561/1500. Intramyocardial shotgun pellets diagnosed on initial emergency room chest X-ray: case report. The diagnosis of retained intracardiac missile is usually made at thoracotomy or fluoroscopy. Close inspection of plain chest x-rays may reveal blurring of radiopaque objects that are moving with the beating heart. In a gunshot wound victim who is initially stable, observation of this phenomenon should prompt a very high index of suspicion for cardiac injury. Invasive hemodynamic monitoring is indicated, and thoracotomy should be performed if penetrating cardiac injury is confirmed. ( info) |
562/1500. Trajectory reconstructions. I: Trace evidence in flight. This paper reviews the use of trace evidence recovered from spent bullets in helping to establish trajectories. The use of information derived from such trace evidence combined with that from geometrical techniques of trajectory reconstruction and other data is discussed. Five cases are reviewed in which the analysis of trace evidential materials adhering to bullets was used to help reconstruct the event. ( info) |
563/1500. The tubular "cookie cutter" bullet: a unique projectile. Recently marketed PMC (Pan Metal Corporation) Ultramag tubular hollow point ammunition is uniquely constructed with a two-part projectile composed of a tubular copper bullet and a Teflon wad. A fatal gunshot wound with this ammunition is described. A unique radiographic pattern and the results of test firing are also presented. ( info) |
564/1500. 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. ( info) |
565/1500. Suicides by starter's pistols and air guns. We report the case of a 25-year-old depressed woman who committed suicide with a starter's pistol loaded with CS tear-gas ammunition. The propellant gases of the contact shot entered her chest through the left sixth intercostal space. exsanguination was caused by perforations of the pericardium and apex of the heart. autopsy did not reveal any metallic or other foreign bodies that might have originated from the propellant, the cartridge, or any bulletlike material. Her injuries were thus caused by the propellant alone. 0.5 mg L-1 of the CS degradation product cyanide was detected in the cardiac blood. We also report the case of a 54-year-old man, suffering from depressive psychosis, who committed suicide with an air rifle. The lead-pointed Diabolo bullet entered his brain through the right large wing of the sphenoid bone, traversed the right temporal brain pole, damaged the right middle cerebral artery and the right optic tract, and finally lodged in the left central ganglia. There was extensive basal subdural hemorrhage and tamponade of all cerebral ventricles. death was attributed to cerebral failure. We furthermore list another 26 cases of suicide by rarely used weapons from 1947 to 1989. ( info) |
566/1500. Late urologic complication of an abdominal gunshot wound. An unusual late complication of an abdominal gunshot wound is presented. It consisted of an acute hydronephrosis of the left kidney by a BB-type bullet that migrated into the ureter of a 11-year-old boy 1 month after he was injured in the left flank, causing its complete obstruction. A percutaneous nephrostomy was performed and, with the help of a basket-type catheter, the bullet was removed. To our knowledge this is the first case reported of this rare complication treated by this technique. ( info) |
567/1500. Intravascular missile embolization in childhood: report of a case, literature review, and recommendations for management. A collective review of 20 cases of missile embolization among children (1961 to 1988) is analyzed, one case added, and guidelines for diagnosis and management are outlined. Causative agents were bullets (14 patients), pellets (5), and fragments (2). Their trajectory was arterioarterial (11), venovenous (5), paradoxical (4), and mixed (1). diagnosis was suspected when an exit wound was absent and the foreign body was traced on regional x-ray. Embolization was predominantly to the legs, with a tendency for the left (5 of 8 cases). upper extremity emboli were exclusively to the right. Only one of five cardiac entries required closure to control bleeding compared with four of six aortic. embolectomy was performed in 16 patients. The overall mortality rate was 9.5%. Factors predicting a favorable outcome are early presentation, diagnosis, and intervention; location of cardiovascular entry and embolus site; and presence of soft tissue tamponade at entry wound. Although embolectomy for cerebral, asymptomatic pulmonary arterial, and silent venous emboli is controversial, universal agreement prevails regarding removal of systemic arterial as well as venous emboli that are potentially problematic. ( info) |
568/1500. Peripheral vascular gunshot bullet embolus migration to the cerebral circulation. Report and literature review. Bullet embolization to intracranial branches of the major cerebral arteries is a rare complication of gunshot wounds. A review of the literature on cerebral vascular bullet embolization from peripheral sources revealed a number of single case reports that included 12 cases involving the anterior cerebral circulation, and one which involved the posterior circulation. This communication details two additional subjects who were treated at our institution. ( info) |
569/1500. It may be more significant than you think: BB air rifle injury to a child's head. BB guns of 20 years ago were constructed of coils and springs which generated relatively little force, so that a projectile posed little threat of serious injury. Today, the coil and spring construction has been replaced by pump action pneumatic chambers which allow generation of muzzle velocities near 350 ft/sec. Speeds of 150 ft/sec and 200 ft/sec are required for skin penetration and bone penetration, respectively. We present a seven-year-old boy who suffered intracranial parenchymal injury from an air-powered BB gun projectile while playing with friends. We discuss literature which suggests these once-innocent toys are now harbingers of severe, if not fatal, injury. ( info) |
570/1500. Microsurgical reconstruction of shotgun-blast wounds to the face. Successful management of shotgun-blast injuries to the face with loss of composite tissue is discussed. While emphasis in the literature has generally been on weapons ballistics and their destructive effect on tissues, the most massive tissue destruction can be anticipated from close-range gun-barrel effects due to rapidly expanding gases. The authors stress uncommonly aggressive tissue transfer as the method of choice in reconstructing facial shotgun wounds. The surgeon must evaluate patient psychological readiness for step-by-step reconstruction. Fistulas are avoided by transplanting several small flaps, rather than one large flap. The dorsalis pedis flap is recommended as an excellent choice for contaminated intraoral reconstruction. A staged approach providing osteocutaneous composite tissue for repair of shotgun-blast facial wounds is presented. At subsequent stages, soft tissue defects are repaired and restoration of mandibular continuity is provided with the use of the scapular flap and other alternatives. Microsurgical management of facial gunshot wounds can provide satisfactory reconstruction and almost normal function. ( info) |