Fatal firearm injuries caused by handmade weapons

Six cases of accidental death caused by a shot from handmade or improvised firearms are described. Data were collected on incident, victim and special autopsy findings. In three cases the weapon used was a so-called 'pen gun' of small calibre (5.6 mm) and in two cases a home-made shotgun/muzzle loader with shotgun cartridge (containing 16 mm pellets) was used. In one case, the weapon was a shop-made gun with home-made ammunition. It is perhaps surprising that in the present war situation in Croatia, when all kinds of firearms are easily available, people continue to produce handmade weapons.     

误将长春新碱肌肉注射引起并发症1例的护理

1998-10收治1例已确诊为右侧中心型肺癌的患者,在用长春新碱静注化疗期间,误将长春新碱给患者作左臀部肌肉注射,患者立即感到注射部位疼痛难忍,随之出现局部皮下硬结,局部皮肤发热伴左下肢活动明显受限。     

突发事故致批量伤员的应急救治探讨

目的探讨批量伤员救治的接诊流程,以提高批量伤员的应急救治水平。方法 2009年7月～2012年3月我院急救中心接诊批量伤员共156人,通过启动绿色通道应急预案,快速分拣合安排至不同的救治区域,施行应对突发批量伤员处理预案,完善批量伤员的急救流程并运用于实践,共治愈149人,因病情危重,抢救无效死亡7人;抢救及时率达到100%。结果 156例中4例重型颅脑损伤患者到院后1～3h内死亡,3例多发伤致失血性休克到院30～60min内死亡,149例通过医院各科室的通力合作、全力抢救,均安然度过危险期治愈出院。结论绿色通道应急预案可以为救治重症伤员争取宝贵时间;在批量伤员的救治处理中起着至关重要的作用。因此,熟悉绿色通道流程,在实践中不断完善抢救流程可以显著提高批量伤员的急救效果。     

White matter changes caused by chronic solvent abuse.

PURPOSETo examine the brain damage of solvent abusers in Japan, where pure industrial toluene is frequently abused.METHODSTwenty solvent abusers 17 to 33 years of age with 7.2 +/- 4.0 years of abuse were examined with a 1.5-T MR imaging system.RESULTSWhite matter hyperintensities in cerebrum, brain stem, and cerebellum on T2-weighted images were found in seven cases. The extent of white matter change was most clearly shown on proton density-weighted images. The patients with restricted white matter change and intermediate white matter change showed white matter hyperintensities in the brain stem and cerebellum on T2-weighted images, in some cases, with additional hypointensities in the corresponding T1-weighted images. These patients had mainly abused pure toluene. The patients with diffuse white matter change showed obvious brain atrophy, including hippocampal atrophy and thinning of the corpus callosum. These patients had mainly abused lacquer thinner.CONCLUSIONThere are some patients with restricted but severe enough change to cause the neurologic symptoms in specific regions, such as the brain stem and/or cerebellum, before the brain atrophy becomes apparent. This suggests that the restricted white matter change represents not only an early change of diffuse white matter change, but at least in some cases also represents a qualitatively different change than that of diffuse white matter change. We suggest that pure toluene has a possible relation to this qualitative difference.     

Fatal wounds to the thorax caused by gunshots from blank cartridges

Lethal injuries of the thorax due to shots fired from blank cartridges calibre 8 mm are reported in three cases. The muzzle of the weapon was in contact with the left side of the breast (contact discharge) and injuries to bones were absent in all three cases. In two of the cases the pericardium was not involved but the anterior wall of the right heart ventricle was ruptured and death was due to cardiac tamponade. In the third case the pericardial sac and the left ventricle were both ruptured and the victim died due to rapid exsanguination. The cases demonstrate that the gas pressure from the exploding propellent of blank ammunition can be powerful enough to penetrate the thoracic wall. Received: 26 May 1997 / Received in revised form: 9 September 1997     

道路交通伤中特重型颅脑损伤的救治新策略

目的探讨道路交通伤中特重型颅脑损伤患者的伤情特点及救治新策略。方法对我院自2005年5月—2011年5月采用综合治疗资料完整的86例由交通事故导致的特重型颅脑损伤患者进行分析,其中高速公路组29例,普通公路组57例,并对高速公路和普通公路发生的特重型颅脑损伤患者进行对比分析。结果高速公路组29例,死亡13例,死亡率为44.8%;生存者按格拉斯哥预后评分(GOS),恢复良好4例(13.8%),中残3例(10.3%),重残5例(17.2%),植物生存4例(13.8%)。普通公路组57例,死亡40例,死亡率为70.2%;恢复良好7例(12.3%),中残5例(8.8%),重残3例(5.2%),植物生存2例(3.5%)。结论高速公路伤员多为男性青壮年,送院时间较长,多发伤比例高,休克发生率高,评分3分患者极难生存。但院前急救为特重型颅脑损伤患者抢救赢得了时间,对于提高生存率与生存质量,改善预后具有重大意义。     

交通伤致对冲性侧裂区脑挫裂伤的早期处理

目的 分析交通伤致对冲性侧裂区脑挫裂伤发病机制、早期处理与预后的关系。方法 回顾性分析我科收治的交通伤致对冲性侧裂区脑挫裂伤36例，根据伤情和受伤机制，早期改善呼吸，处理危及生命的合并伤；采用标准外伤大骨瓣开颅术31例，其中双侧开颅术13例，保守治疗的9例中4例病情加重改为手术。结果 死亡8例，植物状态2例，重残2例，中残6例。恢复良好18例。结论 早期综合处理，及时行标准去大骨瓣减压，重视中线结构区周围的脑挫裂伤，加强病情的动态观察和管理，及时采取有效措施，可降低死亡率，改善预后。     

交通事故致特重型颅脑损伤患者的救治分析

目的探讨交通事故致特重型颅脑损伤(GCS 3~5分)患者的伤情特点及提高救治水平的方法。方法对我院自2001年6月~2008年5月采用综合治疗的资料完整的76例由交通事故导致的特重型颅脑损伤患者进行分析,其中高速公路组24例,普通公路组52例,并对高速公路和普通公路发生的特重型颅脑损伤患者进行对比分析。结果高速公路组24例,死亡12例,死亡率为50%;生存者按格拉斯哥预后评分(GOS),恢复良好3例(12.5%),中残2例(8.3%),重残4例(16.7%),植物生存3例(12.5%)。普通公路组52例,死亡39例,死亡率为75%;恢复良好6例(11.6%),中残4例(7.7%),重残2例(3.8%),植物生存1例(1.9%)。结论高速公路伤员多为男性青壮年,送院时间较长,多发伤比例高,休克发生率高,GCS评分3分患者极难生存。但只要积极救治,高速公路伤员也可以取得与普通公路相似的疗效。     

Ischemic accident caused by thrombosis of a venous angioma. Apropos of a case

Authors report one case of cerebral ischemic accident by thrombosis of a venous angioma of brain. This kind of malformation is quite unusual and was considered by most authors as unable to involve supratentorial ischemic complications. This case seems to be the first reported in the literature and demonstrates that venous brain ischemic accidents can result from venous angioma of the brain.     

Fatal subarachnoid hemorrhage caused by rupture of variant anterior communicating artery: a case report and literature review

Fatal subarachnoid hemorrhage (SAH) caused by anterior communicating artery (ACoA) rupture is a rare event in medicolegal practice. Anatomical variations of the ACoA tend to make its anatomical structure, and as a result, blood flow through it, more complicated, which may increase hemodynamic stress and cause weak spots in the affected blood vessels. Variant ACoAs are prone to rupture in the event of a blunt-force trauma. Here, we report a fatal case of SAH caused by the rupture of a variant ACoA when the victim’s head was struck from behind, causing the head to rotate and the victim to fall forward onto the ground. A medicolegal autopsy revealed diffuse basal SAH and ACoA duplication. The smaller of the two variant ACoA branches had ruptured near its junction with the right anterior cerebral artery. No basal aneurysms or other fatal diseases or injuries were found. This case highlights the significance of anatomical variation in forensic pathology.     

Forensic mtDNA hair analysis excludes a dog from having caused a traffic accident

A dog was suspected of having caused a traffic accident. Three hair fragments were recovered from the damaged car and subjected to DNA sequence analysis of the canine mitochondrial D-loop control region. The results were compared to saliva and hair samples from the alleged dog, as well as to control hair samples from four unrelated dogs of different breeds. Two sequence types exhibiting five nucleotide differences in a 377 bp fragment were identified among the four controls. Whereas the evidence hair fragment was identical to the type 1 control sequence, the alleged dog shared the type 2 control sequence except for one position. Thus the dog could be excluded as the origin of the hair fragment. As canine mtDNA appears to exhibit only limited polymorphism, mitochondrial D-loop sequence comparison is currently only suitable for exclusions. Received: 16 November 1998 / Received in revised form: 10 February 1999     

Fatal penetrating head injury by bamboo fragments

Penetrating head injury by foreign body is relatively uncommon and has been scattered reported in the literature. In this case, a transorbital impalement wound inflicted by bamboo objects was discussed. A 61-year-old alcoholized man died from a transorbital intracranial wound due to penetration of the left orbit after falling from a slope beside the road. Although the facial impalement injury was small and unobtrusive, the penetrating trauma itself could induce lethal consequences, special attention should be paid to such kind of cases. The autopsy and pathological examination revealed subarachnoid hemorrhage, brain contusion and intraparenchymal hematoma. Some pieces of bamboo were also detected in the left anterior cranial fossa. Based on all of the evidence and information, we can draw a conclusion that the bamboo was the instrument causing the injuries and the case was considered as accident.