1/12. 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) |
2/12. Penetrating stab wound of the gluteus--a potentially life-threatening injury: case reports.Presented are two cases of stab wounds through the gluteus in which serious damage was incurred by internal organs: in one case there was penetration of the rectum with the appearance of signs of acute abdomen; in the other there was tearing of retroperitoneal muscles and the internal iliac vessels with resultant hypovolemic shock. These observations suggest that there should be greater awareness of the life-threatening nature of stab wounds of the gluteus under similar circumstances.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/12. Lethal injuries occurring during illegal break-ins.Individuals who undertake criminal activity are often at risk of injury for a variety of reasons. Two cases are reported where individuals who were engaged in illegal breaking and entering activities sustained stab wounds from broken window glass and died of exsanguination. The cases both involved young males who were under the influence of alcohol and/or drugs and who sustained relatively minor tissue damage that had fatal consequences due to a variety of coincident factors. Critical location of wound sites over major vessels resulted in rapid bleeding that was enhanced by vasodilator effects of alcohol and stimulant effects of amphetamines. In addition, adrenergic effects of being engaged in illegal activities, and the subsequent pain from the wounds, may also have contributed to accelerated heart rate and blood loss. Failure to appreciate the potential effects of such wounds, which may initially have appeared relatively minor based on their small size, added to an impaired ability to apply first aid or seek appropriate medical assistance, may also have been due to the combined effects of drugs, alcohol, and concerns regarding the illegal nature of the underlying activity. Such a scenario constitutes a specific subgroup of offender injury that could be termed the break, enter, and die syndrome.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/12. Stabbing chest pain: a case of intermittent diaphragmatic herniation.A case of traumatic diaphragmatic herniation is described in which gross mediastinal shift was caused by a combination of the herniated abdominal organs, purulent exudate, and air. This complex presentation might best be described as a case of gastrocolopyopneumothorax, diagnosis of which was further complicated by the intermittent nature of the herniation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/12. Nonmissile penetrating spinal injury. Case report and review of the literature.Nonmissile penetrating spinal injuries (NMPSIs) are rare, even among the population of patients treated in large trauma centers. patients who present with retained foreign body fragments due to stabbings represent an even smaller subset of NMPSI, and their optimal management is unclear. The authors report the case of a 42-year-old man who presented to the University of california at Davis Medical Center with a retained knife blade after suffering a stab wound to the lower thoracic spine. They discuss this case in the context of a literature review and propose management options for patients with NMPSIs in whom fragments are retained. A search of pubmed was undertaken for articles published between 1950 and 2006; the authors found 21 case reports and eight case series in the English-language literature but discovered no published guidelines on the management of cases of NMPSI with retained fragments. After clinicians undertake appropriate initial trauma evaluation and resuscitation, they should obtain plain x-ray films and computerized tomography scans to delineate the anatomical details of the retained foreign body in relation to the stab wound. Neurosurgical consultation should be undertaken in all patients with an NMPSI, whether or not foreign body fragments are present. Surgical removal of a retained foreign body is generally recommended in these patients because the fragments may lead to a worse neurological outcome. Perioperative antibiotic therapy may be beneficial, but the result depends on the nature of the penetrating agent. There is no documentation in the literature to support the use of steroid agents in patients with NMPSIs.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/12. An unusual case of comingled remains.Two motor cyclists were involved in a head-on collision. One of the motor cyclists sustained a stab wound to the chest by a portion of long bone derived from the other motor cyclist. This case is reported because of its unusual nature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/12. Ischaemic lumbosacral plexopathy in acute vascular compromise: case report.anterior spinal artery syndrome (ASAS) is a well reported cause of spinal cord injury (SCI) following thoracoabdominal aortic surgery. The resultant deficits are often incomplete, typically attributed to the variable nature of the vascular distribution. Our Physical medicine and rehabilitation (PM and rehabilitation) service was consulted about a 36-year-old patient with generalised deconditioning, 3 months after a stab wound to the left ventricle. physical examination revealed marked lower extremity weakness, hypotonia, hyporeflexia, and a functioning bowel and bladder. Further questioning disclosed lower extremity dysesthesias. Nerve conduction studies showed slowed velocities, prolonged distal latencies and decreased amplitudes of all lower extremity nerves. electromyography revealed denervation of all proximal and distal lower extremity musculature, with normal paraspinalis. upper extremity studies were normal. Recently, 3 cases of ischaemic lumbosacral plexopathy, mimicking an incomplete SCI, have been reported. This distinction is particularly difficult in the polytrauma patient with multiple musculoskeletal injuries or prolonged recuperation time, in addition to a vascular insult, as in this patient. The involved anatomical considerations will be discussed. A review of the electrodiagnostic data from 30 patients, with lower extremity weakness following acute ischaemia, revealed a 20% incidence of spinal cord compromise, but no evidence of a plexopathy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/12. paper clip stab wounds: four case reports.Four prisoners recently evaluated at a county hospital sustained self-inflicted paper clip stab wounds of the abdomen on 22 occasions. Guidelines for management based on physical examination, abdominal films and wound exploration with paper clip extraction and short-term admission for observation have been successful in avoiding laparotomy in most instances. Evaluation and surgical treatment of penetrating abdominal injuries are controversial. Some authors propose mandatory laparotomy for all stab wounds violating the peritoneum, while others recommend selective management based on physical findings, local exploration of the wound and subsequent peritoneal lavage. Recently, four prisoners have inserted sharpened paper clips into and through the abdominal wall on 22 occasions, raising questions about the appropriate treatment of these injuries. These wounds differ from other stab wounds in several respects: 1) underlying psychiatric disturbances and the self-inflicted nature of the wound increase the difficulty of patient management; 2) attempts are often multiple, precluding repeated peritoneal lavage for evaluation; 3) the foreign body may be completely intraperitoneal; and 4) peritoneal penetration is similar to that incurred during a peritoneal tap with an 18-gauge needle. The differing presentations of these patients are reported, and a plan for management of these injuries is proposed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/12. Pyogenic vertebral osteomyelitis as a complication of an abdominal stab wound.Haematogenous seeding from the genitourinary tract and the rectosigmoid region may cause pyogenic vertebral osteomyelitis. diagnosis is often difficult due to misleading symptoms. infection in this case arose as a complication of an abdominal stab wound which has been reported only once previously. Our patient suffered from increasing back pain for two months after the abdominal stab wound and laparotomy, before the true nature of the disease was diagnosed. The diagnosis was confirmed radiologically and by blood culture (staphylococcus aureus). ASTA (antistaphylolysin titre) appeared to have diagnostic value in continuing hidden staphylococcal infection. Antibiotics and bed rest were effective in treatment. The patient subsequently made a full recovery and returned to his work. The physical signs and the principles of diagnosis and management of pyogenic vertebral osteomyelitis are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/12. Thoracoscopic repair of missed diaphragmatic injury in penetrating trauma: case report.We report two cases of missed diaphragmatic injury which were diagnosed and repaired using a thoracoscopic approach. A right diaphragmatic injury sustained via a stab wound to the chest was diagnosed and repaired thoracoscopically using a stapling technique. A second patient sustained an injury to the right diaphragm from a gunshot wound, which was sutured thoracoscopically. Both patients recovered uneventfully and had shortened hospital stays in spite of the nature of their injury and initial delay in diagnosis. With the increase in unsuspected diaphragmatic injuries being reported, we feel that combined thoracoscopy and laparoscopy may offer a therapeutic as well as diagnostic benefit in selected stable patients with penetrating injuries to the upper abdomen and lower chest. Although this initial report is encouraging, further investigation is needed to determine optimal patient selection criteria as well as the cost-effectiveness of this approach.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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