1/54. lead toxicity from gunshot wound.lead toxicity from gunshot wound is a rare complication. It occurs when body fluids, especially synovial cavity fluids, dissolve lead from the bullets, resulting in absorption and toxicity. Metabolic stress, infection, or alcoholism can also enhance absorption. Combination of chelation and surgical removal can result in favorable prognosis. awareness of this condition allows appropriate diagnostic and therapeutic interventions to be initiated in a timely manner.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/54. Intra- and perioral shooting fatalities.Determination of the manner of death in the case of intra- and perioral firearm wounds can be difficult especially if death scene investigation is unclear and inadequate. In this study, we investigated some characteristics of these firearm wounds which were autopsied in Istanbul. During the 5-year period from 1991 through 1995, there were 15 intra- and perioral firearm fatalities investigated. In all the cases, only one shot was fired into the mouth. They constituted 1% of all the firearm fatalities. The mean age of the victims was 27 years and males constituted 73.3% of the victims. Most of the wounds were caused by handguns. Homicides accounted for 53.3% of these deaths. Three of 15 cases could not be identified as intraoral firearm wounds by general practitioners during the scene investigations.- - - - - - - - - - ranking = 1.3294534727083keywords = mouth (Clic here for more details about this article) |
3/54. Gunshot wound of the atlas in a youth.The case of a bullet retained, without causing neurological symptoms, in the anterior arch of a youth's atlas after a gun had been fired a short distance from his mouth is reported. The patient was managed with external stabilization.- - - - - - - - - - ranking = 1.3294534727083keywords = mouth (Clic here for more details about this article) |
4/54. brain injury after survived gunshot to the head: reactive alterations at sites remote from the missile track.Gunshot wounds to the brain usually lead to acute respiratory arrest or death after a brief survival period, even in cases involving only slight direct tissue damage. It can be assumed therefore that the damage extends beyond the zone of recognizable destruction and hemorrhages. To determine the true extent of the tissue injury resulting from gunshot wounds to the brain, we carried out microscopic investigations for reactive changes (emigration of leukocytes and macrophages, axonal expression of beta-amyloid precursor protein (beta-APP) in 10 cases of gunshot wound to the narrow channel of the brain with survival times >2h. Demonstration of leukocytes expressing naphthol AS-D chloroacetate esterase activity in the brain tissue at the border of the missile track established the vitality of the gunshot effect. The presence of macrophages (CD68-epitope) allowed demarcation of a 1-2mm wide necrotic zone around the permanent cavity. Within this zone and beyond, beta-APP showed an initial increase followed by a decline in the number of injured axons. Three types of beta-APP positive staining could be differentiated. In the immediate vicinity of the missile track beta-APP positive neurons were present at a distance of 2-4mm from the margin of the permanent cavity (type 1) as a result of primary injured neuronal tissue by the gunshot itself. At longer distances from the narrow channel and the permanent cavity single beta-APP positive axons or axon fragments and two additional types were found; type 2 shows a parallel, wave-like arrangement of the damaged fibers, which suggests that the injury was produced by mechanical acceleration of the brain tissue created by the energy the projectile expended within the brain; irregular aggregation of beta-APP positive axons or axon fragments within a local edema represents type 3, which may be attributed to secondary ischemia or edema.- - - - - - - - - - ranking = 3keywords = cavity (Clic here for more details about this article) |
5/54. Transfemoral extraction of an intracardiac bullet embolus.Missiles may reach the heart via direct penetration of the thoracic cavity or indirectly by means of the venous circulation. Often the hemodynamic stability of the patient dictates the approach that is used not only to retrieve the projectile but also to repair associated life-threatening injuries. The case of a 40-year-old man with an intracardiac missile after a gunshot wound to the right gluteal area is presented along with the transfemoral technique used to recover an intracardiac projectile. This approach may be used instead of thoracotomy for missile extraction in stable patients.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
6/54. The injury pattern of a new law enforcement weapon: the police bean bag.STUDY OBJECTIVE: This case series describes the injury pattern of the police bean bag, a new weapon adopted by US law enforcement agencies. methods: Retrospective chart review between 1996 and 2000 identified bean bag injuries. autopsy data were gathered for 1 fatality. Circumstances of the shootings, toxicology results, and psychiatric diagnoses, if any, were recorded. RESULTS: Thirty-nine men and 1 woman between the ages of 16 and 77 years were shot by officers of either the los angeles police Department or the los angeles Sheriff's Department. The fatality was caused by massive hemothorax after thoracic penetration. The locations of serious penetrating injuries included the thoracic cavity, eye, abdomen, arm, and leg. Blunt injuries included splenic rupture, pneumothorax, compartment syndrome, testicular fracture, subcapsular liver hematoma, and cardiac contusion. Complications included hemothorax, pneumopericardium, wound infection, compartment syndrome, and osteomyelitis. Psychiatric consultation was requested for 27 (69.2%) of 39 surviving patients. The diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) axis I was used for diagnosis in all 27 patients. Psychosis was diagnosed in 16 (59.3%), suicidal ideation in 15 (55.6%), and major depression in 6 (22.2%) of the 27 cases. schizophrenia had previously been diagnosed in 7 (25.9%) of the 27 cases. All but 1 of the patients had toxicology screenings performed, and the results of 29 (74.4%) of 39 were positive. Of these 29 positive results, 15 (51.7%) were positive for alcohol and 8 (27.6%) were positive for cocaine. CONCLUSION: awareness of the broad scope of potential injuries mandates a thorough evaluation of both blunt and penetrating trauma in patients shot with police bean bags. The scope of these injuries raises significant public health considerations because use of this weapon has been adopted by law enforcement agencies in all 50 states and at least 10 countries.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
7/54. death due to accidentally self-inflicted gunshot wound.A 37-year-old man, with the entrance gunshot wound on the front of the right leg several cm above the knee, was found dead at home in his bed. No other lesions were observed except a contusion ring around the wound that spread downward and to the right. On autopsy, the wound path was followed upward from the entrance wound (0.7 cm in diameter). The bullet went through the medial aspect of the quadriceps and adductor muscles and continued upward, adjacently to the internal iliac artery, perforating the pelvic floor and the median lobe of the prostate. It passed by the left kidney, injuring its fatty capsule, then went through the mesentery near the left segment of the transverse and descending colon, and entered the thoracic cavity through the diaphragm, injuring the posterior wall of the pericardium and the posterior wall of the left ventricle at the level of the first left rib. The bullet was found in the apex of the left lung. death was caused by cardiac tamponade.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
8/54. A mouthful of trouble.The prehospital providers in this case performed a thorough and detailed assessment. They searched for and found a puncture wound in the posterior buccal region, and learned the patients was also hypoglycemic, with a history of diabetes, and insulin-dependent. It was not clear how the patient arrived at a hypoglycemic state, or if he had suffered a seizure. After the family arrived at the hospital and went to the patient's home, they determined the circumstances that caused this unusual presentation: The patient was the victim of a home-invasion robbery and had been shot in the mouth with a small-caliber weapon. The home invasion had taken place approximately 12 hours prior to the victim being found. The victim had been knocked unconscious by the force of the shot, although the bullet did not break any bones. He had not eaten prior to the shooting. Upon arrival at the ED, a small exit wound was noted behind the patient's left ear--hair and dried blood had obscured it from the prehospital providers. However, the providers did alert the ED physician to the buccal puncture wound, which enabled the physician to consider the possibility that the mouth wound was the result of a gunshot. Gunshot wounds are unpredictable in their damage patterns and effects on their victims. They might lead a patient to become hemodynamically unstable, but that was not the case here. Hemodynamic stability should not preclude the consideration of traumatic insult throughout your assessment. The initial presentation of this patient may have tempted EMS to pursue the suspicions stated by the neighbor at the scene (seizure), but a detailed assessment provided the information necessary to treat the man appropriately.- - - - - - - - - - ranking = 7.9767208362499keywords = mouth (Clic here for more details about this article) |
9/54. A case of "boomerang" bullet ricochet.A .375 Holland & Holland Magnum Winchester Fail Safe bullet was fired against a steel plate. The big-game hunting bullet (17.4 g, approx. 810 m/s) has a solid copper-alloy hollow point design including a lead core limited to the rear portion. The range of firing was 20 m and the angle of impact was 90 degrees. A large fragment (10.9 g) consisting of the main part of the copper portion was deformed in a peculiar manner similar to a tube or ring and wounded the left hand of the person shooting. The unique fragment trajectory strictly against the line of fire and the velocity sufficient to shatter bone after a distance of 20 m can be explained by an extraordinary deformation mechanism. Unlike in tissue, the high resistance of the steel plate caused the lead core in the rear of the bullet to move forward perforating the central copper barrier behind the hollow point cavity. Thus, the peculiar fragment was created. The subsequent backwards acceleration of the ring-like fragment was probably caused by the partly elastic impact of the copper-alloy portion against the hard steel plate. Due to the perpendicular impact resulting in a centric and symmetrical deformation, the fragment moved in a direction exactly backwards along the original line of fire.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
10/54. Arthroscopical removal of a projectile from the intra-articular cavity of the knee joint.We report the case of a 29-year-old patient with an uncommon handgun accident. A gun was resting in his pocket when an accidental shot was fired. The projectile penetrated the skin of the thigh, travelled through the quadriceps muscle and entered the articular cavity at the upper pole of the suprapatellar recess. It passed the femoropatellar joint space and stopped within the infra-articular fad pad. The bullet was localized by conventional x-rays and removed by arthroscopy. The patient developed no infection, and in a clinical follow-up examination 6 months postoperatively, we observed no pathological findings.- - - - - - - - - - ranking = 5keywords = cavity (Clic here for more details about this article) |
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