1/15. A fatal nail gun injury--an unusual ricochet?An 18-year-old construction worker suddenly collapsed while handling a power-actuated nail gun and died shortly after. A neat, almost circular puncture wound was found on the front of his left chest. No fire-arm residues were detected on the surrounding skin. The police stated that it was an accidental injury, at a construction site, where a nail fired from a nail gun by the deceased had deflected off the wall and struck him on the front of the chest. Since the entry wound appeared to be a neat hole, and that too on the front of the left chest overlying the heart area, there was reluctance on the part of the pathologist to accept it as an accidental injury due to a ricochet. A visit to the scene, interrogation of witnesses, examination of the alleged tool and post-mortem X-ray of the deceased were undertaken prior to autopsy. A bent nail was found in the heart. The scene visit and the subsequent autopsy revealed that the nail took a roughly circular flightpath after it had struck the wall, all the while travelling with its pointed end directed forward. Within the body too, the nail maintained the same path. Various medicolegal issues are discussed pertaining to nail-gun injuries. The importance of a visit to the scene, examination of the alleged tool, interrogation of witnesses and the X-ray of the body, all prior to autopsy, are emphasized. The conclusion was: accidental death due to the unusual ricochet of a nail.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/15. Absence of hemodynamic and ECG changes in a patient with traumatic left ventricular injury and puncture of the left anterior descending branch.patients with penetrating cardiac injury usually present with cardiac tamponade and shock upon hospital arrival. However, absence of hemodynamic depression does not exclude a potentially fatal injury of the heart. This article reports on a patient who developed neither hemodynamic depression nor ECG changes for several hours, despite two left ventricular lacerations with puncture of the LAD. echocardiography is advocated as the diagnostic tool of choice, and it is emphasized that no penetrating objects should be removed from the wound before surgical access to the heart is established, as this may result in the sudden development of cardiac tamponade.- - - - - - - - - - ranking = 5keywords = puncture (Clic here for more details about this article) |
3/15. Atrial myxoma: tumour or trauma?A mass lesion developed in the right atrium at the site of a trans-septal puncture after percutaneous balloon dilatation of the mitral valve in a man aged 74. The lesion had the pathological appearance of an atrial myxoma and seemed to have developed after trauma to the intra-atrial septum. This case suggests that at least some atrial myxomas are reactive rather than neoplastic in origin.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
4/15. Fatality following a sternal bone marrow aspiration procedure: a case report.A 58-year-old man was admitted to hospital for the investigation and treatment of pancytopaenia and anaemic heart failure but four days later he died following a sternal bone marrow aspiration procedure. The autopsy revealed a significant haemopericardium as a result of a puncture wound of the heart. The thickness the body of the sternum was 2 to 3 mm. No other significant pathology was noted and death was ascribed to a haemopericardium due to a puncture wound of the heart associated with bone marrow aspiration. An inquest was held at which the doctor who undertook the procedure was found not to be negligent.- - - - - - - - - - ranking = 2keywords = puncture (Clic here for more details about this article) |
5/15. Intracardiac malpositioning of a sternoclavicular fixation wire.A case of intracardiac malpositioning of a sternoclavicular Kirschner pin is reported. After an uneventful closed wire-fixation of sternoclavicular subluxation and a normal postanesthetic recovery, a 17-year-old male patient developed opacification of the right hemithorax and signs of internal bleeding. The lateral chest roentgenogram showed one fixation wire protruding deeply into the anterior mediastinum. sternotomy showed a large pericardial tear communicating with the right pleural cavity and a puncture hole of the right auricle that had caused a blood loss of 3 L into the pleural space. Although the surgical repair was uneventful, the patient eventually died as a sequelae to prolonged cerebral hypoxemia.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
6/15. Complications of transvenous right ventricular endomyocardial biopsy in adult patients with cardiomyopathy: a seven-year survey of 546 consecutive diagnostic procedures in a tertiary referral center.To determine the incidence, nature and subsequent management of complications occurring during right ventricular endomyocardial biopsy in patients with cardiomyopathy, all events occurring during 546 procedures in 464 consecutive patients were prospectively recorded. The internal jugular vein was the primary site of introduction in 96% of cases. A total of 33 complications (6%) occurred: 15 (2.7%) during catheter insertion including 12 arterial punctures (2%), 2 vasovagal reactions (0.4%) and 1 episode of prolonged bleeding (0.2%), all without sequelae; 18 (3.3%) during biopsy included 6 arrhythmias (1.1%), 5 conduction abnormalities (1%), 4 possible perforations (0.7%) and 3 definite perforations (0.5%) (pericardial fluid). Two (0.4%) of the three patients with a perforation died. There was no secular trend in the complication rate, nor were complications associated with specific clinical or hemodynamic characteristics. It is concluded that the overall rate of endomyocardial biopsy complications (6%) is low, but mortality may occur.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
7/15. Pacemaker-lead puncture of the tricuspid valve. Successful diagnosis and treatment.During insertion, a transvenous pacing lead pierced the tricuspid valve in a 66-year-old man, causing progressive tricuspid insufficiency and congestive heart failure. The defect remained undiagnosed for ten years and was then repaired. To our knowledge, this is the first case in which this problem has been successfully treated rather than being diagnosed at autopsy.- - - - - - - - - - ranking = 4keywords = puncture (Clic here for more details about this article) |
8/15. Residual atrial septal perforation after percutaneous transvenous mitral commissurotomy with Inoue balloon catheter.To estimate the incidence of residual atrial septal perforation (ASP) following percutaneous transvenous mitral commissurotomy (PTMC) with the Inoue balloon catheter and to examine the factors contributing to ASP, we studied 46 patients with mitral stenosis undergoing PTMC. Residual ASP was evaluated by Doppler color flow imaging 1 day after PTMC, and was detected in 7 out of 46 patients (15.2%). We examined the relationship between the development of ASP (ASP ) and the age of the patient, the left atrial dimension before PTMC, the mean pressure difference between left and right atrium after PTMC, and the duration of the procedure from atrial septal puncture by the Brockenbrough method to balloon inflation. There was a good correlation between the development of residual ASP and the duration of the procedure (ASP , 51.0 /- 34.0 minutes; without ASP, 24.6 /- 16.2 minutes; p less than 0.01). However, there was no significant correlation between the development of ASP and other factors. In the follow-up study, ASP disappeared in four patients within 3 months. ASP persisted in two patients for 1 year after PTMC. However, the shunt in these two patients was clinically insignificant. These data suggest that residual ASP may depend on the duration of the procedure, and that most cases of ASP disappear within 1 year after PTMC.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
9/15. diagnosis and management of traumatic ventricular septal defect.Four cases of ventricular septal defect secondary to stab wounds of the heart are presented. One of three patients arriving at the Emergency Department in shock and who were resuscitated required an emergency thoracotomy. These patients had immediate repair of their external cardiac wounds in the Operating Room. Cases 1 and 3 developed heart failure and loud systolic murmur postoperatively. Case 4 was treated with chest tube for a left hemothorax and developed heart failure after discharge. In Cases 1, 2, and 3, 2-D echocardiography detected and located a VSD. In Case 3 Doppler measurement showed elevated RV pressure (45 mm Hg) and decreased peak tricuspid to mitral flow ratio (0.36, normal = 0.6). All patients underwent cardiac catheterization. In Case 4 there was associated mitral regurgitation. Cases 1 and 3 had pulmonary to systemic flow ratios greater than 3:1. Cases 1, 3, and 4 underwent operative repair. In Case 1 the VSD was closed with a dacron patch, and in Cases 3 and 4 it was sutured with Teflon pledgets. In Case 4 a puncture wound of the mitral valve annulus was simultaneously repaired. All patients are alive but in Case 1 postoperative 2-D echocardiography demonstrated partial dehiscence of the patch which has not required reoperation and in Case 3 post-repair 2-D echocardiography and Doppler flow studies have shown an intact VSD repair. This series of post-traumatic VSD demonstrates its varying clinical presentation and the diagnostic and followup benefits offered by 2-D echocardiography, especially when combined with Doppler flow measures.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
10/15. Homicidal cardiac lacerations in children.We report six cases of intentionally inflicted cardiac laceration. The victims ranged in age from 9 weeks to 2 1/2 years. Five victims were girls and in five cases the right atrium was lacerated. The left ventricle was lacerated in the other case. In the three cases with a confession, one victim each was struck with a fist, stomped, and kicked. Four patients had rib fractures, with at least two fractures in each case. Cardiac rupture from blunt trauma most commonly results from compression of the heart between the sternum and vertebral column, but may also occur from compression of the abdomen or legs, deceleration, blast injury, puncture of the heart by a fractured rib, and rupture through a resolving contusion. Accidentally acquired cardiac lacerations usually result from motor vehicle accidents or similarly severe forces. In children there are neither well documented cases of cardiac laceration nor of rib fractures from cardiopulmonary resuscitation. Cardiac lacerations, as with other types of severe trauma acquired at home, are almost never accidental.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
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