long term exposure to gunshots, even when double hearing protection is used. Further study is in progress regarding how to preserve both cochlear and saccular function during long term gunshot exposure. PMID:19925337

  16. The 'triple contrast' method in experimental wound ballistics and backspatter analysis.

    PubMed

    Schyma, Christian; Lux, Constantin; Madea, Burkhard; Courts, Cornelius

    2015-09-01

    In practical forensic casework, backspatter recovered from shooters' hands can be an indicator of self-inflicted gunshot wounds to the head. In such cases, backspatter retrieved from inside the barrel indicates that the weapon found at the death scene was involved in causing the injury to the head. However, systematic research on the aspects conditioning presence, amount and specific patterns of backspatter is lacking so far. Herein, a new concept of backspatter investigation is presented, comprising staining technique, weapon and target medium: the 'triple contrast method' was developed, tested and is introduced for experimental backspatter analysis. First, mixtures of various proportions of acrylic paint for optical detection, barium sulphate for radiocontrast imaging in computed tomography and fresh human blood for PCR-based DNA profiling were generated (triple mixture) and tested for DNA quantification and short tandem repeat (STR) typing success. All tested mixtures yielded sufficient DNA that produced full STR profiles suitable for forensic identification. Then, for backspatter analysis, sealed foil bags containing the triple mixture were attached to plastic bottles filled with 10% ballistic gelatine and covered by a 2-3-mm layer of silicone. To simulate backspatter, close contact shots were fired at these models. Endoscopy of the barrel inside revealed coloured backspatter containing typable DNA and radiographic imaging showed a contrasted bullet path in the gelatine. Cross sections of the gelatine core exhibited cracks and fissures stained by the acrylic paint facilitating wound ballistic analysis.

  17. The 'triple contrast' method in experimental wound ballistics and backspatter analysis.

    PubMed

    Schyma, Christian; Lux, Constantin; Madea, Burkhard; Courts, Cornelius

    2015-09-01

    In practical forensic casework, backspatter recovered from shooters' hands can be an indicator of self-inflicted gunshot wounds to the head. In such cases, backspatter retrieved from inside the barrel indicates that the weapon found at the death scene was involved in causing the injury to the head. However, systematic research on the aspects conditioning presence, amount and specific patterns of backspatter is lacking so far. Herein, a new concept of backspatter investigation is presented, comprising staining technique, weapon and target medium: the 'triple contrast method' was developed, tested and is introduced for experimental backspatter analysis. First, mixtures of various proportions of acrylic paint for optical detection, barium sulphate for radiocontrast imaging in computed tomography and fresh human blood for PCR-based DNA profiling were generated (triple mixture) and tested for DNA quantification and short tandem repeat (STR) typing success. All tested mixtures yielded sufficient DNA that produced full STR profiles suitable for forensic identification. Then, for backspatter analysis, sealed foil bags containing the triple mixture were attached to plastic bottles filled with 10% ballistic gelatine and covered by a 2-3-mm layer of silicone. To simulate backspatter, close contact shots were fired at these models. Endoscopy of the barrel inside revealed coloured backspatter containing typable DNA and radiographic imaging showed a contrasted bullet path in the gelatine. Cross sections of the gelatine core exhibited cracks and fissures stained by the acrylic paint facilitating wound ballistic analysis. PMID:25616629

  18. Honey: A Biologic Wound Dressing.

    PubMed

    Molan, Peter; Rhodes, Tanya

    2015-06-01

    Honey has been used as a wound dressing for thousands of years, but only in more recent times has a scientific explanation become available for its effectiveness. It is now realized that honey is a biologic wound dressing with multiple bioactivities that work in concert to expedite the healing process. The physical properties of honey also expedite the healing process: its acidity increases the release of oxygen from hemoglobin thereby making the wound environment less favorable for the activity of destructive proteases, and the high osmolarity of honey draws fluid out of the wound bed to create an outflow of lymph as occurs with negative pressure wound therapy. Honey has a broad-spectrum antibacterial activity, but there is much variation in potency between different honeys. There are 2 types of antibacterial activity. In most honeys the activity is due to hydrogen peroxide, but much of this is inactivated by the enzyme catalase that is present in blood, serum, and wound tissues. In manuka honey, the activity is due to methylglyoxal which is not inactivated. The manuka honey used in wound-care products can withstand dilution with substantial amounts of wound exudate and still maintain enough activity to inhibit the growth of bacteria. There is good evidence for honey also having bioactivities that stimulate the immune response (thus promoting the growth of tissues for wound repair), suppress inflammation, and bring about rapid autolytic debridement. There is clinical evidence for these actions, and research is providing scientific explanations for them. PMID:26061489

  19. Accurate documentation and wound measurement.

    PubMed

    Hampton, Sylvie

    This article, part 4 in a series on wound management, addresses the sometimes routine yet crucial task of documentation. Clear and accurate records of a wound enable its progress to be determined so the appropriate treatment can be applied. Thorough records mean any practitioner picking up a patient's notes will know when the wound was last checked, how it looked and what dressing and/or treatment was applied, ensuring continuity of care. Documenting every assessment also has legal implications, demonstrating due consideration and care of the patient and the rationale for any treatment carried out. Part 5 in the series discusses wound dressing characteristics and selection.

  20. [Negative pressure wound therapy dressings].

    PubMed

    Téot, Luc

    2016-01-01

    There are many different forms of negative pressure wound therapy dressings and it is important to distinguish clearly between each type. They enable the treatment to be adapted to the shape and depth of the wound, its degree of exudation and the persistence of the fibrinous areas on the surface. The machine's traction capacity, measured in mm of mercury (Hg), must be controlled to establish the healing profile: the more powerful the machine and the more contact there is between the foam and the wound, the faster the formation of the granulation tissue. There are many different solutions which are implemented in accordance with the clinical assessment of the wound.

  1. Wound modulation after filtration surgery.

    PubMed

    Seibold, Leonard K; Sherwood, Mark B; Kahook, Malik Y

    2012-11-01

    Filtration surgery is the standard invasive procedure for the management of intraocular pressure in advanced glaucoma. The key to a successful outcome is to modulate the normal wound healing cascade that leads to closure of the newly created aqueous outflow pathway. Antifibrotic agents such as mitomycin C and 5-fluorouracil have been increasingly used to modulate the wound healing process and increase surgical success. Although these agents have proven efficacy, they also increase the risk of complications. Efforts have centered on the identification of novel agents and techniques that can influence wound modulation without these complications. We detail new agents and methods under investigation to control wound healing after filtration surgery. PMID:23068975

  2. Healing in the irradiated wound

    SciTech Connect

    Miller, S.H.; Rudolph, R. )

    1990-07-01

    Poor or nonhealing of irradiated wounds has been attributed to progressive obliterative endarteritis. Permanently damaged fibroblasts may also play an important part in poor healing. Regardless of the cause, the key to management of irradiated skin is careful attention to prevent its breakdown and conservative, but adequate, treatment when wounds are minor. When wounds become larger and are painful, complete excision of the wound or ulcer is called for and coverage should be provided by a well-vascularized nonparasitic distant flap.16 references.

  3. Murine model of wound healing.

    PubMed

    Dunn, Louise; Prosser, Hamish C G; Tan, Joanne T M; Vanags, Laura Z; Ng, Martin K C; Bursill, Christina A

    2013-05-28

    Wound healing and repair are the most complex biological processes that occur in human life. After injury, multiple biological pathways become activated. Impaired wound healing, which occurs in diabetic patients for example, can lead to severe unfavorable outcomes such as amputation. There is, therefore, an increasing impetus to develop novel agents that promote wound repair. The testing of these has been limited to large animal models such as swine, which are often impractical. Mice represent the ideal preclinical model, as they are economical and amenable to genetic manipulation, which allows for mechanistic investigation. However, wound healing in a mouse is fundamentally different to that of humans as it primarily occurs via contraction. Our murine model overcomes this by incorporating a splint around the wound. By splinting the wound, the repair process is then dependent on epithelialization, cellular proliferation and angiogenesis, which closely mirror the biological processes of human wound healing. Whilst requiring consistency and care, this murine model does not involve complicated surgical techniques and allows for the robust testing of promising agents that may, for example, promote angiogenesis or inhibit inflammation. Furthermore, each mouse acts as its own control as two wounds are prepared, enabling the application of both the test compound and the vehicle control on the same animal. In conclusion, we demonstrate a practical, easy-to-learn, and robust model of wound healing, which is comparable to that of humans.

  4. Honey: A Biologic Wound Dressing.

    PubMed

    Molan, Peter; Rhodes, Tanya

    2015-06-01

    Honey has been used as a wound dressing for thousands of years, but only in more recent times has a scientific explanation become available for its effectiveness. It is now realized that honey is a biologic wound dressing with multiple bioactivities that work in concert to expedite the healing process. The physical properties of honey also expedite the healing process: its acidity increases the release of oxygen from hemoglobin thereby making the wound environment less favorable for the activity of destructive proteases, and the high osmolarity of honey draws fluid out of the wound bed to create an outflow of lymph as occurs with negative pressure wound therapy. Honey has a broad-spectrum antibacterial activity, but there is much variation in potency between different honeys. There are 2 types of antibacterial activity. In most honeys the activity is due to hydrogen peroxide, but much of this is inactivated by the enzyme catalase that is present in blood, serum, and wound tissues. In manuka honey, the activity is due to methylglyoxal which is not inactivated. The manuka honey used in wound-care products can withstand dilution with substantial amounts of wound exudate and still maintain enough activity to inhibit the growth of bacteria. There is good evidence for honey also having bioactivities that stimulate the immune response (thus promoting the growth of tissues for wound repair), suppress inflammation, and bring about rapid autolytic debridement. There is clinical evidence for these actions, and research is providing scientific explanations for them.

  5. Wound Healing and the Dressing*

    PubMed Central

    Scales, John T.

    1963-01-01

    The evolution of surgical dressings is traced from 1600 b.c. to a.d. 1944. The availability of an increasing variety of man-made fibres and films from 1944 onwards has stimulated work on wound dressings, and some of the more important contributions, both clinical and experimental, are discussed. The functions of a wound dressing and the properties which the ideal wound dressing should possess are given. The necessity for both histological and clinical evaluation of wound dressings in animals and in man is stressed. Wound dressings are the most commonly used therapeutic agents, but there is no means whereby their performance can be assessed. An attempt should be made either nationally or internationally to establish a standard method of assessing the performance of wound dressings. For this it is necessary to have an internationally agreed standard dressing which could be used as a reference or control dressing in all animal and human work. The only animal with skin morphologically similar to that of man is the domestic pig. Three types of wounds could be used: (1) partial-thickness wounds; (2) full-thickness excisions; and (3) third-degree burns. The development of standard techniques for the assessment of the efficiency of wound dressings would be of considerable benefit to the research worker, the medical profession, the patient, and the surgical dressings industry. PMID:13976490

  6. Antinociceptive and wound healing activities of Croton adamantinus Müll. Arg. essential oil.

    PubMed

    Ximenes, Rafael Matos; de Morais Nogueira, Lenise; Cassundé, Nathalia Maria Rodrigues; Jorge, Roberta Jeane Bezerra; dos Santos, Simone Maria; Magalhães, Lucimere Paulino Machado; Silva, Monalisa Ribeiro; de Barros Viana, Glauce Socorro; Araújo, Renata Mendonça; de Sena, Kêsia Xisto da Fonseca Ribeiro; de Albuquerque, Julianna Ferreira Cavalcanti; Martins, René Duarte

    2013-10-01

    Leaves of Croton adamantinus have been used to treat inflammation and skin wounds in the semi-arid area of the Northeast of Brazil. In order to evaluate if the essential oil (EO) was responsible for the claimed activities; antinociceptive, wound healing and antimicrobial tests were carried out. Twenty constituents were identified in C. adamantinus EO by GC-MS, ¹H-NMR and ¹³C-NMR, the major compounds being methyl-eugenol (14.81%) and 1,8-cineol (13.74%). Antinociceptive activity was evaluated by the formalin test and the abdominal contortion assay in mice. The EO (50 and 100 mg/kg) decreased the licking time of both phases of the formalin test when compared to the vehicle, but not to morphine (7.5 mg/kg). In the abdominal contortion assay, the EO (50 and 100 mg/kg) reduced the number of contortions compared to the vehicle and to indometacin (10 mg/kg). The wound healing activity was verified also using two experimental models: excisional wound and dead space. Topical treatment with the EO (1%) increased the wound contraction from the third day of treatment (compared with nitrofurazone 0.2%), while systemic treatment (50 mg/kg/day) increased granulation tissue formation and reduced the water content. C. adamantinus EO also showed antimicrobial activity against Staphylococcus aureus in disk diffusion method. These results corroborate the ethnobotanical use of this specie by Brazilian population.

  7. Incisional hernia after repair of wound dehiscence: incidence and risk factors.

    PubMed

    van't, Riet Martijne T; De Vos Van Steenwijk, Peggy J; Bonjer, H Jaap; Steyerberg, Ewout W; Jeekel, Johannes

    2004-04-01

    The true incidence of incisional hernia after wound dehiscence repair remains unclear because thorough long-term follow-up studies are not available. Medical records of all patients who had undergone wound dehiscence repair between January 1985 and January 1999 at the Erasmus University Medical Center Rotterdam were reviewed. Long-term follow-up was performed by physical examination of all patients in February 2001. One hundred sixty-eight patients underwent wound dehiscence repair. Of those, 42 patients (25%) died within 60 days after surgery. During a median follow-up of 37 months (range, 3-146 months), 55 of the remaining 126 patients developed an incisional hernia. The cumulative incidence of incisional hernia was 69 per cent at 10 years. Significant independent risk factors were aneurysm of the abdominal aorta (10-year cumulative incidence of 84%, P = 0.02) and severe dehiscence with evisceration (10-year cumulative incidence of 78%, P = 0.01). Wound dehiscence repair by interrupted sutures had no better outcome than repair by continuous sutures. Suture material did not influence incidence of incisional hernia. Incisional hernia develops in the majority of patients after wound dehiscence repair, regardless of suture material or technique. Aneurysm of the abdominal aorta and severe dehiscence with evisceration predispose to incisional hernia.

  8. Abdominal actinomycosis mimicking acute appendicitis.

    PubMed

    Conrad, Robert Joseph; Riela, Steven; Patel, Ravi; Misra, Subhasis

    2015-01-01

    A 52-year-old Hispanic woman presented to the emergency department, reporting worsening sharp lower right quadrant abdominal pain for 3 days. CT of the abdomen and pelvis showed evidence of inflammation in the peritoneal soft tissues adjacent to an enlarged and thick-walled appendix, an appendicolith, no abscess formation and a slightly thickened caecum consistent with acute appendicitis. During laparoscopic appendectomy, the caecum was noted to be firm, raising suspicion of malignancy. Surgical oncology team was consulted and open laparotomy with right hemicolectomy was performed. Pathology reported that the ileocaecal mass was not a malignancy but was, rather, actinomycosis. The patient was discharged after 10 days of intravenous antibiotics in the hospital, with the diagnosis of abdominal actinomycosis. Although the original clinical and radiological findings in this case were highly suggestive of acute appendicitis, abdominal actinomycosis should be in the differential for right lower quadrant pain as it may be treated non-operatively.

  9. Abdominal radiation causes bacterial translocation

    SciTech Connect

    Guzman-Stein, G.; Bonsack, M.; Liberty, J.; Delaney, J.P.

    1989-02-01

    The purpose of this study was to determine if a single dose of radiation to the rat abdomen leads to bacterial translocation into the mesenteric lymph nodes (MLN). A second issue addressed was whether translocation correlates with anatomic damage to the mucosa. The radiated group (1100 cGy) which received anesthesia also was compared with a control group and a third group which received anesthesia alone but no abdominal radiation. Abdominal radiation lead to 100% positive cultures of MLN between 12 hr and 4 days postradiation. Bacterial translocation was almost nonexistent in the control and anesthesia group. Signs of inflammation and ulceration of the intestinal mucosa were not seen until Day 3 postradiation. Mucosal damage was maximal by Day 4. Bacterial translocation onto the MLN after a single dose of abdominal radiation was not apparently dependent on anatomical, histologic damage of the mucosa.

  10. Development of a functional wound dressing composed of hyaluronic acid spongy sheet containing bioactive components: evaluation of wound healing potential in animal tests.

    PubMed

    Shimizu, Nahoko; Ishida, Daiki; Yamamoto, Akiko; Kuroyanagi, Misato; Kuroyanagi, Yoshimitsu

    2014-01-01

    This study aimed to develop a novel wound dressing composed of hyaluronic acid (HA) spongy sheet containing bioactive components. The wound dressing prepared by the freeze-drying method has a two-layered structure: an upper layer composed of cross-linked high-molecular-weight HA (HMW-HA) and a lower layer composed of low-molecular-weight HA (LMW-HA) containing arginine (Arg), magnesium ascorbyl phosphate (vitamin C derivative: VC), and epidermal growth factor (EGF) (referred to as EGF-dressing). A wound dressing containing only Arg and VC was prepared in a similar manner (referred to as EGF-free-dressing). The potential of each wound dressing was evaluated in animal tests using Sprague Dawley (SD) rats and diabetic mice. In the first experiment, each wound dressing was applied to a full-thickness skin defect in the abdominal region of SD rats. Wound conditions after 1 week and 2 weeks of treatment were evaluated based on macroscopic and histological appearance. A commercially available non-woven alginate wound dressing (Alg-dressing) was used in a control group. Both EGF-free-dressing and EGF-dressing decreased wound size and promoted granulation tissue formation associated with angiogenesis more effectively when compared with Alg-dressing. In particular, EGF-dressing promoted re-epithelialization. In the second experiment, each wound dressing was applied to a full-thickness skin defect in the dorsal region of diabetic mice. Wound conditions after 1 week and 2 weeks of treatment were evaluated based on macroscopic and histological appearance. A commercially available Alg-dressing was used in a control group. Both EGF-free-dressing and EGF-dressing decreased wound size and promoted granulation tissue formation associated with angiogenesis more effectively when compared with Alg-dressing. These findings indicate that EGF-free-dressing and EGF-dressing have the potential for more effective wound healing when compared with Alg-dressing. In particular, EGF-dressing has

  11. Development of a functional wound dressing composed of hyaluronic acid spongy sheet containing bioactive components: evaluation of wound healing potential in animal tests.

    PubMed

    Shimizu, Nahoko; Ishida, Daiki; Yamamoto, Akiko; Kuroyanagi, Misato; Kuroyanagi, Yoshimitsu

    2014-01-01

    This study aimed to develop a novel wound dressing composed of hyaluronic acid (HA) spongy sheet containing bioactive components. The wound dressing prepared by the freeze-drying method has a two-layered structure: an upper layer composed of cross-linked high-molecular-weight HA (HMW-HA) and a lower layer composed of low-molecular-weight HA (LMW-HA) containing arginine (Arg), magnesium ascorbyl phosphate (vitamin C derivative: VC), and epidermal growth factor (EGF) (referred to as EGF-dressing). A wound dressing containing only Arg and VC was prepared in a similar manner (referred to as EGF-free-dressing). The potential of each wound dressing was evaluated in animal tests using Sprague Dawley (SD) rats and diabetic mice. In the first experiment, each wound dressing was applied to a full-thickness skin defect in the abdominal region of SD rats. Wound conditions after 1 week and 2 weeks of treatment were evaluated based on macroscopic and histological appearance. A commercially available non-woven alginate wound dressing (Alg-dressing) was used in a control group. Both EGF-free-dressing and EGF-dressing decreased wound size and promoted granulation tissue formation associated with angiogenesis more effectively when compared with Alg-dressing. In particular, EGF-dressing promoted re-epithelialization. In the second experiment, each wound dressing was applied to a full-thickness skin defect in the dorsal region of diabetic mice. Wound conditions after 1 week and 2 weeks of treatment were evaluated based on macroscopic and histological appearance. A commercially available Alg-dressing was used in a control group. Both EGF-free-dressing and EGF-dressing decreased wound size and promoted granulation tissue formation associated with angiogenesis more effectively when compared with Alg-dressing. These findings indicate that EGF-free-dressing and EGF-dressing have the potential for more effective wound healing when compared with Alg-dressing. In particular, EGF-dressing has

  12. [MORPHOLOGICAL CHANGES OF SKIN IN OPERATIVE WOUND IN SYNDROME OF OPIOID-INDUCED HYPERALGESIA].

    PubMed

    Dmytriyev, D V; Konoplytskyi, V S

    2015-10-01

    Morphological changes of skin in region of operative wound were investigated. There was established, that while application of fentanyl in high doses, using constant infusion for anesthesia in early postoperative period in children, operated for abdominal cavity tumors, the opioid-induced hyperalgesia occurrence is possible, what is accompanied by morphological changes in skin around operative wound, necrosis in centre of focus, pronounced perifocal reactive changes in a kind of significant inflammation and essential disorder of microcirculation with formation of small neural fibers on the 14th day. Pronounced fibrosis of derma, formation of big quantity of collagen fibers with edema, stratification.

  13. Abdominal aortic aneurysms: case report

    PubMed Central

    Hadida, Camille; Rajwani, Moez

    1998-01-01

    A 71-year-old male presented to a chiropractic clinic with subacute low back pain. While the pain appeared to be mechanical in nature, radiographic evaluation revealed an abdominal aortic aneurysm, which required the patient to have vascular surgery. This case report illustrates the importance of the history and physical examination in addition to a thorough knowledge of the features of abdominal aortic aneurysms. The application of spinal manipulative therapy in patients with (AAA) is also discussed. ImagesFigure 1Figure 2Figure 3

  14. Recurrent abdominal pain during childhood.

    PubMed Central

    Scott, R. B.

    1994-01-01

    Recurrent abdominal pain is a common presenting complaint among children. A thorough history and physical examination and limited laboratory investigation should enable a physician to make a positive diagnosis of "functional" recurrent abdominal pain in 90% to 95% of cases; an organic cause is identified in only 5% to 10%. The care and thoroughness of the history and physical examination establish the physician's credibility; explaining the clinical basis for the diagnosis and educating the child and parents on what is known about the condition reassures the parents. PMID:8199511

  15. Abdominal Bloating: Pathophysiology and Treatment

    PubMed Central

    Seo, A Young; Oh, Dong Hyun

    2013-01-01

    Abdominal bloating is a very common and troublesome symptom of all ages, but it has not been fully understood to date. Bloating is usually associated with functional gastrointestinal disorders or organic diseases, but it may also appear alone. The pathophysiology of bloating remains ambiguous, although some evidences support the potential mechanisms, including gut hypersensitivity, impaired gas handling, altered gut microbiota, and abnormal abdominal-phrenic reflexes. Owing to the insufficient understanding of these mechanisms, the available therapeutic options are limited. However, medical treatment with some prokinetics, rifaximin, lubiprostone and linaclotide could be considered in the treatment of bloating. In addition, dietary intervention is important in relieving symptom in patients with bloating. PMID:24199004

  16. Radiological management of abdominal abscess.

    PubMed Central

    Mac Erlean, D P; Gibney, R G

    1983-01-01

    Forty-two abdominal and retroperitoneal abscesses were drained percutaneously under ultrasound guidance. A success rate of 85.7% was achieved. Subsequent surgery was required in only 5 patients. Postoperative and spontaneous abscesses did equally well. Most intra-abdominal and retroperitoneal abscesses are amenable to this form of percutaneous drainage. The procedure requires only local anaesthesia and is well tolerated. Surgical management should probably now be reserved for those cases which are considered unsuitable for percutaneous drainage or which fail to resolve following this procedure. PMID:6842496

  17. Wound tube heat exchanger

    DOEpatents

    Ecker, Amir L.

    1983-01-01

    What is disclosed is a wound tube heat exchanger in which a plurality of tubes having flattened areas are held contiguous adjacent flattened areas of tubes by a plurality of windings to give a double walled heat exchanger. The plurality of windings serve as a plurality of effective force vectors holding the conduits contiguous heat conducting walls of another conduit and result in highly efficient heat transfer. The resulting heat exchange bundle is economical and can be coiled into the desired shape. Also disclosed are specific embodiments such as the one in which the tubes are expanded against their windings after being coiled to insure highly efficient heat transfer.

  18. Laparoscopic excision of intra-abdominal paragonimiasis.

    PubMed

    Kim, Jun-Young; Kang, Chang-Moo; Choi, Gi-Hong; Yang, Woo-Ick; Sim, Seo-Bo; Kwon, Ji-Eun; Kim, Kyung-Sik; Choi, Jin-Sub; Lee, Woo-Jung; Kim, Byong-Ro

    2007-12-01

    Lung fluke, Paragonimus westermani of Paragonimus species usually are accompanied by a persistent cough, hemoptysis, and chest pain. Extrapulmonary paragonimiasis caused by ectopic parasites in aberrant locations such as the abdominal wall, abdominal organs, and brain has been reported and the most commonly involved extrapulmonary organ is the brain. We present a case of 56-year-old male patient with intra-abdominal paragonimiasis who underwent laparoscopic excision of abdominal granuloma caused by parasite infection. An intra-abdominal mass associated with eosinophilia might be related to parasite infection. A laparoscopic approach is the most appropriate treatment modality in such benign abdominal pathology.

  19. Chronic wounds and the medical biofilm paradigm.

    PubMed

    Wolcott, R D; Rhoads, D D; Bennett, M E; Wolcott, B M; Gogokhia, L; Costerton, J W; Dowd, S E

    2010-02-01

    There is a growing recognition that biofilms are the principal cause of wound chronicity. The development of treatments for wound biofilms raises the prospect that chronic wounds can be treated, potentially saving many patients' lives.

  20. Treatment of a perforating thoracic bite wound in a dog with negative pressure wound therapy.

    PubMed

    Nolff, Mirja C; Pieper, Korbinian; Meyer-Lindenberg, Andrea

    2016-10-01

    CASE DESCRIPTION A 4-year-old male Dachshund was examined following a bite attack that had occurred 5 days previously. The dog had acutely deteriorated despite IV antimicrobial treatment and fluid therapy. CLINICAL FINDINGS On initial examination, the patient was recumbent with signs of septic shock and a flail chest. Three penetrating wounds in the left thoracic wall with malodorous discharge were evident. The animal trauma triage score was 8 out of 18. Thoracic and abdominal radiography revealed displaced fractures of the left seventh, eighth, and ninth ribs and extensive subcutaneous emphysema. Additionally, a marked diffuse bronchointerstitial pattern, areas of alveolar pattern, and pneumothorax were present bilaterally. TREATMENT AND OUTCOME Open surgical debridement with left lateral lung lobectomy and resection of portions of the left thoracic wall were performed. Extensive soft tissue loss precluded primary reconstruction. The defect was stabilized with a polypropylene mesh implant, and negative pressure wound therapy (NPWT) at -100 mm Hg was initiated. Microbial culture and susceptibility testing of tissue samples indicated the presence of multidrug-resistant Staphylococcus pseudintermedius. The NPWT dressing was changed 2, 5, and 7 days after surgery. Treatment was well tolerated, and the mesh was completely covered with granulation tissue 10 days after surgery. On follow-up 5, 7, 12, and 19 months after surgery, the dog was clinically normal with no apparent complications. CLINICAL RELEVANCE Findings suggested that NPWT may be a valuable adjunct when treating small animal patients with severe thoracic trauma. PMID:27654166

  1. [Maggots in the wound, debridement, disinfection and wound healing].

    PubMed

    Schouten, Helga W; Knippels, Marion C J; Franken, Ralph J P M

    2009-01-01

    An 87-year-old man had a longstanding untreated large basosquamous carcinoma on his right ear. He was admitted to the emergency department at our hospital. A large portion of the auricle had perished, together with part of the tumour. Surgery was planned but two days before, the patient complained of an irritating loud noise in his ear. We discovered this was caused by maggots in his external acoustic meatus: myiasis. Dozens of maggots were removed. A striking finding was that the smell of the wound had disappeared and that the wound was much cleaner, with a reddish aspect and less necrosis. The surgical procedure was uneventful. Larval therapy has been known for centuries. In recent years it has gained renewed interest as it may enhance wound debridement, wound disinfection, and may promote wound healing.

  2. Murine models of human wound healing.

    PubMed

    Chen, Jerry S; Longaker, Michael T; Gurtner, Geoffrey C

    2013-01-01

    In vivo wound healing experiments remain the most predictive models for studying human wound healing, allowing an accurate representation of the complete wound healing environment including various cell types, environmental cues, and paracrine interactions. Small animals are economical, easy to maintain, and allow researchers to take advantage of the numerous transgenic strains that have been developed to investigate the specific mechanisms involved in wound healing and regeneration. Here we describe three reproducible murine wound healing models that recapitulate the human wound healing process.

  3. Débridement of the noninfected wound.

    PubMed

    Cornell, Rhonda S; Meyr, Andrew J; Steinberg, John S; Attinger, Christopher E

    2010-09-01

    The utility of wound débridement has expanded to include the management of all chronic wounds, even in the absence of infection and gross necrosis. Biofilm, metalloproteases on the wound base, and senescent cells at the wound edge irreversibly change the physiology of wound healing and contribute to a pathologic, chronic inflammatory environment. The objective of this review is to provide surgeons with a baseline understanding of the processes of débridement in the noninfected wound.

  4. Frequency, causes and pattern of abdominal trauma: A 4-year descriptive analysis

    PubMed Central

    Arumugam, Suresh; Al-Hassani, Ammar; El-Menyar, Ayman; Abdelrahman, Husham; Parchani, Ashok; Peralta, Ruben; Zarour, Ahmad; Al-Thani, Hassan

    2015-01-01

    Background: The incidence of abdominal trauma is still underreported from the Arab Middle-East. We aimed to evaluate the incidence, causes, clinical presentation, and outcome of the abdominal trauma patients in a newly established trauma center. Materials and Methods: A retrospective analysis was conducted at the only level I trauma center in Qatar for the patients admitted with abdominal trauma (2008-2011). Patients demographics, mechanism of injury, pattern of organ injuries, associated extra-abdominal injuries, Injury Severity Score (ISS), Abbreviated Injury Scale, complications, length of Intensive Care Unit, and hospital stay, and mortality were reviewed. Results: A total of 6888 trauma patients were admitted to the hospital, of which 1036 (15%) had abdominal trauma. The mean age was 30.6 ± 13 years and the majority was males (93%). Road traffic accidents (61%) were the most frequent mechanism of injury followed by fall from height (25%) and fall of heavy object (7%). The mean ISS was 17.9 ± 10. Liver (36%), spleen (32%) and kidney (18%) were most common injured organs. The common associated extra-abdominal injuries included chest (35%), musculoskeletal (32%), and head injury (24%). Wound infection (3.8%), pneumonia (3%), and urinary tract infection (1.4%) were the frequently observed complications. The overall mortality was 8.3% and late mortality was observed in 2.3% cases mainly due to severe head injury and sepsis. The predictors of mortality were head injury, ISS, need for blood transfusion, and serum lactate. Conclusion: Abdominal trauma is a frequent diagnosis in multiple trauma and the presence of extra-abdominal injuries and sepsis has a significant impact on the outcome. PMID:26604524

  5. Spirally wound electrochemical cells

    SciTech Connect

    Mc Veigh, J.B. Jr.; Reise, T.F.; Taylor, A.H.

    1987-11-17

    A spirally wound electrochemical cell having improved abuse resistance is described comprising a container having a cathode, an anode consisting essentially of an anode metal comprising an alkali or alkaline earth metal, a separator, and a fluid electrolyte all in operative association with each other. Each of the cathode, anode and separator have lengths substantially greater than their respective widths; and the anode, cathode and separator are spirally wound with the separator being positioned to maintain the anode and the cathode out of direct contact with each other. The anode is comprised of first and second sections integral with each other but subject to different rates of utilization during discharge of the cell with the first section of anode being a minor part of the anode and being substantially completely discharged and depleted, during discharge of the cell, prior to completion of discharge and depletion of the second section of anode, with the second section comprising a major portion of the anode. The cell further comprises an anode tab located on the second section of the anode, whereby the discharge and depletion of the first section does not prematurely end the life of the cell.

  6. Stress and Wound Healing

    PubMed Central

    Christian, Lisa M.; Graham, Jennifer E.; Padgett, David A.; Glaser, Ronald; Kiecolt-Glaser, Janice K.

    2009-01-01

    Over the past decade it has become clear that stress can significantly slow wound healing: stressors ranging in magnitude and duration impair healing in humans and animals. For example, in humans, the chronic stress of caregiving as well as the relatively brief stress of academic examinations impedes healing. Similarly, restraint stress slows healing in mice. The interactive effects of glucocorticoids (e.g. cortisol and corticosterone) and proinflammatory cytokines [e.g. interleukin-1β (IL-1β), IL-lα, IL-6, IL-8, and tumor necrosis factor-α] are primary physiological mechanisms underlying the stress and healing connection. The effects of stress on healing have important implications in the context of surgery and naturally occurring wounds, particularly among at-risk and chronically ill populations. In research with clinical populations, greater attention to measurement of health behaviors is needed to better separate behavioral versus direct physiological effects of stress on healing. Recent evidence suggests that interventions designed to reduce stress and its concomitants (e.g., exercise, social support) can prevent stress-induced impairments in healing. Moreover, specific physiological mechanisms are associated with certain types of interventions. In future research, an increased focus on mechanisms will help to more clearly elucidate pathways linking stress and healing processes. PMID:17709956

  7. The detection of gunshot residues in the nasal mucus of suspected shooters.

    PubMed

    Merli, Daniele; Brandone, Alberto; Amadasi, Alberto; Cattaneo, Cristina; Profumo, Antonella

    2016-07-01

    The identification and quantification of metallic residues produced by gunshots, called gunshot residues (GSR), provide crucial elements in forensic investigations. The research has been largely focused on their collection onto the hands of suspected shooters, but the method is often burdened by risks of contamination. This research was focused on the possibility of sampling GSR trapped inside the nasal mucus of consenting shooters. Samples of the nasal mucus of "blank" control subjects and shooters were chemically analysed by Instrumental Neutron Activation Analysis (INAA), for residues of antimony (Sb) and barium (Ba), while lead (Pb) was excluded as ubiquitously environmental contaminant and due to high instrumental quantification limit (IQL) of INAA for this element. Shots were fired using two types of weapons (pistols and revolvers) and different firing sequences. The mucus was sampled at different times: immediately after the shots, after 30-60-120 and 180 min. Different amounts of Sb and Ba were detected between controls and shooters, witnessing the ability of the nasal mucus to retain GSR at concentrations significantly different even from the highest basal levels. Moreover, in order to simulate actual cases, nasal mucus from five groups of shooters was sampled after different shots with the same weapon and cartridges, immediately and after 1, 3, 12, and 24 h. The highest values were always found in the first 3 h from firing, for both weapons. Interestingly, for all the weapons, significant Sb and Ba concentrations were also found up to 12 h after firing, contrary to what occurs on hands, even though a progressive decrease was detected, with values below the detection threshold only after 24 h, thus demonstrating that GSR are persistent in nasal mucus. These first results proving that both Sb and Ba were qualitatively detectable in the nasal mucus of shooters indicate that the chemical analysis of the nasal mucus of suspected shooters may represent a

  8. Modeling gunshot bruises in soft body armor with an adaptive fuzzy system.

    PubMed

    Lee, Ian; Kosko, Bart; Anderson, W French

    2005-12-01

    Gunshots produce bruise patterns on persons who wear soft body armor when shot even though the armor stops the bullets. An adaptive fuzzy system modeled these bruise patterns based on the depth and width of the deformed armor given a projectile's mass and momentum. The fuzzy system used rules with sinc-shaped if-part fuzzy sets and was robust against random rule pruning: Median and mean test errors remained low even after removing up to one fifth of the rules. Handguns shot different caliber bullets at armor that had a 10%-ordnance gelatin backing. The gelatin blocks were tissue simulants. The gunshot data tuned the additive fuzzy function approximator. The fuzzy system's conditional variance V[Y/X = x] described the second-order uncertainty of the function approximation. Handguns with different barrel lengths shot bullets over a fixed distance at armor-clad gelatin blocks that we made with Type 250 A Ordnance Gelatin. The bullet-armor experiments found that a bullet's weight and momentum correlated with the depth of its impact on armor-clad gelatin (R2 = 0.881 and p-value < 0.001 for the null hypothesis that the regression line had zero slope). Related experiments on plumber's putty showed that highspeed baseball impacts compared well to bullet-armor impacts for large-caliber handguns. A baseball's momentum correlated with its impact depth in putty (R2 = 0.93 and p-value < 0.001). A bullet's momentum similarly correlated with its armor-impact in putty (R2 = 0.97 and p-value < 0.001). A Gujarati-Chow test showed that the two putty-impact regression lines had statistically indistinguishable slopes for p-value = 0.396. Baseball impact depths were comparable to bullet-armor impact depths: Getting shot with a .22 caliber bullet when wearing soft body armor resembles getting hit in the chest with a 40-mph baseball. Getting shot with a .45 caliber bullet resembles getting hit with a 90-mph baseball.

  9. Modeling gunshot bruises in soft body armor with an adaptive fuzzy system.

    PubMed

    Lee, Ian; Kosko, Bart; Anderson, W French

    2005-12-01

    Gunshots produce bruise patterns on persons who wear soft body armor when shot even though the armor stops the bullets. An adaptive fuzzy system modeled these bruise patterns based on the depth and width of the deformed armor given a projectile's mass and momentum. The fuzzy system used rules with sinc-shaped if-part fuzzy sets and was robust against random rule pruning: Median and mean test errors remained low even after removing up to one fifth of the rules. Handguns shot different caliber bullets at armor that had a 10%-ordnance gelatin backing. The gelatin blocks were tissue simulants. The gunshot data tuned the additive fuzzy function approximator. The fuzzy system's conditional variance V[Y/X = x] described the second-order uncertainty of the function approximation. Handguns with different barrel lengths shot bullets over a fixed distance at armor-clad gelatin blocks that we made with Type 250 A Ordnance Gelatin. The bullet-armor experiments found that a bullet's weight and momentum correlated with the depth of its impact on armor-clad gelatin (R2 = 0.881 and p-value < 0.001 for the null hypothesis that the regression line had zero slope). Related experiments on plumber's putty showed that highspeed baseball impacts compared well to bullet-armor impacts for large-caliber handguns. A baseball's momentum correlated with its impact depth in putty (R2 = 0.93 and p-value < 0.001). A bullet's momentum similarly correlated with its armor-impact in putty (R2 = 0.97 and p-value < 0.001). A Gujarati-Chow test showed that the two putty-impact regression lines had statistically indistinguishable slopes for p-value = 0.396. Baseball impact depths were comparable to bullet-armor impact depths: Getting shot with a .22 caliber bullet when wearing soft body armor resembles getting hit in the chest with a 40-mph baseball. Getting shot with a .45 caliber bullet resembles getting hit with a 90-mph baseball. PMID:16366262

  10. WOUND HEALING AND COLLAGEN FORMATION

    PubMed Central

    Ross, Russell; Everett, Newton B.; Tyler, Ruth

    1970-01-01

    Healing skin wounds were studied in a series of parabiotic rats. The femurs of one parabiont of each pair were shielded whilst both animals were given 800 r from a Co60 source. The animals were wounded 3 days after irradiation. Each animal with partially shielded marrow was then given tritiated thymidine intraperitoneally daily while the cross-circulation was arrested by clamping. After the thymidine-3H had cleared the blood, the clamp was released. Animals were sacrificed, and wounds were prepared for radioautography 1, 2, and 6 days after wounding. In the wounds of the shielded animals thymidine-3H was observed in epidermis, endothelium, leukocytes, fibroblasts, and mast cells. Only neutrophilic leukocytes, monocytes, and lymphocytes were labeled, as determined by light and electron microscope radioautography, in the wounds of each nonshielded parabiont. None of the many fibroblasts present were found to contain label in the wounds of the nonshielded parabionts through the 6 day period. These observations provide further evidence that wound fibroblasts do not arise from hematogenous precursors and, therefore, must arise from adjacent connective tissue cells. PMID:5415241

  11. Multimodal imaging of ischemic wounds

    NASA Astrophysics Data System (ADS)

    Zhang, Shiwu; Gnyawali, Surya; Huang, Jiwei; Liu, Peng; Gordillo, Gayle; Sen, Chandan K.; Xu, Ronald

    2012-12-01

    The wound healing process involves the reparative phases of inflammation, proliferation, and remodeling. Interrupting any of these phases may result in chronically unhealed wounds, amputation, or even patient death. Quantitative assessment of wound tissue ischemia, perfusion, and inflammation provides critical information for appropriate detection, staging, and treatment of chronic wounds. However, no method is available for noninvasive, simultaneous, and quantitative imaging of these tissue parameters. We integrated hyperspectral, laser speckle, and thermographic imaging modalities into a single setup for multimodal assessment of tissue oxygenation, perfusion, and inflammation characteristics. Advanced algorithms were developed for accurate reconstruction of wound oxygenation and appropriate co-registration between different imaging modalities. The multimodal wound imaging system was validated by an ongoing clinical trials approved by OSU IRB. In the clinical trial, a wound of 3mm in diameter was introduced on a healthy subject's lower extremity and the healing process was serially monitored by the multimodal imaging setup. Our experiments demonstrated the clinical usability of multimodal wound imaging.

  12. Use of human and porcine dermal-derived bioprostheses in complex abdominal wall reconstructions: a literature review and case report.

    PubMed

    Baillie, Daniel R; Stawicki, S Peter; Eustance, Nicole; Warsaw, David; Desai, Darius

    2007-05-01

    The goal of abdominal wall reconstruction is to restore and maintain abdominal domain. A PubMed(R) review of the literature (including "old" MEDLINE through February 2007) suggests that bioprosthetic materials are increasingly used to facilitate complex abdominal wall reconstruction. Reported results (eight case reports/series involving 137 patients) are encouraging. The most commonly reported complications are wound seroma (18 patients, 13%), skin dehiscence with graft exposure without herniation (six, 4.4%), superficial and deep wound infections (five, 3.6%), hernia recurrence (four, 2.9%), graft failure with dehiscence (two), hematoma (two), enterocutaneous fistula (one), and flap necrosis (one). Two recent cases are reported herein. In one, a 46-year-old woman required open abdominal management after gastric remnant perforation following a Roux-en-Y gastric bypass procedure. Porcine dermal collagen combined with cutaneous flaps was used for definitive abdominal wall reconstruction. The patient's condition improved postoperatively and she was well 5 months after discharge from the hospital. In the second, a 54-year-old woman underwent repair of an abdominal wall defect following resection of a large leiomyosarcoma. Human acellular dermis combined with myocutaneous flaps was used to reconstruct the abdominal wall defect. The patient's recovery was uncomplicated and 20 weeks following surgery she was doing well with no evidence of recurrence or hernia. The results reported to date and the outcomes presented here suggest that bioprosthetic materials are safe and effective for repair of large abdominal wall defects. Prospective, randomized, controlled studies are needed to compare the safety and efficacy of other reconstructive techniques as well as human and porcine dermal-derived bioprostheses.

  13. Abdominal pain - children under age 12

    MedlinePlus

    Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... When your child complains of abdominal pain, see if they can describe ... kinds of pain: Generalized pain or pain over more than half ...

  14. Evidence-based surgical wound care on surgical wound infection.

    PubMed

    Reilly, Jaqueline

    2002-09-01

    Surgical wound infection is an important outcome indicator in the postoperative period. A 3-year prospective cohort epidemiological study of 2202 surgical patients from seven surgical wards across two hospitals was carried out using gold standard surveillance methodology. This involved following patients up as inpatients and postdischarge surveillance to 30 days by an independent observer. The results led to the development of a mathematical model for risk of clean, elective surgical wound infection. Risk of surgical wound infection was increased by smoking, higher body mass index, presence of malignancy, haematoma formation, increasing numbers of people in theatre, adherent dressing usage, and higher times to suture removal (P<0.05). The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It was noted that patient care practices affected the surgical wound infection rate and the surveillance was used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the risk from extrinsic risk factors for wound infection. As a result of the implementation of this evidence-based practice there was a significant reduction (P<0.05) in the clean wound infection rate.

  15. [Physiology of wound healing. Modern approach to wound care].

    PubMed

    Juhász, István

    2006-11-26

    The wound healing cascade is based on the programmed, reproducible cooperation of the cells involved in reparation, their products, further humoral factors and the intercellular stroma. The author describes the physiological events during the phases of cutaneous acute wound healing by second intention, such as coagulation, inflammation, proliferation, remodelling, takes into account the local pathophysiological processes found in chronic wounds. The author reviews the recent scientific literature on wound healing as well. Information is rapidly growing about the communication between cells and factors involved in cutaneous wound repair. Parallel control of the same step is common among physiological processes, with redundant safety mechanisms. The failure of therapeutic approaches based on single factor substitution is predictable for the clinician, because it is yet impossible to properly orchestrate the introduction of these factors to the system. In case of chronic wounds sofar the most effective intervention into the course of wound healing can be achieved by adding complex live structures, such as in case of biotechnologically derived materials or skin transplantation.

  16. Early Management, With a Minimal Initial Hospitalization Length, of Major Self-inflicted Rifle Wounds to the Face by a Single Latissimus Dorsi Free Musculocutaneous Flap: A 10-Year Experience

    PubMed Central

    Danino, A. M.; Hariss, P. G.; Servant, J. M.

    2009-01-01

    Objective: Severe ballistic injuries to the face create complex, composite defects of 2 facial subunits. These injuries have an extremely high economic impact for the Medicare system. The surgical goal with these patients is to restore basic functions of the face with a rapid morphological improvement. Our hypothesis is as follows: Early restoration of facial segments with a single free multiple island latissimus dorsi flap without primary bone reconstruction can significantly reduce hospitalization time and allow earlier psychiatric therapy with good morphological results. Surgical method: (1) Large debridement, bony stabilization with external fixation, and tracheotomy. (2) Definitive early reconstruction of soft tissue with composite free latissimus dorsi-scapular musculocutaneous flap. (3) Several refinements will optimize the results. Study design: Retrospective case series of lower- and middle-face composite facial close-range high-energy gunshot wound patients were evaluated. Age, gender, mechanism of injury, anatomic subsites involved, surgical procedures, flaps utilized, complications, functional outcomes, time of tracheotomy closure, hospitalization duration, and beginning of psychiatric treatment were analyzed. Results: Twelve defects were gunshot wounds, 12 free latissimus dorsi flaps, and no flap losses. Patients received psychiatric treatment after 22 days (7–29); the tracheotomy was removed in 10 patients with normal alimentation in all cases. Mean hospitalization duration was 21 days. Conclusions: Free tissue transfer techniques allow early reconstruction of the soft tissue framework of the face with a single multiple-island flap. Rapid restitution of facial compartments at a soft tissue level can dramatically reduce duration of hospitalization. PMID:19587777

  17. Abdominal cocoon secondary to disseminated tuberculosis

    PubMed Central

    Puppala, Radha; Sripathi, Smiti; Kadavigere, Rajagopal; Koteshwar, Prakashini; Singh, Jyoti

    2014-01-01

    Abdominal cocoon, also known as sclerosing encapsulating peritonitis, represents a rare entity where a variable length of the small bowel is enveloped by a fibrocollagenous membrane giving the appearance of a cocoon. It may be asymptomatic and is often diagnosed incidentally at laparotomy. We present a rare case of abdominal cocoon due to abdominal tuberculosis. PMID:25239980

  18. Wound bed preparation: ultrasonic-assisted debridement.

    PubMed

    Butcher, Gillian; Pinnuck, Loreto

    Wound bed preparation is essential for the healing of wounds. The TIME framework (tissue, infection/inflammation, moisture balance, edge of wound) for wound bed preparation shows the importance of debridement in the treatment of chronic wounds. Debridement involves the removal of devitalised tissue from the wound bed. It also facilitates the removal of biofilms-complex microbial communities that are known to contribute to delayed wound healing and chronicity of wounds. Ultrasonic-assisted wound debridement (UAWD) is a lesser known debridement method that uses low-frequency ultrasound waves. There is evidence to show that the three clinical effects of atraumatic selective tissue debridement, wound stimulatory effects and antibacterial activity facilitate early healing of wounds, reducing the cost to the healthcare system and improving the patient's quality of life.

  19. Hereditary Neuropathy with Liability to Pressure Palsies Masked by Previous Gunshots and Tuberculosis

    PubMed Central

    Gencik, Martin; Finsterer, Josef

    2015-01-01

    Objectives. Although hereditary neuropathy with liability to pressure palsies (HNPP) presents with a distinct phenotype on history, clinical exam, and nerve conduction studies, it may be masked if diagnostic work-up suggests other causes. Case Report. In a 37-year-old male with pseudoradicular lumbar pain, neurological exam revealed sore neck muscles, peripheral facial nerve palsy, right anacusis and left hypoacusis, hemihypesthesia of the right face, mild distal quadriparesis, diffuse wasting, and generally reduced tendon reflexes. He had a history of skull fracture due to a gunshot behind the right ear and tuberculosis for which he had received adequate treatment for 3 years; MRI revealed a disc prolapse at C6/7 and Th11/12. Nerve conduction studies were indicative of demyelinating polyneuropathy with conduction blocks. Despite elevated antinuclear antibodies and elevated CSF-protein, HNPP was diagnosed genetically after having excluded vasculitis, CIDP, radiculopathy, and the side effects of antituberculous treatment. Conclusions. HNPP may manifest with mild, painless, distal quadriparesis. The diagnosis of HNPP may be blurred by a history of tuberculosis, tuberculostatic treatment, hepatitis, and the presence of elevated CSF-protein. PMID:26640726

  20. Ammunition identification by means of the organic analysis of gunshot residues using Raman spectroscopy.

    PubMed

    López-López, María; Delgado, Juan José; García-Ruiz, Carmen

    2012-04-17

    The ability to unequivocally identify a gunshot residue (GSR) when a firearm is discharged is a very important and crucial part of crime scene investigation. To date, the great majority of the analyses have focused on the inorganic components of GSR, but the introduction of "lead-free" or "nontoxic" ammunitions makes it difficult to prevent false negatives. This study introduces a fast methodology for the organic analysis of GSR using Raman spectroscopy. Six different types of ammunition were fired at short distances into cloth targets, and the Raman spectra produced by the GSR were measured and compared with the spectra from the unfired gunpowder ammunition. The GSR spectrum shows high similarity to the spectrum of the unfired ammunition, allowing the GSR to be traced to the ammunition used. Additionally, other substances that might be found on the victim's, shooter's, or suspect's clothes and might be confused with GSR, such as sand, dried blood, or black ink from a common ballpoint pen, were analyzed to test the screening capability of the Raman technique. The results obtained evidenced that Raman spectroscopy is a useful screening tool when fast analysis is desired and that little sample preparation is required for the analysis of GSR evidence. PMID:22424274