1/42. Some missile injuries due to civil unrest in northern ireland.Some missile injuries are reviewed after nearly 8 years of continuous warfare. A feature of many of these injuries is the early admission to hospital which has had a profound effect on the survival rate and the recovery period. Some examples are given of injuries inflicted by rubber bullets. The effects of wounding by low and high velocity missiles are described and examples given. An injury caused by a missile incorporated in a bomb is also shown.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/42. Pellet embolization to the right atrium following double shotgun injury.A 28-year-old man sustained two shotgun injuries of the left inguinal region from a distance of about 1.5 m by simultaneous discharge of both shells from a sawn-off double-barrelled 16-bore shotgun (diameter of the lead pellets, 4 mm). The first X-ray examination carried out soon after hospital admission showed a single embolized pellet near the right margin of the cardiac silhouette. Eight months later, the man committed suicide by drug intoxication. At autopsy, the embolized pellet was found embedded between the pectinate muscles of the right atrium. On the basis of the reported case and with reference to the pertinent literature, the paper points out the medico-legal aspects of venous bullet/pellet embolism and the risk of lead poisoning after shotgun injury.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/42. Fourteen shots for a suicide.A 56-year-old man is discovered unconscious in a pool of blood in the kitchen of his house. According to findings, the man used a 22 long Rifle to fire 14 shots at his thorax with trajectories going from front to back, from right to left and on a nearly horizontal level. All the projectiles got into the left front side of his thorax and came out just under the back of his left armpit. One of them then got through his left arm and fractured his left humerus. According to the findings made on the premises and the position of the bloodstains, we think that man put his rifle against the wall, resting on a pipe. He fired, unloading two clips into his thorax. He had to handle the bolt of the rifle before each shot. To reload, he took the bullets which were on the nearby table on which blood marks can be seen. When reloading at a certain moment, he sat down in his armchair and when he wanted to stand up, he leaned on the armrests, on which blood marks can be seen. The last bullet was probably the one which went through his left arm, preventing him from keeping on shooting. His death, caused by a hypovolemical shock, was obviously very slow.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
4/42. 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 = near (Clic here for more details about this article) |
5/42. Fetal gunshot wound characteristics.Firearm injury in pregnant women is reported in the literature; however, no articles to date address the forensic analysis of the wounds sustained by the fetus. This is a report of a 40 weeks gestational age fetus who died following multiple perforating gunshot wounds, while his mother survived. The fetal wounds were atypical, consisting of irregular perforations with radiating linear lacerations and adjacent abrasions. The unusual wound pattern may have been due to the presence of interposed targets, the shoring of the fetus against itself and the uterine corpus, and the intrinsic character of fetal skin.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/42. suicide with two guns represents a special type of combined suicide.suicide by simultaneous gunshots with two firearms is rare. The case of a 90-year-old man who killed himself with two 6.35 mm pistols fired at the temples at the same time is presented. The victim was found dead on the terrace of his home; two guns and two cartridges were present near the corpse. Cases of suicides with two guns published in the literature are compared, and the Italian cases are illustrated briefly. The authors describe the circumstances and autopsy findings that permitted the assertion that it was a case of suicide and to exclude an homicide and show, by figures, the three-dimensional reconstruction of cranial shooting injuries. The use of two guns is considered a representation of a special type of "combined suicide" or "planned complex suicide."- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/42. fracture fixation in the mutilated hand.Early anatomic (or near anatomic; lingers do not impinge or overlap during flexion or extension) stable fracture fixation provides the foundation for successful wound management and for the repair, reconstruction, and healing of all damaged tissues in a mutilating hand injury. It also plays an instrumental role in pain control and affords an optimal opportunity for timely and favorable rehabilitation of and recovery from mutilating injuries of the hand. Kirschner or other wiring systems or mini external fixators may be used for simple fractures, in children, when rapid fracture fixation is necessary, and for provisional fracture fixation. Mini plates should be considered for fractures with comminution or loss and in instances of multiple fractures. fingers with segmental injury of three or more tissues should be considered for early amputation to avoid prolonged and impaired recovery of the hand. Every effort should be made to preserve the thumb and its function by repair or reconstruction.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/42. Use of the biceps femoris following failed inferior gluteal flap transfer. Case report.Considering the high recurrence rate of pressure ulceration in paraplegic patients, flap procedures to reconstruct a defect should not be at the expense of another possible future flap. The posterior thigh fasciocutaneous flap is useful for the coverage of ischial and trochanteric pressure sores; the biceps femoris musculocutaneous flap is a useful choice for deep ischial defects. However, the cutaneous portions of these two flaps is nearly identical. The previous transfer of the biceps flap excludes the further use of the posterior thigh flap. In contrast, use of the posterior thigh flap still permits the employment of a biceps V-Y advancement flap. Even if the donor site of the previous posterior thigh flap must be skin-grafted, the graft will remain viable on its muscular bed and function as the cutaneous portion of the flap; thus stable coverage is provided, despite previous use of 'first line' flaps. We demonstrate how careful planning of the stages of flap procedures can allow the most economic use of donor areas in this difficult patient group.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/42. Primary post-traumatic mandibular reconstruction in infancy: a 10-year follow-up.Ballistic trauma to the craniofacial skeleton combines the challenges of complex bone injury and loss with severe soft tissue injury and violation of the naso-orbital or oropharyngeal cavities. The authors report a patient who experienced a unique ballistic injury at 28 months of age that resulted in loss of the mandibular ramus and condyle. A segmental injury to the facial nerve was also identified. Primary costochondral grafting and delayed interpositional nerve grafting was undertaken. After 10 years, the patient has nearly 40 mm of opening, with only slight deviation to the injured side. Her facial nerve regeneration provides complete orbicularis oculi function, oral competence, and only slight facial asymmetry. This traumatic reconstruction differs from that of patients with hemifacial microsomia or post-traumatic/arthritic ankylosis in that the joint space itself was spared. Thus, the costochondral graft benefits from the remaining articular disk and upper disk space and is able to rotate and translate. Function and growth are adequately re-established, even in this young pediatric patient.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
10/42. Elucidation of a strange gunshot injury.A 50-year-old obese man sought medical treatment for bleeding injuries in the abdomen and thigh. According to his statement he felt a dull blow on the front of the trunk while he was feeding swans at a lake. The forensic wound findings and the examination of the clothing suggested that the injuries were caused by a single close-range gunshot with the bullet path running nearly vertically downwards and having a total length of 38 cm. The bullet primarily entered in the right mesogastrium, left the body in the right inguinal region, re-entered and ultimately lodged in the right thigh. After confronting the man with the results of the forensic examination he admitted that he himself had caused the gunshot injury accidentally when cleaning his small-bore revolver.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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