1/11. Multivascular trauma on an adolescent. Perioperative management.Penetrating vascular injury, in particular at the neck, is a life-threatening trauma not only of the nature and the anatomic proximity of cardiovascular, aerodigestive, glandular and neurologic system but also of the development of early and late complications. The following case report describes our experience with a penetrating wound patient, who was admitted to our emergencies twelve hours after the accident. The only demonstrable objective signs included a large hematoma at the right-side of the neck and distended mediastinum on the chest X-ray. As the patient was cardiovascularly unstable he was immediately transported to the theater without any angiography. The mandatory operative exploration was initially unsuccessful and a median sternotomy with a standard cardiopulmonary bypass and deep hypothermia circulatory arrest was established to restore all the vascular lesions. Actually, the patient was in critical condition with a rupture of the right internal jugular vein, a large pseudoaneurysm of the innominate artery and an avulsion of the ascending aorta with the suspicion of a cardiac tamponade. The postoperative period lasted two full months, while complications appeared. The substantial message from this multivascular trauma is the early diagnosis of the life-threatening complications as exsanguinations, ventricular fibrillation and the ability to minimize postoperative complications, which will impair the normal functional life of the patient.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/11. Tentative injuries to exposed skin in a homicide case.A 28-year-old man stabbed both his wife and his 3-year-old son to death, before unsuccessfully attempting to commit suicide. The incident occurred against a background of marital conflict. The child's body exhibited six tentative wounds to the skin in the area of the heart, with no corresponding defects in the overlying clothing, a pattern normally seen only in suicide. Their presence can be explained by the fact that this can be considered an extended suicide, the father's motivation for the killing being comparable to that for true suicide. However, wounds of this nature can be produced in such cases only if the victim is severely limited in his ability to defend himself, here due to the superior physical strength of the father.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/11. Spinal intradural arachnoid cysts located anterior to the cervical spinal cord. Report of two cases and review of the literature.The authors describe two rare occurrences of radiographically, surgically, and pathologically confirmed spinal intradural arachnoid cysts (not associated with additional pathological entities) that were located anterior to the cervical spinal cord. These lesions have been reported previously in only eight patients. The patients described in this report were young adults who presented with progressive spastic tetraparesis shortly after sustaining mild cervical trauma and in whom no neurological deficit or bone fracture was demonstrated. The presence of an intradural arachnoid cyst was detected on postcontrast computerized tomography (CT) myelography and on magnetic resonance imaging; both diagnostic tools correctly characterized the cystic nature of the lesion. Plain radiography, plain tomography, and contrast-enhanced CT scans were not diagnostic. In both cases a laminectomy was performed, and the wall of the cyst was excised and fenestrated with subarachnoid space. Postoperatively, the patients made complete neurological recoveries. Based on a review of the literature, arachnoid cysts of the spinal canal may be classified as either extra- or intradural. Intradural arachnoid cysts usually arise posterior to the spinal cord in the thoracic spine region; however, these cysts very rarely develop in the cervical region. The pathogenesis of arachnoid cysts is unclear, although congenital, traumatic and inflammatory causes have been postulated. The authors believe that the formation of an arachnoid cyst cannot be explained by simply one mechanism because, in some reported cases, there has been accidental or iatrogenic trauma in association with congenital lesions. They also note that an intradural arachnoid cyst located anterior to the cervical spinal cord is an extremely rare disorder that may cause progressive myelopathy; however, the postoperative prognosis is good.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/11. air-gun pellet injuries to the head and neck in children.air-gun pellet injuries to the head and neck are seldom reported in pediatric practice, although they typically occur in children. The adult skeleton stops these projectiles, but they can easily transverse the thin bones of children. If unnoticed, these apparently trivial injuries may have catastrophic consequences. We report three children who sustained a central nervous system injury resulting from a shot by a compressed-air gun. The true nature and extent of the lesion in two infants was established only by neuroradiological investigations. We also briefly review the management and prevention of this type of injury.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/11. Strangulation injuries.Strangulation accounts for 10% of all violent deaths in the united states. Many people who are strangled survive. These survivors may have minimal visible external findings. Because of the slowly compressive nature of the forces involved in strangulation, clinicians should be aware of the potential for significant complications including laryngeal fractures, upper airway edema, and vocal cord immobility. survivors are most often assaulted during an incident of intimate partner violence or sexual assault, and need to be specifically asked if they were strangled. Many survivors of strangulation will not volunteer this information. Accurate documentation in the medical chart is essential to substantiate a survivor's account of the incident. Medical providers are a significant community resource with the responsibility to provide expert information to patients and other systems working with survivors of strangulation. This case study reviews a strangulation victim who exhibited some classic findings.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/11. Death following atypical compression of the neck.The authors present 3 cases of asphyxia caused by atypical compression of the neck by the metal bed bars fitted at the sides of the bed to prevent falling out. These occurred in 3 elderly women living in nursing homes, confined to bed by severe neuropsychiatric disturbances. In all 3 cases, the minor nature of the skin lesions and absence of blood infiltrations in the anatomic structures of the neck had made it difficult to diagnose the cause of death. Inspection of the rest homes, together with the autopsy findings (acute pulmonary emphysema, conjunctival petechiae, and dark, fluid blood), enabled identification of asphyxia as the cause of death and its causal agent as the bed bars.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/11. External injuries to the neck after free fall from great height.Falls from great height are suicidal in most cases. Any antecedent trauma that would indicate an involvement of a third party should, however, be excluded in each case. Herein lies the difficulty in such cases since injuries prior to the fall which could be of criminal nature may be masked by the impact injuries. Injuries on unexposed parts of the body should always raise the suspicion of an involvement of a third party. This applies especially for neck injuries. By a retrospective analysis of 132 cases of falls from great height, the authors conclude, however, that neck injuries may occur after free fall from great height on a flat surface without antecedent trauma.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/11. Automatic rifle injuries: suicide by eight bullets. Report of an unusual case and a literature review.A 25-year-old man committed suicide by shooting himself with eight bullets fired from a military rifle set on automatic. This rifle has two firing modes: an automatic mode and a self-loading, single-shot mode. Using this case as an example, some important aspects of firearm injuries are discussed with special emphasis on those points that are relevant to automatic military rifles and most applicable to forensic pathology practice. Some of the pathologic features of firearm wounds are reviewed and the role of the pathologist is discussed. Lastly, the most important points that help the pathologist to determine the type or nature of a firearm death--that is, whether it is an accident, homicide, or a suicide--are discussed. Classically, the number of the firearm wounds is used to differentiate suicide from homicide. As in the case reported here, however, when an automatic rifle or a military rifle set on automatic is used, the number of wounds is not a reliable indicator of the type of death.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/11. Injuries produced by judicial hanging. A case report.A judicial hanging occurred in the state of washington. neck injuries were studied by MRI (magnetic resonance imaging) and CT (Computed tomography). In addition, vertebral arteriograms were performed to evaluate the nature of the neck injury. This report details the anatomical changes produced by judicial hanging.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/11. Dual-inflow great vessel aneurysm: delayed presentation after penetrating trauma.Aneurysms constitute uncommon sequelae of injuries to the thoracic outlet. Most such aneurysms are secondary to blunt trauma and usually involve the great vessels at their take-off from the aortic arch. Penetrating injuries are more often identified in the more distal vessels and only very rarely present as pseudoaneurysms. Reported here is a single case of a chronic posttraumatic pseudoaneurysm arising from both the right common carotid artery and the right subclavian artery. The workup and surgical approach provide practical lessons, complemented with illustrations that aid in the understanding of the case. It is an unusual case because of the dual-inflow nature of the aneurysm.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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