Endovideosurgery of gunshot wounds

The paper deals with the opportunities of using endovideosurgery in local armed conflicts. There were worked out methods and technique of endovideosurgical operations in case of gunshot wounds of a chest, a belly and lower limbs. Due to a low level of traumatism and high efficiency the method promotes the decrease of the number of complications, early activation of the insured servicemen during the post-operation period, the reduction in time of treatment and rehabilitation and can be recommended at the initial stage of medical evacuation.     

Self-inflicted accidental gunshot wounds

This presentation will demonstrate the dangers of using a loaded gun as a blunt force object and designing toy guns to mimic realistic weapons. The ultimate goals of this presentation are to increase public education by promoting strict adherence to standard guidelines for safe gun usage, and to re-evaluate the future of toy gun designs that realistically mirror designs of current weapons. In a review of firearm deaths in the Wayne County Medical Examiner's Office (Detroit, Michigan, USA) over 10-year period from 1990 to 2000, there was an average of 500 cases of firearm deaths per year. This figure includes homicides, suicides and accidents. Among the 500 cases, seven of the most unusual self-inflicted accidental gunshot deaths are selected for this presentation.     

Lesions that simulate gunshot wounds

A variety of postmortem and antemortem defects can be misinterpreted as true antemortem injuries. In this paper, we present a collection of six cases with defects which simulate gunshot wounds. We briefly discuss each case and emphasize the importance of scene investigation, clinical correlation and careful examination in such cases.     

非战时颅脑火器伤和非火药弹伤的特点及处理

目的分析非战时颅脑火器伤和非火药弹伤的创伤弹道学特点及处理要点。方法回顾性总结36例颅脑火器伤患者临床资料,分析投掷物类型、伤情及处理。其中颅脑贯通伤2例,盲管伤29例,切线伤1例,颅骨头皮伤4例。根据伤情给予不同的手术处理。结果痊愈35例、死亡1例(2.8%)。结论不同投掷物具有不同的创伤弹道学特性。在对颅脑火器伤处理中应分析创伤弹道学特点和伤情,采用相应的处理方法,才能取得最佳的治疗效果。     

脑干枪弹伤的超微结构研究

目的 观察脑干枪弹伤的形态学变化。方法 切取2例头部枪弹伤死亡后25min的脑干，对中服与服桥被盖部和延脑第四脑深部组织做电镜观察。结果 中脑枪弹伤波及整个脑干及小脑；脑干枪弹伤超微结构见烧灼伤和冲击、压力伤两种，其特点是广泛性神经轴索损伤重，神经元损伤轻；轴索烧灼伤呈现轴索水肿，髓鞘、轴浆及其线性体浓缩、变形；冲击、压力伤呈现轴突扭曲、变形、融合、挤压、缺损、破裂致轴浆内容物外流或缺失、错位、神经微丝与微管偏向轴索一侧等。结论 网状结构严重广泛性神经轴索损伤与对机体的致命性有着重要关系。     

Relaparotomy in abdominal gunshot wounds]

Clinical signs of postoperative complications were studied in 642 patients with abdominal wounds, including 102 (15.9%) cases with relaparotomy features. The article makes a comparison between the frequency of various complications on the one hand, and the character of internal lesions, size of the first surgical intervention and the time of the secondary surgical care on the other hand. The authors determine the basic trends of complex intensive therapy taking into account metabolic disorders in patients with gunshot abdominal injuries.     

Double suicidal gunshot wounds to the heart

A case of double gunshot wounds to the heart is reported, where police investigations determined the manner of death to be suicide. In addition, the autopsy findings supported this conclusion. The localization, appearance, and mutual relations of the inflicted wounds, as well as the direction of the bullet trajectories, helped to determine the most probable sequence of events. The victim had been able to act after the first shot and inflict the second shot as the conduction system of the heart was at least partially preserved. Even when the circumstances indicate the most probable manner of death, multiple gunshot wounds represent a challenge for forensic pathologists; a victim’s ability to act after the first shot must be determined with respect to the degree of initial incapacitation.     

The ability to act--multiple suicidal gunshot wounds

Multiple self-inflicted gunshot wounds are rare and usually present a challenge to the forensic pathologist in determining the manner of death. Determining a person’s capability to act following a gunshot wound can be of major importance in crime scene reconstruction and in differentiation between homicide and suicide. Questions concerning the possibility of physical activity following a given gunshot wound are repeatedly raised in court. We report herein three unusual cases of suicide involving multiple gunshot wounds; all the victims suffered gunshot wounds of the head without immediate incapacitation. In the first two cases, the head was target for two gunshots. Third case was a combination of two gunshots to the head and chest. In the text, we focus on the victim’s ability to act after the first shot, with regards to the character and localization of the gunshot wound. Also, we focus on findings that are typical for a repeated suicidal shot.     

鞍区颅脑枪击伤的救治

目的 探讨鞍区颅脑枪击伤急性期的救治及晚期鞍区金属异物摘除的方法。方法 对7例鞍区颅脑枪击伤患者行早期清创术，3例患者同时摘除金属异物；4例患者晚期采用显微手术摘除下丘脑、垂体内金属弹丸。所有患者均获随访，随访时间3－11年。结果 全部患者均康复，无下丘脑或垂体功能障碍。恢复良好3例，轻残3例，重残1例。结论 鞍区颅服枪击伤患者，应早期行清创术，尽可能摘除金属异物，修补颅底服膜防止脑脊液漏。术后加强抗感染、抗脑水肿治疗。重症患者需及时治疗继发性脑损害，积极治疗内分泌紊乱等并发症，在全身情况稳定后，采用显微手术摘除异物。显微手术对摘除脑深部重要部位的金属异物是一安全可靠的方法。     

Colostomies in gunshot wounds of the large intestine

The frequency and indications to colostoma formation are shown that were performed during the recent military conflicts in 40-70% of the wounded with large intestinal injuries. The authors state the indications to colostoma formation in the injuries of extra- and intra-abdominal parts of rectum and colon as well as the conditions when colostoma could be avoided. Different methods of colostoma formation and technical details are presented. In field surgery it is reasonable to apply the more simple methods. The operation defects, colostoma complications, measures of their prevention and treatment are discussed in details. The authors distinguish the complications developed in the early postoperative periods and colostoma diseases having independent significance and which become manifestative in 2-3 months after operation.