Vicq, P; Jourdan, P; Chapuis, O; Baranger, B
The mortality from abdominal gunshot wounds remains high, either in civilian or military cases. The severity factors of these wounds include bullet calibre and energy transfer of the missile. This paper studies some of the ballistics features of abdominal gunshot wounds. Practical guidelines are inferred concerning diagnosis and treatment of these wounds.
Bahebeck, J; Masso-Misse, P; Essomba, A; Takongmo, S; Ngo-Nonga, B; Ngo-Nyeki, A R; Sosso, M; Malong, E
Abdominal gunshot wound (AGSW) is a trauma emergency. The purpose of this report is to describe our experience with managing AGSW largely without modem investigational modalities. Data was collected retrospectively by reviewing the surgical reports and clinical charts of patients admitted to live hospitals dealing with AGSW over a 5-year period. Incomplete files and wounds not involving the abdomen were not included. A total of 86 files were analyzed. Patients ranged in age from 10 to 63 years ivith mean age of 32 years and a sex ratio of 5.5. Most patients (87%) underwent surgical exploration. Laboratory revealed no lesions in 22.5% of cases, minor lesions in 9.5% and major lesions justifying surgical repair in 68%. A total of 86 visceral lesions were found in the patients who underwent surgical exploration. The lesion involved the small intestine in 31.5% of case, colon in 24.5%, liver in 23.5%, spleen in 7%, stomach in 6%, and uterus in 2%. The kidney, pancreas, mesenteries, large momentum, and transverse mescaline each accounted for 1% of lesions. Conventional operative techniques were used with a mortality of 5.5% and morbidity of 4%. Based on our findings we conclude that when investigational tools (CT-scan, peritoneal lavage and laparoscopy) are unavailable prolonged watchful waiting increases the risk of mortality and morbidity in patients presenting AGSW associated with suspicious clinical signs. Prompt surgical treatment improves prognosis but is associated with a high rate of cases showing no lesions.
Ordog, G.; Drew, R.
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.
... page: //medlineplus.gov/ency/patientinstructions/000737.htm Gunshot wounds - aftercare To use the sharing features on this ... or body are likely to cause more damage. Wound Care If the wound was severe, you may ...
Lorin de la Grandmaison, Geoffroy
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.
Botoi, G; Blăjan, I; Nemeş, S
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.
Hennessy, M J; Banks, H H; Leach, R B; Quigley, T B
The civilian gunshot wound is a low velocity injury. Temporary cavitation does not occur in the low velocity wound and damage is confined to the projectile pathway. Extensive debridement is not indicated for this injury. Surgical cleansing is used to convert the open, contaminated wound to a clean, closed wound. Reparative and definitive reconstruction then follow to restore form and function with minimized patient hazard.
Peleg, Michael; Sawatari, Yoh
The gunshot wound to the mandible is a unique traumatic injury. The resultant injury from the gunshot wound is diverse because of the variability of the projectile, motion, velocity, and tissue characteristics. When a high-velocity projectile strikes the mandible, often times the wound will consist of a severely comminuted mandible surrounded by nonvital soft tissues and the implantation of multiple foreign bodies. This represents a challenge for the treating surgeon. The anatomy and function of the mandible make it such that the care of the gunshot wound requires a combination of trauma and reconstructive surgeries. There are varying techniques advocated for the management of gunshot wound to the face. However, for the comminuted mandible fracture sustained from a gunshot wound, an approach involving the fabrication of an occlusal splint, intermaxillary fixation, aggressive debridement of hard and soft tissues, and immediate reconstruction with a titanium plate is a comprehensive approach that can restore the appropriate function and contour of the patient. At the Division of Oral and Maxillofacial Surgery, University of Miami, this approach to the comminuted mandible fracture secondary to the gunshot wound has led to the effective management of this specific subset of injury. The complication rate is comparable with the current literature and provides an advantage as a 1-stage management to restore appropriate function and cosmesis to the patient.
Barlow, B; Niemirska, M; Gandhi, R P
Gunshot wounds in children have become a significant source of morbidity and mortality in our community in the last 10 yr. One hundred eight children, 16 yr of age and younger, were admitted to the Pediatric Surgical Service for gunshot wounds during this period; only 1 child was admitted for a gunshot wound in the 10 yr preceding this review. Rapid resuscitation and triage of major injuries directly to the operating room achieved a 94% survival. Review of the circumstances of injury revealed that 42% of the gunshot wounds were inflicted by children and 40% were known to have been intentional. Only 20% of the patients had known drug involvement; in general this was involvement in drug selling, not in drug abuse. Social service intervention 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.
Mittal, Radhey Shyam
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
Dougherty, Paul J; Najibi, Soheil; Silverton, Craig; Vaidya, Rahul
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.
Ro, Tae; Murray, Richard; Galvan, Dan; Nazim, Muhammad H.
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
Cohen, M; Morales, R; Fildes, J; Barrett, J
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
Shvyrkov, Michael B
Over the period 1981-1985 the author treated 1486 patients with facial gunshot wounds sustained in combat in Afghanistan. In the last quarter of 20th century, more powerful and destructive weapons such as M-16 rifles, AK-47 and Kalashnikov submachine guns, became available and a new approach to gunshot wound debridement is required. Modern surgeons have little experience in treatment of such wounds because of rare contact with similar pathology. This article is intended to explore modern wound debridement. The management of 502 isolated soft tissue injuries is presented. Existing principles recommend the sparing of damaged tissues. The author's experience was that tissue sparing lead to a high rate of complications (47.6%). Radical primary surgical debridement (RPSD) of wounds was then adopted with radical excision of necrotic non-viable wound margins containing infection to the point of active capillary bleeding and immediate primary wound closure. After radical debridement wound infection and breakdown decreased by a factor of 10. Plastic operations with local and remote soft tissue were made on 14, 7% of the wounded. Only 0.7% patients required discharge from the army due to facial muscle paralysis and/or facial skin impregnation with particles of gunpowder from mine explosions. Gunshot face wound; modern debridement.
Eby, Peter R
We present the case of a 22-year-old man who sustained a gunshot wound to the scrotum. The imaging findings and management of the patient are described and discussed in the context of prior research pertaining to traumatic bladder rupture. Non-pressurized antegrade 10-minute delayed CT may result in unnecessary radiation exposure, delayed diagnosis and is not adequate to exclude bladder rupture. Retrograde pressurized CT cystography should be performed to exclude bladder rupture in patients with high-risk imaging results, clinical findings or injury mechanisms.
Munsterman, Amelia S; Hanson, R Reid
Bullet wounds in horses can cause a wide array of injuries, determined by the type of projectile, the energy of the bullet on entry, and the type of tissue the bullet encounters. Treatment includes identification of all structures involved, debridement of the permanent cavity, and establishing adequate drainage. Bullet wounds should be treated as contaminated, and broad-spectrum antibiotics, including those with an anaerobic spectrum, are indicated. Although musculoskeletal injuries resulting from gunshots are most common in horses, they carry a good prognosis for survival and return to function.
Perez, Danielo B; Molina, D Kimberley
Determining the range of fire is a crucial part of a forensic examination of gunshot wound victims. Traditionally, this has been accomplished by noting the gross appearance of soot or powder around the wound. This study was undertaken to determine the utility of routine histological examination of gunshot wounds as related to range-of-fire determination. A prospective study was performed, and a total of 69 gunshot wounds were examined both macroscopically and microscopically. Of the 45 entrance wounds examined, there was 100% concordance between macroscopic and microscopic analysis for the close-range wounds and 67% concordance for the distant wounds, with 33% of these wounds showing no evidence of soot or powder grossly but where residue was seen microscopically. In addition, 21% of the exit wounds examined showed microscopic evidence of soot/powder residues when none were visible macroscopically. As described in previous studies, it can be assumed that the bullet itself can deposit small residues along the wound track (bullet wipe) that can be seen microscopically and is unrelated to the range of fire. Therefore, the authors conclude there is no utility in the routine histological examination of gunshot wounds for the determination of range of fire.
Hlavaty, Leigh; Avedschmidt, Sarah; Root, Kelly; Amley, Jeffrey; Sung, LokMan
Proper interpretation of gunshot wounds is vital for the forensic pathologist and requires experience and expertise, as well as consultation with a firearms and ballistics expert and careful scene investigation in cases of atypical gunshot wounds. This study is the first large-series examining ricochet gunshot wounds involving different firearm calibers. Typical gunshot wounds created from 4 handgun calibers (22 Long Rifle, 9 × 19 mm Parabellum, .40 Smith &Wesson, and .45 Automatic Colt Pistol) and 2 rifle calibers (5.56 and 7.62 mm) were compared with wounds caused by bullets of those same calibers ricocheting off commonly encountered surfaces (concrete, asphalt, aluminum traffic signs, clay brick, and dry wall). Porcine skin, a human skin analog, attached to sheets of cardboard serviced as witness panels for capturing the entrance wounds. Examination of over 150 handgun and rifle entrance wounds established that every caliber and every ricochet surface resulted in atypical features, including irregularity in size or shape, lack of marginal abrasion, or other injuries on the surrounding skin. The most significant factor influencing the variability of the ricochet wounds was the surface the bullet deflected off before striking the body.
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
Cornwell, Edward E
Trauma remains a significant and persistent public health problem, accounting for 90,000 deaths and 20 million people disabled annually. Current concepts of appropriate triage and emergency treatment of gunshot wounds are addressed from a trauma surgeon's perspective. Recent studies regarding prehospital transport policy, and acute diagnostic studies allow optimal treatment guidelines to be formulated. Specifically, rapid transport rather than prolonged on-scene treatment (including maneuvers such as formal thoracolumbar immobilization) should be given the highest priority. Also, routine arteriography (another time-consuming and invasive procedure) in the treatment of gunshot wounds to the extremity is no longer the standard of care.
Plattner, T; Kneubuehl, B; Thali, M; Zollinger, U
The goal of this study was the reproduction of shape and pattern of gunshot residues in near contact and contact gunshot wounds by a series of experimental gunshots on a skin and soft tissue model. The aim was to investigate the shape and direction of soot deposits with regard to the muzzle according to different muzzle-target angles, firing distances, type of ammunition and weapon and barrel length. Based on a review of the literature and on the results of the experiments the authors could make the following statements of gunshot residues in angled contact and close contact gunshot: (1) gunshot residues on the target surface can be differentiated in a "inner" and "outer powder soot zone"; (2) the outer powder soot zone is much less visible than the inner powder soot zone and may lack on human skin; (3) with increasing muzzle target distance both inner and outer powder soot halo increase in size and decrease in density; (4) in angled shots the inner powder soot halo shows an eccentric, elliptic shape which points towards the muzzle, regardless of ammunition, calibre and barrel length; (5) the outer powder soot points away from the muzzle in angled contact and close contact shots.
Camm, Christian Fielder; Agha, Riaz Ahmed; Edison, Eric
Gunshot wounds are an important cause of both morbidity and mortality within the military. With the deployment of the United States military into a two theater campaign over the past decade, the role of gunshot wounds in military personnel has come to the forefront. Gunshot wounds are often used and glamourized in popular culture. They are also fascinating to clinicians due to the difficulty in assessing such patients for injuries and treatment options.(1) Gunshot wounds also provide an opportunity to develop certain aspects of trauma management.(2) Walker et al. provide a coherent analysis of gunshot wounds to US military personnel during this period.(3).
Langley, Natalie R
This analysis of gunshot trauma to the bony thorax examines 87 handgun and rifle wounds from documented cases in an effort to corroborate an earlier report and to provide the forensic community with additional literature in this area. Specifically, this study tests whether the trauma signatures associated with gunshot wounds in the bony thorax are useful in determining the direction of fire. Because the ribs occupy a significant portion of the bony thorax, they are struck more frequently than other bones and, consequently, they are the focus of this report. This study confirmed that bullets can leave distinctive markers on ribs that indicate the direction of fire, including depressed fractures, bone fragments displaced in the direction of the bullet's path, and beveling. Although forensic anthropologists can determine the direction that a bullet was traveling when it struck a given rib, they cannot give a definitive statement about the number or sequence of gunshots without supporting soft tissue evidence.
Murphy, G K
Both the laboratory and the pathologist are frequently involved in medicolegal cases. A relatively infrequent though important example is the case involving study of gunshot wounds in surgical pathology. Procedures for the proper gross and microscopic examination of gunshot wound specimens have been documented in the literature, and are briefly reviewed. A protocol for documenting the chain of custody for physical evidence recovered in these cases must be strictly observed in each department of surgical pathology. A large hospital's surgical pathology files contained 70 gunshot wound cases for 1969-1978. Review employing Adelson's reference work revealed correct microscopic findings and diagnosis in 90% of specimens, the 11 errors all failures to recognize gunpowder residue in tissues. There were nine specimens of physical evidence. Two errors were made in the gross examination of these specimens, and despite a chain-of-custody protocol pathologists failed to adequately document 44% of them. The surgical pathologist has available ample resources for studying gunshot wound specimens. Using them he can correctly interpret most cases, at the same time fulfilling his medicolegal obligations.
Firat, Cemal; Geyik, Yilmaz
Maxillofacial traumas caused by gunshot wounds may cause quite varied defects. The objective of this study was to evaluate the reconstruction methods in 12 patients with gunshot wound-related mandibular and maxillofacial bony and soft tissue defects. Twelve patients who were operated on for maxillofacial gunshot wounds at our clinic between 2002 and 2012 were included in the study. Seven patients were wounded in a suicide attempt, and 5 were wounded as a result of an accident or in assaults. Two patients underwent reconstruction using free fibula osteocutaneous flap, 4 patients received the free radial forearm osteocutaneous flap, 2 patients received costal bone graft, and 3 patients received iliac bone grafts. Satisfactory functional and aesthetic outcomes were achieved in cases where staged secondary reconstruction, balloon treatment, and consecutive fat and steroid injections into the depressed scar areas were applied. In conclusion, the basic goal in maxillofacial reconstruction is the functional and aesthetic reconstruction of the contours. Because it is not easy to get perfect results with only 1 clinical approach or 1 method, the proper timing and reconstruction method should be selected.
Miller, T R
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
Wunnapuk, Klintean; Durongkadech, Piya; Minami, Takeshi; Ruangyuttikarn, Werawan; Tohno, Setsuko; Vichairat, Karnda; Azuma, Cho; Sribanditmongkol, Pongruk; Tohno, Yoshiyuki
To elucidate characteristics of gunshot residues in gunshot entry wounds with full-jacketed and lead bullets, element contents in entry gunshot wounds and control skins were analyzed by inductively coupled plasma-atomic emission spectrometry (ICP-AES). It was found that a high content of Fe and Zn was deposited in the gunshot entry wounds with full-jacketed bullet, whereas a high content of Pb was deposited in the gunshot entry wounds with lead (unjacked) bullet. It should be noted that the content of Pb was significantly higher in the gunshot entry wounds with lead bullet than in those with full-jacketed bullet. Regarding the relationships among elements, it was found that there were significant direct correlations between Pb and either Sb or Ba contents in both gunshot entry wounds with full-jacketed and lead bullets. As Pb increased in both gunshot entry wounds, Sb and Ba also increased in the wounds.
Swan, K G; Swan, R C
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.
Rhodes, Stancie C.; Gupta, Surupa S.
Over the last century, only four cases have been published of patients sustaining gunshot wounds to the chest, managed nonoperatively, who eventually expectorated the bullet. We report the case of a hemodynamically stable 24-year-old male whose bullet was found in the left pulmonary hilum on admission computed tomography (CT) scan. Further workup revealed no obvious aerodigestive injury. Shortly after extubation, he expectorated the bullet onto the floor. Little is known about how to manage these stable, yet challenging patients. PMID:23723626
Randall, B; Newby, P
Arrow wounds represent an unusual class of wounds rarely seen by most death investigators. Although the edged, broadhead-tipped arrow produces a wound usually characteristic of archery/crossbow weapons, the plain, field-tipped arrow wound can be confused with gunshot injuries in those cases in which powder residue or firearm projectiles or fragments or both are not recovered. We present a case of a deer carcass with a wound of uncertain firearm or archery origin which initiated a comparison of firearm wounds and archery wounds on fresh road-killed deer. We found the following features to be valuable in the differentiation of gunshot wounds and field-tipped archery wounds: First, the majority of the gunshot wounds (but none of the arrow wounds) had identifiable, macroscopic, wipe-off material and chemically identifiable wipe-off residue by spot test. Second, the archery wound defects had very inconspicuous abrasion rings as compared to the often prominent abrasion rings of gunshot wounds. Third, the actual central defect in the archery wounds was more likely to be oblong or slit-like compared to the gunshot wound defects, which were more likely to be round.
Dean, Nichole R.; McKinney, Shane M.; Wax, Mark K.; Louis, Patrick J.; Rosenthal, Eben L.
In this study, we review outcomes for 15 patients with self-inflicted submental gunshot wounds requiring free flap reconstruction. Patients presented to two tertiary care centers over a 7-year period. Mean age was 46 years (range, 16 to 76 years), 67% (n = 10) had a psychiatric history, and four were known to abuse illicit substances. Patients with oromandibular involvement required on average a total of 2.8 procedures, and those with midface (3.7) or combined defects (6) required more total procedures (p = 0.21). Donor sites included osteocutaneous radial forearm (n = 8), fibula (n = 4), fasciocutaneous radial forearm (n = 5), and anterior lateral thigh (n = 1). Median length of hospitalization was 8 days. Overall complication rate was 33% (n = 5), and included hematoma (n = 1), fistula (n = 1), and mandibular malunion (n = 2). Most patients were able to tolerate a regular or soft diet (92%), maintain oral competency (58%), and demonstrate intelligible speech (92%) at a median time to follow-up of 12 months. Despite the devastating nature of this injury, free flap reconstruction of self-inflicted submental gunshot wounds results in acceptable functional results for the majority of patients. PMID:22379504
Husain, Zeeshan S; Schmid, Stephen; Lombardo, Nicholas
The peer-reviewed, clinical data focusing on foot and ankle gunshot wounds are limited. The present study aimed to evaluate functional outcomes in a case series according to the area of injury, articular involvement, and the presence of infection. From January 2003 through February 2011 (8 years), 37 patients treated at Sinai-Grace Hospital (Detroit, MI) for civilian gunshot wounds localized to the foot and/or ankle were reviewed. Of these, 27 (72.97%) met the inclusion criteria. All acute wounds were thoroughly irrigated in the emergency room (8 of 27, 29.63%) or operating room (19 of 27, 70.37%) within 1 hour of presentation. The injuries were categorized as either zone 1 or 2, if localized distally or proximally to the midtarsal joint, respectively. The Maryland Foot Score was recorded and compared based on the location, articular involvement, and infection status, using analysis of variance. The mean Maryland Foot Score in patients with zone 1 injuries was 89.3 (range 72 to 100) and in patients with zone 2 injures was 61.8 (range 13 to 97; p = .001). The mean Maryland Foot Score in patients with type A injuries was 93.1 (range 72 to 100) and in patients with type B injures was 69.2 (range 13 to 99; p = .001), regardless of location. Intraoperative cultures yielded Staphylococcus epidermidis (7 of 27, 25.93%) and Enterococcus cloacae (1 of 27, 3.7%). No cases of Pseudomonas aeruginosa were found, although 9 cases (33.33%) involved shoe penetration. One third of the cases (9 of 27) yielded intra-articular pain, of which 4 (14.82%) required joint arthrodesis.
Delannoy, Y; Colard, T; Becart, A; Tournel, G; Gosset, D; Hedouin, V
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.
Tributsch, W; Ambach, E; Henn, R
To support police in reenacting criminal acts is one of the most important functions of forensic investigation. This case report deals with the discovery of the corpse of a 42-year old man at the bank of the river Inn. First of all the man was supposed to be drowned, but the autopsy showed a gunshot wound of the neck and a shot-through of the brain-stem. Intensive search for the weapon by the police and by divers was unsuccessful and therefore suspicion of homicide arose. The reconstruction of the act at the site of discovery of the corpse led to the discovery of the weapon and the case became clear to be a suicide.
Wunnapuk, Klintean; Minami, Takeshi; Durongkadech, Piya; Tohno, Setsuko; Ruangyuttikarn, Werawan; Moriwake, Yumi; Vichairat, Karnda; Sribanditmongkol, Pongruk; Tohno, Yoshiyuki
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.
Payne, W K; Gabriel, R A; Massoud, R P
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.
Thogmartin, J R; Start, D A
Atypical gunshot wounds due to ricochet and intermediate targets have been well described in the literature. We represent a case of suicide with an atypical entrance wound and bullet without rifling marks due to 9 mm ammunition being loaded and fired from a 40 caliber semiautomatic pistol.
Ordog, G J; Wasserberger, J; Ibanez, J; Bishop, M; Velayos, E; Balasubramanium, S; Shoemaker, W
An analysis of the number of gunshot wound victims seen at a Los Angeles County Hospital both before and after the Los Angeles riot of 1992 was undertaken. Since the riot, the gang truce between the "Bloods" and the "Crips" has resulted in a significant decrease in the number of gunshot wound victims seen at a level I trauma center in Los Angeles.
Fais, Paolo; Giraudo, Chiara; Boscolo-Berto, Rafael; Amagliani, Alessandro; Miotto, Diego; Feltrin, Giampietro; Viel, Guido; Ferrara, S Davide; Cecchetto, Giovanni
Incineration or extensive burning of the body, causing changes in the content and distribution of fluids, fixation and shrinking processes of tissues, can alter the typical macroscopic and microscopic characteristics of firearm wounds, hampering or at least complicating the reconstruction of gunshot fatalities. The present study aims at evaluating the potential role of micro-computed tomography (micro-CT) for detecting and quantifying gunshot residue (GSR) particles in experimentally produced intermediate-range gunshot wounds severely damaged by fire. Eighteen experimental shootings were performed on 18 sections of human calves surgically amputated for medical reasons at three different firing distances (5, 15 and 30 cm). Six stab wounds produced with an ice pick were used as controls. Each calf section underwent a charring cycle, being placed in a wood-burning stove for 4 min at a temperature of 400 °C. At visual inspection, the charred entrance wounds could not be differentiated from the exit lesions and the stab wounds. On the contrary, micro-CT analysis showed the presence of GSR particles in all burnt entrance gunshot wounds, while GSR was absent in the exit and stab wounds. The GSR deposits of the firearm lesions inflicted at very close distance (5 cm) were mainly constituted of huge particles (diameter >150 μm) with an irregular shape and well-delineated edges; at greater distances (15 and 30 cm), agglomerates of tiny radiopaque particles scattered in the epidermis and dermis layers were evident. Statistical analysis demonstrated that also in charred firearm wounds the amount of GSR roughly correlates with the distance from which the gun was fired. The obtained results suggest that micro-CT analysis can be a valid screening tool for identifying entrance gunshot wounds and for differentiating firearm wounds from sharp-force injuries in bodies severely damaged by fire.
Bird, Cate E; Fleischman, Julie M
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.
Amadasi, Alberto; Mazzarelli, Debora; Merli, Daniele; Brandone, Alberto; Cattaneo, Cristina
The presence of "chipping" or "flaking" around the edges of gunshot entry wounds has been described among the characteristics of gunshot wounds in bone. In this study, the real frequency of such a peculiar feature was investigated. The presence of "chipping" was assessed on 22 gunshot wounds fired at a near-contact range on bovine ribs with 9-mm bullets. As controls, five samples were shot with a 3 cm range, and five from 40 cm. In 77% of cases shot at near-contact range, a detachment of small fragments of the upper layers of bone was detected, mainly with a circumferential disposition, whereas this feature was lacking in control samples. The study demonstrated the frequency of "chipping" and that it may probably be due to a combined ballistic effect of impact of the bullet itself and expansion of gases. It may be thus considered indicative of close-range shots.
Bizhan, Aarabi; Mossop, Corey; Aarabi, Judith Ann
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.
Dolinak, David; Wise, Steven H; Jones, Curtiss
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.
Vinuthinee, Naidu; Azreen-Redzal, Anuar; Juanarita, Jaafar; Zunaina, Embong
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
Reddy, Amit K.; Baker, Meredith S.; Sobel, Rachel K.; Whelan, David A.; Carter, Keith D.; Allen, Richard C.
IMPORTANCE Suicides and attempted suicides are major public health issues in the United States and around the world. Self-inflicted gunshot wounds (SIGSWs) are a common method of attempting suicide, the head being the most commonly injured body region; however, the literature lacks an overview of the orbital and ocular injuries as well as outcomes associated with SIGSWs. OBJECTIVES To characterize the ocular and orbital injuries and outcomes of patients presenting with SIGSWs and to examine the cost associated with these injuries. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review was performed of all patients who presented to the University of Iowa Hospitals and Clinics between 2003 to 2013 with the admitting diagnosis of self-inflicted injuries via firearms. Patients with no periorbital or ocular injuries and/or those who did not survive for at least 2 months following the incident were excluded. MAIN OUTCOMES AND MEASURES Ocular injuries and outcomes and health care costs and reimbursements, which were generated by a financial report obtained from the hospital finance department that included data from both the hospital billing and cost accounting systems. RESULTS All patients in this study (n = 18) were men with a mean age of 47.2 years. Eight patients (44.4%) displayed submental missile entry points, 7 (38.9%) displayed intraoral entry points, and 3 (16.7%) displayed pericranial entry points. Patients with pericranial entries sustained more severe ocular injuries and had poorer ocular outcomes. Seven patients (38.9%) were found at final follow-up to have visual acuity of 20/40 or better in each eye and all showed missile trajectories in the sagittal plane. The mean cost of treatment of these patients totaled $117 338 while the mean reimbursement amount was $124 388. CONCLUSIONS AND RELEVANCE Data regarding ocular injuries and outcomes may assist ophthalmologists in the treatment of patients with SIGSWs in the future. Many patients had
Hatfield, S; Challa, V R
The case history of a 28-year-old man who sustained a gunshot wound to the head and developed multiple pulmonary emboli composed of cerebral tissue is presented. The brain tissue fragments probably entered the severed end of a bridging vein, traveled along the superior sagittal sinus, and gained access to the internal jugular vein and systemic venous return.
Havel, J; Zelenka, K
The article describes using of energo-dispersive X-ray fluorescence spectrometry (EDXRF) as the forensic method as the tool for detection of metals (gunshot residues--GSR) in connection with gunshot-wounds of persons.
Amadasi, Alberto; Brandone, Alberto; Rizzi, Agostino; Mazzarelli, Debora; Cattaneo, Cristina
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.
García-Perdomo, Herney Andrés
Twenty percent of genital traumas are caused by penetrating injuries; accordingly gunshot and stab wounds have increased in the last couple of years around the globe, even in Colombia. A 67-year-old male patient was admitted to the emergency room because he received multiple gunshot wounds. On physical examination, multiple wounds on his penis with loss of tissue in the foreskin, glans, anterior urethra (distal third) and cavernous corpora were found. The urologist performed a partial penectomy with a penis reconstruction, he debrided the cutaneous flap of the dorsal foreskin and its glans, sutured the distal cavernous corpora and dissected the urethra. Penetrating genital injuries are extremely important due to their impact on the functional, psychological and the aesthetic consequences. It is necessary to define the best possible treatment to minimize the damage.
Cecchetto, Giovanni; Amagliani, Alessandro; Giraudo, Chiara; Fais, Paolo; Cavarzeran, Fabiano; Montisci, Massimo; Feltrin, Giampietro; Viel, Guido; Ferrara, Santo Davide
Gunshot residue (GSR) evidence may be altered or obscured by after-death events such as putrefaction, autolysis, and/or damage by animals. The present study aimed at evaluating and comparing the amount and differential distribution of GSR utilizing microcomputed tomography (microCT) analysis of fresh and decomposed gunshot wounds. A total of 60 experimental shootings at three different firing distances (5, 15, and 30 cm) were performed on human calves surgically amputated for medical reasons. Thirty specimens (10 for each tested distance) were immediately formalin-fixed, while the other 30 specimens were enclosed in a cowshed for 15 days, before formalin fixation (air temperature ranging from 11°C to 38°C). MicroCT analysis with three-dimensional image reconstruction detected GSR particles in all the investigated entrance wounds. In fresh specimens, GSR was concentrated on the skin surface around the entrance hole and in the epidermis and dermis layers around the cavity, while in decomposed specimens, the high density particles were detected only in the dermis layer. No GSR was detected in exit wounds of both fresh and decomposed specimens regardless of the tested firing distance. Statistical analysis demonstrated that also in decomposed wounds the amount of GSR roughly correlated with the distance from which the gun was fired, exhibiting, however, a higher variability than in fresh samples. The obtained results suggest that microCT analysis can be a valid screening tool for differentiating decomposed entrance and exit gunshot wounds.
Cecchetto, Giovanni; Giraudo, Chiara; Amagliani, Alessandro; Viel, Guido; Fais, Paolo; Cavarzeran, Fabiano; Feltrin, Giampietro; Ferrara, Santo Davide; Montisci, Massimo
Estimation of the firing range is often critical for reconstructing gunshot fatalities, where the main measurable evidence is the gunshot residue (GSR). In the present study intermediate-range gunshot wounds have been analysed by means of a micro-computed tomography (micro-CT) coupled to an image analysis software in order to quantify the powder particles and to determine the firing distance. A total of 50 shootings were performed on skin sections obtained from human legs surgically amputated for medical reasons. For each tested distance (5, 15, 23, 30 and 40 cm), firing was carried out perpendicularly at the samples using a 7.65-mm pistol loaded with jacketed bullets. Uninjured skin sections were used as controls. By increasing the firing distance, micro-CT analysis demonstrated a clear decreasing trend in the mean GSR percentage, particularly for shots fired from more than 15 cm. For distances under 23 cm, the powder particles were concentrated on the epidermis and dermis around the hole, and inside the cavity; while, at greater distances, they were deposited only on the skin surface. Statistical analysis showed a nonlinear relationship between the amount of GSR deposits and the firing range, well explained by a Gaussian-like function. The proposed method allowed a good discrimination for all the tested distances, proving to be an objective, rapid and inexpensive tool for estimating the firing range in intermediate-range gunshot wounds.
Samokhvalov, I M; Zavrazhnov, A A; Kornilov, E A; Margarian, S A
An investigation of materials of treatment of 130 wounded with combined wounds (CW) of extremity blood vessels during war in Afghanistan and in counter-terrorist operations in the Northern Caucasus has shown that the specific feature of surgical treatment of wounds of the extremity arteries associated with severe wounds of other localizations consists in limited possibilities to save the extremities. The scale MESS of a severity of extremity wounds was improved. It allowed a reliable prognosis for wounded with gunshot injuries of the arteries concerning necessary amputation (97%) or a possibility to save the extremity (100%). A strategy of surgical treatment of CW of the extremity arteries is proposed on the basis of an estimation of the general severity of the trauma, the V.A. Kornilov classification of the severity of acute ischemia and a FS-MESS scale of extremity injuries.
Lebeau, R; Diané, B; Kassi, A B F; Yénon, S K; Koffi, A; Akpa-Bédi, E S A; Kouassi, J C
The authors report the case of a 24-years old pregnant woman gravida 2 para 1 who sustained a gunshot injury at 23 weeks gestation. The bullet injured the rectosigmoid jonction, the jejunum and traversed the uterine cavity with resultant of fatal injury of the fetus. Laparotomy was required for treatment of the maternal injuries. Although a fetus demise was delivered by caesarian section a review of literature indicated that operative delivery should be avoided when the fetus has died already and the gravid uterus don't impaired the surgeon's ability to repair other visceral injuries. But the patient should be followed closely for signs of coagulopathy and intra uterine infection.
Machado, Marcos Paulo Salles; Simões, Márcia Pereira; Gamba, Thiago de Oliveira; Flores, Isadora Luana; Haiter Neto, Francisco; Durão, Carlos Henrique; Daruge Júnior, Eduardo; Cunha, Eugénia
Wormian bones (WB) are irregular small cranial ossicles found along suture lines and fontanels. In Brazil, gunshot wounds to the skull are quite common in young individuals. Nevertheless, as far as we know, this is the first report of a WB giving an erroneous aspect of gunshot entrance due to its displacement position. The present manuscript describes the case of a Brazilian young man who died due to ballistic trauma, where a gaping bony defect on the right side of the skull was thought to be the exit wound of an injury related to the destruction found on the left side, highly suggestive of firearm injury. Thus, this case study has brought to light similarities between a traumatic lesion and an orifice of a WB, with emphasis on differential diagnosis during routine anthropological examinations.
Phillips, P; Hansraj, K K; Cox, E E; Ashley, E M
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.
Kovacević, Vesna; Krstić, Dragan; Jović, Milena; Stanković, Zoran; Milosavljević, Ivica; Marinković, Nadica
Alizarin red S, a commonly used organic dye in the histologic identification of calcium deposits, also forms colored reaction products with other metal ions, such as barium and lead, which are present in primer residue. The possibility was presented of using this histochemical technique in determination of firing distance based on the results in experimentally made close-range gunshot wounds (up to 1 m) by using several types of firearms.
Brown, H; Cauchi, D M; Holden, J L; Allen, F C; Cordner, S; Thatcher, P
A statistical investigation of the relationship between firing range and the amount and distribution of gunshot residue (GSR), used automated image analysis (IA) to quantify GSR deposit resulting from firings into pig skin, from distances ranging between contact and 45 cm. Overall, for a Ruger .22 semi-automatic rifle using CCI solid point, high velocity ammunition, the total area of GSR deposit on the skin sections decreased in a non-linear fashion with firing range. More specifically there were significant differences in the amount of GSR deposited from shots fired at contact compared with shots fired from distances between 2.5 and 45 cm; and between shots fired from a distance of 20 cm or less, with shots fired at a distance of 30 cm or more. In addition, GSR particles were heavily concentrated in the wound tract only for contact and close range shots at 2.5 cm, while the particle distribution was more uniform between the wound tract and the skin surfaces for shots fired from distances greater than 2.5 cm. Consequently, for future scientific investigations of gunshot fatalities, once standards have been established for the weapon and ammunition type in question, image analysis quantification of GSR deposited in and around the gunshot wound may be capable of providing a reliable, statistical basis for estimating firing range.
Nejjar, M; Bennani, S; Zerouali, O N
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.
Background The management of brachial plexus injuries due to gunshot wounds is a surgical challenge. Better surgical strategies based on clinical and electrophysiological patterns are needed. The aim of this study is to clarify the factors which may influence the surgical technique and outcome of the brachial plexus lesions caused by gunshot injuries. Methods Two hundred and sixty five patients who had brachial plexus lesions caused by gunshot injuries were included in this study. All of them were male with a mean age of 22 years. Twenty-three patients were improved with conservative treatment while the others underwent surgical treatment. The patients were classified and managed according to the locations, clinical and electrophysiological findings, and coexisting lesions. Results The wounding agent was shrapnel in 106 patients and bullet in 159 patients. Surgical procedures were performed from 6 weeks to 10 months after the injury. The majority of the lesions were repaired within 4 months were improved successfully. Good results were obtained in upper trunk and lateral cord lesions. The outcome was satisfactory if the nerve was intact and only compressed by fibrosis or the nerve was in-contunuity with neuroma or fibrosis. Conclusion Appropriate surgical techniques help the recovery from the lesions, especially in patients with complete functional loss. Intraoperative nerve status and the type of surgery significantly affect the final clinical outcome of the patients. PMID:19627573
Brown, H; Cauchi, D M; Holden, J L; Wrobel, H; Cordner, S
An automated image analysis (IA) technique has been developed to obtain a measure of the amount (i.e. number and area) of gunshot residue (GSR) particles within and around a gunshot wound. Sample preparation and IA procedures were standardised to improve the reproducibility of the IA measurements of GSR. Measurements of GSR from test firings into goat hide were enhanced by staining the barium and lead components present on the skin sections with Alizarin Red S. The amount of GSR detected on the stained skin sections was compared with backscatter electron micrographs of the same sections. The differences were deemed to be insignificant when the variability in the repeated test firings were taken into consideration. Preliminary results indicated that the decreasing relationship between firing range and the amount of GSR deposited was non-linear, and that for firing ranges of up to 20 cm the amount of GSR deposited from repeated shots fired from the same distance was highly variable.
Maiden, Nicholas R; Hiss, Jehuda; Gips, Hadas; Hocherman, Gil; Levin, Nadav; Kosachevsky, Olga; Vinokurov, Asya; Zelkowicz, Avraham; Byard, Roger W
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.
Kastanaki, Anastasia E; Kranioti, Elena F; Theodorakis, Pavlos N; Michalodimitrakis, Manolis
In this report, the authors present a case of suicide committed by a 66-year-old man, inside a grave at the local cemetery, with two gunshot wounds to the head. A multiple-paged, handwritten suicide note was found in an army type bag inside the victim's car, while a second one was found in his house. Medicolegal examination of the body revealed two typical contact gunshot entrance wounds and one exit wound to the head. Toxicological analysis of the femoral blood was negative for alcohol and drugs. The history, scene and autopsy findings, along with further police investigation, indicated an obvious case of suicide. The literature is reviewed and discussed. We report this case as the place of suicide is extremely uncommon and as there is no mention of a gunshot suicide inside a grave in the current literature.
Molina, D Kimberley; DiMaio, Vincent; Cave, Rowena
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.
Marinović, Marin; Radović, Endi; Bakota, Bore; Mikacević, Marijan; Grzalja, Nikola; Ekl, Darko; Cepić, Ivica
Civilian gunshot injuries of the foot are not so common in Croatia. They are related with accidents in hunting or weapon cleaning. Gunshot injuries represent a special challenge for surgeon because of specific anatomical relations and biomechanical function of the foot. We have decided to present a patient with a complex foot injury caused by hunting firearm in self-inflicted accident. A 45-year-old male presented with 12-gauge shotgun wound to his left foot. We found a complicated fracture with bone defect of 3rd, 4th and 5th metatarsals and wide soft tissue injury with skin and subcutaneous defect of the dorsal and lateral side of the foot. The wound was contaminated with numerous metal fragments, particles of rocks and ground. Surgical treatment was performed three hours after trauma and included extensive debridement of damaged soft tissue, removing of the non-viable bone and metal fragments, rocks and other foreign bodies. Negative Pressure Wound Therapy (NPWT) was applicated in the operating table. The starting therapy was continuously -125 mm Hg of vacuum. We continued with intermittent therapy of -100 mm Hg and change NPWT dressing every fourth day. After four weeks of NPWT the defect was filled with granulation tissue and split thickness skin graft was applied. Skin graft was additionally fixed with NPWT using continuous therapy at -100 mm Hg for a period of four days. Forthy days after injury there was a complete healing of all soft tissue. Control X-ray showed good bone healing process.
Poret, H A; Fabian, T C; Croce, M A; Bynoe, R P; Kudsk, K A
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.
Ordog, G J; Shoemaker, W; Wasserberger, J; Bishop, M
An analysis was undertaken of the number of gunshot wound victims seen at a Los Angeles County hospital both before and after the Los Angeles riot. Since the LA riot the gang truce between the "Bloods" and the "Crips" resulted in a significant decrease in the number of gunshot wound victims seen at a level I trauma center in Los Angeles. Unfortunately, this lasted for only three months. The resurgence of shootings, mainly of the drive-by type (82%), to an occurrence rate higher than ever before, has negated any positive effect of the gang truce and indicates the need for additional measures to control gang violence.
Weinstein, Joseph; Putney, Emily; Egol, Kenneth
Controversy exists among the orthopedic community regarding the treatment of gunshot injuries. No consistent treatment algorithm exists for treatment of low energy gunshot wound (GSW) trauma. The purpose of this study was to critically examine the wound contamination following low velocity GSW based upon bullet caliber and clothing fiber type found within the injury track. Four types of handguns were fired at ballistic gel from a 10-foot distance. Various clothing materials were applied (denim, cotton, polyester, and wool) circumferentially around the tissue agar in a loose manor. A total of 32 specimens were examined. Each caliber handgun was fired a minimum of 5 times into a gel. Regardless of bullet caliber there was gross contamination of the entire bullet track in 100% of specimens in all scenarios and for all fiber types. Furthermore, as would be expected, the degree of contamination appeared to increase as the size of the bullet increased. Low velocity GSWs result in significant contamination regardless of bullet caliber and jacket type. Based upon our results further investigation of low velocity GSW tracks is warranted. Further clinical investigation should focus on the degree to which debridement should be undertaken.
Hootman, J; Annest, J; Mercy, J; Ryan, G; Hargarten, S
Objective—To characterize non-fatal firearm related injuries other than gunshot wounds (non-GSWs) treated in hospital emergency departments in the United States that occur during routine gun handling and recreational use as well as violence related use of a firearm. Methods—Cases were identified through the National Electronic Injury Surveillance System (NEISS). During the study period, 1 January 1993 through 31 December 1996, NEISS consisted of a nationally representative sample of 91 hospitals in the United States having at least six beds and providing 24 hour emergency services. Results—An estimated 65 374, or an average of 16 300 per year, non-fatal, non-GSWs were treated in American hospital emergency departments during the four year study period. Fifty seven per cent of all the non-fatal, non-GSWs were violence related, most of which involved being struck by a firearm. The majority of unintentional non-fatal, non-GSWs were self inflicted and occurred during routine gun handling or recreational use of a firearm; 43% of these injuries resulted from gun recoils. Conclusions—Non-fatal, non-GSWs make a notable contribution to the public health burden of firearm related injuries. Firearm related injury prevention programs should focus on not only the reduction of gunshot wounds but also the reduction of unintentional and violence related non-GSWs. PMID:11144625
Szleszkowski, Łukasz; Thannhäuser, Agata; Szwagrzyk, Krzysztof; Kawecki, Jerzy; Jurek, Tomasz
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.
Giraudo, Chiara; Fais, Paolo; Pelletti, Guido; Viero, Alessia; Miotto, Diego; Boscolo-Berto, Rafael; Viel, Guido; Montisci, Massimo; Cecchetto, Giovanni; Ferrara, Santo Davide
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.
Naomi, Akira; Oyamatsu, Yoshinori; Narita, Kunio; Nakayama, Masato
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.
Champeaux, C; Raballand, E
An orphan female chimpanzee was wounded by a left craniocerebral gunshot complicated with a right hemiparesis. Local treatment and long-term antibiotherapy failed to lead to healing. A neurosurgical procedure was planned and achieved. She fully recovered, and 2 years after the procedure, there is no evidence of infection.
Murry, Jason S; Hoang, David M; Ashragian, Sogol; Liou, Doug Z; Barmparas, Galinos; Chung, Rex; Alban, Rodrigo F; Margulies, Daniel R; Ley, Eric J
Stab wounds (SW) to the abdomen traditionally require urgent exploration when associated with shock, evisceration, or peritonitis. Hemodynamically stable patients without evisceration may benefit from serial exams even with peritonitis. We compared patients taken directly to the operating room with abdominal SWs (ED-OR) to those admitted for serial exams (ADMIT). We retrospectively reviewed hemodynamically stable patients presenting with any abdominal SW between January 2000 and December 2012. Exclusions included evidence of evisceration, systolic blood pressure ≤110 mm Hg, or blood transfusion. NON-THER was defined as abdominal exploration without identification of intra-abdominal injury requiring repair. Of 142 patients included, 104 were ED-OR and 38 were ADMIT. When ED-OR was compared with ADMIT, abdominal Abbreviated Injury Score was higher (2.4 vs 2.1; P = 0.01) and hospital length of stay was longer (4.8 vs 3.3 days; P = 0.04). Incidence of NON-THER was higher in ED-OR cohort (71% vs 13%; P ≤ 0.001). In a regression model, ED-OR was a predictor of NON-THER (adjusted odds ratio 16.6; P < 0.001). One patient from ED-OR expired after complications from NON-THER. There were no deaths in the ADMIT group. For those patients with abdominal SWs who present with systolic blood pressure ≥110 mm Hg, no blood product transfusion in the emergency department and lacking evisceration, admission for serial abdominal exams may be preferred regardless of abdominal exam.
Briusov, P G; Kuritsyn, A N; Urazovskiĭ, N Iu
The modern doctrine of military surgery is based on the concept of maximal and, if possible, simultaneous surgical aid to the wounded in the shortest period of time after the injury. It could be achieved by approximation of specialized surgical section to the zone of fighting and improvement of medical evaluation. These are conditions for applicability of modern methods of treatment and for perfecting of surgical strategies to the wounded, such as videothoracoscopy. To report the experience of the usage of videothoracoscopy in the treatment of the wounded with penetrating gunshot wounds of chest (PFAWT) in military hospital. 23 patients with PFWAT was administer surgical therapy: 19 patients had pleural draining at previous stages of medical evacuation, 4 patients were delivered directly from the battle Geld 1.5 hours after the injury. 11 patients with pleural drains and 4 patients, delivered from battle Geld, had indications for videothoracoscopy. These indications included ongoing intrapleural bleeding, clotted hemothorax and prolonged leakage of the air through the drain. Suturing of the lung wounds was performed by Endo-GIA-30 stapler. If it was impossible, manual suture EndoStitch USSC was used. In 2 cases was performed wedge-like resection by EndoGIA-30. The bleeding from the thoracic wall wounds was controlled by electrocautery. The clotted hemothorax was removed by fragmentation with EndoBabcock, washing out and aspiration through large diameter tubes. The duration of the procedure ranged from 40 to 90 minutes. None had suppurative complications. All patients was survived. The mean duration of inpatient period was 20 days, rehabilitation period-14 days.
Galligan, Aisling A; Fries, Craig; Melinek, Judy
Forensic pathologists who autopsy the victims of gun violence are often called upon to answer questions in both criminal and civil proceedings about the relative position of the shooter and the victim. In this case report of an officer-involved shooting incident, the statement of the police officer appeared to be in direct contradiction to the statements of other eyewitnesses, the evidence at the scene, and the final resting position of the decedent's body. Trajectory analysis of two gunshot wound pathways (only one of which was instantaneously incapacitating) was performed to assess the veracity of the officer's statement and forensic animation was used to create a court exhibit. A discussion of the current peer-reviewed literature is included.
Amadasi, Alberto; Merli, Daniele; Brandone, Alberto; Cattaneo, Cristina
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.
Germerott, Tanja; Preiss, Ulrich S; Ross, Steffen G; Thali, Michael J; Flach, Patricia M
We sought to determine the effect of postmortem ventilation in combination with a suction pump in cases showing penetrating trauma to the chest with haemo- and/or pneumothorax, for better evaluation of the lungs in postmortem computed tomography (PMCT). The study included 6 subjects (1 female, 5 male; age 32-67years) with a penetrating gunshot or stab wound to the chest and consecutive pneumo- and/or haemothorax. The pneumo- and haemothorax were evacuated by a suction pump, and postmortem ventilation was applied using a home care ventilator. PMCT images with and without postmortem ventilation were compared, as well as the autopsy results. In three cases haemo- and pneumothorax was clearly reduced. Postmortem ventilation led to distinct re-expansion of the lungs in two cases, and to re-expansion of single lung lobes in two cases with shotgun injuries. No visible effect was seen in the remaining two cases, because of extensive destruction of lung tissue and blood aspiration. In two cases the injuries sustained in the individual lung lobes were successfully located during postmortem ventilation. The bullet channel was apparent in one case; in another case, injury of the pericardium became visible by generating pneumopericardium. The present method is capable of improving evaluation of the postmortem lung in the presence of single stab or gunshot wounds and if there is no severe destruction of the respiratory system and aspiration. Forensic autopsy should still be considered as the gold standard, although in some cases the present method might be helpful, especially where no autopsy is required.
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.
Scialpi, M; Boccuzzi, F; Romeo, F; Ax, G; Scapati, C; Rotondo, A; Angelelli, G
To assess the diagnostic and medicolegal contribution of Computed Tomography (CT) in patients with craniocerebral, maxillofacial, neck and spine gunshot wounds, we submitted to CT 106 patients with gunshot wounds examined over a 7-year period (February, 1988 to December, 1994). Twenty-four of them had craniocerebral injuries (23%), 9 maxillofacial (8%), 8 neck (8%) and 10 vertebral (9%) injuries. Emergency CT demonstrated the mechanism of the injury, the bullet path and site, the site of bone and/or metallic fragments, and damage extent. In all perforating cranioencephalic injuries (n = 7) intracerebral or extrathecal bone fragments were demonstrated adjacent to the bullet entrance and exit holes, respectively. In injury monitoring. CT showed injury evolution, retained fragments and complications, thus enabling damage extent assessment. High Resolution Computed Tomography (HRCT) was useful in locating minute orbitary retrobulbar and intraspinal fragments. Magnetic Resonance (MR) Imaging in postoperative patients proved a valuable tool to assess the extent of spinal cord damage. To conclude, CT is a useful technique to examine the patients with gunshot wounds, which helps plan adequate treatment and solve complex medicolegal problems.
Hicks, Caitlin W.; Velopulos, Catherine G.; Sacks, Justin M.
INTRODUCTION Heterotopic ossification (HO) refers to the formation of bone in non-ossifying tissue. Heterotopic mesenteric ossification is a rare form of HO that is characterized by the formation of an ossifying pseudotumour at the base of the mesentery, usually following abdominal surgery. PRESENTATION OF CASE We describe a case of mesenteric HO in a young male who presented for elective ventral incisional hernia repair following a stab wound to the abdomen requiring exploratory laparotomy 21 months earlier. Preoperative workup was unremarkable, but a hard, bone-like lesion was noted to encircle the base of the mesentery upon entering the abdomen, consistent with HO. The lesion was excised with close margins, and his hernia was repaired without incident. DISCUSSION Traumatic HO describes the ossification of extra-skeletal tissue that specifically follows a traumatic event. It usually occurs adjacent to skeletal tissue, but has been occasionally described in the abdomen as well, usually in patients who suffer abdominal trauma. Overall the prognosis of HO is good, as it is considered a benign lesion with no malignant potential. However, the major morbidity associated with mesenteric HO is bowel obstruction. CONCLUSION The size, location, and symptoms related to our patient's mesenteric HO put him risk for obstruction in the future. As a result, the mass was surgically excised during his ventral hernia repair with good outcomes. PMID:24981165
Acute inflammatory disease 5 Superior mesenteric artery syndrome 4 Biliary tract disease 4 surface in the patients with abdominal burns, and only...ity of these critically ill patients were equally affected by polypropylene was used for fascial closure, the wound ileus , sepsis, abdominal distention
Madsen, A S; Laing, G L; Bruce, J L; Clarke, D L
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
Madsen, AS; Laing, GL; Bruce, JL
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
Patil, Rahul; Jaiswal, Gaurav; Gupta, Tarun Kumar
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
Rüeger-Schaad, Elisabeth; Panfil, Eva-Maria; Viehl, Carsten T; Spirig, Rebecca
Chronic abdominal wounds lead to prolonged hospital stays. However, no data exist that describe the experience of persons living with a chronic abdominal wound. The aim of this qualitative study was to explore the experience of persons living with chronic abdominal wounds and elicit their expectations in health professionals. Narrative interviews were conducted with five women and four men. Using content analysis techniques, five categories with one to four subcategories emerged from the data. "Returning to everyday life without a wound" represents the main goal of the participants and is driven by their hope to achieve this outcome. "Everyday life with the wound" illustrates the reality of participants' lives, which is affected by suffering. "The patients' work" demonstrates the component that patients contribute to managing their wound. "The work of primary support persons" shows the importance of the work of people close to the patient. "The work of professionals" includes the expectations that patients have in their caregivers. Teamwork between professionals, patients and primary support persons seems to be an essential condition for the successful healing of an abdominal wound.
Louwes, Thijs M; Ward, William H; Lee, Kendall H
The vast majority of combat-related penetrating spinal injuries from gunshot wounds result in severe or complete neurological deficit. Treatment is based on neurological status, the presence of cerebrospinal fluid (CSF) fistulas, and local effects of any retained fragment(s). We present a case of a 46-year-old male who sustained a spinal gunshot injury from a 7.62-mm AK-47 round that became lodged within the subarachnoid space at T9-T10. He immediately suffered complete motor and sensory loss. By 24-48 hours post-injury, he had recovered lower extremity motor function fully but continued to have severe sensory loss (posterior cord syndrome). On post-injury day 2, he was evacuated from the combat theater and underwent a T9 laminectomy, extraction of the bullet, and dural laceration repair. At surgery, the traumatic durotomy was widened and the bullet, which was laying on the dorsal surface of the spinal cord, was removed. The dura was closed in a water-tight fashion and fibrin glue was applied. Postoperatively, the patient made a significant but incomplete neurological recovery. His stocking-pattern numbness and sub-umbilical searing dysthesia improved. The spinal canal was clear of the foreign body and he had no persistent CSF leak. Postoperative magnetic resonance imaging of the spine revealed contusion of the spinal cord at the T9 level. Early removal of an intra-canicular bullet in the setting of an incomplete spinal cord injury can lead to significant neurological recovery following even high-velocity and/or high-caliber gunshot wounds. However, this case does not speak to, and prior experience does not demonstrate, significant neurological benefit in the setting of a complete injury. PMID:25705346
Louwes, Thijs M; Ward, William H; Lee, Kendall H; Freedman, Brett A
The vast majority of combat-related penetrating spinal injuries from gunshot wounds result in severe or complete neurological deficit. Treatment is based on neurological status, the presence of cerebrospinal fluid (CSF) fistulas, and local effects of any retained fragment(s). We present a case of a 46-year-old male who sustained a spinal gunshot injury from a 7.62-mm AK-47 round that became lodged within the subarachnoid space at T9-T10. He immediately suffered complete motor and sensory loss. By 24-48 hours post-injury, he had recovered lower extremity motor function fully but continued to have severe sensory loss (posterior cord syndrome). On post-injury day 2, he was evacuated from the combat theater and underwent a T9 laminectomy, extraction of the bullet, and dural laceration repair. At surgery, the traumatic durotomy was widened and the bullet, which was laying on the dorsal surface of the spinal cord, was removed. The dura was closed in a water-tight fashion and fibrin glue was applied. Postoperatively, the patient made a significant but incomplete neurological recovery. His stocking-pattern numbness and sub-umbilical searing dysthesia improved. The spinal canal was clear of the foreign body and he had no persistent CSF leak. Postoperative magnetic resonance imaging of the spine revealed contusion of the spinal cord at the T9 level. Early removal of an intra-canicular bullet in the setting of an incomplete spinal cord injury can lead to significant neurological recovery following even high-velocity and/or high-caliber gunshot wounds. However, this case does not speak to, and prior experience does not demonstrate, significant neurological benefit in the setting of a complete injury.
Solli, Elena; Carberry, Nathan
Tension pneumocephalus is a rare complication of head trauma and neurosurgical procedures, amongst other causes. It is defined by the combination of intracranial air, increased intracranial pressure, and mass effect. Although it often presents soon after surgery, it can also rarely present in a delayed fashion. We present a case of delayed tension pneumocephalus, occurring approximately 16 weeks after bifrontal craniectomy for a self-inflicted gunshot wound. Following a month of rhinorrhea, postnasal drip, and cough, the patient presented with a sensation of expansion in the area of the right forehead. As tension pneumocephalus is an emergency that can be fatal, this patient was treated expediently and avoided severe neurological deficits. The case recounted here is important as a demonstrative example that tension pneumocephalus does not always follow a defined course immediately after trauma or neurosurgery but rather can develop insidiously without obvious signs. PMID:28074167
Lazarjan, M S; Geoghegan, P H; Taylor, M C; Jermy, M C
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.
Akhtar, Abbasi J.; Funnyé, Allen S.; Akanno, Jonathan
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
Amadasi, Alberto; Borgonovo, Simone; Brandone, Alberto; Di Giancamillo, Mauro; Cattaneo, Cristina
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.
Riehl, John T.; Connolly, Keith; Haidukewych, George; Koval, Ken
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
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
Abghari, Michelle; Monroy, Alexa; Schubl, Sebastian; Davidovitch, Roy; Egol, Kenneth
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
[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].
Svetlolobov, D Iu; Luzanova, I S; Demidov, I V; Zorin, Iu V; Sonis, M A; Likhachev, A S
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.
Harnish, Carissa; Gross, Brian; Rittenhouse, Katelyn; Bupp, Katherine; Vellucci, Ashley; Anderson, Jeffrey; Riley, Deborah; Rogers, Frederick B
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.
Birk, Daniel M; Tobin, Matthew K; Moss, Heather E.; Feinstein, Eric; Charbel, Fady T; Alaraj, Ali
The most commonly described indications for surgical management of closed depressed skull fractures are hematoma evacuation and repair of extensive cosmetic deformity. Venous sinus injury, which occurs in a subset of depressed skull fractures is not typically listed as an indication for surgical treatment due to the potential for major venous hemorrhage associated with operation near these structures. However, if patients exhibit signs and symptoms of intracranial hypertension and radiographic findings demonstrate sinus compromise, surgical elevation of the depressed skull fragments is indicated. The authors present the case of a 25-year-old woman with a depressed skull fracture secondary to a gunshot wound with symptomatic compromise in venous outflow of the posterior one-third of the superior sagittal sinus. The patient was treated with surgical decompression via bilateral craniectomy along with intracranial pressure lowering medical therapy and had almost full resolution of her presenting symptoms with documented improvement in flow through the superior sagittal sinus. While the use of surgical treatment for these types of injuries is highly debated we demonstrate here that safe, effective surgical management of these patients is possible and that surgical decompression should always be considered in the case of symptomatic venous sinus flow obstruction. PMID:25839927
Rozin, Yu A; Ivanenko, A A
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.
Ramji, Zahra; Laflamme, Mélissa
Intra-articular bullet wounds have been found to cause both local and systemic consequences, in particular, when retained over many years. Only a few such cases have been described in published reports, each with different implications, depending on the joint involved and whether the patient experienced lead toxicity. We report the rare case of a 63-year-old male with lead arthropathy of the ankle secondary to a gunshot wound 49 years earlier. In addition to his severe tibiotalar arthritis, he presented with significantly elevated blood lead levels. Although he remained asymptomatic of lead toxicity, the patient was treated with preoperative chelator therapy and arthroscopic debridement, excision of accessible bullet fragments, and partial synovectomy to alleviate his ankle pain. However, he continued to experience ankle pain, and his blood lead levels remained elevated. He, therefore, underwent arthroscopic ankle arthrodesis with preoperative chelator therapy to prevent a further increase in blood lead levels secondary to surgical manipulation. Although lead arthropathy and toxicity secondary to retained intra-articular bullets has been documented in various joints during the past decades, to the best of our knowledge, the present case is the first adult case of an affected ankle reported in published English studies in 40 years. The standard of care has evolved since then, in particular, in regard to chelator therapy and the necessity for removal of intra-articular lead fragments to prevent further lead toxicity. The present case serves as an example of lead arthropathy of the ankle and highlights the importance of balancing the standard of care with symptomatic care to optimize patient well-being.
Savall, Frederic; Dedouit, Fabrice; Telmon, Norbert; Rougé, Daniel
Candida albicans spondylodiscitis is a fungal infection of the spine which is still unusual in spite of the increasing frequency of predisposing factors. A 22-year-old man received an abdominal stab wound during a physical assault. Initial medical care included surgery, prolonged use of indwelling vascular catheters with administration of broad-spectrum antibiotics, and hospitalization in intensive care. Two months after the event, the victim experienced back pain in the right lumbar region and septic spondylodiscitis secondary to C. albicans was diagnosed three weeks later. This case is noteworthy because of its clinical forensic context. In France, the public prosecutor orders a medico-legal assessment after an assault for all living victims in order to establish a causal relationship between the assault and its complications. In our case, the patient presented numerous risk factors for candidemia and the forensic specialist reasonably accepted that the causal relationship was certain but indirect. We have only found one published case of spondylodiscitis after an abdominal penetrating injury and the pathogenic agent was not mentioned. We have found no case reported in a forensic context. This unusual observation shows that it may be genuinely difficult to prove the causal relationship between an abdominal penetrating injury and an unusual infectious complication such as fungal spondylodiscitis.
Kache, Stephen Akau; Mshelbwala, Philip M.; Ameh, Emmanuel A.
Background: Primary wound closure following laparotomy for peritonitis is generally believed to be associated with wound complications and long hospital stay. Open wound management has long been the most common practice after laparotomy for peritonitis. Primary closure (PC), however, has recently been advocated to reduce cost and morbidity. This study determined the incidence and severity of wound complications and their impact on hospital stay and overall outcome when PC of abdominal wounds is done following laparotomy for peritonitis. Patients and Methods: A prospective review of patients who had PC of abdominal wounds following laparotomy for peritonitis over a 6-year period. Results: Fifty-six children were analysed (35 boys and 21 girls), aged 11 months to 13 years (median: 8 years). The indication for laparotomy was typhoid intestinal perforation 47 (83.9%), perforated appendicitis 4 (7.1%), complicated cholecystitis 3 (5.3%) and penetrating abdominal injury with bowel perforation and intestinal obstruction with bowel perforation, 1 (1.8%) each, respectively. Postoperatively, 34 patients had wound complications. Nine patients (16.1%) had superficial wound infection alone, 12 (21.4%) had superficial wound infection with partial wound dehiscence, 6 (10.7%) had deep wound infection, 7 (12.5%) had deep wound infection with complete wound dehiscence, whereas 22 (39.3%) had no wound complication. Overall, wound complications in 13 (23.2%) patients were considered to be severe, but none resulted in mortality. Hospital stay in patients who developed wound complications was 8–37 days (median: 25 days) and 6–22 days (median: 10 days) in patients who had no wound complications (P = 0.02). Conclusion: The rate of wound complications following PC of dirty abdominal wounds remain but PC is safe and gives good healing outcomes. PMID:28051048
Background Modern high-velocity projectiles produce temporary cavities and can thus cause extensive tissue destruction along the bullet path. It is still unclear whether gelatin blocks, which are used as a well-accepted tissue simulant, allow the effects of projectiles to be adequately investigated and how these effects are influenced by caliber size. Method Barium titanate particles were distributed throughout a test chamber for an assessment of wound contamination. We fired .22-caliber Magnum bullets first into gelatin blocks and then into porcine hind limbs placed behind the chamber. Two other types of bullets (.222-caliber bullets and 6.5 × 57 mm cartridges) were then shot into porcine hind limbs. Permanent and temporary wound cavities as well as the spatial distribution of barium titanate particles in relation to the bullet path were evaluated radiologically. Results A comparison of the gelatin blocks and hind limbs showed significant differences (p < 0.05) in the mean results for all parameters. There were significant differences between the bullets of different calibers in the depth to which barium titanate particles penetrated the porcine hind limbs. Almost no particles, however, were found at a penetration depth of 10 cm or more. By contrast, gas cavities were detected along the entire bullet path. Conclusion Gelatin is only of limited value for evaluating the path of high-velocity projectiles and the contamination of wounds by exogenous particles. There is a direct relationship between the presence of gas cavities in the tissue along the bullet path and caliber size. These cavities, however, are only mildly contaminated by exogenous particles. PMID:22490236
Sigrist, T; Knüsel, H P; Markwalder, C; Rabl, W
Gunshot residue below the surface of the skin is typical of a contact gunshot wound. However, in a case of our own, when a taxi-robber was shot by the cab driver through his right hand at a distance of several yards, this finding provoked quite a confusion. Only when experimental shots at thick glabrous skin were performed, it could be established that long range shots led to intraepidermal gunshot deposit too. The explanation of this phenomenon lies in the tenacity of thick skin. Unlike the thin hairy skin, which is punched out by the penetrating projectile, the thicker and more tenacious plantar/palmar epidermis gets displaced radially, the stratum germinativum tears and the projectile casts its gunshot residue in the pouch formed in such a manner. Therefore, intraepidermal gunshot residue is proof of an entrance gunshot wound but not always a sign of contact shot if the wound is located in the palmar or plantar region. It is typically produced by shots at thick skin.
Dougherty, Paul J; Vaidya, Rahul; Silverton, Craig D; Bartlett, Craig S; Najibi, Soheil
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.
Franchin, Marco; Tozzi, Matteo; Soldini, Gabriele; Piffaretti, Gabriele
Lymphocele is a common complication after kidney transplantation. Although superinfection is a rare event, it generates a difficult management problem; generally, open surgical drainage is the preferred method of treatment but it may lead to complicated postoperative course and prolonged healing time. Negative pressure wound therapy showed promising outcomes in various surgical disciplines and settings. We present a case of an abdominal infected lymphocele after kidney transplantation managed with open surgery and negative pressure wound therapy. PMID:25374744
Yamane, Kazuyoshi; Yamanaka, Takeshi; Maruyama, Hugo; Wang, Pao-Li; Komasa, Satoshi; Okazaki, Joji
Here, we present the complete genome sequence of Actinomyces naeslundii strain ATCC 27039, isolated from an abdominal wound abscess. This strain is genetically transformable and will thus provide valuable information related to its crucial role in oral multispecies biofilm development. PMID:28034855
Vafaei, Ali; Heidari, Kamran; Saboorizadeh, Afshin; shams akhtari, Amin
Introduction: Screening of patients with anterior abdominal penetrating trauma in need for laparotomy is an important issue in management of these cases. This study aimed to compare the accuracy of abdominal wall ultrasonography (AWU) and local wound exploration (LWE) in this regard. Methods: This diagnostic accuracy study was conducted on ≥ 18 year-old patients presenting to emergency department with anterior abdominal stab wound and stable hemodynamics, to compare the characteristics of AWU and LWE in screening of patients in need of laparotomy. Results: 50 cases with the mean age of 28.44 ± 7.14 years were included (80% male). Sensitivity, specificity and area under the receiver operating characteristic (ROC) curve of AWU were 70.58 (95% CI: 44.04 – 88.62), 93.33 (95% CI: 76.49 – 98.83), and 81.96 (95% CI: 69.91 – 94.01), respectively. These measures were 88.23 (62.25 – 97.93), 93.33 (76.49 – 98.83), and 90.78 (95% CI: 81.67 – 99.89) for LWE, respectively. The difference in overall accuracy of the two methods was not statistically significant (p = 0.0641). Conclusion: Based on the findings of the present study, AWU and LWE had the same specificity but different sensitivities in screening of anterior abdominal stab wound patients in need of laparotomy. The overall accuracy of LWE was slightly higher (91.48% versus 85.1%). PMID:28286841
severity at the time of presentation to veterinary care was not correlated with length of time until return to duty. (J Vet Emerg Crit Care 2013; 23(1...action MWD Military Working Dogs OEF Operation Enduring Freedom OIF Operation Iraqi Freedom RTD Return to duty time TACEVAC tactical evacuation TCCC...Tactical Combat Casualty Care WIA wounded in action Introduction Military Working Dogs (MWDs) have been used exten- sively in current military areas of
de Araújo, Gabriel Costa Serrão; Mourão, Natália Teixeira; Pinheiro, Igor Natário; Xavier, Analúcia Rampazzo; Gameiro, Vinicius Schott
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
Dabdoub, CB; Serra, SM; da Cunha, AH; Silveira, EN; Lopez, A; Azevedo-Filho, H
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
Abadir, Adel R; Nicolas, Fred; Gharabawy, Ramiz; Shah, Trusha; Michael, Rafik
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.
Korohl, S O
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.
Baeza-Herrera, C; Baeza-Herrera, M A
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.
Puentes, Katerina; Ribeiro, Cristina; Jardim, Patrícia; Santos, Agostinho; Magalhães, Teresa
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
Guiberteau, B; Kohen, M; Borde, L; Sartre, J Y; Bourseau, J C; Le Neel, J C
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.
Taha, Mohamed; Davis, Niall F; Power, Richard; Mohan, Ponusamy; Forde, James; Smyth, Gordon; Little, Dilly M
Kidney transplant recipients are at an increased risk of developing surgical site wound complications due to their immunosuppressed status. We aimed to determine whether increased mid-abdominal circumference (MAC) is predictive for wound complications in transplant recipients. A prospective study was performed on all kidney transplant recipients from October 2014 to October 2015. "Controls" consisted of kidney transplant recipients without a surgical site wound complication and "cases" consisted of recipients that developed a wound complication. In total, 144 patients underwent kidney transplantation and 107 patients met inclusion criteria. Postoperative wound complications were documented in 28 (26%) patients. Patients that developed a wound complication had a significantly greater MAC, body mass index (BMI), and body weight upon renal transplantation (P<.001, P=.011, and P=.011, respectively). On single and multiple logistic regression analyses, MAC was a significant predictor for developing a surgical wound complication (P=.02). Delayed graft function and a history of preformed anti-HLA antibodies were also predictive for surgical wound complications (P=.003 and P=.014, respectively). Increased MAC is a significant predictor for surgical wound complications in kidney transplant recipients. Integrating clinical methods for measuring visceral adiposity may be useful for stratifying kidney transplant recipients with an increased risk of a surgical wound complication.
Hussain, Qasim; Maleux, Geert Heye, Sam; Fourneau, Inge
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.
Victoroff, B N; Robertson, W W; Eichelberger, M R; Wright, C
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.
Young, Christopher N.J.; Ng, Ka Ying Bonnie; Webb, Vanessa; Vidow, Sarah; Parasuraman, Rajeswari; Umranikar, Sameer
Abstract Introduction: Bacterial cellulitis post-Cesarean section is rare. Negative pressure wound therapy (NPWT) is widely used in various medical specialities; its effectiveness in obstetrics however remains the topic of debate—used predominantly as an adjunct to secondary intention specific to high-risk patient groups. Its application in the treatment of actively infected wounds post-Cesarean is not well documented. Here, we document NPWT in the treatment of an unusually severe case of bacterial cellulitis with abdominal abscess postpartum. We provide a unique photographic timeline of wound progression following major surgical debridement, documenting the effectiveness of 2 different NPWT systems (RENASYS GO and PICO, Smith & Nephew). We report problems encountered using these NPWT systems and “ad-hoc” solutions to improve efficacy and patient experience. A 34-year-old primiparous Caucasian female with no prior history or risk factors for infection and a normal body mass index (BMI) presented with severe abdominal pain, swelling, and extensive abdominal redness 7 days postemergency Cesarean section. Examination revealed extensive cellulitis with associated abdominal abscess. Staphylococcus aureus was identified in wound exudates and extensive surgical debridement undertaken day 11 postnatally due to continued febrile episodes and clinical deterioration, despite aggressive intravenous antibiotic therapy. Occlusive NPWT dressings were applied for a period of 3 weeks before discharge, as well as a further 5 weeks postdischarge into the community. NPWT was well tolerated and efficacious in infection clearance and wound healing during bacterial cellulitis. Wound healing averaged 1 cm2 per week before NPWT withdrawal; cessation of NPWT before full wound closure resulted in significantly reduced healing rate, increased purulent discharges, and skin irritation, highlighting the efficacy of NPWT. Five-month follow-up in the clinic found the wound to be fully
Usui, Akihito; Kawasumi, Yusuke; Hosokai, Yoshiyuki; Kozakai, Masataka; Saito, Haruo; Funayama, Masato
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.
Gibelli, Daniele; Brandone, Alberto; Andreola, Salvatore; Porta, Davide; Giudici, Elena; Grandi, Marco Aurelio; Cattaneo, Cristina
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.
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
Lindström, Anne-Christine; Hoogewerff, Jurian; Athens, Josie; Obertova, Zuzana; Duncan, Warwick; Waddell, Neil; Kieser, Jules
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.
Lin, David J.; Lam, Fred C.; Siracuse, Jeffrey J.; Thomas, Ajith; Kasper, Ekkehard M.
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
Seçer, Mehmet; Ulutaş, Murat; Yayla, Erdal; Çınar, Kadir
INTRODUCTION This report describes a rare case of the gunshot injury of the spine and spinal cord. PRESENTATION OF CASE A rare case of the bullet lodged intra-durally in the upper cervical region without damaging the vertebrae or the spinal cord. The bullet was removed as microneurosurgical and duraplasty was performed. DISCUSSION Surgical management of the gunshot wounds of the spine and spinal cord is not widely advocated and controversial. CONCLUSION Advances in microneurosurgical instrumentation and microscopic techniques may open up a new era of surgical treatment of spinal cord gunshot wounds. PMID:24566426
Lee, W C; Uddo, J F; Nance, F C
A 10-year retrospective study of patients with stab wounds to the abdomen managed under a protocol of selective management has been performed. Patients were assessed on the basis of clinical presentation and physical examination, with minimal diagnostic studies. Peritoneal lavage was not utilized in the evaluation of the patients. Two hundred and nineteen such patients were identified. One hundred and eleven of these patients were treated nonoperatively. Ninety patients were treated by immediate laparotomy. Eighteen patients, initially observed, underwent delayed laparotomy. One patient, not explored despite clear-cut indications for laparotomy, died of sepsis, emphasizing the need for strict adherence to the stated protocol. The negative or unnecessary laparotomy rate was 7.8%. The false-negative examination rate was 5.5%. Overall mortality rate was 2.3%. The accuracy of careful clinical evaluation and observation is comparable to, or better than, any other method currently available to identify intra-abdominal injuries in patients with abdominal stab wounds. The study suggests that selective management of stab wounds of the abdomen may be safely practiced in a smaller community hospital. PMID:6721604
Mihaljevic, André L.; Müller, Tara C.; Kehl, Victoria; Friess, Helmut; Kleeff, Jörg
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
Shin, Jin Su
Necrotizing fasciitis (NF) is an aggressive soft-tissue infection involving the deep fascia and is characterized by extensive deterioration of the surrounding tissue. Immediate diagnosis and intensive treatment, including debridement and systemic antibiotics, represent the most important factors influencing the survival of NF patients. In this report, we present a case of NF in the abdomen due to an infection caused by a perforated small bowel after abdominal liposuction. It was successfully treated using negative-pressure wound therapy, in which a silicone sheet functioned as a barrier between the sponge and internal organs to protect the small bowel. PMID:28194352
Berryman, Hugh E; Kutyla, Alicja K; Russell Davis, J
Pork ribs with intact muscle tissue were used in an experimental attempt to identify bullet wipe on bone at distances from 1 to 6 feet with 0.45 caliber, full metal jacket ammunition. This resulted in the unexpected finding of primer-derived gunshot residue (GSR) deep within the wound tract. Of significance is the fact that the GSR was deposited on the bone, under the periosteum, after the bullet passed through a Ziploc bag and c. 1 inch of muscle tissue. It is also important to note that the GSR persisted on the bone after the periosteum was forcibly removed. The presence of primer-derived GSR on bone provides the potential to differentiate gunshot trauma from blunt trauma when the bone presents an atypical gunshot wound. In this study, the presence of gunshot primer residue at a distance of 6 feet demonstrates the potential for establishing maximum gun-to-target distance for remote shootings.
Pinto, Antonio; Brunese, Luca; Scaglione, Mariano; Scuderi, Maria Giuseppina; Romano, Luigia
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.
Arunkumar, K. V.; Kumar, Sanjeev; Aggarwal, Rajat; Dubey, Prajesh
The use of firearms is becoming more prevalent in the society and hence the number of homicidal and suicidal cases. The severity of gunshot wounds varies depending on the weapons caliber and the distance of firing. Close-range, high-velocity gunshot wounds in the head and neck region can result in devastating esthetic 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 reconstructions. Here we present the successful management of a patient shot by a low-velocity short-range pistol with basic life support measures, wound management, reconstruction, and rehabilitation. PMID:23482828
Arunkumar, K V; Kumar, Sanjeev; Aggarwal, Rajat; Dubey, Prajesh
The use of firearms is becoming more prevalent in the society and hence the number of homicidal and suicidal cases. The severity of gunshot wounds varies depending on the weapons caliber and the distance of firing. Close-range, high-velocity gunshot wounds in the head and neck region can result in devastating esthetic 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 reconstructions. Here we present the successful management of a patient shot by a low-velocity short-range pistol with basic life support measures, wound management, reconstruction, and rehabilitation.
Junge, Karsten; Klinge, Uwe; Klosterhalfen, Bernd; Rosch, Raphael; Stumpf, Michael; Schumpelick, Volker
A 58-year-old man has been under our care with an inguinal hernia that has recurred 8 times. This stimulated us to review the biochemistry of wound repair. We studied the composition of his collagen and tried to find out whether it was intrinsically faulty or whether its fault had been caused by the medication he was taken.
Kunz, Sebastian Niko; Meyer, Harald J; Kraus, Sybille
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.
Borlase, B C; Metcalf, R K; Moore, E E; Manart, F D
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.
Ferrada, R; Birolini, D
In the future, trauma research and care will have to become better, faster, and less expensive. Surgeons in the next millennium must be able to diagnose wounds, initiate correct procedures, and anticipate complications more accurately than before. Violent crime will not abate, nor will the proliferation of more powerful arms; these trends translate into graver traumatic wounds, giving the operating team less time to stabilize patients. Time management and team coordination are becoming key elements for patient survival, especially for patients with potentially fatal wounds, such as those to the heart. The authors have reduced the time from arrival to surgery to a few minutes. The keys to this feat are readiness, team coordination, and high morale. Financial resources will continue to be limited and allocated on a need-first basis. In the future, trauma centers will compete for dwindling funds. Technology is and always will be just a tool, whereas qualified trauma surgeons are irreplaceable, much more so than in any other surgical specialty. Observation, diagnosis, and surgery are, of course, greatly facilitated by ever-evolving technology, but since the time of Hippocrates, split-second decisions can ultimately be made only by the caregiver in the white smock. Trauma surgeons in the next millennium will have to exercise judgment based on knowledge, surgical skills, and contact with patients. To err is human, but in surgery, errors often cause death, and no machine will ever relieve surgeons of that burden.
Kumar, Senthil; Rao, Murali G
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
Havel, J; Vajtr, D; Starý, V; Vrána, J; Zelenka, K; Adámek, T
Scanning electron microscope improves the possibility of investigation of surroundings near of gunshot wounds in forensic medicine, it is the next subsequent method for differentiating of area of entrance and exit wound, supplemental method for determination of firing distance, permit of detection (GSR) on the hand of shooter and ensured describing of samples and their stored. Detection of GSR provides many information about composition of bullet and primer. Authors are demonstrating the possibility of detection of GSR on experimental shooting to the krupon (pigs' skin) in different situation (such as in a room and in outside area) and using of different weapon (hand gun CZ No.75 and machine gun No.58).
Witnesses, friends and family of a man chased through a field by the police, said they heard gunshots. The man chased says that the police shot at him. The police say that no shots were fired. Could the witnesses have heard the gunshots? The main technical issues are source strength and directivity, weather effects on sound propagation, attenuation by forests, sound transmissions through walls, and signal detectability. This paper lays out the material much as the jury heard it.
Taborelli, Anna; Gibelli, Daniele; Rizzi, Agostino; Andreola, Salvatore; Brandone, Alberto; Cattaneo, Cristina
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.
Buszewska-Forajta, Magdalena; Struck-Lewicka, Wiktoria; Bujak, Renata; Siluk, Danuta; Kaliszan, Roman
Wound healing is still a serious medical problem due to process complexity and lack of effective medicaments. This is particularly true in the treatment of wounds arising in the course of such diseases as AIDS or diabetes. Therefore, scientific efforts are focused on the search for new compounds of natural origin, which could be used as medicines or evaluated for subsequent drug design. In folk medicine, grasshopper (Chorthippus spp.) abdominal secretion has been used to accelerate the wound healing process. In this context, the knowledge of the composition of grasshopper abdominal secretion is crucial. The aim of this study was to determine the main water-soluble components of grasshopper abdominal secretion with the use of GC/MS/MS. Liquid-liquid extraction was used as a pretreatment method to clean up, concentrate and fractionate compounds from the complex insect matrix. To obtain more stable and volatile compounds, necessary for GC/MS/MS analysis, a double-step derivatization process was carried out with the use of methoxyamine hydrochloride and a mixture of bis-N,O-trimethylsilyl trifluoroacetamide and chlorotrimethylsilane. As a result, 2,108 compounds were identified, mainly as amino acids, carbohydrates and organic acids. Some of the identified compounds are emphasized due to antimicrobial, antifungal or antioxidant activities reported in the literature. Moreover, a set of compounds characteristic for Chorthippus spp. samples has been selected. In the last part of the study, a statistical analysis was performed to demonstrate differences in composition of aqueous fractions of abdominal secretions from grasshoppers collected at two distant locations: Starogard Gdański and Łubianka meadows.
Straka, Lubomir; Novomesky, Frantisek; Stuller, Frantisek; Janik, Martin; Krajcovic, Jozef; Hejna, Petr
Complex suicide is usually defined as the application of more than one killing mechanism to ensure a fatal outcome. Herein we report an unusual case of a planned complex suicide of a 20 year old-male combining gunshot with coincidental intentional vehicular crash. The case was initially assumed to be a simple traffic accident until a rimfire pistol was found in close proximity to the deceased as well as gunshot wound of the head. This paper demonstrates the importance of careful inspection of the death scene, as well as the complex performance of autopsy examination to explain the manner of death and distinguish accidental deaths from suicides in such cases. Nevertheless, this assessment might by very difficult or even impossible. It has to be assumed that a high number of suicides in road traffic remain undetected.
Ojo, Emmanuel Olorundare; Ozoilo, Kenneth N.; Sule, Augustine Z.; Ugwu, Benjamin T.; Misauno, Michael A.; Ismaila, Bashiru O.; Peter, Solomon D.; Adejumo, Adeyinka A.
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
Comparative study of the microvascular blood flow in the intestinal wall, wound contraction and fluid evacuation during negative pressure wound therapy in laparostomy using the V.A.C. abdominal dressing and the ABThera open abdomen negative pressure therapy system.
Lindstedt, Sandra; Malmsjö, Malin; Hlebowicz, Joanna; Ingemansson, Richard
This study aimed to compare the changes in microvascular blood flow in the small intestinal wall, wound contraction and fluid evacuation, using the established V.A.C. abdominal dressing (VAC dressing) and a new abdominal dressing, the ABThera open abdomen negative pressure therapy system (ABThera dressing), in negative pressure wound therapy (NPWT). Midline incisions were made in 12 pigs that were subjected to treatment with NPWT using the VAC or ABThera dressing. The microvascular blood flow in the intestinal wall was measured before and after the application of topical negative pressures of −50, −75 and −125mmHg using laser Doppler velocimetry. Wound contraction and fluid evacuation were also measured. Baseline blood flow was defined as 100% in all settings. The blood flow was significantly reduced to 64·6±6·7% (P <0·05) after the application of −50mmHg using the VAC dressing, and to 65·3±9·6% (P <0·05) after the application of −50mmHg using the ABThera dressing. The blood flow was significantly reduced to 39·6±6·7% (P <0·05) after the application of −125mmHg using VAC and to 40·5±6·2% (P <0·05) after the application of −125mmHg using ABThera. No significant difference in reduction in blood flow could be observed between the two groups. The ABThera system afforded significantly better fluid evacuation from the wound, better drainage of the abdomen and better wound contraction than the VAC dressing.
Bebchuk, T N; Harari, J
The increase in gun ownership and shootings of dogs and cats in urban and rural areas has made it important for veterinarians to be familiar with the treatment of gunshot injuries. The damage inflicted on the soft tissues and bone depends on the type of firearm used and the range at which it was fired. Proper initial evaluation and management are critical in the treatment of these injuries. Fractures caused by gunshots are contaminated and can often be stabilized with external fixation. Complications and special considerations of these fractures and associated soft tissue injuries are discussed.
Sánchez-Cabezón, Carmen; Montes-Olangua, Maria Isabel; García-Suarez, Sara; García-Carretero, Rafael
The Hospital at Home is a range of hospital care provided to patients in the comfort of their own homes, so patient and family can actively participate in the process. Cesarean section is a surgical procedure that requires a short hospital stay. However if complications arise during the process, such as a dehiscence of surgical wound, the hospital stay is prolonged, delaying mother-child bonding, which is very important for the growth of the child. Nursing care in wound healing by secondary intention is a priority for the patient's recovery. VAC therapy (vacuum assisted closure) promotes a rapid recovery, although it requires dressings and active medical surveillance, as well as training by the nursing staff for carrying it out at home. We describe the outcome and the process of the healing of a surgical wound after cesarean section, not only because of a complex wound, but the previously mentioned factors that make us consider the Hospital at Home as the best alternative care.
Fischer, Tatjana V; Folio, Les R; Backus, Christopher E; Bunger, Rolf
Penetrating trauma is frequently encountered in forward deployed military combat hospitals. Abdominal blast injuries represent nearly 11% of combat injuries, and multiplanar computed tomography imaging is optimal for injury assessment and surgical planning. We describe a multiplanar approach to assessment of blast and ballistic injuries, which allows for more expeditious detection of missile tracts and damage caused along the path. Precise delineation of the trajectory path and localization of retained fragments enables time-saving and detailed evaluation of associated tissue and vascular injury. For consistent and reproducible documentation of fragment locations in the body, we propose a localization scheme based on Cartesian coordinates to report 3-dimensional locations of fragments and demonstrating the application in three cases of abdominal blast injury.
Migliorini, Arnaldo Stanislao; Andreola, Salvatore; Battistini, Alessio; Gentile, Guendalina; Muccino, Enrico; Vancheri, Giulia; Zoja, Riccardo
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
Poppa, Pasquale; Porta, Davide; Gibelli, Daniele; Mazzucchi, Alessandra; Brandone, Alberto; Grandi, Marco; Cattaneo, Cristina
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.
Burnett, Bryan R.
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.
Taudte, Regina Verena; Beavis, Alison; Blanes, Lucas; Cole, Nerida; Doble, Philip; Roux, Claude
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.
Tattoli, Lucia; Schmid, Simone; Tsokos, Michael
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.
... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Mechanical; gunshot. 313.16 Section 313.16 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE.... Choice of firearms and ammunition with respect to caliber and choice of powder charge required to...
Comiskey, Patrick; Yarin, Alexander; Kim, Sungu; Attinger, Daniel
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 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. The model 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 number of, distribution, and location of blood stains and their shapes and sizes. The drop cloud originating from a wound entrains a significant mass of air due to the action of viscous forces. As a result of this collective effect, air drag acting on individual drops in the cloud is significantly reduced and fully accounted for in the model. The results of the model are compared to experimental data on back spatter generated by a gunshot impacting a blood-impregnated sponge. The model proposed in this work is in reasonable agreement with the results from the experimental data. Support of this work by the US National Institute of Justice (Award NIJ 2014-DN-BX-K036) is greatly appreciated.
Carey, M E; Sarna, G S; Farrell, J B; Happel, L T
Among civilians in the United States, 33,000 gunshot wound deaths occur each year; probably half of these involve the head. In combat, head wounds account for approximately half of the immediate mortality when death can be attributed to a single wound. No significant reduction in the neurosurgical mortality associated with these wounds has occurred between World War II and the Vietnam conflict, and very little research into missile wounds of the brain has been undertaken. An experimental model has been developed in the anesthetized cat whereby a ballistic injury to the brain may be painlessly reproduced in order that the pathophysiological effects of brain wounding may be studied and better treatments may be designed to lower the mortality and morbidity rates associated with gunshot wounds. Prominent among physiological effects observed in this model was respiratory arrest even though the missile did not injure the brain stem directly. The incidence of prolonged respiratory arrest increased with increasing missile energy, but arrest was often reversible provided respiratory support was given. It is possible that humans who receive a brain wound die from missile-induced apnea instead of brain damage per se. The mortality rate in humans with brain wounding might be reduced by prompt respiratory support. Brain wounding was associated with persistently increased intracranial pressure and reduced cerebral perfusion pressure not entirely attributable to intracranial bleeding. The magnitude of these derangements appeared to be missile energy-dependent and approached dangerous levels in higher-energy wounds. All wounded cats exhibited postwounding increases in blood glucose concentrations consistent with a generalized stress reaction. A transient rise in hematocrit also occurred immediately after wounding. Both of these phenomena could prove deleterious to optimal brain function after injury.
Singer, R L; Davis, D; Houck, M M
A survey was sent to 80 forensic laboratories in 44 States and two Canadian Provinces concerning methodology in analyzing gunshot residue (GSR) and interpreting the results. Of the 80 surveys, 50 (63%) were returned completed. Questions included standard procedures, collection methods, thresholding problems and specificity of data. These results are compared to a previous survey reported in 1990. Implications for the interpretation and future study of these methods are discussed.
Bolliger, Stephan A; Thali, Michael J; Bolliger, Michael J; Kneubuehl, Beat P
By measuring the total crack lengths (TCL) along a gunshot wound channel simulated in ordnance gelatine, one can calculate the energy transferred by a projectile to the surrounding tissue along its course. Visual quantitative TCL analysis of cut slices in ordnance gelatine blocks is unreliable due to the poor visibility of cracks and the likely introduction of secondary cracks resulting from slicing. Furthermore, gelatine TCL patterns are difficult to preserve because of the deterioration of the internal structures of gelatine with age and the tendency of gelatine to decompose. By contrast, using computed tomography (CT) software for TCL analysis in gelatine, cracks on 1-cm thick slices can be easily detected, measured and preserved. In this, experiment CT TCL analyses were applied to gunshots fired into gelatine blocks by three different ammunition types (9-mm Luger full metal jacket, .44 Remington Magnum semi-jacketed hollow point and 7.62 × 51 RWS Cone-Point). The resulting TCL curves reflected the three projectiles' capacity to transfer energy to the surrounding tissue very accurately and showed clearly the typical energy transfer differences. We believe that CT is a useful tool in evaluating gunshot wound profiles using the TCL method and is indeed superior to conventional methods applying physical slicing of the gelatine.
Amadasi, Alberto; Gibelli, Daniele; Mazzarelli, Debora; Porta, Davide; Gaudio, Daniel; Salsarola, Dominic; Brandone, Alberto; Rizzi, Agostino; Cattaneo, Cristina
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.
Blanes, Lucas; Cole, Nerida; Doble, Philip; Roux, Claude
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
Comiskey, P. M.; Yarin, A. L.; Kim, S.; Attinger, D.
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.
Khominets, V V; Zhigalo, A V; Mikhailov, S V; Shakun, D A; Shcuhkin, A V; Foos, I V; Pochtenko, V V
Plastic reconstruction of soft tissue defects of extremities' resulted from gunshot with the help of triangular flap. The authors suggested an original technique of plastic surgery of round and oval-shaped gunshot wounds of soft tissues with the use. of triangular flap. The core of technique is to move triangular skin flap in the form of the letter
Dubrovin, I A; Dubrovina, I A
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.
Saverio Romolo, F; Margot, P
A review of the scientific papers published on inorganic gunshot residue (GSR) analysis permits to study how the particle analysis has shown its capability in detection and identification of gunshot residue. The scanning electron microscope can be the most powerful tool for forensic scientists to determine the proximity to a discharging firearm and/or the contact with a surface exposed to GSR. Particle analysis can identify individual gunshot residue particles through both morphological and elemental characteristics. When particles are detected on the collected sample, the analytical results can be interpreted following rules of a formal general interpretative system, to determine whether they come from the explosion of a primer or from other possible sources. The particles on the sample are compared with an abstract idea of "unique" GSR particle produced by the sole source of the explosion of a primer. "Uniqueness" is not the only problem related to GSR detection and identification for a forensic scientist. With "not-unique" particles interpretation of results is extremely important. The evidential strength of "not-unique" particles can increase with a more fruitful interpretative framework based on Bayes rule. For the assessment of the value of a GSR in linking a suspect and a crime, it is important to compare two hypothesis: the first can be that of the evidence if the suspect has been shooting in a specific situation, the second that of the evidence if the suspect was not involved in this shooting. This case specific or case-by-case approach is closer to what the court is interested in. The authors consider that a "case-by-case" approach should be followed whenever possible. Research of models and data such as those developed in other trace evidence material (fibres, glass, etc.) using a Bayesian approach is suggested in the interpretation of GSR.
Strajina, Veljko; Živković, Vladimir; Nikolić, Slobodan
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).
Duarte, A.; Silva, L. M.; de Souza, C. T.; Stori, E. M.; Boufleur, L. A.; Amaral, L.; Dias, J. F.
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.
Keskinbora, Mert; Yalçin, Sercan; Oltulu, İsmail; Erdil, Mehmet Emin; Örmeci, Tuğrul
Gunshot injuries are getting more frequently reported while the civilian (nongovernmental) armament increases in the world. A 42-year-old male patient presented to emergency room of Istanbul Medipol University Hospital due to a low-velocity gunshot injury. We detected one entry point on the posterior aspect of the thigh, just superior to the popliteal groove. No exit wound was detected on his physical examination. There was swelling around the knee and range of motion was limited due to pain and swelling. Neurological and vascular examinations were intact. Following the initial assessment, the vascular examination was confirmed by doppler ultrasonography of the related extremity. There were no signs of compartment syndrome in the preoperative physical examination. A bullet was detected in the knee joint on the initial X-rays. Immediately after releasing the tourniquet, swelling of the anterolateral compartment of the leg and pulse deficiency was detected on foot in the dorsalis pedis artery. Although the arthroscopic removal of intra-articular bullets following gunshot injuries seems to have low morbidity rates, it should always be considered that the articular capsule may have been ruptured and the fluids used during the operation may leak into surrounding tissues and result in compartment syndrome.
Yalçin, Sercan; Oltulu, İsmail; Erdil, Mehmet Emin; Örmeci, Tuğrul
Gunshot injuries are getting more frequently reported while the civilian (nongovernmental) armament increases in the world. A 42-year-old male patient presented to emergency room of Istanbul Medipol University Hospital due to a low-velocity gunshot injury. We detected one entry point on the posterior aspect of the thigh, just superior to the popliteal groove. No exit wound was detected on his physical examination. There was swelling around the knee and range of motion was limited due to pain and swelling. Neurological and vascular examinations were intact. Following the initial assessment, the vascular examination was confirmed by doppler ultrasonography of the related extremity. There were no signs of compartment syndrome in the preoperative physical examination. A bullet was detected in the knee joint on the initial X-rays. Immediately after releasing the tourniquet, swelling of the anterolateral compartment of the leg and pulse deficiency was detected on foot in the dorsalis pedis artery. Although the arthroscopic removal of intra-articular bullets following gunshot injuries seems to have low morbidity rates, it should always be considered that the articular capsule may have been ruptured and the fluids used during the operation may leak into surrounding tissues and result in compartment syndrome. PMID:26929809
Zack, F; Manhart, J; Rummel, J; Büttner, A
Against the background of a problematic reconstruction of a hunting accident, the question arises how such cases can be handled in hospitals and how exhibits can be adequately dealt with. After evaluating a questionnaire on current conditions of securing evidence in cases of surgically treated gunshot wounds from 26 surgical institutions in Mecklenburg-Western Pomerania and in consideration of the certified advanced training in the field of legal medicine, recommendations are given regarding the securing of evidence within the clinical setting without primary involvement of police or legal medicine.
Amadasi, Alberto; Merli, Daniele; Brandone, Alberto; Poppa, Pasquale; Gibelli, Daniele; Cattaneo, Cristina
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.
Tokdemir, Mehmet; Kafadar, Huseyin; Turkoglu, Abdurrahim; Bork, Turgay
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.
Bluman, Eric M; Ficke, James R; Covey, Dana C
Foot and ankle trauma sustained in the Global War on Terror have unique causes and characteristics. At least one-quarter of all battle injuries involve the lower extremity. These severe lower extremity wounds require specialized early treatment. Ballistic mechanisms cause almost all injuries, and as such, most combat foot and ankle wounds are open in nature. Wounds are characteristically caused by blast mechanisms, but high velocity gunshot injuries are also common. The severe and polytraumatic nature of injuries sustained frequently call for damage control orthopaedics to be utilized. Cautious early treatment of irregular and highly exudative ballistic wounds with subatmospheric wound dressings may ease their early management.
Balsa, Ingrid M; Culp, William T N
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.
Sen, P.; Panigrahi, N.; Rao, M.S.; Varier, K.M.; Sen, S.; Mehta, G.K.
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.
Wang, J; Ye, C Y; Zhu, M Y; Yuan, J D; Ten, H L
A 32-year old male patient was wounded by a pistol. As shown in computed tomography (CT) scanning images, there was comminuted fracture of the left mandible and the bullet was found in the left side behind the sixth cervical vertebra. After the patient was hospitalized, the debridement was done in the emergency room and the operation of open reduction and internal fixation for comminuted fracture of left mandible was performed successfully. Eighteen days later, the patient was taken to surgery for anterior cervical decompression and fusion with autogenous iliac bone grafting for the sixth cervical vertebra. Postoperative follow-up of the patient over two years indicated that the left biceps muscle strength was recovered to level 4. Gunshot wound to the face associated with injury of the low cervical spine has the possibility of survival. It is safe to treat facial wounds early in the patient's treatment course, even if the bullet remains in the cervical vertebral body and there is neurological function damage.
Wang, J; Ye, CY; Zhu, MY; Yuan, JD; Ten, HL
A 32-year old male patient was wounded by a pistol. As shown in computed tomography (CT) scanning images, there was comminuted fracture of the left mandible and the bullet was found in the left side behind the sixth cervical vertebra. After the patient was hospitalized, the debridement was done in the emergency room and the operation of open reduction and internal fixation for comminuted fracture of left mandible was performed successfully. Eighteen days later, the patient was taken to surgery for anterior cervical decompression and fusion with autogenous iliac bone grafting for the sixth cervical vertebra. Postoperative follow-up of the patient over two years indicated that the left biceps muscle strength was recovered to level 4. Gunshot wound to the face associated with injury of the low cervical spine has the possibility of survival. It is safe to treat facial wounds early in the patient's treatment course, even if the bullet remains in the cervical vertebral body and there is neurological function damage. PMID:25429487
... Kidney - blood and urine flow Abdominal ultrasound References Chen L. Abdominal ultrasound imaging. In: Sahani DV, Samir ... the Health on the Net Foundation (www.hon.ch). The information provided herein should not be used ...
... tap; Cirrhosis - abdominal tap; Malignant ascites - abdominal tap Images Digestive system Peritoneal sample References Garcia-Tiso G. ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...
Maurya, Sanjay; Bhandari, Prem Singh
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
Maurya, Sanjay; Bhandari, Prem Singh
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.
Samokhvalov, I M; Reva, V A; Denisov, A V; Ozeretskovskiĭ, L B; Pronchenko, A A
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.
... call your doctor. In Spanish— Dolor abdominal en niños menores de 12 años What is recurrent abdominal ... Functional abdominal pain (FAP) typically affects kids ages 4-12, and is quite common, affecting up to ...
Nesbakken, A; Pillgram-Larsen, J; Naess, F; Gerner, T; Solheim, K; Stadaas, J O; Gjøra, O
We have reviewed the medical records of 111 patients treated for abdominal stab wounds during the period 1980-87. Our two hospitals serve a catchment area of about 450,000 people. Exploratory laparotomy was performed in 89 patients with suspected peritoneal penetration. In 16 patients the laparotomy was negative, and in 15 patients only minor injuries were noted. There were no serious complications in these 31 patients. Twenty-seven patients had thoracic wounds below the fourth intercostal space, 15 with intraabdominal injuries. The most common injuries were lacerations of the liver, the small bowel and the diaphragm. The mortality in the series was 2%. Stab wounds are infrequent in Norway, and most surgeons have limited experience of such injuries. We discuss whether to employ immediate exploratory laparotomy or selective management when the peritoneum has been penetrated. When there is no evidence of evisceration or omental protrusion, local exploration of the wound should be performed in order to confirm or exclude peritoneal penetration. Injury to the diaphragm and intraabdominal viscera should always be suspected in thoracic stab wounds below the fourth intercostal space.
Molina, D Kimberley; Martinez, Michael; Garcia, James; DiMaio, Vincent J M
Several different methods can be employed to test for gunshot residue (GSR) on a deceased person's hands, including scanning electron microscopy with energy-dispersive x-ray spectroscopy (SEM-EDX) and inductively coupled plasma-atomic emission spectrometry (ICP-AES). Each of these techniques has been extensively studied, especially on living individuals. The current studies (Part I and Part II) were designed to compare the use and utility of the different GSR testing techniques in a medical examiner setting. In Part I, the hands of deceased persons who died from undisputed suicidal handgun wounds were tested for GSR by SEM-EDX over a 4-year period. A total of 116 cases were studied and analyzed for caliber of weapon, proximity of wound, and results of GSR testing, including spatial deposition upon the hands. It was found that in only 50% of cases with a known self-inflicted gunshot wound was SEM-EDX positive for at least 1 specific particle for GSR. In 18% of the cases there was a discernible pattern (spatial distribution) of the particles on the hand such that the manner in which the weapon was held could be determined. Since only 50% of cases where the person is known to have fired a weapon immediately prior to death were positive for GSR by SEM-EDX, this test should not be relied upon to determine whether a deceased individual has discharged a firearm. Furthermore, in only 18% of cases was a discernible pattern present indicating how the firearm was held. The low sensitivity, along with the low percentage of cases with a discernible pattern, limits the usefulness of GSR test results by SEM-EDX in differentiating self-inflicted from non-self-inflicted wounds.
Musin, E Kh; Lepik, D; Viali, M
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.
Alvis-Miranda, Hernando Raphael; Adie Villafañe, Roberto; Rojas, Alejandro; Alcala-Cerra, Gabriel
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
Kuppermann, Nathan; Holmes, James F.; Haukoos, Jason S.; Wetzel, Brian; Hsia, Renee Y.; Wang, N. Ewen; Bulger, Eileen M.; Staudenmayer, Kristan; Mann, N. Clay; Barton, Erik D.; Wintemute, Garen
OBJECTIVE: To describe the incidence, injury severity, resource use, mortality, and costs for children with gunshot injuries, compared with other injury mechanisms. METHODS: This was a population-based, retrospective cohort study (January 1, 2006–December 31, 2008) including all injured children age ≤19 years with a 9-1-1 response from 47 emergency medical services agencies transporting to 93 hospitals in 5 regions of the western United States. Outcomes included population-adjusted incidence, injury severity score ≥16, major surgery, blood transfusion, mortality, and average per-patient acute care costs. RESULTS: A total of 49 983 injured children had a 9-1-1 emergency medical services response, including 505 (1.0%) with gunshot injuries (83.2% age 15–19 years, 84.5% male). The population-adjusted annual incidence of gunshot injuries was 7.5 cases/100 000 children, which varied 16-fold between regions. Compared with children who had other mechanisms of injury, those injured by gunshot had the highest proportion of serious injuries (23%, 95% confidence interval [CI] 17.6–28.4), major surgery (32%, 95% CI 26.1–38.5), in-hospital mortality (8.0%, 95% CI 4.7–11.4), and costs ($28 510 per patient, 95% CI 22 193–34 827). CONCLUSIONS: Despite being less common than other injury mechanisms, gunshot injuries cause a disproportionate burden of adverse outcomes in children, particularly among older adolescent males. Public health, injury prevention, and health policy solutions are needed to reduce gunshot injuries in children. PMID:24127481
Korohl, S O; Zherdev, I I; Domanskiy, A M
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.
Molina, D Kimberley; Castorena, Joe L; Martinez, Michael; Garcia, James; DiMaio, Vincent J M
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.
Glauser, Frédéric; Barras, Anne-Catherine; Pache, Isabelle; Monti, Matteo
Abdominal paracentesis is frequently performed in the clinical setting. Every newly developed ascites need to be investigated by abdominal paracentesis. Any clinical or biological deterioration in patients with chronic ascites also requires a new paracentesis. Therapeutically abdominal paracentesis is performed for refractory or symptomatic ascites. As other invasive procedures, it is critical to master its indications, contra-indications and complications. The aim of this article is to review the basics of abdominal paracentesis in order to help physicians to carry out this technical skill.
Papachristos, Ioannis C.; Daliakopoulos, Stavros I.; Chatzoulis, Kostas; Lampridis, Savvas; Svarnas, Grigorios; Katsiadramis, Ioannis
Diaphragmatic rupture (DR) after thoracoabdominal trauma has a reported rate of 0.8% to 5% and up to 30% of diaphragmatic hernias are accompanied with delayed diagnosis. The DR occurs after high-energy blunt or penetrating (stab or gunshot wounds) trauma. The purpose of this article is to analyze the DR, its clinical presentation, complications and possible causes of the delay in diagnosis, whilst recording a rare interesting case. A 44-year old moribund male with a fifteen years history of paraplegia, came to the emergency department with a clinical presentation of extremely severe respiratory distress. Chest X-ray showed the colon present in the left hemithorax. The onset of symptoms was 48 hours before, resulting in hemodynamic instability and severe sepsis condition. Emergency left thoracotomy and laparotomy were carried out. A rupture of the left hemidiaphragm was found as well as intrathoracic presence of colon, incarcerated and perforated, feces and omentum, also incarcerated and necrotic. There were dense adhesions between the ectopic viscera and the thoracic structures. The necrotic parts of the colon and the omentum were mobilized, and then resected. The viable parts of the colon were laboriously reintroduced into the intraperitoneal cavity. We conclude that early diagnosis is crucial to the morbidity and mortality after DR. The course and the kinetic energy of bullets determine the extent of the wound and the size of the DR. The diagnosis of rupture of the diaphragm after penetrating trauma is sometimes difficult and delay can lead to life threatening complications. PMID:24255791
Trimpe, Michael A.
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.
Donzier, Alain; Millet, Joel
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.
Neri, Margherita; Turillazzi, Emanuela; Riezzo, Irene; Fineschi, Vittorio
In this study, we applied a microscopic quantitative method based on the use of sodium rhodizonate to verify the presence of residues and their distribution on the cutis of gunshot wounds. A total of 250 skin samples were selected from cases in which the manner of death (accidental, suicide, and homicide) and the shooting distance could be reliably determined. The samples were examined under a light microscope, in transmitted bright field illumination and phase contrast mode, and with confocal laser scanning microscopy. In all skin specimens the area of each histological section was directly measured by an image analysis system. Both the number and the size of powder particles were measured. The distribution of gunshot residues (GSR) in the epidermal and subepidermal layers was also analyzed. The evaluation of the microscopic entrance wounds demonstrated different findings related to the range of fire. The data derived from the evaluation of both macroscopic and microscopic features demonstrated that the amount and the spatial distribution of GSR deposits in the skin surrounding entrance wounds strictly correlate with shooting distance.
Introduction The extent of wound contamination in gunshot injuries is still a topic of controversial debate. The purpose of the present study is to develop a model that illustrates the contamination of wounds with exogenous particles along the bullet path. Material and methods To simulate bacteria, radio-opaque barium titanate (3-6 μm in diameter) was atomized in a dust chamber. Full metal jacket or soft point bullets caliber .222 (n = 12, v0 = 1096 m/s) were fired through the chamber into a gelatin block directly behind it. After that, the gelatin block underwent multi-slice CT in order to analyze the permanent and temporary wound cavity. Results The permanent cavity caused by both types of projectiles showed deposits of barium titanate distributed over the entire bullet path. Full metal jacket bullets left only few traces of barium titanate in the temporary cavity. In contrast, the soft point bullets disintegrated completely, and barium titanate covered the entire wound cavity. Discussion Deep penetration of potential exogenous bacteria can be simulated easily and reproducibly with barium titanate particles shot into a gelatin block. Additionally, this procedure permits conclusions to be drawn about the distribution of possible contaminants and thus can yield essential findings in terms of necessary therapeutic procedures. PMID:22032229
Perdekamp, Markus Grosse; Bohnert, Michael; Braunwarth, Roland; Pollak, Stefan
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.
Thali, M J; Kneubuehl, B P; Dirnhofer, R; Zollinger, U
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.
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 ...
Gschossmann, J M; Holtmann, G; Netzer, P; Essig, M; Balsiger, B M; Scheurer, U
Abdominal pain can result from a variety of different intra- and extra-abdominal disorders. Given the wide variety of etiological triggers for this pain, the primary task during the first stage of the diagnostic work-up is to determine as soon as possible the underlying cause and the degree of emergency. The aim of this evaluation is to adapt the therapeutic measures which are necessary for a causal treatment to the individual situation. Contrary to somatic causes of abdominal pain, the availability of such a causal therapy for functional bowel disorders is still very limited. Given this dilemma, the therapeutic focus of abdominal pain associated with these functional syndromes has to be placed on symptom-oriented treatment.
Udey, Ruth N; Hunter, Brian C; Smith, Ruth Waddell
Porcine tissue samples shot with two different types of bullets, jacketed and nonjacketed, were collected in the fresh state and throughout moderate decomposition. Wound samples were microwave-digested and analyzed using inductively coupled plasma mass spectrometry (ICP-MS) to detect all elements present at measurable levels in gunshot residue (GSR). Elements detected included antimony (Sb), barium (Ba), and lead (Pb), which are considered characteristic of GSR, as well as iron (Fe) and copper (Cu). These five elements were used to differentiate shot tissue and unshot tissue, as well as tissue shot by the two different bullet types, both in the fresh state and throughout moderate decomposition. The concentrations of Cu, Sb, and Pb were able to distinguish the two bullet types in fresh tissue samples at the 95% confidence level. Cu and Pb were able to differentiate the bullet types throughout moderate decomposition at the 99% confidence level.
Lagoo, Lisa; Schaeffer, Luther S; Szymanski, David W; Smith, Ruth Waddell
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.
exteriorization of the injured segment as a loop colostomy . A smaller percentage of the colonic injuries required resection of extensive lesions with double...barrel colostomy . Most liver injuries were managed by drainage alone or by suture and drainage. Resection was required in only 15 of the 112 hepatic...solid organs such as the liver, spleen, and kidney. Massive liver injury with hemorrhage and postoperative sepsis, usually after colostomy , were the
Johnson, Donald J; Andersen, Cheryl; Scriven, Katherine A; Klein, Amberly N; Choi, Mo Re; Carroll, Cindy; de Leon, Ray D
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.
Boesch, Cedric E; Umek, Wolfgang
A systematic review was undertaken using the Cochrane and PubMed databases to answer the question of how wound closure affects wound healing after gynecologic surgery. Leaving the vaginal vault open after vaginal and abdominal hysterectomy is as safe as closing it. When closing the vaginal vault, there is no difference between sutures and staples. Nonclosure of the peritoneum is a safe method after vaginal and abdominal hysterectomy. After laparotomy there is no difference between continuous and interrupted sutures regarding wound infection and/or dehiscence. After vertical midline incisions it is possible to close Camper's fascia, use drainage or close the skin only. The overall wound complication rate after laparoscopic surgery is lower when using transcutaneous as compared to subcuticular sutures. Adhesive paper tapes save time when closing smaller skin incisions. In conclusion, specific wound closure techniques improve wound healing after gynecologic operations.
Page, Edward A.; Sharkey, Brian
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.
Arndt, James; Bell, Suzanne; Crookshanks, Lindsey; Lovejoy, Marco; Oleska, Casey; Tulley, Tanya; Wolfe, Drew
The organic components of gunshot residue (OGSR, also called firearms discharge residue (FDR) or cartridge discharge residue (CDR)) have been studied and discussed in the literature. These residues, consisting of particulates such as burned and unburned powder as well as molecular compounds, are rarely used in casework except for purposes such as shooting reconstructions. Molecular compounds that survive the firing event or that are created as a result of the firing event could, with focused research and development, open a new avenue for forensic gunshot residue analysis. In this study, the persistence of organic gunshot residue was evaluated using diphenylamine (DPA) as a target analyte and ion mobility spectrometry (IMS) as the detection system. Samples were collected from hands using a solvent swabbing technique and the swab was analyzed using direct thermal desorption for sample introduction into the IMS. OGSR was found to persist for at least 4 h. Although DPA is a widely used industrial compound, analysis of numerous blank and background samples (n∼100) did not show any significant response for DPA using this detector. Variations were noted among individuals and as such, the data set does not support estimation of a half-life as has been done for traditional primer residues. No secondary transfers were observed, suggesting the possibility of skin adhesion via interactions between the lipophilic organic compounds and skin lipids. IMS proved valuable as a means of generating patterns for forensic pattern matching and shows promise as a screening tool applied to firearms discharge.
Atwater, Christina S; Durina, Marie E; Durina, John P; Blackledge, Robert D
Determination of the muzzle-to-target distance is often a critical factor in criminal and civil investigations involving firearms. However, seeing and recording gunshot residue patterns can be difficult if the victim's clothing is dark and/or bloodstained. Trostle reported the use of infrared film for the detection of burn patterns. However, only after the film is developed are the results visible and multiple exposures at different settings may be needed. The Video Spectral Comparator 2000 (Foster & Freeman Ltd., Evesham, Worcestershire, U.K.) is an imaging instrument routinely used by forensic document examiners. Without use of specialized film could the VSC 2000 (at appropriate instrument settings) quickly, easily, and reliably provide instantaneous viewing, saving, and printing of gunshot residue patterns on dark and/or blood soaked clothing? At muzzle-to-target distances of 6, 12, and 18 in., test fires were made into five different types of dark clothing using eight different handguns of different calibers. Gunshot residues were detected for all eight calibers, and powder burn patterns were seen on dark clothing for all three target distances and calibers except 0.22 long rifle and 0.25 ACP. Bloodstains did not preclude the viewing of these patterns.
Ramos, Antonio L. L.; Holm, Sverre; Gudvangen, Sigmund; Otterlei, Ragnvald
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.
Executive Summary Objective This review was conducted to assess the effectiveness of negative pressure wound therapy. Clinical Need: Target Population and Condition Many wounds are difficult to heal, despite medical and nursing care. They may result from complications of an underlying disease, like diabetes; or from surgery, constant pressure, trauma, or burns. Chronic wounds are more often found in elderly people and in those with immunologic or chronic diseases. Chronic wounds may lead to impaired quality of life and functioning, to amputation, or even to death. The prevalence of chronic ulcers is difficult to ascertain. It varies by condition and complications due to the condition that caused the ulcer. There are, however, some data on condition-specific prevalence rates; for example, of patients with diabetes, 15% are thought to have foot ulcers at some time during their lives. The approximate community care cost of treating leg ulcers in Canada, without reference to cause, has been estimated at upward of $100 million per year. Surgically created wounds can also become chronic, especially if they become infected. For example, the reported incidence of sternal wound infections after median sternotomy is 1% to 5%. Abdominal surgery also creates large open wounds. Because it is sometimes necessary to leave these wounds open and allow them to heal on their own (secondary intention), some may become infected and be difficult to heal. Yet, little is known about the wound healing process, and this makes treating wounds challenging. Many types of interventions are used to treat wounds. Current best practice for the treatment of ulcers and other chronic wounds includes debridement (the removal of dead or contaminated tissue), which can be surgical, mechanical, or chemical; bacterial balance; and moisture balance. Treating the cause, ensuring good nutrition, and preventing primary infection also help wounds to heal. Saline or wet-to-moist dressings are reported as
Matoso, Rodrigo Ivo; Freire, Alexandre Rodrigues; Santos, Leonardo Soriano de Mello; Daruge Junior, Eduardo; Rossi, Ana Claudia; Prado, Felippe Bevilacqua
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
De Waele, Jan J
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.
Karger, Bernd; Nüsse, Roland; Bajanowski, Thomas
The deposition of backspatter on the firearm or person shooting can greatly assist the reconstruction of shooting incidents. Backspatter was investigated in experimental transverse gunshots (9-mm Luger) to the heads of calves (n = 9) from shooting distances of 0 to 10 cm. The firearms were examined with a magnifying glass; the surgical gloves and the right sleeve worn by the person shooting were examined with a stereomicroscope. On the firearms, backspatter of blood was found in five of the nine cases, and one or both gloves showed bloodspatter deposits in six and the right sleeves in four cases. Most droplets were 1 to 3 mm and circular or elongated. In addition, a fine spray of tiny blood deposits was present on the firearm and textiles in four cases. The distribution of the droplets on the firearms varied: the areas included regions shielded by prominent parts, and the droplets were predominantly located on the extensor side of the fingers and the radial aspect of the hands and sleeves. Backspatter of tiny bone fragments was recovered from the firearm and sleeve in only one case, but tissue (bone, fat, muscle, skin) was present on the ground in front of the entrance wound in seven cases. A careful investigation, including appropriate lightning and magnification, is necessary for reliable statements concerning the absence of backspatter or the extent of backspatter present.
Heng, Hock Gan; Teoh, Wen Tian; Sheikh-Omar, Abdul Rahman
Postmortem radiographic examinations of animals are commonly performed in judicial investigations to rule out gunshot and fractures. However, there was no available data on radiographic postmortem changes of animals. Forty-one sets of abdominal radiographs of feline cadavers made within 12 h of death were evaluated for postmortem changes. Intravascular gas was detected in 11 of 41 (27%) cadavers. The most common site of intravascular gas was the liver. Intravascular gas was also present in the aorta, femoral artery, celiac and cranial mesenteric arteries, and caudal superficial epigastric artery. Intrasplenic gas was detected in two cadavers. Only two cadavers had distended small intestine. One cadaver had pneumatosis coli. The changes detected were most likely due to putrefaction.
Parks, Susan E; Hotchkin, Cara F; Cortopassi, Kathryn A; Clark, Christopher W
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.
Peled, Micha; Leiser, Yoav; Emodi, Omri; Krausz, Amir
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
Baumann, Donald P; Butler, Charles E
Abdominal wall defects requiring soft tissue coverage can be either partial-thickness defects or full-thickness composite defects. Soft tissue flap reconstruction offers significant advantages in defects that cannot be closed primarily. Flap reconstruction is performed in a single-stage procedure obviating chronic wound management. If the defect size exceeds the availability of local soft tissue for coverage, regional pedicled flaps can be delivered into the abdominal wall while maintaining blood supply from their donor site. Microsurgical free tissue transfer increases the capacity to provide soft tissue coverage for abdominal wall defects that are not amenable to either local or regional flap coverage.
... Adhesions 1 Ward BC, Panitch A. Abdominal adhesions: current and novel therapies. Journal of Surgical Research. 2011;165(1):91–111. Seek Help for ... and how to participate, visit the NIH Clinical Research Trials and You website ... Foundation for Functional Gastrointestinal Disorders 700 West Virginia ...
Connolly, G; Doyle, M; Barrett, T; Byrne, P; De Mello, M; Harrison, R F
This study aimed to evaluate the morbidity and pregnancy outcome of myomectomy in infertile women with uterine fibroids. This was a cross-sectional study. Records were reviewed for 100 consecutive women in the Rotunda Hospital who underwent myomectomy in the years 1995-1996. A questionnaire regarding subsequent fertility was sent. The study was carried out in the infertility unit at the Rotunda Hospital, Dublin, Ireland. Seventy-five women responded. Multiple myomectomy was performed in 52 (70%). Mean fibroid size was 6.8 cm (range 2-14.5 cm). Nine women (12%) developed complications; five had menstrual problems, two had wound discomfort and two had abdominal discomfort. Twenty-five women (33%) became pregnant. Seven (28%) were IVF pregnancies. Overall six (24%) miscarried. In 19 of 25, pregnancy occurred where fibroids were the only identifiable cause of infertility. We conclude that abdominal myomectomy is associated with a favourable outcome in infertile women particularly if no other confounding variable is present.
La Harpe, Romano; Mohamed, Nadja Ben; Burkhardt, Sandra
We have conducted a retrospective study of all gunshot deaths that occurred in Geneva, Switzerland, over a 10-year period (2001-2010). The 133 cases reviewed were classified according to the manner of death, that is, suicide (106 cases), homicide (25 cases), and accident (2 cases). Various data from police authorities and the medicolegal examinations of the bodies were studied, including the age and sex of the victims, location of the event, type of firearm used, concomitant use or nonuse of alcohol and/or other drugs, seasonality, and entry site. These various elements were compared with data found in the literature.
Kieser, Jules A; Tahere, Joy; Agnew, Caitlin; Kieser, David C; Duncan, Warwick; Swain, Michael V; Reeves, Matthew T
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.
Solarino, Biagio; Nicoletti, Emanuele Maria; Di Vella, Giancarlo
Fatal gunshot injuries are routinely encountered by forensic pathologists practicing in Southern Italy. Bari, the capital city of the Italian region known as Apulia, is a leader with regard to the number of firearm deaths in Italy. This is mainly attributable to local organized crime groups which control a variety of illicit activities. This retrospective study analyzes autopsy data related to fatal firearm wounds, handled by the Institute of Legal Medicine [University of Bari], between 1988 and 2003. A total of 717 cases were selected and classified as follows: firearm homicides (634); suicides (82); and accidental death (1). A significant number of variables have been reviewed such as: month in which the violent event took place; the victims' nationalities; gender and age of victims; site and number of entrance wounds; weapon type used; and manner of death (i.e. homicide; suicide; accidental). Analysis has revealed a homicide versus suicide ratio of almost 8:1. Victims were mostly male with a lower mean age than in other similar studies. Homicides with multiple gunshot wounds were more common than ones with single entrance wounds. For example, in one case, 30 entrance wounds were identified in the murder of a gang boss. Four suicides with two entrance gunshot wounds were identified. Handguns were the most frequently used weapon in all groups (i.e. homicide, suicide, and accidental), with 7.65 mm and 9 mm being the most common calibres. This study revealed a very low incidence of suicide among females. Mental and other types of illness, as well as financial stress were the apparent motives which prompted most of the suicide victims. The homicide cases described were most often related to continual, ongoing fights among local criminal gangs (75%).
Krywanczyk, Alison; Shapiro, Steven
The distinction between self-inflicted blade wounds and blade wounds inflicted by another can be difficult in situations where there is little available history or context. We reviewed homicides and suicides in the past 10 years at the Vermont Office of the Chief Medical Examiner to define the characteristics of homicidal and suicidal blade wounds. All homicides and suicides involving blade wounds, not just those in which blade wounds were the cause of death, were included. Information regarding victim demographics, location and type of injuries, toxicology, and evidence of suicidality was gathered. Blade wounds were the cause of death in 85.7% of homicides but only in 36% of suicides. Hanging and gunshot wounds were the cause of death in 28% and 24% of suicides, respectively. Multiple stab wounds were found in 10% of homicides and in 0% of suicides, whereas multiple incised wounds were found in 60% of suicides and only 10% of homicides. However, several unusual instances of suicide were found, including suicides with clothing damage or bone or cartilage injury from blade wounds. No characteristics of blade wounds were definitive for homicide or suicide. History and circumstances of the scene are thus crucial in determining the manner of death.
Lewis, Glynn; Shaw, Scott; Crowe, Michael; Cranford, Clay; Torvik, Kevin; Scharf, Peter; Stellingworth, Bob
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.
Eitel, F; Sklarek, J
This review article intends to discuss the clinical management of wounds in respect to a pathophysiological background. Recent results of research in the field of wound healing are demonstrated. Wound healing can be seen as aseptic inflammatory response to a traumatic stimulus. The activation of the clotting cascade by the trauma induces a sequence of humoral and cellular reactions. Platelets, granulocytes and macrophages are activated stepwisely. In the first phase of wound healing the wounded tissue area will be prepared for phagocytosis by enzymatic degradation of ground substance and depolymerisation of protein macromolecules (wound edema). Following the phagocytic microdebridement mesenchymal cells proliferate and produce matrix substance. Microcirculation within the traumatized area will be restored by angiogenesis, macroscopically observed as new formed granulation tissue. This leads to the wound healing phase of scar tissue formation. In this complexity of reactions naturally many possibilities of impairment are given. The most common complication during wound healing is the infection. It can be seen as self reinforcing process. The therapy of the impairment of wound healing consists in the disruption of the specific vicious circle, in the case of an osseus infection that would be a macrodebridement (that is necrectomy) and biomechanical stabilization. The surgical management of wounds principally consists in ensuring an undisturbed sequence of the healing process. This can be done by the wound excision that supports the phagocytic microdebridement. A further possibility is to avoid overwhelming formation of edema by eliminating the traumatic stimulus, by immobilization of the injured region and by ensuring a physiological microenvironment with a primary suture if possible. There are up to the present no drugs available to enhance cell proliferation and to regulate wound healing but it seems that experimental research is successful in characterizing
Norouzpour, Amir; Khoshdel, Ali Reza; Modaghegh, Mohammad-Hadi; Kazemzadeh, Gholam-Hossein
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
Siu, Sonya; Pender, Jennifer; Springer, Faye; Tulleners, Frederic; Ristenpart, William
Bloodstain pattern analysis (BPA) provides significant evidentiary value in crime scene interpretation and reconstruction. In this work, we develop a quantitative methodology using digital image analysis techniques to differentiate impact bloodstain patterns. The bloodstain patterns were digitally imaged and analyzed using image analysis algorithms. Our analysis of 72 unique bloodstain patterns, comprising more than 490,000 individual droplet stains, indicates that the mean drop size in a gunshot spatter pattern is at most 30% smaller than the mean drop stain size in blunt instrument patterns. In contrast, we demonstrate that the spatial distribution of the droplet stains-their density as a function of position in the pattern-significantly differs between gunshot and blunt instrument patterns, with densities as much as 400% larger for gunshot impacts. Thus, quantitative metrics involving the spatial distribution of droplet stains within a bloodstain pattern can be useful for objective differentiation between blunt instrument and gunshot bloodstain patterns.
Kazimirov, V. I.; Zorin, A. D.; Zanozina, V. F.
We have used x-ray fluorescence analysis to study the elemental composition of gunshot residues from smooth-bore and rifled-bore guns. We have established that it is possible to differentiate between types of projectiles (jacketed/lead), types of primers (corrosive/noncorrosive), and types of propellant powders (black/smokeless) by analysis of the elemental composition of the gunshot residues. We have shown that the mercury content in gunshot residues on the surface of the object carrying the residues steadily decreases as storage time increases. Despite this fact, mercury can be preserved as a component of gunshot residues on the object (cotton cloth) under room conditions for more than 45 days.
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).
Kapoor, V. K.
Tuberculosis has staged a global comeback and forms a dangerous combination with AIDS. The abdomen is one of the common sites of extrapulmonary involvement. Patients with abdominal tuberculosis have a wide range and spectrum of symptoms and signs; the disease is therefore a great mimic. Diagnosis, mainly radiological and supported by endoscopy, is difficult to make and laparotomy is required in a large number of patient. Management involves judicious combination of antitubercular therapy and surgery which may be required to treat complications such as intestinal obstruction and perforation. The disease, though potentially curable, carries a significant morbidity and mortality. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 PMID:9926119
Rodacy, Philip J.; Walker, Pamela K.
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.
Leonov, S V
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.
Arabi, Mohammad; Mat’hami, Abdulaziz; Said, Mohammad T.; Bulbul, Muhammad; Haddad, Maurice; Al-Kutoubi, Aghiad
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
... in the United States, there's little research on gun violence from a public health perspective. Part of ... passed in 1996 that restricts federal funding for firearms research, Spitzer said. "Firearm injuries are tied to ...
Ozertskovskiĭ, L B; Tiurin, M V; Denisov, A V
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.
Mielniczek, Paweł; Zieliński, Grzegorz; Koziarski, Andrzej
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.
Li, George Z; Duke, James H; Pappas, Theodore N
: 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.
Hughes, Betsy D; Vender, John R
Bullet fragment emboli are uncommon, and there have been only a few reports of intracranial-to-extracranial migration of these fragments. The authors present the case of an 11-year-old girl who was struck in the suboccipital region with a "soft nose" bullet fired at close range. Several months later, the patient was found to have asymptomatic pulmonary emboli. Similar cases are reviewed, and a management strategy is recommended.
Gokkus, Kemal; Sagtas, Ergin; Suslu, Feride Ekimler; Aydin, Ahmet Turan
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. PMID:24136914
Kozlov, V K; Akhmedov, B G; Chililov, A M
Цель исследования — обосновать подходы и алгоритмы увеличения эффективности комплексного лечения пострадавших с диафизарными огнестрельными переломами длинных костей конечностей путем внедрения в клиническую практику гражданского здравоохранения современных малоинвазивных хирургических технологий внутреннего остеосинтеза и улучшить результаты комплексного лечения пострадавших. Материал и методы. В основу проспективного сравнительного клинического исследования, выполненного в период 2009—2011 гг. в Республике Йемен, положен опыт комплексного лечения 104 первично обратившихся за медицинской помощью пострадавших с огнестрельными ранениями конечностей различной степени тяжести. Характер полученных огнестрельных повреждений — диафизарные переломы длинных костей конечностей и сопутствующие огнестрельным переломам повреждения мягких тканей. Мужчины составили абсолютное большинство пострадавших — 80,7%. Возраст раненых колебался от 15 до 80 лет и в среднем составил 38,5±5,7 года. Наличие огнестрельных переломов длинных костей конечностей различной тяжести обусловило применение различных хирургических методик одномоментного и поэтапного лечения. Для профилактики инфекционных осложнений пострадавшим с наиболее тяжелыми переломами дополнительно к основным лекарственным средствам консервативного лечения назначали медикаментозную иммуноориентированную терапию. Результаты и обсуждение. Пострадавшие были комплексно пролечены в соответствии с разными технологиями поэтапного лечения: при низкоэнергетических переломах проводили или традиционное хирургическое лечение с применением аппаратов внешней фиксации (АВФ) в качестве окончательного метода фиксации, или же максимально ранний первичный малоинвазивный функционально стабильный остеосинтез пластинами LCP или БИОС; при высококоэнергетических переломах на первом этапе хирургического лечения устанавливали АВФ с последующей их заменой при отсроченном малоинвазивном остеосинтезе металлопластинами. Сутью усовершенствования известных технологий комплексного лечения являлось стремление к одномоментности и минимальной травматичности оперативного вмешательства путем широкого использования для остеосинтеза современных металлопластин и превентивная иммунокоррекция формирующейся при тяжелых огнестрельных переломах дисфункции иммунной системы для исключения инфекционных осложнений. В итоге удалось увеличить эффективность комплексного лечения пострадавших с огнестрельными переломами: вдвое сократить степень инвазивности оперативного вмешательства (р≤0,01) и продолжительность стационарного лечения пострадавших (р≤0,01); исключить выполнение операций реостеосинтеза; резко уменьшить (в 4 раза — инфекционные и до 40 раз —неинфекционные) частоту осложнений, грозящих инвалидизацией пострадавших; сократить реабилитационный период и значительно улучшить качество жизни пролеченных пациентов путем восстановления функциональности травмированной конечности. Заключение. Усовершенствована методика и предложен алгоритм комплексного лечения диафизарных огнестрельных переломов длинных костей конечностей. При оказании специализированной медицинской помощи гражданским лицам, пострадавшим в вооруженных конфликтах, методика лечения раненых с огнестрельными переломами костей конечностей, включающая сберегательную хирургическую обработку, ранний малоинвазивный функционально-стабильный остеосинтез современными имплантатами и неспецифическую иммунопрофилактику инфекционных осложнений более эффективна и экономически более оправдана в сравнении с традиционной методикой лечения, когда используются аппараты внешней фиксации и не применяются в составе консервативного лечения иммуноактивные препараты.
Detrick, Frederiek, Nmryland 21701-5012 Contract f. DAl-17-S3-C-3235 Mdloal Colle" of Georgia Augusta, GA 30912 Approved for public distribution...about 30 sec, and replaced In the abdominal cavity. The mucle layer was sutured with 4.0 silk, and the skin was closed with wound clips. Blood samples
White, Thomas R.
The Texas DPS Crime Laboratory Service analyzes an average of 45 gunshot residue (GSR) kits a month using three different SEM/EDS systems and involving four different analysts. To maintain the volume of cases, we have developed a robust, cost-efficient method to ensure that all three systems are performing automated GSR analysis within laboratory specifications, and yielding consistent results across all three systems. This analysis commonly includes analysis of GSR kits collected from suspects' hands, but can also include kits from screening of suspects' clothing for GSR. Analysts have developed procedures for cleaning and monitoring areas where clothing and GSR stubs are processed and analyzed in order to ensure that casework stubs were not contaminated in the laboratory.
Reid, Lisa; Chana, Kal; Bond, John W; Almond, Matthew J; Black, Stuart
The collection efficiency of two widely used gunshot residue (GSR) collection techniques-carbon-coated adhesive stubs and alcohol swabs-has been compared by counting the number of characteristic GSR particles collected from the firing hand of a shooter after firing one round. Samples were analyzed with both scanning electron microscopy and energy dispersive X-rays by an experienced GSR analyst, and the number of particles on each sample containing Pb, Ba, and Sb counted. The adhesive stubs showed a greater collection efficiency as all 24 samples gave positive results for GSR particles whereas the swabs gave only positive results for half of the 24 samples. Results showed a statistically significant collection efficiency for the stub collection method and likely reasons for this are considered.
Goudsmits, Ellen; Sharples, George P; Birkett, Jason W
For the first time, a classification system for organic gunshot residue (OGSR) compounds with respect to the confirmation of OGSR materials is presented. There are 136 compounds considered to be associated with OGSR that have been highlighted in the literature. Many of these compounds could be classified as being ubiquitous in the environment and thus their detection as characteristic components of OGSR could cause issues with the interpretation of chemical ballistic evidence. The proposed system aims to address this problem by classifying OGSR compounds based on their forensic relevance with respect to the confirmation of GSR materials. To increase the forensic relevance of such a system, the large number of OGSR compounds reported in the literature has been decreased to 20 OGSR compounds based on the organic chemical composition of over 200 propellant powders. Occupational and environmental materials also associated with OGSR compounds have been considered.
Dalby, Oliver; Butler, David; Birkett, Jason W
A comprehensive review of the scientific literature on gunshot residue (GSR) is presented. Aspects of both inorganic and organic GSR are discussed, from formation and distribution, to sample collection, preparation, and analysis using a variety of techniques. The interpretation of GSR results is also considered including issues surrounding the contamination, distribution, and transfer of GSR. Potential problems with ulterior sources of GSR like particles have been reported in the literature. For example, particles from environmental and occupational sources have been highlighted as exhibiting similar chemical and morphological characteristics to GSR. These findings are put into context with regard to interpreting samples. A move toward a "case by case" approach is argued to be more preferable to a "formal" classification system where possible. The analysis of both inorganic and organic compositions of residue samples as well as morphological considerations is considered to be a more ideal approach to GSR analysis, wherever practicable.
Gauriot, Romain; Gunaratnam, Lawrence; Moroni, Rossana; Reinikainen, Tapani; Corander, Jukka
The discharging of a gun results in the formation of extremely small particles known as gunshot residues (GSR). These may be deposited on the skin and clothing of the shooter, on other persons present, and on nearby items or surfaces. Several factors and their complex interactions affect the number of detectable GSR particles, which can deeply influence the conclusions drawn from likelihood ratios or posterior probabilities for prosecution hypotheses of interest. We present Bayesian network models for casework examples and demonstrate that probabilistic quantification of GSR evidence can be very sensitive to the assumptions concerning the model structure, prior probabilities, and the likelihood components. This finding has considerable implications for the use of statistical quantification of GSR evidence in the legal process.
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
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).
White, Robert S.; Mershon, William J.
Some government agencies take the position that the results of gunshot residue from the hands of victims of shootings are not probative and meaningless. It is my opinion from experience in many cases that this is not the case and the results can mean life or death in some cases. Actual individual cases are described. The results of samples examined years ago with a small number of gunshot residue particles and reexamined recently shows the number and quality of particles that can be located and identified with modern equipment.
Amadasi, Alberto; Borgonovo, Simone; Brandone, Alberto; Di Giancamillo, Mauro; Cattaneo, Cristina
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.
... care to prevent infection. Continue Reading Stages of Wound Healing Wounds heal in stages. The smaller the wound, ... How lacerations heal References Leong M, Phillips LG. Wound healing. In: Townsend CM, Beauchamp RD, Evers BM, Mattox ...
... and services. Advertising & Sponsorship: Policy | Opportunities Bacterial Wound Culture Share this page: Was this page helpful? Also known as: Aerobic Wound Culture; Anaerobic Wound Culture Formal name: Culture, wound Related ...
Fackler, M L; Malinowski, J A; Hoxie, S W; Jason, A
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.
Park, Jung Je; Shim, Hyun Seok; Jeong, Jae Ho; Whang, Soo Hyun; Kim, Jin Pyeong; Jeon, Sea Young; Kwon, Oh Jin
Vertebral artery injuries are the least common arterial injuries because of the deep location of the vessel in a bony canal. Injury of this vessel has not been associated with neurological deficits, and it is thought that many of these injuries are not recognized. The incidence of vertebral artery injury occurring after a penetration wound to the neck varies from 1.0% in gunshot wounds to 7.4% in stab wounds. However, even with vertebral artery injury in penetration wounds of the neck the association with cerebellar infarction is a rare occurrence. We describe a case of cerebellar infarction caused by vertebral artery injury from a stab wound that severed the vessel between the transverse processes of C3 and C4 with a hypoplastic contralateral vertebral artery. The patient ultimately suffered infarction of the cerebellum due to the lack of preservation of the posterior inferior cerebellar artery blood flow. Management is discussed and the medical literature is reviewed.
The wide variety of dermatologic surgical procedures has resulted in a corresponding choice of wound dressings. Considering the chemical and physical properties as well as the function of the dressings, standardized dressing techniques can be performed with relatively few materials. This saves both time and money.
Williams, Andrew S; Bowes, Matthew J
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.
With advances in abdominal surgery and the management of major trauma, complex abdominal wall defects have become the new surgical disease, and the need for abdominal wall reconstruction has increased dramatically. Subsequently, how to reconstruct these large defects has become a new surgical question. While most surgeons use native abdominal wall whenever possible, evidence suggests that synthetic or biologic mesh needs to be added to large ventral hernia repairs. One particular group of patients who exemplify "complex" are those with contaminated wounds, enterocutaneous fistulas, enteroatmospheric fistulas, and/or stoma(s), where synthetic mesh is to be avoided if at all possible. Most recently, biologic mesh has become the new standard in high-risk patients with contaminated and dirty-infected wounds. While biologic mesh is the most common tissue engineered used in this field of surgery, level I evidence is needed on its indication and long-term outcomes. Various techniques for reconstructing the abdominal wall have been described, however the long-term outcomes for most of these studies, are rarely reported. In this article, I outline current practical approaches to perioperative management and definitive abdominal reconstruction in patients with complex abdominal wall defects, with or without fistulas, as well as those who have lost abdominal domain.
Melo, Lis G A; Martiny, Andrea; Pinto, André L
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.
Grima, Matthew; Butler, Mark; Hanson, Robert; Mohameden, Ahmed
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.
Gassner, Anne-Laure; Ribeiro, Cristina; Kobylinska, Joanna; Zeichner, Arie; Weyermann, Céline
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.
Yılmaz, Demet; Turşucu, Ahmet; Uzunoğlu, Zeynep; Korucu, Demet
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.
Kaya, Adnan; Caliskan, Emine; Tatlisu, Mustafa Adem; Hayiroglu, Mert Ilker; Tekessin, Ahmet Ilker; Cakilli, Yasin; Avsar, Sahin; Oz, Ahmet; Uzman, Osman
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
Kokhan, E P; Gliantsev, S P; Galik, N I
review in the article are opinions and experience of outstanding academic military surgeons, participants of the Great Patriotic war: Burdenko N N., Kupriyanov P.A., Akhutin M.N., Banaitis A.I., Elansky N.N, Petrovsky B.V., and others. The methods they worked out and practically implemented made it possible to substantially improve the outcomes of gunshot wounds and vascular lesions.
... small intestine and the rectum. This can cause an infection or abscess. Scarring of the connection between the small intestine and the rectum. This can cause a blockage of the intestine Wound breaking open Wound infections
Slade, Dominic Alexander James; Carlson, Gordon Lawrence
Key steps in managing patients with enterocutaneous fistulation and an abdominal wall defect include dealing effectively with abdominal sepsis and providing safe and effective nutritional support and skin care, then assessing intestinal and abdominal anatomy, before undertaking reconstructive surgery. The complexity, cost, and morbidity associated with such cases justifies creation of specialized centers in which gastroenterologic, hernia, and plastic surgical expertise, as well as experienced wound and stoma nursing and nutritional and psychological support, can be made available for patients with these challenging problems.
... Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis or plaque buildup causes the ... weak and bulge outward like a balloon. An AAA develops slowly over time and has few noticeable ...
... this page: //medlineplus.gov/ency/article/000162.htm Abdominal aortic aneurysm To use the sharing features on this page, ... blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ...
Janssen, Martin; Stamouli, Amalia; Knijnenberg, Alwin
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.
Doebler, O; Spierer, R
A full-thickness defect of the abdominal wall is rare and may occur as a complication of extended abdominal surgery procedures. We report about a 69-year-old patient who was presented to our department with a full-thickness abdominal wall defect and a fully exposed collagen-mesh for reconstructive wound closure. 13 operations with resections of necrotic parts of the abdominal wall were performed following a complicated intraabdominal infection. After debridement and mesh explantation, closure of the remaining defect of the lower abdominal region was achieved by a cutaneous groin flap.
Howle, Chris R.; Spear, Abigail M.; Gazi, Ehsan; Crane, Nicole J.
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.
Moullot, P; Philandrianos, C; Gonnelli, D; Casanova, D
Looking at a full-thickness abdominal wall defect, it is necessary to use reconstructive surgery techniques. The authors present an original case of reconstruction of the abdominal wall, using an anterolateral thigh flap (ALT) harvested with vascularised fascia lata. We describe the advantages of this technique, which has rarely been used for this indication. An 80-year-old woman presenting a full-thickness abdominal wall defect of 15×18cm was reconstructed by a pedicled ALT flap. Skin wound healing was obtained within 15 days, with no complication. There was no donor site sequela. The pedicled ALT flap appears to be a good solution for hypogastric abdominal wall defect in a one step procedure. Vacularised fascia lata bring with the cutaneous flap is useful to reconstruct the abdominal fascia.
Covey, D C; Lurate, R B; Hatton, C T
The spectrum of wounding and treatment of forty-one patients with musculoskeletal blast injuries at a U.S. military field hospital in the former Yugoslavia was reviewed. Patients underwent wound exploration, irrigation, debridement, broad-spectrum antibiotic therapy, early fracture stabilization, and appropriate reconstructive surgery. Four patients developed wound infections. Two patients died as a result of their injuries (overall mortality 5 percent). There were three below-knee amputations and five other amputations (above-knee, ankle, midtarsal, partial forefoot, and finger). Three patients sustained lumbar burst fractures from mines that exploded under their vehicles, resulting in paraplegia in one case. Our patients underwent 112 surgical procedures, an average of 2.1 per patient. Twenty-two patients (54 percent) had other injuries or conditions in addition to their orthopaedic wounds. There were wide variations in the bone and soft tissue injuries caused by detonating ordnance, and the tissue damage was qualitatively different from that caused by gunshot wounds. Early debridement, leaving wounds open, and treatment with broad-spectrum antibiotics were important factors in wound healing to allow subsequent successful reconstructive surgery in an austere field setting.
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
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
Elserry, Tarek; Anwer, Hesham; Esene, Ignatius Ngene
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
Showen, R. L.; Dunson, J. C.; Woodman, G.; Christopher, S.; Wilson, S.
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.
Kolkutin, V V; Makarov, I Iu; Evteeva, I A
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.
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
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
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
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.
Aliste, Marina; Chávez, Luis Guillermo
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.
Voyles, C R; Richardson, J D; Bland, K I; Tobin, G R; Flint, L M; Polk, H C
The acute replacement of full-thickness abdominal wall has been facilitated by polypropylene mesh (Marlex) (PPM), allowing debridement of nonviable tissue and restoration of abdominal wall integrity without tension. However, no substantial long-term follow-up has been reported on the definitive wound coverage after the use of PPM in open wounds. Since 1976, we have placed PPM in 31 patients; 25 for infectious complication, three for massive bowel distension preventing abdominal closure, and three for shotgun wounds with extensive tissue loss. In 29 of 31 patients, the mesh was placed in heavily contaminated wounds; extensive fasciitis was present in 23 patients and 21 had intra-abdominal abscesses. Following mesh placement, 23 reoperations were required for continuing complications. No patients eviscerated, despite these multiple procedures. Polypropylene mesh was highly effective in restoring abdominal wall continuity. Despite advantages when PPM was used, significant long-term problems developed. Seven patients died from their primary illness in the postoperative period. Nine wounds were closed by granulation and subsequent split-thickness skin grafts. All nine developed mesh extrusion and/or enteric fistulae. Nine wounds healed by secondary intention, six developed enteric fistulae or continuing mesh extrusion. Full-thickness flap coverage after granulation provided the best means of wound closure. Polypropylene mesh had significant early advantages for providing abdominal wall integrity even in the presence of severe infection. However, long-term problems were common when wounds were closed to skin grafts or secondary intention. If the mesh cannot be completely removed, strong consideration should be given to myocutaneous flaps for coverage after the primary illness has resolved. Images Fig. 1. Fig. 2. Fig. 3. PMID:6455099
Romolo, F S; Christopher, M E; Donghi, M; Ripani, L; Jeynes, C; Webb, R P; Ward, N I; Kirkby, K J; Bailey, M J
Gunshot Residue (GSR) is residual material from the discharge of a firearm, which frequently provides crucial information in criminal investigations. Changes in ammunition manufacturing are gradually phasing out the heavy metals on which current forensic GSR analysis is based, and the latest Heavy Metal Free (HMF) primers urgently demand new forensic solutions. Proton scanning microbeam Ion Beam Analysis (IBA), in conjunction with the Scanning Electron Microscope equipped with an Energy Dispersive X-ray Spectrometer (SEM-EDS), can be introduced into forensic analysis to solve both new and old problems, with a procedure entirely commensurate with current forensic practice. Six cartridges producing GSR particles known to be interesting in casework by both experience and the literature were selected for this study. A standard procedure to relocate the same particles previously analysed by SEM-EDS, based on both secondary electron (SE) and X-ray imaging was developed and tested. Elemental Particle Induced X-ray Emission (PIXE) mapping of the emitted X-rays allowed relocation in a scan of 10 μm × 10 μm of even a 1 μm GSR particle. The comparison between spectra from the same particle obtained by SEM-EDS and IBA-PIXE showed that the latter is much more sensitive at mid-high energies. Results that are very interesting in a forensic context were obtained with particles from a cartridge containing mercury fulminate in the primer. Particle-induced gamma-ray emission (PIGE) maps of a particles from HMF cartridges allowed identification of Boron and Sodium in particles from hands using the (10)B(p,α1γ)(7)Be, (11)B(p,p1γ)(11)B and (23)Na(p,p1γ)(23)Na reactions, which is extraordinary in a forensic context. The capability for quantitative analysis of elements within individual particles by IBA was also demonstrated, giving the opportunity to begin a new chapter in the research on GSR particles. The integrated procedure that was developed, which makes use of all the IBA
James, Garth A; Swogger, Ellen; Wolcott, Randall; Pulcini, Elinor deLancey; Secor, Patrick; Sestrich, Jennifer; Costerton, John W; Stewart, Philip S
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.
Cho, Jinbeom; Park, Ilyoung; Lee, Dosang; Sung, Kiyoung; Baek, Jongmin
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
Englbrecht, J S; Pogatzki-Zahn, E M
Abdominal and thoracic surgical procedures can result in significant acute postoperative pain. Present evidence shows that postoperative pain management remains inadequate especially after "minor" surgical procedures. Various therapeutic options including regional anesthesia techniques and systemic pharmacotherapy are available for effective treatment of postoperative pain. This work summarizes the pathophysiological background of postoperative pain after abdominal and thoracic surgery and discusses the indication, effectiveness, risks, and benefits of the different therapeutic options. Special focus is given to the controversial debate about the indication for epidural analgesia, as well as various alternative therapeutic options, including transversus abdominis plane (TAP) block, paravertebral block (PVB), wound infiltration with local anesthetics, and intravenous lidocaine. In additional, indications and contraindications of nonopioid analgesics after abdominal and thoracic surgery are discussed and recommendations based on scientific evidence and individual risk and benefit analysis are made. All therapeutic options discussed are eligible for clinical use and may contribute to improve postoperative pain outcome after abdominal and thoracic surgical procedures.
Karrouf, Gamal; Zaghloul, Adel; Abou-Alsaud, Mohamed; Barbour, Elie; Abouelnasr, Khaled
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
Karrouf, Gamal; Zaghloul, Adel; Abou-Alsaud, Mohamed; Barbour, Elie; Abouelnasr, Khaled
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.
Davidson, Peter L; Taylor, Michael C; Wilson, Suzanne J; Walsh, Kevan A J; Kieser, Jules A
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.
Bonfante Ramírez, E; Bolaños Ancona, R; Simón Pereyra, L; Juárez García, L; García-Benitez, C Q
Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studiford criteria. A retrospective study, between January 1989 and December 1994, realized at Instituto Nacional de Perinatología, found 35,080 pregnancies, from which 149 happened to be ectopic, and 6 of them were abdominal. All patients belonged to a low income society class, age between 24 and 35 years, and average of gestations in 2.6. Gestational age varied from 15 weeks to 32.2 weeks having only one delivery at term with satisfactory postnatal evolution. One patient had a recurrent abdominal pregnancy, with genital Tb as a conditional factor. Time of hospitalization varied from 4 to 5 days, and no further patient complications were reported. Fetal loss was estimated in 83.4%. Abdominal pregnancy is often the sequence of a tubarian ectopic pregnancy an when present, it has a very high maternal mortality reported in world literature, not found in this study. The stated frequency of abdominal pregnancy is from 1 of each 3372, up to 1 in every 10,200 deliveries, reporting in the study 1 abdominal pregnancy in 5846 deliveries. The study had two characteristic entities one, the recurrence and two, the delivery at term of one newborn. Abdominal pregnancy accounts for 4% of all ectopic pregnancies. Clinical findings in abdominal pregnancies are pain, transvaginal bleeding and amenorrea, being the cardinal signs of ectopic pregnancy.
Modrzejewski, Andrzej; Smietański, Maciej
An interstitial hernia is one in which the hernia sac is located between the layers of the abdominal wall. The analysis of contemporary literature shows that interstitial hernias are most often seen in children as a type of inguinal hernia and often accompany undescended testis. The hernia sac is usually located between the external-oblique and internal-oblique muscles in a lateral-cephalic direction. The authors present 3 cases of interstitial hernia found during laparoscopic exploration of the front abdominal wall done due to incisional wound site pain. No previous diagnosis of hernia was considered in all the cases. Hernias were found as complications of appendectomy and wound healing after radiotherapy of uterine and cervical cancer. In conclusion, in obscure wound site pain, the presence of an interstitial postoperative hernia should be considered as a possible reason for the complaint. Laparoscopic examination of the anterior abdominal wall during adhesiolysis in patients with abdominal pain enables proper diagnosis and treatment.
Powers, Jennifer G; Higham, Catherine; Broussard, Karen; Phillips, Tania J
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.
... Health Information Diabetic Wound Care What is a Diabetic Foot Ulcer? A diabetic foot ulcer is an open sore or wound that ... key factors in the appropriate treatment of a diabetic foot ulcer: Prevention of infection Taking the pressure off ...
... 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 ...
... types of dressings as your wound heals. Hyperbaric Oxygen Therapy Depending on the type of wound, your doctor may recommend hyperbaric oxygen therapy . Oxygen is important for healing. During this ...
Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T
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.
III and IV decubitus ulcers ). Wounds can also be classified by etiology as (a) surgical, (b) traumatic (such as mechanical or thermal injuries), and...had either decubitus ulcers or venous stasis ulcers . Each patient’s wound was measured with each of the three methods. First, the wound was...standardized and clinically available method to estimate wound volume is needed to determine rate of pressure ulcer healing. This quasi-experimental
therapy on wound repair have been amply demonstrated. Increased oxygen supply promotes wound healing whereas decreased oxygen supply retards repair...appmarn as early as 6 hms afte the a~ddton of DMF (Figl. 2). The increase was linea during the 24 hrs period of observaumoe in order toconfimn if the...Examine the effect of superoxide on collagen synthesis in vivo, * Examine the effect of increased superoxide levels on wound healing , and * Develop strategies to administer superoxide to wounds.
Sansare, K; Khanna, V; Karjodkar, F
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
Wang, Weijian; Duan, Jianmin; Wang, Qiao; Kuang, Wei
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
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.
Lucas, Nick; Cook, Michael; Wallace, James; Kirkbride, K Paul; Kobus, Hilton
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.
Sansare, K; Khanna, V; Karjodkar, F
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.
... Loss Surgery? A Week of Healthy Breakfasts Shyness Wound Healing and Care KidsHealth > For Teens > Wound Healing and Care Print A A A What's in ... mouth, or sunken eyes. There's good news about wound healing when you're a teen: Age is on ...
Stone, H. Harlan; Hooper, C. Ann; Millikan, William J.
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
Öztürk, Ferdi; Ermertcan, Aylin Türel
Cutaneous wound healing is a complex and well-coordinated interaction between inflammatory cells and mediators, establishing significant overlap between the phases of wound healing. Wound healing is divided into three major phases: inflammatory phase, proliferative phase, and remodeling phase. Unlike the acute wound, the nonhealing wound is arrested in one of the phases of healing, typically the inflammatory phase. A systematic approach to the management of the chronic nonhealing wound emphasizes three important elements of wound bed preparation in chronic wounds: debridement, moisture, and countering bacterial colonization and infection. In this article, wound-healing process and new approaches to the topical wound care have been reviewed.
... or cancer Infection of the tubes (salpingitis) Ectopic pregnancy Fibroid tumors of the uterus (womb) Malignant tumors of the uterus or cervix Endometriosis Adhesions (scars) Screening and Diagnosis How is the cause of abdominal pain determined? ...
Seiler, Christian A
Patients with an abdominal catastrophe are in urgent need of early, interdisciplinary medical help. The treatment plan should be based on medical priorities and clear leadership. First priority should be given to achieve optimal oxygenation of blood and stabilization of circulation during all treatment-phases. The sicker the patient, the less invasive the (surgical) treatment should to be, which means "damage control only". This short article describes 7 important, pragmatic rules that will help to increase the survival of a patient with an abdominal catastrophe. Preexisting morbidity and risk factors must be included in the overall risk-evaluation for every therapeutic intervention. The challenge in patients with an abdominal catastrophe is to carefully balance the therapeutic stress and the existing resistance of the individual patient. The best way to avoid abdominal disaster, however, is its prevention.
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 ...
Abdominal pain is among the most frequent ailments reported in the office setting and can account for up to 40% of ailments in the ambulatory practice. Also, it is in the top three symptoms of patients presenting to emergency departments (ED) and accounts for 5-10% of all ED primary presenting ailments. There are several common sources for acute abdominal pain and many for subacute and chronic abdominal pain. This article explores the history-taking, initial evaluation, and examination of the patient presenting with acute abdominal pain. The goal of this article is to help differentiate one source of pain from another. Discussion of acute cholecystitis, pancreatitis, appendicitis, ectopic pregnancy, diverticulitis, gastritis, and gastroenteritis are undertaken. Additionally, there is discussion of common laboratory studies, diagnostic studies, and treatment of the patient with the above entities.
... as ulcerative colitis or Crohn's disease , pancreatitis or liver cirrhosis. cancers of the liver, kidneys, pancreas, ovaries and bladder as well as ... injuries to abdominal organs such as the spleen, liver, kidneys or other internal organs in cases of ...
... the results of abdominoplasty. Many feel a new sense of self-confidence. Alternative Names Cosmetic surgery of the abdomen; Tummy tuck; Abdominoplasty Images Abdominoplasty - series Abdominal muscles References McGrath MH, Pomerantz J. Plastic surgery. In: Townsend ...
Sulamanidze, Marlen A; Sulamanidze, George M
Background: A cosmetically pleasing postoperative scar is an important aim of all aesthetic surgeries. Use of proper suture materials for delicate and gentle suturing of the operative injury is an important requirement for achieving satisfactory scars. However, closure of the edges of wounds by means of conventional suture materials does not always meet the requirements to achieve this objective. Aim: To simplify and facilitate the process of surgical wound closure, to improve the quality of scar, and to achieve a good cosmetic effect through the introduction of a new type of suture material. Materials and Methods: We have introduced a new surgical suturing material—a nontraumatic, barbed thread connected with the suture needle—APTOS SUTURE (European patent 1075843 as of 1999). Presented herein is a new modification of the technique of uninterrupted subcutaneous and intracutaneous suturing of wound edges, and the details of our experience with this material. Results: Our experience shows that, with use of APTOS, wound closure is carried out easily and quickly. The wound remains stable, the time of healing is shortened, and the process of suture removal is simplified, resulting in an aesthetically pleasing scar. Conclusions: The technique of surgical wound suturing proposed herein is a simple, facilitated, and efficient option of wound-edge closure, which can successfully be used, both in general and in aesthetic surgery for wound closure, such as plasty of scars, face lift, mammoplasty, and abdominal plasty. PMID:20808595
Neyman, Edward G; Georgiades, Christos S; Fishman, Elliot K
Rising incidence of disseminated and extrapulmonary tuberculosis (TB), especially in immunocompromised hosts and patients with multi-drug-resistant tuberculosis, has resulted in an increase of unusual clinical and radiographic presentations of TB. With CT being a common part of emergency room (ER) evaluation of abdominal pain, it is imperative that radiologists be able to recognize abdominal presentations of TB. We discuss and illustrate typical and less common CT manifestations of tuberculosis in the abdomen to help ER radiologists in this task.
Savarese, R P; Rosenfeld, J C; DeLaurentis, D A
Between January 1976 and December 1982, 181 patients with abdominal aortic aneurysms were treated surgically, and in 13 patients the aneurysms were found to be inflammatory. Inflammatory aneurysms of the abdominal aorta (IAAA) share important characteristics with typical atherosclerotic abdominal aortic aneurysms. Diagnosis and surgical management of IAAA are distinctive which suggests that IAAA should be considered separately, as a varient of typical abdominal aortic aneurysms. IAAA occur predominantly in males. The presenting symptoms are often idiosyncratic and include severe abdominal or back pain, or both, and ureteral obstruction; the diagnosis of IAAA should be considered when these symptoms are present. Although grossly and microscopically, the perianeurysmal fibrosis resembles idiopathic retroperitoneal fibrosis, the two conditions can be differentiated. At the present time, ultrasonography and computed tomography appear to offer reliable means for diagnosing IAAA. The presence of IAAA, whether established preoperatively or discovered unexpectedly at operation, necessitate certain modifications in the surgical approach, in order to avoid injuring the duodenum and the venous structures. Most patients can be successfully treated by resection and graft replacement. Rupture of the aneurysm in IAAA appears to be less frequent than in typical atherosclerotic abdominal aortic aneurysm.
King, Hollis H; Cayce, Charles Thomas; Herrin, Jeph
Early osteopathic theory and practice, and the work of the medical intuitive Edgar Cayce suggested that the abdominal areas of individuals with epilepsy would manifest "cold spots." The etiology for this phenomenon was thought to be abdominal adhesions caused by inflammation and viscero-somatic reflexes caused by adhesions or injury to visceral or musculoskeletal system structures. Indeed, until that advent of electroencephalography in the 1930s, medical practice regarding epilepsy focused on abdominal neural and visceral structures. Following two hypotheses were formulated to evaluate any abdominal temperature phenomena: (1) an abdominal quadrant division analysis would find one or more quadrants "colder" in the focal-onset epilepsy group (ICD9-CM 345.4 and 345.5) compared to controls. (2) Total abdominal areas of individuals with focal-onset epilepsy wound be colder than a control group.
Parks, Susan E.; Hamilton, Philip; Kraus, Scott D.; Tyack, Peter L.
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.
Filipović, Marinko; Novinscak, Tomislav
Chronic ulcers have adverse effects on the patient quality of life and productivity, thus posing financial burden upon the healthcare system. Chronic wound healing is a complex process resulting from the interaction of the patient general health status, wound related factors, medical personnel skill and competence, and therapy related products. In clinical practice, considerable improvement has been made in the treatment of chronic wounds, which is evident in the reduced rate of the severe forms of chronic wounds in outpatient clinics. However, in spite of all the modern approaches, efforts invested by medical personnel and agents available for wound care, numerous problems are still encountered in daily practice. Most frequently, the problems arise from inappropriate education, of young personnel in particular, absence of multidisciplinary approach, and inadequate communication among the personnel directly involved in wound treatment. To perceive them more clearly, the potential problems or complications in the management of chronic wounds can be classified into the following groups: problems mostly related to the use of wound coverage and other etiology related specificities of wound treatment; problems related to incompatibility of the agents used in wound treatment; and problems arising from failure to ensure aseptic and antiseptic performance conditions.
Caley, Matthew P.; Martins, Vera L.C.; O'Toole, Edel A.
Significance: Matrix metalloproteinases (MMPs) are present in both acute and chronic wounds. They play a pivotal role, with their inhibitors, in regulating extracellular matrix degradation and deposition that is essential for wound reepithelialization. The excess protease activity can lead to a chronic nonhealing wound. The timed expression and activation of MMPs in response to wounding are vital for successful wound healing. MMPs are grouped into eight families and display extensive homology within these families. This homology leads in part to the initial failure of MMP inhibitors in clinical trials and the development of alternative methods for modulating the MMP activity. MMP-knockout mouse models display altered wound healing responses, but these are often subtle phenotypic changes indicating the overlapping MMP substrate specificity and inter-MMP compensation. Recent Advances: Recent research has identified several new MMP modulators, including photodynamic therapy, protease-absorbing dressing, microRNA regulation, signaling molecules, and peptides. Critical Issues: Wound healing requires the controlled activity of MMPs at all stages of the wound healing process. The loss of MMP regulation is a characteristic of chronic wounds and contributes to the failure to heal. Future Directions: Further research into how MMPs are regulated should allow the development of novel treatments for wound healing. PMID:25945285
Davidson, Jacqueline R
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.
Jena, Anupam B; Sun, Eric C; Prasad, Vinay
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.
Coca Robinot, D; Liébana de Rojas, C; Aguirre Pascual, E
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.
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.
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.
Balén, E; Herrera, J; Miranda, C; Tarifa, A; Zazpe, C; Lera, J M
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.
Mikami, Y; Kyogoku, M
Inflammatory abdominal aortic aneurysm (IAAA) is a distinct clinicopathological entity, characterized by: (1) clinical presentation, such as back pain, weight loss, and increased ESR, (2) patchy and/or diffuse lymphoplasmacytic infiltration, and (3) marked periaortic fibrosis resulting in thickening of the aneurysmal wall and occasional retroperitoneal fibrosis. Its pathogenesis is unknown, but some authors support the theory that IAAA is a subtype of atherosclerotic abdominal aortic aneurysm because of close relationship between IAAA and atherosclerotic change. In this article, we describe clinical and histological features of IAAA on the basis of the literature and our review of 6 cases of IAAA, emphasizing the similarity and difference between IAAA and atherosclerotic abdominal aortic aneurysm. Our review supports that marked lamellar fibrosis completely replacing the media and adventitia, patchy lymphocytic infiltration (mostly B cells) and endarteritis obliterans are characteristic features of IAAA.
Balla, Vinod; Daniel, Angleena Y
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
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.
Ninan, Neethu; Thomas, Sabu; Grohens, Yves
Wound healing is a dynamic and complex phenomenon of replacing devitalized tissues in the body. Urethral healing takes place in four phases namely inflammation, proliferation, maturation and remodelling, similar to dermal healing. However, the duration of each phase of wound healing in urology is extended for a longer period when compared to that of dermatology. An ideal wound dressing material removes exudate, creates a moist environment, offers protection from foreign substances and promotes tissue regeneration. A single wound dressing material shall not be sufficient to treat all kinds of wounds as each wound is distinct. This review includes the recent attempts to explore the hidden potential of growth factors, stem cells, siRNA, miRNA and drugs for promoting wound healing in urology. The review also discusses the different technologies used in hospitals to treat wounds in urology, which make use of innovative biomaterials synthesised in regenerative medicines like hydrogels, hydrocolloids, foams, films etc., incorporated with growth factors, drug molecules or nanoparticles. These include surgical zippers, laser tissue welding, negative pressure wound therapy, and hyperbaric oxygen treatment.
wound invasion was identified only Nine of 97 patients (9%) with histologic burn wound after septic or cardiogenic shock had been present in invasion...051= ADA12589 Th JouRHAL oP TRAUMA Vol. 21, No. 9 Copyright 0 1981 by The Williams & Wilkins Co. ,r, Prin U.S.A. . Burn Wound Infection WILLIAM F...admitted to a burn center during a 3-year period C had histologically confirmed bacterial or tungal burn wound invasion. Nine of t X Q these 97
THORAX, BATTLES), (*BATTLES, THERAPY), (*MILITARY MEDICINE, BATTLES), SURGERY, WARFARE, VIETNAM, ETIOLOGY, WEAPONS, HEMORRHAGE, MORTALITY RATES , LUNG, SPLEEN, LIVER, PATHOLOGY, WOUNDS AND INJURIES, CASUALTIES, (U)CASUALTIES
Zhao, Ruilong; Liang, Helena; Clarke, Elizabeth; Jackson, Christopher; Xue, Meilang
Non-healing chronic wounds present a major biological, psychological, social, and financial burden on both individual patients and the broader health system. Pathologically extensive inflammation plays a major role in the disruption of the normal healing cascade. The causes of chronic wounds (venous, arterial, pressure, and diabetic ulcers) can be examined through a juxtaposition of normal healing and the rogue inflammatory response created by the common components within chronic wounds (ageing, hypoxia, ischaemia-reperfusion injury, and bacterial colonisation). Wound bed care through debridement, dressings, and antibiotics currently form the basic mode of treatment. Despite recent setbacks, pharmaceutical adjuncts form an interesting area of research. PMID:27973441
Kamprath, S; Merker, A; Kühne-Heid, R; Schneider, A
We report a case of abdominal actinomycosis in a 54 year old woman using an intrauterine device for a period of 8 years. The most important finding was a tuboovarialabscess at the left pelvic side with involvement of the serosa of the jejunum, ileum, sigma, and omentum majus. Intraoperative exploration showed a solid retroperitoneal infiltration between the pelvic side wall and sigma. Another infiltration was found on the left side of the abdominal wall. The diagnosis was confirmed by histopathological examination and the patient was treated by a combination of Aminopenicillin and Metronidazol. After a period of three months we observed a complete regression of the clinical and the MRI findings.
Randeberg, Lise L.; Hegstad, Janne-Lise; Paluchowski, Lukasz; Milanič, Matija; Pukstad, Brita S.
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.
Shim, Hyung-Sup; Kim, Dong-Hwi; Kwon, Ho; Jung, Sung-No
Abdominal pocketing is one of the most useful methods in salvation of compromised replanted fingertips. Abdominal pocketing has generally been performed in the ipsilateral lower abdominal quadrant, but we have also performed contralateral pocketing at our institute. To determine which approach is more beneficial, a total of 40 patients underwent an abdominal pocketing procedure in either the ipsilateral or contralateral lower abdominal quadrant after fingertip replantation. Dates of abdominal pocketing after initial replantation, detachment after abdominal pocketing, range of motion (ROM) before abdominal pocketing, and sequential ROM after the detachment operation and date of full ROM recovery and Disabilities of Arm, Shoulder, and Hand questionnaire (DASH) score were recorded through medical chart review. Mean detachment date, mean abduction of shoulder after the detachment operation, and mean days to return to full ROM were not significantly different between the ipsilateral and contralateral pocketing groups. However, the mean DASH score was significantly lower in the contralateral group than the ipsilateral group. There were also fewer postoperative wound complications in the contralateral group than in the ipsilateral group. We, therefore, recommend contralateral abdominal pocketing rather than ipsilateral abdominal pocketing to increase patient comfort and reduce pain and complications. PMID:25379539
Shim, Hyung-Sup; Kim, Dong-Hwi; Kwon, Ho; Jung, Sung-No
Abdominal pocketing is one of the most useful methods in salvation of compromised replanted fingertips. Abdominal pocketing has generally been performed in the ipsilateral lower abdominal quadrant, but we have also performed contralateral pocketing at our institute. To determine which approach is more beneficial, a total of 40 patients underwent an abdominal pocketing procedure in either the ipsilateral or contralateral lower abdominal quadrant after fingertip replantation. Dates of abdominal pocketing after initial replantation, detachment after abdominal pocketing, range of motion (ROM) before abdominal pocketing, and sequential ROM after the detachment operation and date of full ROM recovery and Disabilities of Arm, Shoulder, and Hand questionnaire (DASH) score were recorded through medical chart review. Mean detachment date, mean abduction of shoulder after the detachment operation, and mean days to return to full ROM were not significantly different between the ipsilateral and contralateral pocketing groups. However, the mean DASH score was significantly lower in the contralateral group than the ipsilateral group. There were also fewer postoperative wound complications in the contralateral group than in the ipsilateral group. We, therefore, recommend contralateral abdominal pocketing rather than ipsilateral abdominal pocketing to increase patient comfort and reduce pain and complications.
Musin, É Kh; Roman'ko, N A; Makarov, I Iu; Kutsenko, K I
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.
Bailey, M. J.; Jeynes, C.
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.
Call your health care provider if: You have a fever above 100.5°F (38°C). Your surgical wound is bleeding, red and warm to touch, or has thick, yellow, or green drainage. Your pain medicine is not helping your pain. It is hard to breathe. You have a cough that ...
Steffen, S.; Otto, M.; Niewoehner, L.; Barth, M.; Bro¿żek-Mucha, Z.; Biegstraaten, J.; Horváth, R.
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.
Abdominal laparoscopy is a useful aid in diagnosing disease or trauma in the abdominal cavity with less scarring than ... as liver and pancreatic resections may begin with laparoscopy to exclude the presence of additional tumors (metastatic ...
... of collagen. So they're tougher and less flexible than the skin around them. Caring for Serious Wounds at Home Serious wounds don't heal overnight. It can take weeks for the body to build new tissue. So after you leave ...
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 ...
A number of benign and malignant tumors may develop in the abdominal cavity. Sarcomas are rather rare tumors of the abdominal cavity. They are often diagnosed at advanced growth stages as their local growth can cause clinical problems to the patients. The author presents a case report of myxofibrosarcoma in the abdominal cavity.Key words: myxofibrosarcoma.
Fabian, T C; Croce, M A; Pritchard, F E; Minard, G; Hickerson, W L; Howell, R L; Schurr, M J; Kudsk, K A
OBJECTIVE: Analysis of a staged management scheme for initial and definitive management of acute abdominal wall defects is provided. METHODS: A four-staged scheme for managing acute abdominal wall defects consists of the following stages: stage I--prosthetic insertion; stage II--2 to 3 weeks after prosthetic insertion and wound granulation, the prosthesis is removed; stage III--2 to 3 days later, planned ventral hernia (split thickness skin graft [STSG] or full-thickness skin and subcutaneous fat); stage IV--6 to 12 months later, definitive reconstruction. Cases were evaluated retrospectively for benefits and risks of the techniques employed. RESULTS: Eighty-eight cases (39 visceral edema, 27 abdominal sepsis, 22 abdominal wall resection) were managed during 8.5 years. Prostheses included polypropylene mesh in 45 cases, polyglactin 910 mesh in 27, polytetrafluorethylene in 10, and plastic in 6. Twenty-four patients died from their initial disease. The fistula rates associated with prosthetic management was 9%; no wound-related mortality occurred. Most wounds had split thickness skin graft applied after prosthetic removal. Definitive reconstruction was undertaken in 21 patients in the authors' institution (prosthetic mesh in 12 and modified components separation in 9). Recurrent hernias developed in 33% of mesh reconstructions and 11% of the components separation technique. CONCLUSIONS: The authors concluded that 1) this staged approach was associated with low morbidity and no technique-related mortality; 2) prostheses placed for edema were removed with fascial approximation accomplished in half of those cases; 3) absorbable mesh provided the advantages of reasonable durability, ease of removal, and relatively low cost--it has become the prosthesis of choice; and 4) the modified components separation technique of reconstruction provided good results in patients with moderate sized defects. Images Figure 2. Figure 3. Figure 4. Figure 5. PMID:8203973
Hondrogiannis, Ellen; Andersen, Danielle; Miziolek, Andrzej W.
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.
Erol, Özge Ö; Erdoğan, Behice Y; Onar, Atiye N
Simultaneous determination of nitrate and nitrite in gunshot residue has been conducted by capillary electrophoresis using an acidic run buffer (pH 3.5). In previously developed capillary electrophoretic methods, alkaline pH separation buffers were used where nitrite and nitrate possess similar electrophoretic mobility. In this study, the electroosmotic flow has been reversed by using low pH running buffer without any additives. As a result of reversing the electroosmotic flow, very fast analysis has been actualized, well-defined and separated ion peaks emerge in less than 4 min. Besides, the limit of detection was improved by employing large volume sample stacking. Limit of detection values were 6.7 and 4.3 μM for nitrate and nitrite, respectively. In traditional procedure, mechanical agitation is employed for extraction, while in this work the extraction efficiency of ultrasound mixing for 30 min was found sufficient. The proposed method was successfully applied to authentic gunshot residue samples.
Moran, Jordan Wade; Bell, Suzanne
Traditional gunshot residue (GSR) analysis is based on detection of particulates formed from metals found in the primer. Recent concerns regarding the interpretation of GSR evidence has led to interest in alternatives such as the organic constituents (organic gunshot residue, OGSR) found in propellants. Previous work has shown OGSR to be detectable on hands for several hours after a firing event, and given the lipophilic nature of these compounds, it was expected that losses due to secondary transfer (an issue with GSR particulates) would be negligible. However, other loss mechanisms have been identified, specifically skin permeation and evaporation. This paper describes experimental and modeling studies used to elucidate characteristics of skin permeation of 5 compounds present in OGSR. Pharmaceutical methods were adapted to characterize skin permeation using a skin surrogate and Franz diffusion cells. The amount of compounds deposited on skin after an authentic firing event (1 and 2 shots) was experimentally determined and applied for the permeation experiments. A fully validated selected ion monitoring GC/MS method was developed for quantitative analysis, and easily accessible online tools were employed for modeling. Results showed that OGSR residues should be detectable on skin for many hours after a firing event of as few as one or two shots, with detection capability being a function of the efficacy of sampling and sample preparation and the instrumental method employed. The permeation rates of the OGSR compounds were sufficiently different to suggest the potential to develop methods to approximate time-since-deposition.
Cardinetti, Bruno; Ciampini, Claudio; D'Onofrio, Carlo; Orlando, Giovanni; Gravina, Luciano; Ferrari, Francesco; Di Tullio, Donatello; Torresi, Luca
The possibility of detection of lead-antimony-barium aggregates from non-firearm sources is confirmed according to the tests performed on brake pads, and firework and automobile workers. Moreover, information on particles taken from cartridge cases shows the relative feeble importance of the morphology in distinguishing gunshot residues (GSRs). Furthermore, also the presence in the spectrum of other elements (e.g., iron) is not so conclusive. In this panorama, the possibility of discriminating gunshot residue particles from other non-firearm lead-antimony-barium aggregates is investigated: the proposed method is based on X-ray mapping technique--currently applied used in Reparto Carabinieri Investigazioni Scientifiche in Rome, the forensic service of Italian Carabinieri--according to which the spatial distribution of the emission energy of each element of the sample is pictured. Gunshot residues present the same lead-antimony-barium distribution (or at least the same antimony-barium distribution with lead nodules), as some other environmental occupational aggregates do not (different plaques of lead, antimony, and barium). So, X-ray mapping technique can offer a new fundamental evaluation parameter in analysis of gunshot residues with scanning electron microscopy/energy-dispersive (SEM/EDS) spectrometry, and new standards could be considered.
Wang, Y-G; Wu, J-S; Jiang, B; Wang, J-H; Liu, C-P; Peng, C; Tian, B-Z
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.
Ganesh, Kasturi; Sinha, Mithun; Mathew-Steiner, Shomita S.; Das, Amitava; Roy, Sashwati; Sen, Chandan K.
Significance: Multispecies microbial biofilms may contribute to wound chronicity by derailing the inherent reparative process of the host tissue. In the biofilm form, bacteria are encased within an extracellular polymeric substance and become recalcitrant to antimicrobials and host defenses. For biofilms of relevance to human health, there are two primary contributing factors: the microbial species involved and host response which, in turn, shapes microbial processes over time. This progressive interaction between microbial species and the host is an iterative process that helps evolve an acute-phase infection to a pathogenic chronic biofilm. Thus, long-term wound infection studies are needed to understand the longitudinal cascade of events that culminate into a pathogenic wound biofilm. Recent Advances: Our laboratory has recently published the first long-term (2 month) study of polymicrobial wound biofilm infection in a translationally valuable porcine wound model. Critical Issues: It is widely recognized that the porcine system represents the most translationally valuable approach to experimentally model human skin wounds. A meaningful experimental biofilm model must be in vivo, include mixed species of clinically relevant microbes, and be studied longitudinally long term. Cross-validation of such experimental findings with findings from biofilm-infected patient wounds is critically important. Future Directions: Additional value may be added to the experimental system described above by studying pigs with underlying health complications (e.g., metabolic syndrome), as is typically seen in patient populations. PMID:26155380
Buchanan, Edward P; Longaker, Michael T; Lorenz, H Peter
The developing fetus has the ability to heal wounds by regenerating normal epidermis and dermis with restoration of the extracellular matrix (ECM) architecture, strength, and function. In contrast, adult wounds heal with fibrosis and scar. Scar tissue remains weaker than normal skin with an altered ECM composition. Despite extensive investigation, the mechanism of fetal wound healing remains largely unknown. We do know that early in gestation, fetal skin is developing at a rapid pace and the ECM is a loose network facilitating cellular migration. Wounding in this unique environment triggers a complex cascade of tightly controlled events culminating in a scarless wound phenotype of fine reticular collagen and abundant hyaluronic acid. Comparison between postnatal and fetal wound healing has revealed differences in inflammatory response, cellular mediators, cytokines, growth factors, and ECM modulators. Investigation into cell signaling pathways and transcription factors has demonstrated differences in secondary messenger phosphorylation patterns and homeobox gene expression. Further research may reveal novel genes essential to scarless repair that can be manipulated in the adult wound and thus ameliorate scar.
An experiment was performed to compare the effects of stressors--cold, heat and noise--on primary wound activity (i.e., wound closure in the first 24 h after wound infliction) and on rate of healing in mice. A significant correlation was found between reduced primary wound activity and a faster rate of healing. Conversely, a correlation was found between relatively greater primary wound activity and a slower rate of healing. A possible explanation of this correlation is a compensatory mechanism inherent to the skin healing process. This mechanism is visualized as (1) stress exposure affecting the skin by (a) causing it to become thinner and tauter and (b) causing it to have less elastic recoil; therefore, (2) when a square wound is produced in stressed skin, (a) the wound does not recoil readily or gapes soon after cutting and (b) a longer wound perimeter results. Because there is evidence that rate of healing is governed by cells on the wound perimeter, the greater the perimeter, the greater the number of cells that will undergo rapid mitosis and the faster will be the rate of healing. Therefore, stressed skin will heal at a faster rate, compensating for the loss of elasticity and cellular depletion caused by stress. This study is of interest to anthropology because it deals with dynamic adaptation, trying to grasp the meaning of the elusive endocrine interface between environmental stimulation and a measurable physical entity like healing. This work may have revealed a functional complex that is common to the healing of all mammalian skin, whereby retarding effects of stress on the healing process are obviated.
Sachs, T; Schermerhorn, M
Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management.
Aliverti, Andrea; Bovio, Dario; Fullin, Irene; Dellacà, Raffaele L.; Lo Mauro, Antonella; Pedotti, Antonio; Macklem, Peter T.
Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs) is the difference between changes in trunk and body volume. This is so because both trunk and body volume change identically with breathing and gas expansion or compression. During tidal breathing Vbs was 50–75 ml with an ejection fraction of 4–6% and an output of 750–1500 ml/min. Step increases in abdominal pressure resulted in rapid emptying presumably from the liver with a time constant of 0.61±0.1SE sec. followed by slower flow from non-hepatic viscera. The filling time constant was 0.57±0.09SE sec. Splanchnic emptying shifted up to 650 ml blood. With emptying, the increased hepatic vein flow increases the blood pressure at its entry into the inferior vena cava (IVC) and abolishes the pressure gradient producing flow between the femoral vein and the IVC inducing blood pooling in the legs. The findings are important for exercise because the larger the Vbs the greater the perfusion of locomotor muscles. During asystolic cardiac arrest we calculate that appropriate timing of abdominal compression could produce an output of 6 L/min. so that the abdominal circulatory pump might act as an auxiliary heart. PMID:19440240
Baumann, Donald P.; Butler, Charles E.
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
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.
Abdominal catastrophe is a serious clinical condition, usually being a complication arising during treatment of intraabdominal nontraumatic disorders or abdominal injuries. Most commonly, inflamation- secondary peritonitis, is concerned. Abdominal catastrophe also includes secondary signs of sepsis, abdominal compartment syndrome and enterocutaneous fistules. Most septic abdominal disorders which show signs of abdominal catastrophy, require surgical intervention and reinterventions--planned or "on demand" laparotomies. During the postoperative period, the patient requires intensive care management, including steps taken to stabilize his/hers condition, management of sepsis and metabolic and nutritional support measures, as well as adequate indication for reoperations. New technologies aimed at prevention of complications in laparostomies and to improve conditions for final laparotomy closure are used in phase procedures for surgical management of intraabdominal infections. Despite the new technologies, abdominal catastrophe has higher morbidity and lethality risk rates.
Van Heertum, R.L.; Brunetti, J.C.; Yudd, A.P.
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.
Bouyou, J; Gaujoux, S; Marcellin, L; Leconte, M; Goffinet, F; Chapron, C; Dousset, B
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.
Matthews, P; Aziz, Q
Functional abdominal pain or functional abdominal pain syndrome (FAPS) is an uncommon functional gut disorder characterised by chronic or recurrent abdominal pain attributed to the gut but poorly related to gut function. It is associated with abnormal illness behaviour and patients show psychological morbidity that is often minimised or denied in an attempt to discover an organic cause for symptoms. Thus the conventional biomedical approach to the management of such patients is unhelpful and a person's symptom experience is more usefully investigated using a biopsychosocial evaluation, which necessarily entails a multidisciplinary system of healthcare provision. Currently the pathophysiology of the disorder is poorly understood but is most likely to involve a dysfunction of central pain mechanisms either in terms of attentional bias, for example, hypervigilance or a failure of central pain modulation/inhibition. Although modern neurophysiological investigation of patients is promising and may provide important insights into the pathophysiology of FAPS, current clinical management relies on an effective physician-patient relationship in which limits on clinical investigation are set and achievable treatment goals tailored to the patient's needs are pursued. PMID:15998821
Hnatko, S. I.; Macdonald, G. R.; Rodin, A. E.
Published records of the frequency of wound sepsis are often unreliable sources of information on the general frequency of this complication because of unstandardized methods of reporting and because of the various views of different investigators as to what constitutes sepsis. A method of infection reporting, its study and analysis are outlined. A survey of postoperative infections by this method for the years 1959, 1960 and 1961 revealed infection rates of 2.02%, 1.20% and 1.14%, respectively. For the same period the percentages of wound infections caused by Staph. aureus were 83.06%, 69.8% and 51.8%, respectively. The most prevalent phage types were 55/53/54 and 52/80/81/82, although types 80/81/82 and 80 were also involved. Infections with Gram-negative organisms were encountered more often in 1961 than in 1959. The majority of these were of mixed type, and followed abdominal surgery. There is need for more comprehensive study and analysis of postoperative wound sepsis and its complications. It was apparent from this study that, statistically, a relatively low rate of postoperative infections may mask a high rate following a specific surgical procedure. PMID:13954844
Oh, Chaeyoun; Youn, Joong Kee; Han, Ji-Won; Kim, Hyun-Young; Jung, Sung-Eun
Abstract The use of minimally invasive surgery (MIS) in pediatric patients has been steadily increasing in recent years. However, its use for diagnosing and treating abdominal tumors in children is still limited compared with adults, especially when malignancy is a matter of debate. Here, we describe the experience at our center with pediatric abdominal tumors to show the safety and feasibility of MIS. Based on a retrospective review of patient records, we selected for study those pediatric patients who had undergone diagnostic exploration or curative resection for abdominal tumors at a single center from January 2010 through August 2015. Diagnostic exploration for abdominal tumors was performed in 32 cases and curative resection in 173 cases (205 operations). MIS was performed in 11 cases of diagnostic exploration (34.4%) and 38 cases of curative resection (21.9%). The mean age of the children who underwent MIS was 6.09 ± 5.2 years. With regard to diagnostic exploration, patient characteristics and surgical outcomes were found to be similar for MIS and open surgery. With regard to curative resection, however, the mean age was significantly lower among the patients who underwent open surgery (4.21 ± 4.20 vs 6.02 ± 4.99 for MIS, P = 0.047), and the proportion of malignancies was significantly higher (80% vs 39.4% for MIS, P < 0.001). MIS compared favorably with open surgery with respect to the rate of recurrence (6.7% vs 35.1%, P = 0.035), the rate of intraoperative transfusions (34.2% vs 58.5%, P = 0.01), the median amount of blood transfused (14 vs 22 mL/kg, P = 0.001), and the mean number of hospital days (4.66 ± 2.36 vs 7.21 ± 5.09, P < 0.001). Complication rates did not differ significantly between the MIS and open surgery groups. The operation was converted to open surgery in 3 cases (27.2%) of diagnostic MIS and in 5 cases (13.1%) of curative MIS. MIS was found to be both feasible and effective for the
Niu, Yiwen; Cao, Xiaozan; Song, Fei; Xie, Ting; Ji, Xiaoyun; Miao, Mingyuan; Dong, Jiaoyun; Tian, Ming; Lin, Yuan; Lu, Shuliang
Dermatological problems in diabetes might play an important role in the spontaneous ulcers and impaired wound healing that are seen in diabetic patients. Investigation of the cause of diabetic skin disorders is critical for identifying effective treatment. The abdominal full-thickness skin tissues of 33 patients (14 nondiabetic and 19 diabetic) were analyzed. The cell viability and malondialdehyde (MDA) production of fibroblasts were measured after advanced glycosylation end product (AGE)-bovine serum albumin (BSA) exposure. Cutaneous histological observation showed reduced thickness of the diabetic abdominal dermis with morphological characteristics of obscured multilayer epithelium and shortened, thinned, and disorganized collagen fibrils with focal chronic inflammatory cell infiltration when compared with controls of the same age. Accumulation of AGEs in diabetic skin was prominent. Less hydroxyproline, higher myeloperoxidase activity, and increased MDA content were detected in diabetic skin. In vitro, the time- and dose-dependent inhibitory effects of AGE-BSA on fibroblast viability as well as the fact that AGE-BSA could promote MDA production of fibroblasts were shown. It is shown that the accumulation of AGEs in diabetic skin tissue induces an oxidative damage of fibroblasts and acts as an important contributor to the thinner diabetic abdominal dermis. The authors believe that diabetic cutaneous properties at baseline may increase the susceptibility to injury, and diabetic wounds possess atypical origin in the repair process.
... Skin Problems Dry Skin Itching Skin Color Changes Pressure Sores Scars and Wounds Treatments and Side Effects Managing ... purple bruising of skin Scaly, broken skin (see Pressure Sores ) Crusts, scabs, or cuts in the skin Bleeding ...
... 2009:chap 39. Simon BC, Hern HG. Wound management principles. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ...
Haverstock, Brent D
Puncture wounds often appear benign but can cause significant pedal morbidity. Podiatric physicians who treat such wounds should educate local emergency room, urgent care center, and primary care physicians as to the potential complications associated with puncture wounds. Timely referral, recognition of the potential complications, and appropriate treatment ensure that the wound does not advance beyond a puncture wound. If complications have developed, aggressive treatment is required to eradicate the infection and prevent pedal amputation.
Nikolaos, Tsiatis E.
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
... Pediatrician Health Issues Conditions Abdominal ADHD Allergies & Asthma Autism Cancer Chest & Lungs Chronic Conditions Cleft & Craniofacial Developmental ... of immune globulin and begin a series of immunizations against the rabies virus, which will prevent the ...
Targońska, Sylwia; Stążka, Janusz; Kozioł-Montewka, Maria
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. PMID:26336388
Kozioł, Małgorzata; Targońska, Sylwia; Stążka, Janusz; Kozioł-Montewka, Maria
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.
Eardley, W. G. P.; Brown, K. V.; Bonner, T. J.; Green, A. D.; Clasper, J. C.
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
Abreu-Blanco, Maria Teresa; Verboon, Jeffrey M
Cell wounding is a common event in the life of many cell types, and the capacity of the cell to repair day-to-day wear-and-tear injuries, as well as traumatic ones, is fundamental for maintaining tissue integrity. Cell wounding is most frequent in tissues exposed to high levels of stress. Survival of such plasma membrane disruptions requires rapid resealing to prevent the loss of cytosolic components, to block Ca2+ influx and to avoid cell death. In addition to patching the torn membrane, plasma membrane and cortical cytoskeleton remodeling are required to restore cell function. Although a general understanding of the cell wound repair process is in place, the underlying mechanisms of each step of this response are not yet known. We have developed a model to study single cell wound repair using the early Drosophila embryo. Our system combines genetics and live imaging tools, allowing us to dissect in vivo the dynamics of the single cell wound response. We have shown that cell wound repair in Drosophila requires the coordinated activities of plasma membrane and cytoskeleton components. Furthermore, we identified an unexpected role for E-cadherin as a link between the contractile actomyosin ring and the newly formed plasma membrane plug. PMID:21922041
Molnar, Joseph Andrew; Underdown, Mary Jane; Clark, William Andrew
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
I have tried to briefly review the evidence (summarized in Table II) indicating that fibronectin is important in cutaneous wound healing. Fibronectin appears to be an important factor throughout this process. It promotes the spreading of platelets at the site of injury, the adhesion and migration of neutrophils, monocytes, fibroblasts, and endothelial cells into the wound region, and the migration of epidermal cells through the granulation tissue. At the level of matrix synthesis, fibronectin appears to be involved both in the organization of the granulation tissue and basement membrane. In terms of tissue remodeling, fibronectin functions as a nonimmune opsonin for phagocytosis of debris by fibroblasts, keratinocytes, and under some circumstances, macrophages. Fibronectin also enhances the phagocytosis of immune-opsonized particles by monocytes, but whether this includes phagocytosis of bacteria remains to be determined. In general, phagocytosis of bacteria has not appeared to involve fibronectin. On the contrary, the presence of fibronectin in the wound bed may promote bacterial attachment and infection. Because of the ease of experimental manipulations, wound healing experiments have been carried out on skin more frequently than other tissues. As a result, the possible role of fibronectin has not been investigated thoroughly in the repair of internal organs and tissues. Nevertheless, it seems reasonable to speculate that fibronectin plays a central role in all wound healing situations. Finally, the wound healing problems of patients with severe factor XIII deficiencies may occur because of their inability to incorporate fibronectin into blood clots.
Thangapazham, Rajesh L.; Sharad, Shashwat; Maheshwari, Radha K.
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
Albina, J.E.; Mills, C.D.; Barbul, A.; Thirkill, C.E.; Henry, W.L. Jr.; Mastrofrancesco, B.; Caldwell, M.D.
Arginine metabolism in wounds was investigated in the rat in 1) lambda-carrageenan-wounded skeletal muscle, 2) Schilling chambers, and 3) subcutaneous polyvinyl alcohol sponges. All showed decreased arginine and elevated ornithine contents and high arginase activity. Arginase could be brought to the wound by macrophages, which were found to contain arginase activity. However, arginase was expressed by macrophages only after cell lysis and no arginase was released by viable macrophages in vitro. Thus the extracellular arginase of wounds may derive from dead macrophages within the injured tissue. Wound and peritoneal macrophages exhibited arginase deiminase activity as demonstrated by the conversion of (guanido-/sup 14/C)arginine to radiolabeled citrulline during culture, the inhibition of this reaction by formamidinium acetate, and the lack of prokaryotic contamination of the cultures. These findings and the known metabolic fates of the products of arginase and arginine deiminase in the cellular populations of the wound suggest the possibility of cooperativity among cells for the production of substrates for collagen synthesis.
Ogul, Hayri; Bayraktutan, Ummugulsum; Kizrak, Yesim; Pirimoglu, Berhan; Yuceler, Zeynep; Sagsoz, M Erdem; Yilmaz, Omer; Aydinli, Bulent; Ozturk, Gurkan; Kantarci, Mecit
The purpose of this article is to provide an up to date review on the spectrum of applications of perfusion computed tomography (CT) in the abdomen. New imaging techniques have been developed with the objective of obtaining a structural and functional analysis of different organs. Recently, perfusion CT has aroused the interest of many researchers who are studying the applicability of imaging modalities in the evaluation of abdominal organs and diseases. Per-fusion CT enables fast, non-invasive imaging of the tumor vascular physiology. Moreover, it can act as an in vivo biomarker of tumor-related angiogenesis.
Ogul, Hayri; Bayraktutan, Ummugulsum; Kizrak, Yesim; Pirimoglu, Berhan; Yuceler, Zeynep; Sagsoz, M. Erdem; Yilmaz, Omer; Aydinli, Bulent; Ozturk, Gurkan; Kantarci, Mecit
The purpose of this article is to provide an up to date review on the spectrum of applications of perfusion computed tomography (CT) in the abdomen. New imaging techniques have been developed with the objective of obtaining a structural and functional analysis of different organs. Recently, perfusion CT has aroused the interest of many researchers who are studying the applicability of imaging modalities in the evaluation of abdominal organs and diseases. Per-fusion CT enables fast, non-invasive imaging of the tumor vascular physiology. Moreover, it can act as an in vivo biomarker of tumor-related angiogenesis. PMID:25610249
Evanson, Brian J; Mullis, Brian H; Anglen, Jeffrey O
The treatment of nonunions often can be a complex and challenging venture. This case report details the treatment of a young patient's pertrochanteric femoral nonunion due to a low-velocity gunshot. Fracture fixation and union were attempted with various implants, including a sliding hip screw, blade plate, and proximal femoral locking plate; however, all eventually failed. Successful union ultimately was obtained only after use of a cephalomedullary nail. There have been few reports in the literature on the failure of proximal femoral locking plates in the treatment of pertrochanteric femur fractures, though much has been published regarding the sliding hip screw and blade plate. Multiple options for use in nonunion surgery were used and discussed in this case, such as autogenous bone graft, bone morphogenic protein, and implantable bone stimulators.
Reis, Edson L T; Sarkis, Jorge E Souza; Neto, Osvaldo N; Rodrigues, Claudio; Kakazu, Maurício H; Viebig, Sônia
This work presents a novel collection method for gunshot residues (GSR) using a sampling procedure based on ethylenediaminetetraacetic acid (EDTA) solution as a complexing agent on moistened swabs. Detection was via a sector-field inductively coupled plasma mass spectrometry (HRICP-MS). The proposed collection and analytical method allowed detection of antimony (Sb), barium (Ba) and lead (Pb) after .38 shot tests. at detection limits of less than 1 microg L(-1) in four different areas of the hands of volunteers. This paper includes a discussion concerning hand areas near the thumb and forefinger as being more suitable for GSR collection as well as a comparison between differences observed using 2% diluted EDTA. 2% nitric acid solution, and simple deionized water as collecting solutions, proving the superior efficiency of EDTA in GSR recoveries.
Kersh, Kyla L; Childers, James M; Justice, Dale; Karim, Greg
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.
Christopher, Matthew E; Warmenhoeven, John-William; Romolo, Francesco S; Donghi, Matteo; Webb, Roger P; Jeynes, Christopher; Ward, Neil I; Kirkby, Karen J; Bailey, Melanie J
Imaging and analyzing gunshot residue (GSR) particles using the scanning electron microscope equipped with an energy dispersive X-ray spectrometer (SEM-EDS) is a standard technique that can provide important forensic evidence, but the discrimination power of this technique is limited due to low sensitivity to trace elements and difficulties in obtaining quantitative results from small particles. A new, faster method using a scanning proton microbeam and Particle Induced X-ray Emission (μ-PIXE), together with Elastic Backscattering Spectrometry (EBS) is presented for the non-destructive, quantitative analysis of the elemental composition of single GSR particles. In this study, the GSR particles were all Pb, Ba, Sb. The precision of the method is assessed. The grouping behaviour of different makes of ammunition is determined using multivariate analysis. The protocol correctly groups the cartridges studied here, with a confidence >99%, irrespective of the firearm or population of particles selected.
Kara, Ilker; Lisesivdin, Sefer Bora; Kasap, Mehmet; Er, Elif; Uzek, Ugur
In this study, chemical composition and morphology of gunshot residue (GSR) of 9 × 19 mm Parabellum-type MKE (Turkey)-brand ammunition were analyzed by scanning electron microscope and energy dispersive X-ray spectrometer. GSR samples were collected by "swab" technique from the shooter's right hand immediately after shooting. According to general principles of thermodynamics, it is likely that the structures will have a more regular (homogeneous) spherical form to minimize their surface area due to very high temperatures and pressures that occur during explosion. Studied samples were collected under the same conditions with the same original ammunition, from the same firearm and a single shooter. This is because many other variables may affect size, structure, and composition in addition to the concentrations of elements of the structure. Results indicated that the chemical compositions are effective in the formation of GSR morphological structures.
Burnett, Bryan R
These experiments were designed to determine whether skin debris (desquamated epithelial cells and apparent skin oils) affects gunshot residue (GSR) particle detection on the sticky tape lift samples prepared for scanning electron microscopy (SEM). A dabbing experiment showed that GSR particles accumulate not only on the adhesive surface of the sampler, but also on the epithelial cell surfaces. Samplers were loaded with target GSR followed by dabbing 30 times on the back of a hand. Backscatter electron images were taken at 20 kV and for some at 30 kV of the same areas. The samplers were then treated with a sodium/calcium hypochlorite solution (bleach) to remove skin debris and again imaged in the SEM. Comparison of these images shows more GSR particles will likely be revealed at 30 kV than 20 kV and more particles revealed by the bleach treatment in an automated SEM system.
Berk, Robert E; Rochowicz, Scott A; Wong, Mary; Kopina, Michael A
Suspects in shooting investigations in Chicago are routinely transported in department vehicles and detained in department facilities prior to gunshot residue (GSR) evidence collection. The GSR test results are used to associate the suspect with primary exposure to GSR. The potential for these vehicles and facilities being sources of secondary GSR contamination needed to be determined. A total of 201 samples were collected from randomly selected vehicles and detention facilities. The sampling collected trace materials from surfaces that suspects' hands may contact during the arrest process. These samples were examined for the presence of GSR particles using scanning electron microscopy. Upon completion of the automated analysis, those particles that met an initial GSR screening criterion were relocated and reanalyzed. The locations where GSR particles were recovered allowed us to make recommendations to the Chicago Police Department with regard to transporting and detaining these suspects. The low number of GSR particles recovered suggests that the potential for secondary contamination, although present, is relatively low.
Chang, Jay; Mendyk, William; Thier, Lisa; Yun, Paul; LaRow, Andy; Shaw, Scott; Schoenborn, William
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.
Mickelson, Megan A; Mans, Christoph; Colopy, Sara A
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.
Stafford, P. J.
A 62 year old man presented with abdominal ascites, without pleural effusion, due to peritoneal mesothelioma. He had chronic obstructive airways disease and a past history of right upper lobectomy for tuberculosis. On two occasions abdominal paracentesis was followed within 72 hours by pneumothorax. This previously unreported complication of abdominal paracentesis may be due to increased diaphragmatic excursion following the procedure and should be considered in patients with preexisting lung disease. PMID:2385561
COW 03 PUBLICATION REPORT 94-30227 * ABDOMINAL TUBERCULOSIS IN CAIRO, BY RWIavni 0. IHibbs6 M. Kuanmm ad Z. Fun .Y .~ ... W I Form ApprovedREPORT...Leave blank) 2. REPORT DATE 3. REPORT TYPE AND DATES COVERED 8 April 1993 4. TITLE AND SUBTITLE S. FUNDING NUMBERS Abdominal Tuberculosis in Cairo...abdominal tuberculosis patients seen at Abbassia Fever Hospital in Cairo, Egypt from January 1990 to August 1992 are described; their mean age was 21.5
Okafor, Ii; Ude, Ac; Aderibigbe, Aso; Amu, Oc; Udeh, Pe; Obianyo, Nen; Ani, Coc
A case of abdominal pregnancy in a 39 year old female gravida 4, para 0(+3) is presented. Ultrasonography revealed a viable abdominal pregnancy at 15 weeks gestational age. She was initially managed conservatively. Surgical intervention became necessary at 20 weeks gestational age following Ultrasound detection of foetal demise. The maternal outcome was favourable. This case is presented to highlight the dilemma associated with diagnosis and management of abdominal pregnancy with a review of literature.
Wilson, Michael L; Lewis, Erin R
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.
Schumacher, Rüdiger; Barth, Martin; Neimke, Dieter; Niewöhner, Ludwig
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.
Ghoraba, Hammouda Hamdy; Mansour, Hosam Osman; Abdelfattah, Haithem Mamon; Elgemai, Emad Mohamed
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
Hendrick, D A; Meyers, A
Compared with scalpel wounds, CO2 laser wounds show delays in inflammation, collagen production, reepithelialization, and tensile strength in the early stages of healing. Some of these delays are similar to those seen with electrocautery and burn wounds. Later stages compensate for these early deficiencies, because scalpel and laser wounds become more similar in epithelialization and wound strength over time. Healed CO2 laser wounds tend to have less scar contraction than scalpel wounds. Débridement of initial laser wound char, tissue cooling techniques during lasering, and pulsed modes of laser delivery all seem to result in more rapid, favorable healing. Similar wound healing trends have been seen with the CO2 laser in bone, with other lasers, and with laser vascular and neural anastomosis. Biostimulation with low-level laser energy is a complex subject of ongoing investigations.
Siebenmann, R; Schneider, K; von Segesser, L; Turina, M
348 cases of abdominal aortic aneurysm were reviewed for typical features of inflammatory aneurysm (IAAA) (marked thickening of aneurysm wall, retroperitoneal fibrosis and rigid adherence of adjacent structures). IAAA was present in 15 cases (14 male, 1 female). When compared with patients who had ordinary aneurysms, significantly more patients complained of back or abdominal pain (p less than 0.01). Erythrocyte sedimentation rate was highly elevated. Diagnosis was established in 7 of 10 computed tomographies. 2 patients underwent emergency repair for ruptured aneurysm. Unilateral ureteral obstruction was present in 4 cases and bilateral in 1. Repair of IAAA was performed by a modified technique. Histological examination revealed thickening of the aortic wall, mainly of the adventitial layer, infiltrated by plasma cells and lymphocytes. One 71-year-old patient operated on for rupture of IAAA died early, and another 78-year-old patient after 5 1/2 months. Control computed tomographies revealed spontaneous regression of inflammatory infiltration after repair. Equally, hydronephrosis due to ureteral obstruction could be shown to disappear or at least to decrease. IAAA can be diagnosed by computed tomography with high sensitivity. Repair involves low risk, but modification of technique is necessary. The etiology of IAAA remains unclear.
Boos, C; Kujath, P; Bruch, H-P
The incidence of invasive mycoses in patients undergoing abdominal surgery amounts to approximately 8% and shows an upward trend in epidemiological studies. The lethality of these systemic mycoses, which are mostly based on Candida infections constitutes up to 60%. The development of a sytemic mycosis is marked by exogenic, endogenic and iatrogenic risk factors and typically displays tissue invasion after an initial fungal contamination or systemic dissemination via fungal sepsis. Fungal peritonitis is generally a monoinfection with Candida spp., where Candida albicans outweighs in 70% of cases. Aspergillus spp. are only detected abdominally in rare cases. The histological verification of a fungal invasion is regarded as proof of the existence of an invasive mycosis, but typical macroscopic findings with corresponding cultural findings can also confirm the diagnosis. Systemic mycosis requires an early initiation of a consistent antimycotic therapy as well as definitive surgical eradication of the focus in order to reduce high lethal rate. Resistances or incorrect dosages can be validated objectively by means of histological monitoring of the antimycotic therapy, thus affording early recognition of the need to change the substance class.
Sugimoto, Satoshi; Miyazaki, Yasuaki; Hirose, Sou; Michiura, Toshiya; Fujita, Shigeo; Yamabe, Kazuo; Miyazaki, Satoru; Nagaoka, Makio
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.
Moazzez, Ashkan; Mason, Rodney J; Katkhouda, Namir
Since Ramirez et al. presented the first case of component separation for abdominal wall hernias in 1990, it has undergone multiple modifications. This technique, which has been mainly used for large hernias where primary closure of the abdominal wall is not feasible, or for staged management of patients with open abdomens, results in multiple wound complications. In 2007, Rosen et al. reported on the laparoscopic approach to component separation that is associated with less subcutaneous dissection and the consequent advantage of a decreased risk of flap necrosis and wound infection. Here we discuss our totally laparoscopic approach to abdominal wall reconstruction. A minimally invasive abdominal wall reconstruction consists of a bilateral component separation, an intra-abdominal adhesiolysis, primary approximation of rectus muscles, and placement of an intraperitoneal mesh for reinforcing the repair, all performed laparoscopically. Patient-selection criteria, detailed operative technique, tips in preventing and managing the potential pitfalls, and postoperative care are discussed.
Bège, T; Berdah, S V; Brunet, C
Stab wounds represent the most common cause of penetrating wounds, occurring mainly in case of aggression or suicide attempt. Clinical severity depends on the superficial or penetrating aspect of the wound, its location and damaged organs. Medical management must be known because the vital risk is involved in penetrating wounds. Hemodynamically unstable patients should be operated without delay after performing a chest X-ray and ultrasound Focus assisted sonography for trauma (FAST) to guide the surgery. In the stable patients, the general clinical examination, exploration of the wound and medical imaging detect injuries requiring surgical management. Stab penetrating wounds require close and rapid collaboration between medical teams, tailored to the institution's resources.
Kääriäinen, M; Kuokkanen, H
"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.
Hagel, C; Schilling, M
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.
Wilkins, Robert G; Unverdorben, Martin
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.
Dockery, Christopher R.; Goode, Scott R.
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.
Burnweit, C; Bilik, R; Shandling, B
We studied the clinical course of 506 children consecutively admitted with appendicitis at The Hospital for Sick Children from 1985 to 1989. One hundred eighty-one children (35%), ranging in age from 1 to 17 years, presented with perforation verified by histological examination. Ninety-six of them (53%) had generalized peritonitis, 47 (26%) had localized peritonitis, and 38 (21%) had abscess formation. Usually, triple antibiotics were begun preoperatively if perforation was suspected; otherwise, cefoxitin was started. Triple antibiotics were used postoperatively for 5 to 7 days in almost all children in the perforated group. Neither abdominal nor subcutaneous drainage was routinely used even in cases of intraabdominal abscess. The skin was closed primarily with steri-strips (63%), staples (20%), subcutaneous Dexon (11%), or silk (4%). Postoperative wound infection arose in 20 children (11%). Wound infections were noted from 1 to 14 days postoperatively (mean, 5.9 days). Whereas 9 of these were treated with local therapy only, 11 delayed the child's discharge or necessitated readmission. No patient suffered major complications from wound infection in that there were no cases of necrotizing fasciitis, reoperation for debridement, sepsis, or death. The intraabdominal abscess rate in this group of 181 children was 6% (n = 11). The low rate of infective complications fully justifies the policy of primary closure in contaminated wounds. This policy eliminates the necessity for painful and time-consuming dressing changes, shortens hospitalization, and obviates the trauma of delayed suturing of wounds in children.
Haycock, Christine E.
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)
Morton, Laurel M; Phillips, Tania J
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.
civilian trauma center. The parameters bearing the most weight will be used to diagnose trauma wounds and predict patient outcome. 15. SUBJECT TERMS...are most important for a correct initial assessment of the wound along with a more accurate wound healing prediction. The parameters bearing the
Inoue, Yuji; Hasegawa, Minoru; Maekawa, Takeo; Le Pavoux, Andres; Asano, Yoshihide; Abe, Masatoshi; Ishii, Takayuki; Ito, Takaaki; Isei, Taiki; Imafuku, Shinichi; Irisawa, Ryokichi; Ohtsuka, Masaki; Ohtsuka, Mikio; Ogawa, Fumihide; Kadono, Takafumi; Kodera, Masanari; Kawakami, Tamihiro; Kawaguchi, Masakazu; Kukino, Ryuichi; Kono, Takeshi; Sakai, Keisuke; Takahara, Masakazu; Tanioka, Miki; Nakanishi, Takeshi; Nakamura, Yasuhiro; Hashimoto, Akira; Hayashi, Masahiro; Fujimoto, Manabu; Fujiwara, Hiroshi; Matsuo, Koma; Madokoro, Naoki; Yamasaki, Osamu; Yoshino, Yuichiro; Tachibana, Takao; Ihn, Hironobu
The Japanese Dermatological Association determined to prepare the Wound/Burn Guidelines focusing on treatments, catering to needs for the clinical practice of dermatology. Among these guidelines, "Wounds in General" was intended to explain knowledge necessary "to heal wounds" without specifying particular disorders.
Epstein, B.M.; Mann, J.H.
Intraabdominal tuberculosis (TB) presents with a wide variety of clinical and radiologic features. Besides the reported computed tomographic (CT) finding of high-density ascites in tuberculous peritonitis, this report describes additional CT features highly suggestive of abdominal tuberculosis in eight cases: (1) irregular soft-tissue densities in the omental area; (2) low-density masses surrounded by thick solid rims; (3) a disorganized appearance of soft-tissue densities, fluid, and bowel loops forming a poorly defined mass; (4) low-density lymph nodes with a multilocular appearance after intravenous contrast administration; and (5) possibly high-density ascites. The differential diagnosis of these features include lymphoma, various forms of peritonitis, peritoneal carcinomatosis, and peritoneal mesothelioma. It is important that the CT features of intraabdominal tuberculosis be recognized in order that laparotomy be avoided and less invasive procedures (e.g., laparoscopy, biopsy, or a trial of antituberculous therapy) be instituted.
Malachovský, I; Straka, L; Novomeský, F; Statelová, D; Janícková, M; Stilla, J; Urbanová, E
Maxillofacial shot wounds belong to the relatively less frequent injuries. The soft tissues might be affected in particular, however the most of injuries are combined with infliction of hard tissues. Shot wounds by the bow or crossbow are very rare. They might result as a consequence of either accident or suicide. In the literature some cases of a suicidal experiments had been published, all of these cases were due to arrow from the crossbow. There was no injury being documented due to arrow from the bow. The authors present a case of maxillofacial injury done by shoot of arrow from the bow in the course of a child's play.
Anderson, Caesar A.; Hare, Marc A.; Perdrizet, George A.
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
You, Hi-Jin; Han, Seung-Kyu
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.
Shah, Jayesh B.
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
... Your 1- to 2-Year-Old Wound Drainage Culture KidsHealth > For Parents > Wound Drainage Culture Print A A A What's in this article? ... de heridas What It Is A wound drainage culture is a test to detect germs such as ...
Situm, Mirna; Kolić, Maja
Wound represents disruption of the anatomic and physiologic continuity of the skin. Regarding the healing process, wounds can be classified as acute or chronic wounds. A wound is considered chronic if healing does not occur within the expected period according to its etiology and localization. Chronic wounds can be classified as typical and atypical. Typical wounds include ischemic, neurotrophic and hypostatic ulcers and two separate entities: diabetic foot and decubitus ulcers. Eighty percent of chronic wounds localized on the lower leg are the result of chronic venous insufficiency, in 5-10 percent the cause is of arterial etiology, whereas the remainder is mostly neuropathic ulcer. Ninety-five percent of chronic wounds manifest as one of the above mentioned entities. Other forms of chronic wounds represent atypical chronic wounds, which can be caused by autoimmune disorders, infectious diseases, vascular diseases and vasculopathies, metabolic and genetic diseases, neoplasm, external factors, psychiatric disorders, drug related reactions, etc. Numerous systemic diseases can present with atypical wounds. The primary cause of the wound can be either systemic disease itself (Crohn's disease) or aberrant immune response due to systemic disease (pyoderma gangrenosum, paraneoplastic syndrome).
... around the incision increases or becomes thick, tan, green, or yellow, or smells bad (pus). Also call if your temperature is above 100°F (37.7°C) for more than 4 hours. Alternative Names Surgical incision care; Closed wound care References Leong M, Phillips LG. ...
severely limits the may prove to be useful in burn patients. Clotrimazole , applied clinical utility of such a culture. Biopsy and frozen-section and as...useful in wound and permit prompt institution of appropriate the treatment of systemic fungal infections. Clotrimazole is treatment. poorly absorbed
Church, Deirdre; Elsayed, Sameer; Reid, Owen; Winston, Brent; Lindsay, Robert
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
Wisted, Eric E.; Lundquist, Susan H.
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.
Wisted, E.E.; Lundquist, S.H.
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.
Adams, Erica J.
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…
Nishio, Naomi; Ito, Sachiko; Suzuki, Haruhiko; Isobe, Ken-ichi
The wound repair process is a highly ordered sequence of events that encompasses haemostasis, inflammatory cell infiltration, tissue regrowth and remodelling. Wound healing follows tissue destruction so we hypothesized that antibodies might bind to wounded tissues, which would facilitate the engulfment of damaged tissues by macrophages. Here, we show that B cells, which produce antibodies to damaged tissues, are engaged in the process of wound healing. Splenectomy delayed wound healing, and transfer of spleen cells into splenectomized mice recovered the delay in wound healing. Furthermore, wound healing in splenectomized nude mice was also delayed. Transfer of enriched B220(+) cells by magnetic beads accelerated wound healing in splenectomized mice. We detected immunoglobulin G1 (IgG1) binding to wounded tissues by using fluorescein isothiocyanate-labelled anti-IgG1 6-24 hr after wounding. Splenectomy reduced the amount of IgG1 binding to wounded tissues. Immunoblotting studies revealed several bands, which were reduced by splenectomy. Using immunoprecipitation with anti-IgG bound to protein G we found that the intensity of several bands was lower in the serum from splenectomized mice than in that from sham-operated mice. These bands were matched to myosin IIA, carbamoyl-phosphate synthase, argininosuccinate synthase, actin and alpha-actinin-4 by liquid chromatography tandem mass spectrometry analysis.
Dabiri, Ganary; Damstetter, Elizabeth; Phillips, Tania
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.
ROSA, Roberto Maranhão; CAIADO, Rafael Coelho; REIS, Paulo Roberto de Melo; LACERDA, Elisângela de Paula Silveira; SUGITA, Denis Masashi; MRUÉ, Fátima
Background The number of malignancies increased alarmingly. Surgery constitutes one of the most efficient therapeutic modalities for the treatment of solid tumors. The neoplastic implant in surgical wound is a complication whose percentage of occurrence reported in the literature is variable, but sets with high morbidity and therapeutic difficulties. Protecting the wound is one of the recommended principles of oncologic surgery. Aim To evaluate the influence of wound protection in the development of tumor implantation. Methods Sarcoma 180 tumor cells were used, with intraperitoneal inoculation in Swiss mice. After the establishment of neoplastic ascites, animals were randomized into two groups of 10, each group consisting of five males and five females. In both groups, laparotomy and manipulation of intra-abdominal organs was performed. In a group laparotomy was performed using the protection of the abdominal wound and the other group without it. On the 9th postoperative day macroscopic evaluation of the operative scar was performed, which was later removed for microscopic evaluation. Results There was microscopic infiltration of tumor cells in the wound of all animals. However, the group that held the protection, infiltration was less intense when compared to the group without it. The infiltration was also more severe in females than in males of the same group. Conclusion Tumor infiltration into the wound was more intense in the group in which the protection of the surgical site was not performed, and in females when compared to males of the same group. PMID:25861061
Tseng, Yi-Ling; Hsu, Chun-Hung; Tseng, Hui-Chen
This article describes a nursing experience applying the protocol of bilateral Zusanli (ST-36) acupressure to reduce abdominal bloating in a colon cancer patient who had undergone a right hemicolectomy. The period of care was between November 13 and November 23, 2014. Data were collected through direct care, interviews, observation, and physical assessment. The main health problems of the patient included anxiety, surgical wound pain, and abdominal bloating. We provided pre- and postoperative routine nursing care, wound pain management, and the protocol of Zusanli (ST-36) acupressure for reducing abdominal bloating. Results of care recorded the first passage of flatus and intestinal motility during the second postoperative day, with no complaints of bloating from the fourth postoperative day. The subject exhibited a relaxed mood and slept soundly following each acupressure session. Furthermore, the subject reported experiencing no abdominal bloating during the week following discharge, during which he continued to follow the acupressure protocol. This article provides support via an instance of nursing care for the effectiveness of the Zusanli (ST-36) acupressure in improving abdominal bloating and thus reducing the complications of hemicolectomy surgery.
Ong, Cheri A
Although wound care has been practiced for centuries, telewound care is a relatively new concept. Currently, only a few pilot programs are in existence. Telewound care has yet to achieve the popularity and recognition of its other telemedicine predecessors amongst members of the health care industry and public alike. The tremendous potential of incorporating the technology of telemedicine into wound care needs to be realized. Wound care is a representation of the care of chronic and debilitating conditions that require long-term specialized care. We have seen the positive effects of improved living conditions and advances in health care globally. The result: people are now living longer. Every day a small piece is added to the pie: the percentage of world's elderly and those with chronic medical conditions that would require medical attention is rising. With the escalating costs of health care, and the push of the industry towards outpatient care, this is a part of the health care crisis that is demanding our immediate attention. We have seen positive outcomes in the care of other chronic medial conditions using telemedicine such as home telecare programs. In addition, the effectiveness of several programs using available advances in technology such as the field of radiology has been established. Wound care can build on success created in these fields to create an effective and useful method of care. The aim of this chapter is to recognize the impact of this problem, to introduce several pilot programs in several different aspects of wound care and to build on current resources in order to achieve a novel method of wound care. The goal would be to create a technologically advanced, cost-effective and user-friendly program, and be able to bridge the gap between the sick and available specialized care. Both store-and-forward technology and televideo have a role to play in telewound care, the latter greater in the role of home telecare and teleconsultation, and the
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.
Turcić, J; Hancević, J; Antoljak, T; Zic, R; Alfirević, I
In a prospective study on 35 wounded persons we examined the effects of ozone on how well split-thickness skin grafts took in war wounds. Each of the 35 wounded persons hat at least two similar gunshot wounds, one on the lower leg or forearm and the other on the upper leg or upper arm. During the first 10 days all wounds were treated with 10% NaCl water solution dressings until the moment when healthy granulations were observed. Thereafter, the defects were covered with split-thickness skin grafts according to Thiersch. For technical reasons we treated grafts on the lower leg and forearm with ozone following the usual scheme. Grafts on the upper leg or upper arm were treated in the conventional way and they served as a control group. The results obtained in the group followed up are presented by percentage of graft takes after 10 days and accordingly compared with the results obtained in the control group. There was a higher percentage of takes in ozone-treated split-thickness skin grafts. More than 74.3% of the split-thickness skin grafts treated with ozone had a take of more than 75% of the covered surface as apposed to only 40% of the grafts treated with the conventional method. The results in these two groups were compared with a chi square matched pair test. Difference in take of the skin grafts in these two groups was statistically significant at P < 0.01.
Dasgupta, Roshni; Wales, Paul W; Zuker, Ronald M; Fisher, David M; Langer, Jacob C
Abdominal wall reconstruction in omphalopagus twins poses a difficult reconstructive challenge, as separation often results in a large abdominal wall defect. A number of options are available for closure, including tissue flaps, expanders and patches made of foreign material. Surgisis is a new biodegradable small intestine scaffolding substrate that permits tissue in-growth and results in a permanent durable scar. We describe its use in abdominal wall reconstruction after separation of a set of conjoined twins. A set of omphalopagus conjoined twins shared liver and abdominal wall. After separation at 6 months of age, Twin A's abdomen could be closed primarily, but Twin B could not. A 4-ply Surgisis mesh was used in the upper abdominal closure, and a skin flap was created, to completely cover the patch. Both twins survived the operation. A small portion of the skin flap over the Surgisis broke down, healing by secondary intention. In follow up of over 18 months post procedure, there have been no wound infections and the abdominal wall is intact with no evidence of a hernia. Surgisis can be successfully used for the reconstruction of complex abdominal wall defects in the pediatric patient, including reconstruction after separation of conjoined twins.
Validire, J; Imbaud, P; Dutet, D; Duron, J J
One hundred and fifty large abdominal incisional hernias were treated following a standardized operating technique using metallic mesh (Toilinox) and approximation of the anterior sheath of the rectus abdominis. The average follow-up was four years. Good clinical results without pain were found in more than 95 per cent of the patients. Recurrence occurred in 9.5 per cent of the patients. The complications, wound infection or parietal necrosis, never necessitated removal of the prosthesis. These results justify the use of this technique even when intra-abdominal septic procedure is associated.
Bower, Curtis; Roth, J Scott
The economic aspects of abdominal wall reconstruction are frequently overlooked, although understandings of the financial implications are essential in providing cost-efficient health care. Ventral hernia repairs are frequently performed surgical procedures with significant economic ramifications for employers, insurers, providers, and patients because of the volume of procedures, complication rates, the significant rate of recurrence, and escalating costs. Because biological mesh materials add significant expense to the costs of treating complex abdominal wall hernias, the role of such costly materials needs to be better defined to ensure the most cost-efficient and effective treatments for ventral abdominal wall hernias.
Zucchini, Giorgia; Pezzilli, Raffaele; Ricci, Claudio; Casadei, Riccardo; Santini, Donatella; Calculli, Lucia; Corinaldesi, Roberto
In spite of careful intraoperative precautions and gauze counts, mistakes can still occur during surgery. In the case reported, a retained gauze leaved during a surgical approach for removing a solid-cystic papillary tumor localized in the pancreatic tail, caused both persistent abdominal discomfort and the presence of an abdominal cystic lesion at imaging techniques. When a previous operative history is present, a foreign body should be taken into account in the differential diagnosis of a patient with an intra-abdominal cystic mass. Finally, radio-opaque marker should be routinely used by surgeons in order to reach a correct diagnosis in operated patients having retained gauze.
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
Lee, Ian; Kosko, Bart; Anderson, W French
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.
MacKay, Douglas; Miller, Alan L
Healing of wounds, whether from accidental injury or surgical intervention, involves the activity of an intricate network of blood cells, tissue types, cytokines, and growth factors. This results in increased cellular activity, which causes an intensified metabolic demand for nutrients. Nutritional deficiencies can impede wound healing, and several nutritional factors required for wound repair may improve healing time and wound outcome. Vitamin A is required for epithelial and bone formation, cellular differentiation, and immune function. Vitamin C is necessary for collagen formation, proper immune function, and as a tissue antioxidant. Vitamin E is the major lipid-soluble antioxidant in the skin; however, the effect of vitamin E on surgical wounds is inconclusive. Bromelain reduces edema, bruising, pain, and healing time following trauma and surgical procedures. Glucosamine appears to be the rate-limiting substrate for hyaluronic acid production in the wound. Adequate dietary protein is absolutely essential for proper wound healing, and tissue levels of the amino acids arginine and glutamine may influence wound repair and immune function. The botanical medicines Centella asiatica and Aloe vera have been used for decades, both topically and internally, to enhance wound repair, and scientific studies are now beginning to validate efficacy and explore mechanisms of action for these botanicals. To promote wound healing in the shortest time possible, with minimal pain, discomfort, and scarring to the patient, it is important to explore nutritional and botanical influences on wound outcome.
Mortimer, Alice Emily
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.
Dritt, William S.; Gerth, Howard L.; Knight, Jr., Charles E.; Pardue, Robert M.
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.
Tributsch, W; Rabl, W; Ambach, E
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.
Walker, Judi; Cullen, Marianne; Chambers, Helen; Mitchell, Eleanor; Steers, Nicole; Khalil, Hanan
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.
Bowler, P. G.; Duerden, B. I.; Armstrong, D. G.
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
... signs or symptoms of an abdominal aortic aneurysm (AAA). The final recommendation statement summarizes what the Task ... the potential benefits and harms of screening for AAA: (1) Men ages 65 to 75 who smoke ...
... not use ionizing radiation, has no known harmful effects, and is particularly valuable for evaluating abdominal, pelvic ... of the reflected sound waves (called the Doppler effect). A computer collects and processes the sounds and ...
Davis, Suja P
Patients face various possible complications after abdominal surgery. This article examines best practice in guiding and teaching them how to use an incentive spirometer to facilitate recovery and prevent respiratory complications.
abdominal compartment syndrome, schemic bowel, biliary disease, peptic ulcer disease and astritis requiring laparotomy, small bowel obstruction, rimary fungal...complications in- luded trauma exploratory laparotomy, abdominal com- artment syndrome, ischemic bowel, biliary disease, peptic lcer disease and gastritis, large...70%); 13 for other compli- ations, such as biliary or perineal conditions (26%); and 4 or feeding access (8%). For the civilians, 2 had trauma
Introduction Hysterectomy is one of the most common gyneacological surgeries performed worldwide. The vaginal technique has been introduced and performed centuries back, but has been less successful due to lack of experience and enthusiasm among Gynaecologists, due to a misconception that the abdominal route is safer and easier. Aim To evaluate the most efficient route of hysterectomy in women with mobile nonprolapsed uteri of 12 weeks or lesser by comparing the intra and postoperative complications of vaginal and abdominal hysterectomies. Materials and Methods A prospective, randomized controlled trial was performed wherein, 300 consecutive patients requiring hysterectomy for benign diseases were analysed over a period of 2 years (December 2012–November 2014). Group A (n = 150) underwent vaginal hysterectomy (non descent vaginal hysterectomy, NDVH) which was compared with group B (n = 150) who had abdominal hysterectomy. The primary outcome measures were operative time, intraoperative blood loss, postoperative analgesia, hospital stay, postoperative mobility, blood transfusion, wound infection, febrile morbidity and postoperative systemic infections. Secondary outcome measures were conversion of vaginal to abdominal route and re-laparotomy. Results Baseline characteristics were similar between the two groups. There were no intraoperative complications in either group. Regarding operation duration, intraoperative blood loss, postoperative pain, postoperative blood transfusion, mobilization in post operative ward, postoperative wound infection, febrile morbidity, duration of hospital stay, p-value was significant in vaginal hysterectomy compared to abdominal hysterectomy. Regarding postoperative systemic infections, p-value was not significant. None of the cases in the vaginal group were converted to abdominal route and none of the cases in the whole study group underwent re-laparotomy. Conclusion The present study concludes that patients requiring hysterectomy
Janis, Jeffrey; Harrison, Bridget
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.
Almost 1/2 century ago, H. E. ``Doc'' Edgerton demonstrated a simple and elegant direct-shadowgraph technique for imaging large-scale events like explosions and gunshots. Only a retroreflective screen, flashlamp illumination, and an ordinary view camera were required. Retroreflective shadowgraphy has seen occasional use since then, but its unique combination of large scale, simplicity and portability has barely been tapped. It functions well in environments hostile to most optical diagnostics, such as full-scale outdoor daylight ballistics and explosives testing. Here, shadowgrams cast upon a 2.4 m square retroreflective screen are imaged by a Photron Fastcam APX-RS digital camera that is capable of megapixel image resolution at 3000 frames/sec up to 250,000 frames/sec at lower resolution. Microsecond frame exposures are used to examine the external ballistics of several firearms, including a high-powered rifle, an AK-47 submachine gun, and several pistols and revolvers. Muzzle blast phenomena and the mechanism of gunpowder residue deposition on the shooter's hands are clearly visualized. In particular, observing the firing of a pistol with and without a silencer (suppressor) suggests that some of the muzzle blast energy is converted by the silencer into supersonic jet noise.
Ortega-Ojeda, F E; Torre-Roldán, M; García-Ruiz, C
This work used chemical imaging in the short-wave infrared region for analysing gunshot residues (GSR) patterns in cotton fabric targets shot with conventional and non-toxic ammunition. It presents a non-destructive, non-toxic, highly visual and hiperspectral-based approach. The method was based on classical least squares regression, and was tested with the ammunition propellants and their standard components' spectra. The propellants' spectra were satisfactorily used (R(2) >0.966, and CorrCoef >0.982) for identifying the GSR irrespective of the type of ammunition used for the shooting. In a more versatile approach, nitrocellulose, the main component in the ammunition propellants, resulted an excellent standard for identifying GSR patterns (R(2)>0.842, and CorrCoef >0.908). In this case, the propellants' stabilizers (diphenilamine and centralite), and its nitrated derivatives as well as dinitrotoluene, showed also high spectral activity. Therefore, they could be recommended as complementary standards for confirming the GSR identification. These findings establish the proof of concept for a science-based evidence useful to support expert reports and final court rulings. This approach for obtaining GSR patterns can be an excellent alternative to the current and traditional chemical methods, which are based in presumptive and invasive colour tests.
Hay, Christine Ella
Gunshot residue (GSR) was deposited on porcine tissue with hand loaded non-jacketed (NJ) and full-jacketed (FJ) ammunition at two different firing distances. Fresh tissue samples, as well as samples collected throughout decomposition were microwave digested in nitric acid and analyzed by inductively coupled plasma-optical emission spectroscopy (ICP-OES) and inductively coupled plasma-mass spectrometry (ICP-MS) to determine the elemental composition of the GSR. Element concentrations for lead (Pb), antimony (Sb), barium (Ba), copper (Cu), iron (Fe), and zinc (Zn) were statistically compared in order to investigate differentiation of bullet type and firing distance based on chemical concentrations in the GSR. Control (unshot) samples were collected in order to assess for environmental contaminants. Results of this study demonstrated that ICP-OES was adequate to detect the characteristic elements of GSR in fresh tissue, but was not sensitive enough to detect all elements throughout decomposition. Lead and Sb were significantly greater in NJ samples. Barium was useful in differentiating firing distance for both bullet types, while Cu was used to differentiate firing distance in FJ ammunition only. Analysis using ICP-MS, which has detection limits up to three orders of magnitude lower compared to ICP-OES, demonstrated the persistence of Pb, Sb, and Ba on porcine tissue throughout decomposition at a firing distance of 5 cm for both NJ and FJ ammunition.
López-López, María; Alvarez-Llamas, César; Pisonero, Jorge; García-Ruiz, Carmen; Bordel, Nerea
The study of gunshot residue (GSR) patterns can assist in the reconstruction of shooting incidences. Currently, there is a real need of methods capable of furnishing simultaneous elemental analysis with higher specificity for the GSR pattern visualization. Laser-Induced Breakdown Spectroscopy (LIBS) provides a multi-elemental analysis of the sample, requiring very small amounts of material and no sample preparation. Due to these advantages, this study aims at exploring the potential of LIBS imaging for the visualization of GSR patterns. After the spectral characterization of individual GSR particles, the distribution of Pb, Sb and Ba over clothing targets, shot from different distances, were measured in laser raster mode. In particular, an array of spots evenly spaced at 800μm, using a stage displacement velocity of 4mm/s and a laser frequency of 5Hz was employed (e.g. an area of 130×165mm(2) was measured in less than 3h). A LIBS set-up based on the simultaneous use of two spectrographs with iCCD cameras and a motorized stage was used. This set-up allows obtaining information from two different wavelength regions (258-289 and 446-463nm) from the same laser induced plasma, enabling the simultaneous detection of the three characteristic elements (Pb, Sb, and Ba) of GSR particles from conventional ammunitions. The ability to visualize the 2D distribution GSR pattern by LIBS may have an important application in the forensic field, especially for the ballistics area.
Gilchrist, Elizabeth; Jongekrijg, Fleur; Harvey, Laura; Smith, Norman; Barron, Leon
Gunshot residue (GSR) is commonly analysed in forensic casework using either scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDX) or gas chromatography-mass spectrometry (GC-MS). Relatively little work has been reported on the post-discharge GSR content of non-metallic inorganic or low molecular weight organic anions to distinguish between different ammunition types. The development of an analytical method using suppressed micro-bore anion exchange chromatography (IC) is presented for the analysis of GSR. A hydroxide gradient was optimised for the separation of 19 forensically relevant organic and inorganic anions in <23min and sensitivities of the order of 0.12-3.52ng of anion detected for all species were achieved. Along with an optimised extraction procedure, this method was applied to the analysis of post-ignition residues from three selected ammunition types. By profiling and comparing the anionic content in each ammunition residue, the possibility to distinguish between each type using their anionic profiles and absolute weight is presented. The potential for interference is also discussed with respect to sample types which are typically problematic in the analysis of GSR using SEM-EDX and GC-MS. To the best of our knowledge this represents the first study on the analysis of inorganic anions in GSR using suppressed ion chromatography.
Bueno, Justin; Sikirzhytski, Vitali; Lednev, Igor K
The ability to link a suspect to a particular shooting incident is a principal task for many forensic investigators. Here, we attempt to achieve this goal by analysis of gunshot residue (GSR) through the use of attenuated total reflectance (ATR) Fourier transform infrared spectroscopy (FT-IR) combined with statistical analysis. The firearm discharge process is analogous to a complex chemical process. Therefore, the products of this process (GSR) will vary based upon numerous factors, including the specific combination of the firearm and ammunition which was discharged. Differentiation of FT-IR data, collected from GSR particles originating from three different firearm-ammunition combinations (0.38 in., 0.40 in., and 9 mm calibers), was achieved using projection to latent structures discriminant analysis (PLS-DA). The technique was cross (leave-one-out), both internally and externally, validated. External validation was achieved via assignment (caliber identification) of unknown FT-IR spectra from unknown GSR particles. The results demonstrate great potential for ATR-FT-IR spectroscopic analysis of GSR for forensic purposes.
Bueno, Justin; Lednev, Igor K
An alternative approach for the nondestructive, rapid and selective detection of gunshot residue (GSR) was investigated. A cloth substrate containing GSR particles expelled during a firearm discharge was used as an analog for the clothing of a shooting victim or a suspect discharging a firearm. An established and efficient procedure for GSR collection (tape lifting) was utilized to recover GSR particles from the cloth substrate. Microscopic-attenuated total reflectance (ATR) Fourier transform (FT) infrared (IR) spectroscopic imaging rapidly and automatically scanned large areas of the tape collection substrate and detected varying morphologies (microscopic and macroscopic) and chemical compositions (organic and inorganic) of GSR. The "spectroscopic fingerprint" of each GSR type provided unique virbrational modes, which were not characteristic of the tape collection substrate or the cloth debris which was also recovered. ATR images (maps) targeted the detection of these unique chemical markers over the mapped area. The hues of the ATR images were determined by the intensity of the signal for the chemical marker of each analyte. The spatial resolution of the technique was determined to be 4.7 μm. Therefore, all GSR particles sized 4.7 μm or larger will be resolved and detected on the tape substrate using micro-ATR imaging.
Bueno, Justin; Sikirzhytski, Vitali; Lednev, Igor K
Near-infrared (NIR) Raman microspectroscopy combined with advanced statistics was used to differentiate gunshot residue (GSR) particles originating from different caliber ammunition. The firearm discharge process is analogous to a complex chemical reaction. The reagents of this process are represented by the chemical composition of the ammunition, firearm, and cartridge case. The specific firearm parameters determine the conditions of the reaction and thus the subsequent product, GSR. We found that Raman spectra collected from these products are characteristic for different caliber ammunition. GSR particles from 9 mm and 0.38 caliber ammunition, collected under identical discharge conditions, were used to demonstrate the capability of confocal Raman microspectroscopy for the discrimination and identification of GSR particles. The caliber differentiation algorithm is based on support vector machines (SVM) and partial least squares (PLS) discriminant analyses, validated by a leave-one-out cross-validation method. This study demonstrates for the first time that NIR Raman microspectroscopy has the potential for the reagentless differentiation of GSR based upon forensically relevant parameters, such as caliber size. When fully developed, this method should have a significant impact on the efficiency of crime scene investigations.
López-López, María; Merk, Virginia; García-Ruiz, Carmen; Kneipp, Janina
Gunshot residues (GSR) result from the discharge of a firearm being a potential piece of evidence in criminal investigations. The macroscopic GSR particles are basically formed by burned and non-burned gunpowder. Motivated by the demand of trace analysis of these samples, in this paper, the use of surface-enhanced Raman scattering (SERS) was evaluated for the analysis of gunpowders and macroscopic GSR particles. Twenty-one different smokeless gunpowders were extracted with ethanol. SERS spectra were obtained from the diluted extracts using gold nanoaggregates and an excitation wavelength of 633 nm. They show mainly bands that could be assigned to the stabilizers diphenylamine and ethylcentralite present in the gunpowders. Then, macroscopic GSR particles obtained after firing two different ammunition cartridges on clothing were also measured using the same procedure. SERS allowed the detection of the particles collected with an aluminum stub from cloth targets without interferences from the adhesive carbon. The results demonstrate the great potential of SERS for the analysis of macroscopic GSR particles. Furthermore, they indicate that the grain-to-grain inhomogeneity of the gunpowders needs to be considered. Graphical Abstract SERS allows the detection of GSR particles collected with adhesive stubs from cloth targets using gold nanoaggregates and an excitation wavelength of 633 nm.
Bueno, Justin; Lednev, Igor K
A novel approach utilizing automated Raman microspectroscopic mapping for gunshot residue (GSR) detection was investigated. A well-established technique for GSR recovery (tape lifting) was utilized for GSR particle collection. Uncontaminated samples of the substrate (tape), organic GSR (OGSR), and inorganic GSR (IGSR) particles were characterized to generate three respective Raman spectroscopic training sets. Automated Raman mapping was used to rapidly collect spectra over areas of the tape substrate populated with GSR particles. Raman spectra collected from the maps were classified against the training sets via partial least squares discriminant analysis (PLS-DA) to determine if GSR was present. We report the application of Raman chemical mapping as a proof of concept for the positive detection of GSR particles of varying morphologies. The estimated size of GSR particles, which could be readily detected by this method, is about 3.4 μm. The efficiency of the classification was quantitated with rates of true positives and negatives. Validation studies scrutinizing the practicality of this approach as a viable tool for potential forensics investigations are currently in progress.
Gencik, Martin; Finsterer, Josef
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
Graves, Jordan R.
For decades, law enforcement organizations have increasingly utilized audio detection and localization systems to identify potential gunshot incidents and to respond accordingly. These systems have grown from simple microphone configurations used to estimate location into complex arrays that seem to pinpoint gunfire to within mere feet of its actual occurrence. Such technology comes from a long and dynamic history of developing equipment dating back to the First World War. Additionally, though basic designs require little in terms of programming or engineering experience, the mere presence of this tool invokes a firestorm of debate amongst economists, law enforcement groups, and the general public, which leads to questions about future possibilities for its use. The following pages will retell the history of these systems from theoretical conception to current capabilities. This work will also dissect these systems to reveal fundamental elements of their inner workings, in order to build a basic demonstrative system. Finally, this work will discuss some legal and moral points of dissension, and will explore these systems’ roles in society now and in the future, in additional applications as well.
Because young children often present to EDs with abdominal complaints, emergency physicians must have a high index of suspicion for the common abdominal emergencies that have serious sequelae. At the same time, they must realize that less serious causes of abdominal symptoms (e.g., constipation or gastroenteritis) are also seen. A gentle yet thorough and complete history and physical examination are the most important diagnostic tools for the emergency physician. Repeated examinations and observation are useful tools. Physicians should listen carefully to parents and their children, respect their concerns, and honor their complaints. Ancillary tests are inconsistent in their value in assessing these complaints. Abdominal radiographs can be normal in children with intussusception and even malrotation and early volvulus. Unlike the classic symptoms seen in adults, young children can display only lethargy or poor feeding in cases of appendicitis or can appear happy and playful between paroxysmal bouts of intussusception. The emergency physician therefore, must maintain a high index of suspicion for serious pathology in pediatric patients with abdominal complaints. Eventually, all significant abdominal emergencies reveal their true nature, and if one can be patient with the child and repeat the examinations when the child is quiet, one will be rewarded with the correct diagnosis.
Koo, Abraham J.K.; Howe, Gregg A.
Plant tissues are highly vulnerable to injury by herbivores, pathogens, mechanical stress, and other environmental insults. Optimal plant fitness in the face of these threats relies on complex signal transduction networks that link damage-associated signals to appropriate changes in metabolism, growth, and development. Many of these wound-induced adaptive responses are triggered by de novo synthesis of the plant hormone jasmonate (JA). Recent studies provide evidence that JA mediates systemic wound responses through distinct cell autonomous and nonautonomous pathways. In both pathways, bioactive JAs are recognized by an F-box protein-based receptor system that couples hormone binding to ubiquitin-dependent degradation of transcriptional repressor proteins. These results provide a new framework for understanding how plants recognize and respond to tissue injury. PMID:19695649
Sharma, Vishal; Bhatia, Anmol; Malik, Sarthak; Singh, Navjeet; Rana, Surinder S.
Objective: Scalloping of visceral organs is described in pseudomyxoma peritonei, malignant ascites, among other conditions, but not tuberculosis. Methods: We report findings from a retrospective study of patients with abdominal tuberculosis who had visceral scalloping on abdominal computed tomography (CT). Diagnosis of abdominal tuberculosis was made on the basis of combination of clinical, biochemical, radiological and microbiological criteria. The clinical data, hematological and biochemical parameters, and findings of chest X-ray, CT, Mantoux test, and HIV serology were recorded. Results: Of 72 patients with abdominal tuberculosis whose CT scans were included, seven patients had visceral scalloping. The mean age of these patients was 32.14 ± 8.43 years and four were men. While six patients had scalloping of liver, one had splenic scalloping. The patients presented with abdominal pain (all), abdominal distension (five patients), loss of weight or appetite (all), and fever (four patients). Mantoux test was positive in five, while none had HIV infection. The diagnosis was based on fluid (ascitic or collections) evaluation in four patients, ileo-cecal biopsy in one patient, fine needle aspiration from omental thickening in one patient, and sputum positivity for acid fast bacilli (AFB) in one patient. On CT examination, four patients had ascites, five had collections, one had lymphadenopathy, four had peritoneal involvement, three had pleural effusion, and two had ileo-cecal thickening. All except one patient received standard ATT for 6 months or 9 months (one patient). Pigtail drainage for collections was needed for two patients. Discussion: This report is the first description of visceral scalloping of liver and spleen in patients with abdominal tuberculosis. Previously, this finding has been reported primarily with pseudomyxoma peritonei and peritoneal carcinomatosis. Conclusion: Visceral scalloping may not conclusively distinguish peritoneal
Belmont, Philip J; Schoenfeld, Andrew J; Goodman, Gens
The United States forces in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) are primarily engaged in counterinsurgency operations within an irregular war. The US combat medical experience has reported new injury patterns secondary to the enemy's reliance on explosive mechanisms, particularly improvised explosive devices (IEDs), and the widespread use of individual and vehicular body armor. Musculoskeletal extremity injuries have been reported to comprise approximately 50% of all combat wounds for OIF/OEF. Utilization of individual body armor has dramatically reduced thoracic injuries and has decreased the lethality of gunshot wounds, as measured by the percent killed in action, which in conflicts prior to OIF/OEF was estimated at 33% but is now 4.6%. Explosive mechanisms of injury, with IEDs being the most common, account for over 75% of all combat casualties. The lethality of IEDs coupled with the protection of the thorax and abdomen provided by individual body armor has resulted in increasingly severe orthopaedic injuries. Collection and careful examination of orthopaedic combat casualties will allow for improved military personnel protective measures and treatment of injured soldiers.
Schyma, Christian; Lux, Constantin; Madea, Burkhard; Courts, Cornelius
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.
Metcalf, Daniel G; Bowler, Philip G
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.
Rose, Lloyd F.; Chan, Rodney K.
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
Chanussot-Deprez, Caroline; Contreras-Ruiz, José
Telemedical wound care is one of the applications of teledermatology. We present our experience using telemedicine in the successful assessment and treatment of three patients with hard-to-heal ulcers. Three patients were seen at the PEMEX General Hospital in Veracruz, Mexico. The first patient was a 53-year-old man with hypertension, morbid obesity, chronic venous insufficiency, recurrent erysipelas, leg ulcers and lymphoedema. There was one ulcer on his left lower leg (20 x 10 cm) and one on his right leg (9 x 7 cm). The second patient was a 73-year-old woman with class III obesity and ulcers in her right leg, secondary to surgical debridement of bullous erysipelas. The third patient was a 51-year-old female with rheumatoid arthritis with one ulcer on each leg and chronic lymphostasis. Photographs with a digital camera were taken and sent weekly via email to a wound care specialist in Mexico City. The photographs allowed the expert to diagnose and evaluate the chronic wounds periodically. In the present cases, telemedicine allowed us to have a rapid evaluation, diagnosis and treatment. The images were of enough quality to be useful and small enough to be sent via regular email to the remote physician who immediately gave his feedback. The expert was confident to give therapeutic recommendations in this way, and we considered this method to be very cost-effective, saving the patient and the health care system, especially in transportation.
Moreno, Emilia; Pannocchia, Cecilia; Carricondo, Concepción
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.
Nance, F C
Since 1888 98 papers have been presented to the Southern Surgical Association (SSA) dealing directly or indirectly with abdominal trauma. The papers reflect the progress over the century in the management of this injury. Almost two-thirds of the papers have originated from the major city hospitals of the south. An interest in abdominal trauma has been manifest among the officers of SSA. Twenty-two presidents have presented papers or taken part in discussions. Four 25-year eras were identified. In the earliest, exploration of abdominal wounds was firmly established as a principle. The second period was characterized by consolidation of principles and strengthening of supportive care. The third era encompassing World War II marked a nadir in productivity. In the last 25 years a reawakened interest has resulted in a marked increase in the number and quality of presentations, which have increasingly focused on specific organ injuries. Images Fig. 1. Fig. 2. Fig. 5. Fig. 6. Fig. 7. Fig. 8. PMID:3291795
Broyles, Justin M.; Abt, Nicholas B.; Sacks, Justin M.
Background: Complex abdominal defects are difficult problems encountered by surgeons in multiple specialties. Although current evidence supports the primary repair of these defects with mesh reinforcement, it is unclear which mesh is superior for any given clinical scenario. The purpose of this review was to explore the characteristics of and clinical relevance behind bioprosthetic tissue matrices in an effort to better clarify their role in abdominal wall reconstruction. Methods: We reviewed the peer-reviewed literature on the use of bioprosthetic mesh in human subjects. Basic science articles and large retrospective and prospective reviews were included in author’s analysis. The clinical performance and characteristics of 13 bioprosthetic tissue matrices were evaluated. Results: The majority of the products evaluated perform well in contaminated fields, where the risk of wound-healing difficulties is high. Clinical outcomes, which included infection, reherniation, and bulge formation, were variable, and the majority of the studies had a mean follow-up of less than 24 months. Conclusions: Although bioprosthetic matrix has a multitude of indications within the growing field of abdominal wall reconstruction, the functionality, regenerative capacity, and long-term fate of these products have yet to be fully established. Furthermore, the clinical performance, indications, and contraindications for each type of matrix need to be fully evaluated in long-term outcome studies. PMID:25289285
Aksamija, Goran; Mulabdic, Adi; Rasic, Ismar; Aksamija, Lejla
Objectives: The percentage of patients with difficult and prolonged healing of the wound is still high, while the immediate complications such as wound dehiscence occurs in up to 3 % of all treated patients in abdominal surgery. The aim of study was to analyze the risk factors and comorbidities in the group patients undergoing laparotomy and associated with early postoperative wound dehiscence. Methods: The retrospective study included all patients treated surgically at Clinic of General and Abdominal surgery, Clinical Center of the University of Sarajevo in the period from January 1, 2013 until January 1, 2016, with clinically verified surgical wound dehiscence. Results: The results showed statistically proportion of male patients (70%) compared to female (30%). The largest number of respondents were in age group 71-80. Surgical wound infection was evident in 61% of patients, malignant staining in 52%, hypoproteinemia was found in 50% of patients, anemia in 43%, peritonitis in 36% and diabetes in 14% of respondents. Of the total respondents with surgical wound dehiscence, 30 (68%) had comorbidities present. By analyzing the prevalence of comorbidity and risk factors recorded in relation to comorbidity, it was noted that hypertension is most often associated with hypoproteinemia (X2=4.399; p=0.036), wound infection (X2=4.112; p=0.043) and malignant diseases (X2=4.016; p=0.045). The frequency of the anemia, peritonitis and diabetes in the sample was not different in relation to the comorbidity conditions (p >0.05). Conclusions: The risk factors occurrence of surgical wound dehiscence in our study were identified as hypoproteinemia, malignant disease, anemia and peritonitis. The highest incidence of dehiscence was in patients operated on in medical emergencies, and in patients with malignant disease. PMID:27994299
Bozhchenko, A P; Tolmachev, I A
The professional activity of professor V.L. Popov is considered with special reference to the major achievements of himself and his disciples in the field of forensic medical ballistics. The essence of provisions formulated by V.L. Popov on the mechanisms of formation and extent of gunshot injuries is discussed with regard to their importance for the determination of the large shooting distance. V.L. Popov is the founder of the scientific and pedagogical school that was justifiably regarded as the largest in this country and remains as such. The main achievements of this school have been obtained in studies of gunshot injuries.
Hong, Young-Ho; Mun, Seog-Kyun
The reasons behind sudden sensorineural hearing loss are mostly unknown, but viral infections, blood disorders, ototoxicity, noise trauma, autoimmune disease, acoustic tumor, and even mental stress may be related to the disease. In cases of hearing loss as a result of psychogenic factors, early diagnosis and adequate treatment under collaboration with the psychiatric department are crucial, since failure to take appropriate measures may result in permanent sequela. We report a case, with a review of the literature, of sudden unilateral sensorineural hearing loss with contralateral psychogenic hearing loss induced by gunshot noise.
Scales, John T.
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
EYE, *WOUNDS AND INJURIES), (*ADHESIVES, EYE), (*ACRYLIC RESINS, ADHESIVES), CORNEA , HEALING, TISSUES(BIOLOGY), TOLERANCES(PHYSIOLOGY), NECROSIS, SURGICAL SUPPLIES, STRENGTH(PHYSIOLOGY), SURGERY, THERAPY
Miller, S.H.; Rudolph, R. )
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.
Molan, Peter; Rhodes, Tanya
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.
Morales Hernández, Sara; Díaz Velázquez, Mary Flor; Puello Tamara, Edgardo; Morales Hernández, Jorge; Basavilvazo Rodríguez, Maria Antonia; Cruz Cruz, Polita del Rocío; Hernández Valencia, Marcelino
Abdominal pregnancies are the implantation of gestation in some of the abdominal structures. This kind of pregnancies represents sevenfold maternal death risk than tubarian ectopic pregnancies, and 90-fold death risk than normal ones. Previous cases have erroneously reported as abscess in Douglas punch, and frequently result in obitus or postnatal deaths. We report a case of a patient with 27 years old, and diagnosis of 25.2 weeks of pregnancy, prior placenta and anhidramnios, referred due to difficult in uterine contour delimitation, easy palpation of fetal parts, cephalic pole in left hypochondrious and presence of mass in hypogastria, no delimitations, pain with mobilization, no transvaginal bleed and fetal movements. Interruption of pregnancy is decided by virtue of severe oligohidramnios, retardation in fetal intrabdominal growth, and recurrent maternal abdominal pain. Surgical intervention was carried out for resolution of the obstetrical event, in which was found ectopic abdominal pregnancy with bed placental in right uterine horn that corresponded to a pregnancy of 30 weeks of gestation. Abdominal pregnancy is still a challenge for obstetrics due to its diagnosis and treatment. Early diagnosis is oriented to prevent an intrabdominal hemorrhage that is the main maternal cause of mortality.
Molina, D Kimberley; DiMaio, Vincent J M; Cave, Rowena
Citizens of the United States own more firearms than those in any other country, and the majority of the firearms owned are handguns. Given such prevalence, surprisingly few studies have been published describing the characteristics of deaths due to handguns. To address this gap, nonaccidental handgun deaths examined at the Bexar County Medical Examiner's Office between 2000 and 2010 were reviewed. A total of 1450 cases were identified, including 797 suicides and 653 homicides. Age, range of fire, location of wound, and manner of death were analyzed. The average age of suicide victims (46.7 years) was found to be greater than that of homicides (34.3 years). Suicidal wounds tended to be contact wounds to the head; abdominal, extremity, back, and multiple wound locations were more common in homicides as were distant and intermediate wounds. Handgun wounds to the forehead, side of head, submental, and intraoral locations were significantly more common in suicide, whereas those to the face, apex of the head, and back of the head were more common in homicides. Where possible, likelihood ratios were calculated to determine relative likelihood of suicide or homicide for specific wound locations and ranges. While each death should be analyzed based on its unique circumstances and not solely its statistical probability, these data may help inform the pathologist's conclusions.
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
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.
Danino, A. M.; Hariss, P. G.; Servant, J. M.
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
Vijayakrishnan, Rajakrishnan; Adhikari, Deep; Anand, Curuchi P
A 70 years old male on ventilatory and circulatory support for sepsis and non ST segment elevation myocardial infarction developed abdominal distension 14 d after placement of a percutaneous endoscopic gastrostomy tube for enteral feeding. Radiography revealed free air in the abdomen and gastrograffin (G) study showed no extravasation into the peritoneum. The G tube was successfully repositioned with mechanical release of air. Imaging showed complete elimination of free air but the patient had a recurrence of pneumoperitoneum. Mechanical release of air with sealing of the abdominal wound was performed. Later, the patient was restarted on tube feeding with no complications. This case demonstrates a late complication of pneumoperitoneum with air leakage from the abdominal wall stoma.
Ecker, Amir L.
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.
Mauermann, William J; Sampathkumar, Priya; Thompson, Rodney L
Deep sternal wound infections (DSWI) continue to be a relatively uncommon event occurring in about 1%-2% of all patients undergoing cardiac surgery. However, the sheer number of cardiac surgery patients and the relatively high mortality associated with DSWIs makes them of clinical relevance. This review will describe the current incidence of DSWIs and their associated morbidity and mortality as well as risk factors for the development of this complication. The microbiology of DSWIs will be reviewed and strategies to prevent these complications will be discussed with a focus on interventions that may be undertaken by the clinical anesthesiologist.
Jensen, Kristian Kiim
Incisional hernia is a common long-term complication to abdominal surgery, occurring in more than 20% of all patients. Some of these hernias become giant and affect patients in several ways. This patient group often experiences pain, decreased perceived body image, and loss of physical function, which results in a need for surgical repair of the giant hernia, known as abdominal wall reconstruction. In the current thesis, patients with a giant hernia were examined to achieve a better understanding of their physical and psychological function before and after abdominal wall reconstruction. Study I was a systematic review of the existing standardized methods for assessing quality of life after incisional hernia repair. After a systematic search in the electronic databases Embase and PubMed, a total of 26 studies using standardized measures for assessment of quality of life after incisional hernia repair were found. The most commonly used questionnaire was the generic Short-Form 36, which assesses overall health-related quality of life, addressing both physical and mental health. The second-most common questionnaire was the Carolinas Comfort Scale, which is a disease specific questionnaire addressing pain, movement limitation and mesh sensation in relation to a current or previous hernia. In total, eight different questionnaires were used at varying time points in the 26 studies. In conclusion, standardization of timing and method of quality of life assessment after incisional hernia repair was lacking. Study II was a case-control study of the effects of an enhanced recovery after surgery pathway for patients undergoing abdominal wall reconstruction for a giant hernia. Sixteen consecutive patients were included prospectively after the implementation of a new enhanced recovery after surgery pathway at the Digestive Disease Center, Bispebjerg Hospital, and compared to a control group of 16 patients included retrospectively in the period immediately prior to the
Guzman-Stein, G.; Bonsack, M.; Liberty, J.; Delaney, J.P.
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.
Dabbagh, Ali; Mar'ashi, Ali S; Malek, Bahman
A 75-year-old man referred to the outpatient vascular surgery clinic of Taleghani Hospital (Shaheed Beheshti University of Medicine, Tehran, Iran) due to a local nontender mass in his groin. In his history, it was discovered that the mass had appeared a few months after a gunshot injury. He had a history of shortness of breath with a New York Heart Association functional class fluctuating between II and III, but no history of smoking or addiction. In the physical examination, a 5-cm by 5-cm nonpulsatile mass with engorged vessels was found in the anterior portion of the left groin, which was not tender. An elective arterial angiography revealed an arteriovenous fistula joining the femoral artery to the femoral vein at the left groin. The cardiac assessments revealed cor pulmonale (with a restrictive pattern and diastolic dysfunction) and pulmonary hypertension due to primary pulmonary dysfunction. The patient was anesthetized with a balanced general anesthesia method, considering all relevant cardiac and respiratory monitoring methods and specially withholding drugs increasing pulmonary vascular bed pressure, suppressing the myocardium, or increasing the regurgitant flow across the mitral and, especially, the tricuspid valve. The moment the fistula was closed, a rapid fall in the patient's heart rate was noted, from approximately 60 beats per minute to above 40 beats per minute; this decreased heart rate continued up to a few hours after the surgery and did not accompany any significant hemodynamic derangement including the patient's blood pressure. The patient received his postoperative care in the ordinary surgical ward and was discharged a few days later.
Lucas, Nick; Brown, Hayley; Cook, Michael; Redman, Kahlee; Condon, Tanith; Wrobel, Harald; Kirkbride, K Paul; Kobus, Hilton
When considering the impact and value of gunshot residues (GSR) as forensic trace evidence, the likelihood of a suspect producing a positive GSR analysis result without having direct exposure to a firearm is a major consideration. Therefore, the random prevalence of GSR and 'GSR-like' residues in the wider population is a highly pertinent question when considering the probative value of such evidence. The random prevalence of GSR in two Australian jurisdictions - Victoria and South Australia - was assessed through the collection and analysis of GSR samples obtained from randomly selected members of the public. Volunteers were asked to declare any firearms use, hobbies or potential firearms exposure before allowing their hands to be sampled using aluminium GSR sample stubs coated in adhesive tape. A total of 289 samples, 120 from Victoria and 169 from South Australia were collected and analysed using scanning electron microscopy coupled with energy dispersive X-ray microanalysis (SEM-EDS). Across all samples, three 'characteristic' three-component Pb/Ba/Sb particles were detected from a single subject in South Australia, corresponding to an overall prevalence of 0.3%. Two-component 'consistent' particles were more prevalent, with Pb/Sb particles being the most frequently occurring, in 8% of samples, and in South Australia only. A number of samples, approximately 7%, showed populations of single element particles of Pb, Ba and Sb, which has the potential to generate a false positive for GSR if using a bulk analysis technique such as NAA or AAS. The prevalence of GSR or 'GSR like' particles in this study matches closely with similar surveys conducted in other jurisdictions. Such surveys are a useful foundation for the creation of a probabilistic method for the assessment of GSR evidence.
Seo, A Young; Oh, Dong Hyun
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
Sukkarieh, F; Brasseur, P; Bissen, L
The authors report the case of a 93-year old woman referred to the emergency department and presenting with an intestinal obstruction. Abdominal CT reveals a biliary ileus caused by the migration and the impaction of a 3 cm gallstone in the small bowel. Surgical treatment by enterolithotomy was successful. In over 90% of cases, gallstone ileus is a complication of cholelithiasis and accounts for 25% of intestinal obstruction in patients over 65 years. To reduce morbidity and mortality, early diagnosis and prompt treatment are essential. Abdominal CT-scan is the gold standard technique.
Després, Jean-Pierre; Lemieux, Isabelle
Metabolic syndrome is associated with abdominal obesity, blood lipid disorders, inflammation, insulin resistance or full-blown diabetes, and increased risk of developing cardiovascular disease. Proposed criteria for identifying patients with metabolic syndrome have contributed greatly to preventive medicine, but the value of metabolic syndrome as a scientific concept remains controversial. The presence of metabolic syndrome alone cannot predict global cardiovascular disease risk. But abdominal obesity - the most prevalent manifestation of metabolic syndrome - is a marker of 'dysfunctional adipose tissue', and is of central importance in clinical diagnosis. Better risk assessment algorithms are needed to quantify diabetes and cardiovascular disease risk on a global scale.
Bryant, James E; Gaughan, Earl M
Abdominal surgery in foals under 30 days old has become more common with improved neonatal care. Early recognition of a foal at risk and better nursing care have increased the survival rates of foals that require neonatal care. The success of improved neonatal care also has increased the need for accurate diagnosis and treatment of gastrointestinal, umbilical, and bladder disorders in these foals. This chapter focuses on the early and accurate diagnosis of specific disorders that require abdominal exploratory surgery and the specific treatment considerations and prognosis for these disorders.
Zhang, Shiwu; Gnyawali, Surya; Huang, Jiwei; Liu, Peng; Gordillo, Gayle; Sen, Chandan K.; Xu, Ronald
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.
Racz, Roger S; Ramanujam, Crystal L; Zgonis, Thomas
Puncture wounds are common injuries of the foot. Although most puncture wounds are benign, devastating complications are possible without adequate treatment. These injuries can occur in all age groups and in various circumstances. Early diagnosis and appropriate medical and surgical management is paramount in achieving successful outcomes.
Arumugam, Suresh; Al-Hassani, Ammar; El-Menyar, Ayman; Abdelrahman, Husham; Parchani, Ashok; Peralta, Ruben; Zarour, Ahmad; Al-Thani, Hassan
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
Rickman, John M; Smith, Martin J
Recent years have seen increasing involvement by forensic anthropologists in the interpretation of skeletal trauma. With regard to ballistic injuries, there is now a large literature detailing gross features of such trauma; however, less attention has been given to microscopic characteristics. This article presents analysis of experimentally induced gunshot trauma in animal bone (Bos taurus scapulae) using full metal jacket (FMJ), soft point (SP), and captive bolt projectiles. The results were examined using scanning electron microscopy (SEM). Additional analysis was conducted on a purported parietal gunshot lesion in a human cranial specimen. A range of features was observed in these samples suggesting that fibrolamellar bone response to projectile impact is analogous to that observed in synthetic composite laminates. The results indicate that direction of bullet travel can be discerned microscopically even when it is ambiguous on gross examination. It was also possible to distinguish SP from FMJ lesions. SEM analysis is therefore recommended as a previously underexploited tool in the analysis of ballistic trauma.
Hannigan, Thomas J; McDermott, Sean D; Greaney, Claire M; O'Shaughnessy, John; O'Brien, Cliona M
The evaluative approach is a logical approach to interpreting scientific findings in criminal cases, applying knowledge regarding the transfer, persistence and recovery of particulate material. The application of this approach to interpreting the finding of gunshot residue on the clothing of a suspect requires knowledge of background levels of GSR on clothing and on the frequency of different residue types in a particular environment. The cuffs of 100 upper outer garments submitted to a forensic laboratory in connection with non-firearms offences were sampled for gunshot residue. No 3-component lead/antimony/barium particles were found on 98 of them. Two 3-component particles were found on one of them and one 3-component particle was found on another. The frequency of occurrence of various particle types regarded as consistent with GSR was also explored. The findings show that, while 3-component particles were somewhat more likely to be encountered by chance on clothing than on hands, they are still relatively uncommon events. To investigate the frequency of occurrence of particular residue types, 100 discharged rounds of ammunition recovered at crime scenes were sampled and the types of residue present were determined. The results show that some residue types are significantly more common than others. Both sets of data will be of value in evaluating the significance of finding GSR on clothing of suspects in criminal cases.
Chang, Kah Haw; Yew, Chong Hooi; Abdullah, Ahmad Fahmi Lim
Gunshot residues, produced after shooting activity, have acquired their importance in analysis due to the notoriety of firearms-related crimes. In this study, solid-phase microextraction was performed to extract the headspace composition of spent cartridges using 85-μm polyacrylate fiber at 66°C for 21 min. Organic compounds, that is, naphthalene, 2,6-dinitrotoluene, 2,4-dinitrotoluene, diphenylamine, and dibutyl phthalate were detected and analyzed by gas chromatography-flame ionization detection technique. Evaluation of chromatograms for diphenylamine, dibutyl phthalate, and naphthalene indicates the period after a gunshot was discharged, whether it was 1 days, 2-4 days, <5 days, 10 days, 20 days, or more than 30 days ago. This study revealed the potential effects of environmental factors such as occasional wind blow and direct sunlight on the estimation of time after spent cartridges were discharged. In conclusion, we proposed reliable alternative in analyzing the headspace composition of spent cartridges in a simulated crime scene.
Roeterdink, Evan M; Dadour, Ian R; Watling, R John
Whole body concentrations of lead (Pb), barium (Ba) and antimony (Sb) were determined in larvae of the blowfly Calliphora dubia (Macquart) (Diptera: Calliphoridae) removed from a piece of beef shot and contaminated with gunshot residue and compared with the concentrations detected within larvae feeding on a control piece of beef. Whole larvae were taken into solution and analysed using inductively coupled plasma-mass spectrometry (ICP-MS). Significantly higher concentrations of Pb, Ba and Sb were detected within the larvae feeding on the shot piece of beef compared with larvae that were feeding on the control piece of beef. Initial results indicate that the concentrations of Pb and Sb within the larvae decrease as the duration of feeding increases, whereas Ba concentrations appear to increase, suggesting a bioaccumulation of Ba within the larvae. The second part of this experiment investigated the depuration of Pb, Ba and Sb from the larvae following removal of the gunshot residue source. A significant reduction in Pb, Ba and Sb concentrations within the larvae was observed following the transfer of larvae from the shot piece of beef to the control piece of beef.
Ramos, António L. L.; Holm, Sverre; Gudvangen, Sigmund; Otterlei, Ragnvald
Acoustical sniper positioning is based on the detection and direction-of-arrival estimation of the shockwave and the muzzle blast acoustical signals. In real-life situations, the detection and direction-of-arrival estimation processes is usually performed under the influence of background noise sources, e.g., vehicles noise, and might result in non-negligible inaccuracies than can affect the system performance and reliability negatively, specially when detecting the muzzle sound under long range distance and absorbing terrains. This paper introduces a multi-band spectral subtraction based algorithm for real-time noise reduction, applied to gunshot acoustical signals. The ballistic shockwave and the muzzle blast signals exhibit distinct frequency contents that are affected differently by additive noise. In most real situations, the noise component is colored and a multi-band spectral subtraction approach for noise reduction contributes to reducing the presence of artifacts in denoised signals. The proposed algorithm is tested using a dataset generated by combining signals from real gunshots and real vehicle noise. The noise component was generated using a steel tracked military tank running on asphalt and includes, therefore, the sound from the vehicle engine, which varies slightly in frequency over time according to the engine's rpm, and the sound from the steel tracks as the vehicle moves.
Ramos, António L. L.; Holm, Sverre; Gudvangen, Sigmund; Otterlei, Ragnvald
Counter sniper systems rely on the detection and parameter estimation of the shockwave and the muzzle blast in order to determine the sniper location. In real-world situations, these acoustical signals can be disturbed by natural phenomena like weather and climate conditions, multipath propagation effect, and background noise. While some of these issues have received some attention in recent publications with application to gunshot acoustics, the multipath propagation phenomenon whose effect can not be neglected, specially in urban environments, has not yet been discussed in details in the technical literature in the same context. Propagating sound waves can be reflected at the boundaries in the vicinity of sound sources or receivers, whenever there is a difference in acoustical impedance between the reflective material and the air. Therefore, the received signal can be composed of a direct-path signal plus N scaled delayed copies of that signal. This paper presents a discussion on the multipath propagation effect and its impact on the performance and reliability of sniper positioning systems. In our formulation, propagation models for both the shockwave and the muzzle blast are considered and analyzed. Conclusions following the theoretical analysis of the problem are fully supported by actual gunshots acoustical signatures.
Omar, Amin; Wright, J. Barry; Schultz, Gregory; Burrell, Robert; Nadworny, Patricia
Background is provided on biofilms, including their formation, tolerance mechanisms, structure, and morphology within the context of chronic wounds. The features of biofilms in chronic wounds are discussed in detail, as is the impact of biofilm on wound chronicity. Difficulties associated with the use of standard susceptibility tests (minimum inhibitory concentrations or MICs) to determine appropriate treatment regimens for, or develop new treatments for use in, chronic wounds are discussed, with alternate test methods specific to biofilms being recommended. Animal models appropriate for evaluating biofilm treatments are also described. Current and potential future therapies for treatment of biofilm-containing chronic wounds, including probiotic therapy, virulence attenuation, biofilm phenotype expression attenuation, immune response suppression, and aggressive debridement combined with antimicrobial dressings, are described. PMID:28272369
Johnston, Benjamin R; Ha, Austin Y; Kwan, Daniel
In this article, we outline the important role the surgeon plays in the management of chronic wounds. Debridement and washout are required for grossly infected wounds and necrotizing soft tissue infections. Cutaneous cancers such as squamous cell carcinomas may contribute to chronic wounds and vice versa; if diagnosed, these should be treated with wide local excision. Arterial, venous, and even lymphatic flows can be restored in select cases to enhance delivery of nutrients and removal of metabolic waste and promote wound healing. In cases where vital structures, such as bones, joints, tendons, and nerves, are exposed, vascularized tissue transfers are often required. These tissue transfers can be local or remote, the latter of which necessitates anastomoses of arteries and veins. Pressure sores are managed by relieving pressure, treating acute trauma or infection, and using rotation fasciocutaneous flaps. Lastly, the surgeon must always consider the possibility of osteomyelitis and retained foreign body as etiology for chronic wounds.
Omar, Amin; Wright, J Barry; Schultz, Gregory; Burrell, Robert; Nadworny, Patricia
Background is provided on biofilms, including their formation, tolerance mechanisms, structure, and morphology within the context of chronic wounds. The features of biofilms in chronic wounds are discussed in detail, as is the impact of biofilm on wound chronicity. Difficulties associated with the use of standard susceptibility tests (minimum inhibitory concentrations or MICs) to determine appropriate treatment regimens for, or develop new treatments for use in, chronic wounds are discussed, with alternate test methods specific to biofilms being recommended. Animal models appropriate for evaluating biofilm treatments are also described. Current and potential future therapies for treatment of biofilm-containing chronic wounds, including probiotic therapy, virulence attenuation, biofilm phenotype expression attenuation, immune response suppression, and aggressive debridement combined with antimicrobial dressings, are described.