1/14. 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 = intoxication (Clic here for more details about this article) |
2/14. lead poisoning after gunshot wound.CONTEXT: Despite the absence of symptoms in the majority of patients carrying lead bullet fragments in their bodies, there needs to be an awareness of the possible signs and symptoms of lead intoxication when bullets are lodged in large joints like knees, hips and shoulders. Such patients merit closer follow-up, and even surgical procedure for removing the fragments. OBJECTIVE: To describe a patient who developed clinical lead intoxication several years after a gunshot wound. DESIGN: Case report. CASE REPORT: A single white 23-year-old male, regular job as a bricklayer, with a history of chronic alcohol abuse, showed up at the emergency department complaining of abdominal pain with colic, weakness, vomiting and diarrhea with black feces. All the symptoms had a duration of two to three weeks, and had been recurrent for the last two years, with calming during interval periods of two to three weeks. Abdominal radiograms showed a bullet lodged in the left hip, with a neat bursogram of the whole synovial capsule. A course of chelating treatment using calcium versenate (EDTACaNa2) intravenously was started. After the chelation therapy the patient had recurrence of his symptoms and a radical solution for the chronic mobilization of lead was considered. A hip arthroplasty procedure was performed, leading to complete substitution of the left hip.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
3/14. The Mickey Finn defense: involuntary intoxication and insanity.The legal context of voluntary and involuntary intoxication is delineated. The author reports a case of involuntary intoxication involving scopolamine toxic psychosis or delirium, in which he testified as a psychiatric expert witness. The specific psychological and physiological symptomatology produced by scopolamine intoxication is outlined. The forensic psychiatrist should be alert to the involuntary intoxication defense in these cases and should familiarize himself with the specific toxicity of scopolamine, in view of the significant increase in the number of incidents in which it is utilized as "knockout" drops in certain jurisdictions.- - - - - - - - - - ranking = 8keywords = intoxication (Clic here for more details about this article) |
4/14. Increased lead absorption and lead poisoning from a retained bullet.A young man was found to have elevated blood lead and erythrocyte protoporphyrin levels seven years after he had been shot in the foot with a .22 caliber bullet. Although clearly evident in radiographs obtained at the time of the accident, the bullet had never been removed. Over the course of the intervening years the radiographic appearance of the projectile changed dramatically. The patient underwent a surgical debridement procedure with some resolution of his lead intoxication. This case was reviewed in the context of the literature describing the disposition of retained lead projectiles. Lead bullets or fragments lodged within joints are slowly disintegrated and, as absorption accelerates, predispose the patient to the risk of lead poisoning which may occur many years after the original incident. Prompt removal of any lead projectile entering a joint space is strongly recommended.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
5/14. lead poisoning from a gunshot wound. Report of a case and review of the literature.A man was hospitalized on three occasions for symptoms of lead intoxication 20 to 25 years after a gunshot wound that resulted in retention of a lead bullet in his hip joint. The potential for lead toxicity as a complication of a lead missile injury appears to be related to (1) the surface area of lead exposed for dissolution, (2) the location of the lead projectile, and (3) the length of time during which body tissues are exposed to absorbable lead. Cases of lead poisoning of immediate onset resulting from lead shot have been reported in europe, but all documented cases of ammunition-related plumbism reported in the united states have involved synovial fluid dissolution of a single lead bullet over many years. The solvent characteristics of synovial fluid and associated local arthritis are apparently important factors in the dissolution and absorption of lead from projectiles located in joints. awareness that lead intoxication can be a complication of retained lead projectiles should allow rapid institution of appropriate diagnostic and therapeutic modalities when such a clinical situation arises.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
6/14. lead poisoning from a gunshot wound to the hand.Lead intoxication from retained bullets is uncommon but potentially fatal. A 45-year-old man was shot in the left wrist with a .32-caliber rifle. He was first seen 16 months later with symptoms, signs, and laboratory values that were consistent with the diagnosis of plumbism. The factors leading to plumbism, its evaluation, and treatment are reviewed.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
7/14. Gunshot wound to the foot: early management and pathophysiology of projectile wounds.The authors present a case study of gunshot wound and discuss the rationale for therapy after hemostasis is established. Treatment consists of debridement of necrotic tissue, immobilization to prevent further movement of the bullet, and immediate antibiotic therapy to prevent bacterial invasion. They emphasize the necessity of understanding the pathomechanics and pathophysiology of ballistic injuries and advocate removal of the bullet, when possible, to relieve discomfort, to prevent anemia and renal failure, and to avoid the danger of lead intoxication.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
8/14. Lead intoxication 18 months after a gunshot wound.lead poisoning can result from a retained intra-articular bullet. A 30-year-old man who was shot with a .38-caliber pistol illustrates the symptoms, signs, and differential diagnosis of lead intoxication.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
9/14. lead poisoning from retained bullets. Pathogenesis, diagnosis, and management.Lead intoxication (plumbism) from retained bullets has rarely been reported but may be fatal if unrecognized. Bullets lodged within joint spaces or pseudocysts are more likely to develop this complication, although patients with retained missiles in other locations may also be at risk. Subtle findings such as the occurrence of unexplained anemia, abdominal colic, nephropathy, or neurologic deterioration in patients with retained missiles may suggest consideration of plumbism. An intercurrent metabolic stress such as infection, endocrinopathy, or alcoholism may be a precipitating factor. Among the various diagnostic studies available, mass spectrometric stable isotope dilution analysis may be the most reliable. It is important to employ chelation therapy prior to any operative intervention. This will reduce the mobilization of lead from bone during or following the surgical procedure.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
10/14. ethanol in intracerebral clot. Report of two homicidal cases with prolonged survival after injury.Two homicidal cases are reported with prolonged survival after injury. In one case there was a 33-hour survival and the other had a 9-hour survival before death. In both cases there was severe injury to the brain: in one by blunt force and in the other by penetrating injury by firearm. blood and urine alcohol levels in these cases were low or negative. The blood clot is another potential resource for information in an unnatural death investigation where intoxication is suspected or indicated by the behavior of the victim.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
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