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11/31. Anterior hypopituitarism with unusual delayed onset of diabetes insipidus after penetrating head injury.

    Neuroendocrine dysfunctions are among the various complications that occur after traumatic brain injury. We report a case of onset of diabetes insipidus during acute rehabilitation of a 20-yr-old patient with a traumatic brain injury caused by a gunshot wound. Our case is the latest onset of diabetes insipidus after traumatic brain injury that has been reported in the literature.
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12/31. A review of nail gun suicides and an atypical case report.

    The nail gun was designed as a powerful industrial tool to drive nails into various hard surfaces with ease. Serious injuries associated with the tool are uncommon and deaths are rare. Unintentional injuries normally occur from misuse of the tool or from ricocheting nails. The intentional use of a nail gun to commit suicide is unusual. This paper will review successful and unsuccessful suicide attempts by use of a nail gun. We will present an atypical case of suicide committed with a nail gun by a 46-year-old depressed male investigated by the Allegheny County Coroner's Office in Allegheny County, pennsylvania in April 2002. This case reports for the first time a unique pathological finding of a ring of bone traveling with the nail, which has not been seen in wounds of the head caused by other types of projectiles.
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13/31. Nonterrorist suicidal deaths involving explosives.

    Suicidal deaths involving explosives unconnected to terrorism are rare. The investigation of deaths from explosive devices requires a multidisciplinary collaborative effort, as demonstrated in this study. Reported are 2 cases of nonterrorist suicidal explosive-related deaths with massive craniocerebral destruction. The first case involves a 20-year-old man who was discovered in the basement apartment of his father's home seconds after an explosion. At the scene investigators recovered illegal improvised power-technique explosive devices, specifically M-100s, together with the victim's handwritten suicide note. The victim exhibited extensive craniofacial injuries, which medicolegal officials attributed to the decedent's intentionally placing one of these devices in his mouth. The second case involves a 46-year-old man who was found by his wife at his home. In the victim's facial wound, investigators recovered portions of a detonator blasting cap attached to electrical lead wires extending to his right hand. A suicide note was discovered at the scene. The appropriate collection of physical evidence at the scene of the explosion and a detailed examination of the victim's history is as important as documentation of injury patterns and recovery of trace evidence at autopsy. A basic understanding of the variety of explosive devices is also necessary. This investigatory approach greatly enhances the medicolegal death investigator's ability to reconstruct the fatal event as a means of separating accidental and homicidal explosive-related deaths from this uncommon form of suicide.
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14/31. Lethal head injury due to tear-gas cartridge gunshots.

    We report a fatal head injury caused by a tear-gas cartridge and point out the underestimated potential injury of this type of weapon. Gas pressure wounds and the death mechanisms are also described. A review of the literature and forensic considerations of head injury without projectile are presented.
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15/31. Planned complex suicide by self-poisoning and a manipulated blank revolver: remarkable findings due to multiple gunshot wounds and self-made wooden projectiles.

    A remarkable case of complex suicide with poisoning and multiple self-inflicted gunshot wounds to the head is reported. After ingestion of a liquid insecticide, the victim shot himself twice in the head, once in each temple. Self-manufactured wooden dowels were used as projectiles in combination with conventional blank cartridges. The dowels had been glued on top of the blank cartridges and expelled by propellant gases. Moreover, the blank revolver used had been extensively manipulated in a rarely observed manner. Several occlusive devices had been removed from the barrel and the cylinder chamber to enable the expulsion of the wooden projectiles. The investigation of the methods used and the circumstances found at the scene pointed towards a planned complex suicide. A remarkable case with unusual projectiles, i.e., wooden dowels, fired by an extensively manipulated blank gun is reported, emphasizing the importance of close collaboration between the police firearm laboratory and forensic pathology in practical casework.
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16/31. Surgical treatment of trauma-induced periodic alternating nystagmus.

    PURPOSE: To report a new treatment for acquired periodic alternating nystagmus in which medical therapy with baclofen was not tolerated. DESIGN: Interventional case report and literature review. INTERVENTION: Simultaneous adjustable bilateral retroequatorial horizontal rectus muscle recessions. MAIN OUTCOME MEASURES: Ocular alignment and ocular motility recordings. RESULTS: A 30-year-old man had blurred vision after an emergency left temporal craniotomy for gunshot wounds. Ophthalmologic examination revealed periodic alternating nystagmus that was documented by an infrared electronystagmogram. baclofen was started but was not tolerated. Bilateral lateral and medial retroequatorial rectus muscle recessions were performed and were successful in the treatment of this patient. CONCLUSION: Simultaneous bilateral retroequatorial horizontal rectus recessions may be an effective treatment for intractable acquired periodic alternating nystagmus.
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17/31. Lhermitte's phenomenon after high velocity missile injuries of the brain.

    High velocity wounds of the brain have been associated with the development of Lhermitte's phenomenon in 26 of 56 consecutive cases from vietnam studied from 1 month to 1 year after injury. No antecedent factors could be identified. Civilian trauma and elective neurosurgical procedures have not, to our knowledge, been reported to cause this sign. Subarachnoid or subdural adhesions are suggested as the cause of Lhermitte's phenomenon in these patients.
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18/31. Unusual penetrating cranio-orbital injury by a cut-off wheel.

    The rare case of a penetrating cranio-orbital injury and the surgical treatment is presented. A 38-year-old woman was brought to the Emergency Unit of the University of Leipzig Hospital after suffering a severe craniocerebral injury from a broken cut-off wheel. A computed tomography (CT) scan demonstrated the entrance of the cut-off wheel with extension from the left sinus maxillaris and frontalis through the median part of the left-sided orbit to the anterior skull base. After removing the cut-off wheel and metal splinters, the neurosurgeon performed an osteoplastic bifrontobasal trepanation with revision of the wound channel. Three years later, the patient has no neurological deficit and the CT scan shows a small hypodensity behind the sinus frontalis on the left side.
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19/31. suicide with a butcher's bolt.

    The captive bolt pistol is an atypical firearm exclusively produced and used for butchery of breeding animals, but in some rare cases, it has been used as a lethal weapon for committing suicide by butchers, breeders and other people who have access to such weapons during their professional activities. This study describes the suicide committed by a butcher in the province of Udine (N. italy) in 2001 who shot himself with his own captive bolt pistol that produced in the right temporal region a circular wound and a bone lesion of the temporal squama with a groove involving the frontal lobe; he died five days later of the fatal consequences of the meningo-encephalic lesions. The medico-legal issues implicated in this case, seen in the light of the data reported in the international literature, illustrate the difficulties faced when diagnosing these types of lesions, bearing in mind their rarity and peculiar nature, and introduce elements of differential diagnosis regarding lesions produced by similar weapons that lead to ascertainment of the event as accidental, suicidal, or homicidal.
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20/31. Gun burner injury: a peculiar accidental self-inflicted missile head injury.

    The objective of this study was to report the pattern of unusual accidental missile head injuries from the use of the locally-manufactured Dane gun, which presented at the Obafemi Awolowo University teaching hospitals Complex, Ile-Ife, nigeria. Six illustrative patients are presented, each with a peculiar injury. All the patients except one, who died prior to surgery, had wound debridement and elevation of associated fractures with removal of the metallic foreign body. With the exception of the patient that died prior to surgical intervention, all did well without noticeable neurological deficits. Missile injury to the head is increasing. Firearm-related death is also on the increase and our environment is not exempted. Accidental injuries from stray bullets are fairly common; however, self-inflicted injuries are usually due to the improper handling of firearms, particularly by novices, suicide attempts and faulty technology of locally made firearms.
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