骨盆火器伤死亡3例剖检资料分析

通过对3例骨盆火器伤尸体解剖观察,探讨骨盆火器伤早期伤情特点,总结死亡原因,以提高骨盆火器伤的救治水平。     

腹腔火器伤感染积脓6例尸检资料分析

由于腹腔脏器位置和组织结构的特殊性 ,一旦遭受火器击伤后易引起腹腔感染积脓。我院收治腹腔火器伤 134例 ,继发感染积脓 6例 (4 5 % )均死亡。为探讨腹腔火器伤继发感染积脓的防治措施 ,提高救治效果 ,我们对该 6例尸检资料进行了分析。1　临床资料1 1　一般情况　 6例均为男性青壮年。弹片伤 3例 ,枪弹丸伤 3例。伤后 2ｄ内入院 2例 ,3ｄ后入院 4例。受伤后神志清醒 2例 ,休克昏迷 4例。均有腹胀、腹痛 ,呼吸困难、烦躁不安 ,恶心、呕吐及蛋白尿 ;伤后 3ｄ始持续发热 ,直至死亡。伤口分泌物培养出大肠杆菌 1例。1 2　致伤效应　 6例体表…     

结肠火器伤8例尸解资料分析

结肠火器伤完整尸解资料较少见。为积累结肠火器伤尸解资料,现将我院1979-1984年收治的结肠火器伤抢救无效死亡的8例尸解资料报告如下。     

现代火器伤剖检的价值

尸检即尸体解剖,是指对死亡机体进行剖检以查明死因,对人体死后体表和内脏器官的病理改变进行研究的一种方法,是探讨疾病性质和死因的“金标准”。早在第一次世界大战时,前苏联各级卫勤部门就建立了病理解剖所。美军在二战、朝鲜和越南战场上,均组织了战伤调查队,对战伤伤亡病例进行尸体剖检。二战以前,失血性休克和感染是严重创伤后的首要致死因素,后来,随着休克复苏技术的改进和各种新型抗生素的出现,使许多严重休克和感染的伤员得以渡过危险期而获救。     

四肢单纯火器伤死亡5例尸解资料分析

本组5例均为四肢单纯火器伤死亡者,而且均是经过一线医院的早期救治,在转送二线医院途中或转送后死亡的。为探讨其死亡原因,我们对尸解资料进行了分析。     

火器伤截肢23例分析

目的：探讨平时火器伤截肢的适应症和手术方法及要求。方法：对近16年实施的23例平时火器作截肢资料进行回顾性分析。结果：多数采用闭合截肢，总体满意率达91．3%（21／33）。结论：致伤能量低、伤后至手术时间〈8h、软组织条件较好、污染程度低、手术时能获得良好的清创、有充分的血液和抗生素供应、术后管理条件好时可选择性采用闭合截肢。     

腹部枪伤继发黄疸1例尸检资料分析

腹部贯通枪伤引起黄疸的伤例实属少见 ,我院尸体解剖中遇见一例。1　病例报告伤者男 ,2 1岁 ,战士。右腹部贯通枪伤 ,伤口流血。立即包扎 ,伤后 6h行剖腹探查 ,见升结肠破裂行外置造口术。第 2天转入我院。入院诊断 :(1)右腹贯通枪伤 ;(2 )升结肠枪伤行外置造口术 ;(3)黄疸原因待查。经多方治疗于伤后第 7天死亡。尸体解剖见腹腔化脓性炎症 ,升结肠外置造口有炎性粘连 ,部分坏死。回肠中段坏死长 4 0cm。大网膜与小肠广泛粘连、坏死。腹腔积脓约 5 0 0 0ml。胆囊高度肿大 ,总胆管肿胀 ,管腔狭窄 ,与周围组织粘连 ,有坏死、积脓 ,肝包膜下脓…     

Virtual autopsy: preliminary experience in high-velocity gunshot wound victims

PURPOSE: To retrospectively assess virtual autopsy performed with multidetector computed tomography (CT) for the forensic evaluation of gunshot wound victims. MATERIALS AND METHODS: The institutional review board approved this HIPAA-compliant study and did not require informed consent of the next of kin. Thirteen consecutive male gunshot wound victims (mean age, 27 years) were scanned with 16-section multidetector CT prior to routine autopsy. Retrospectively, the total-body nonenhanced scans were interpreted at a three-dimensional workstation by radiologists blinded to autopsy findings. Images were evaluated for lethal wound, number and location of wound tracks, injured structures, and metal fragment location. After image review, autopsy reports and photographs were compared with the images and interpretations to validate the multidetector CT determinations. RESULTS: Multidetector CT aided in correct identification of all lethal wounds, and metallic fragment location was always precise. In four cases, multidetector CT aided in accurate assessment of organ injuries and lethal wounds but led to underestimation of the number of wounds if comingling paths occurred. In two cases of a chest wound, multidetector CT aided in accurate assessment of the chest as having the lethal wound but failed to help identify specific sites of hemorrhage. In two cases of craniofacial injury, the path of the wound was not clear. Autopsy revealed a total of 78 wound tracks (mean, 6; range, 1-24). Ten (13%) wound tracks were not identified at multidetector CT (six upper extremity wounds and four thigh wounds). In two cases, findings missed at autopsy (fracture of the cervical spine, bullet fragments in the posterior area of the neck) were identified at multidetector CT. CONCLUSION: Multidetector CT can aid prediction of lethal wounds and location of metallic fragments.     

Self inflicted gunshot wound caused by a home-made gun--medico-legal and ballistic examination

The reconstruction of the mechanism of a fatal gunshot wound inflicted with a zip gun is presented. The joint investigation of medico-legal team and firearms experts teams resulted in an explanation of the unusual distribution of gunpowder encountered around the entry wound. Although the use of crude home-made weapons associated with various criminal activities and suicide is widespread, the forensic literature on this subject is sparse especially concerning tests conducted on the weapon.     

Radiological findings in gunshot wounds caused by hunting ammunition. An experimental study

Experimental gunshots were made with hunting ammunition using a dummy model made of skin and foam rubber as the target. After penetration of intermediate targets of wood by the bullets, the characteristics of the wounds changed and their dimensions increased. The morphology of the wounds presented a very varied spectrum. When the gunshots had initially passed through wood 50 mm thick, radiographs of the skin showed a quantity of metallic residues of between 10 m and 1 mm. The metallic particles were wiped off the surface of the projectile by the target itself, whereby the best wipe-off effect was achieved with skin. The experimental findings suggest that the formation of the fine metallic residues is analogous to the development of the bullet wipe formed by lead bullets. Larger fragments flew into the target independently of the bullet and depending on the distance between the intermediate and final targets. A case example is documented.     

An autopsy case of a decomposed body with keyhole gunshot wound and secondary skull fractures

The decomposed body of a 53 or 57-year-old male was found with a gun in a locked car parked in a coin-operated parking lot. During autopsy, the entrance wound in the frontal bone showed a characteristic keyhole defect with internal and external beveling. There was no exit wound. The fragmented bullet traveled downward within the calvarium and struck the right orbital plate. Two independent linear fractures were observed away from the entrance. These were believed to be secondary fractures resulting neither from internal ricochet of the bullet nor from direct blunt force to the head. Although decomposition complicated the evaluation of the gunshot wound characteristics, microscopic examination confirmed large quantities of soot along the wound tract, supporting our conclusion that the range of fire was contact.     

肢体枪弹伤的MRI表现及其病理形态学基础的实验研究

目的通过动物模型，观察肢体枪弹伤的MRI表现，并探讨其病理形态学基础。方法将16只犬分成伤后5、24、48和72h组，手枪致伤犬后大腿制成动物模型后，进行MR多层面多序列扫描。观察各时相点损伤组织的病理形态学改变与MRI表现。结果原发伤道为组织缺损区，5h组4只犬伤道内充填的血液与24、48、72h组12只犬充填的脓液在MRI上均表现为长T1和长T2信号。挫伤区以均质样变的凝固性坏死为主，在MR各时相点的图像上均表现为不规则线样或点片状等T1和短T2信号，静脉注入钆喷替酸葡甲胺(Gd-DTPA)后无强化。震荡区：5h组的4只犬以肌细胞水肿、变性、溶解及组织间隙内大量红细胞为主；24、48、72h组的12只犬细胞间出现大量中性粒细胞和脓细胞，随着时间的增加，变性肌细胞的溶解逐渐加剧，组织水肿更加明显；各时相的震荡区在MRI上均呈Tl稍低信号、T2高信号，并有明显强化，且T2信号随时间的增加而增高，使相邻的挫伤区显示更清楚。结论在肢体枪弹伤后72h内，MRI能较准确地显示组织的损伤状况，其中T2WI和增强T1WI价值较大。枪弹伤特有的组织缺损、细胞凝固性坏死、大范围血管与细胞损伤是其不同于普通创伤MRI表现的重要病理形态学基础。     

海水中肢体火器伤伤后伤道细菌种类分析

目的：观察海水中犬肢体火器伤后伤道早期细菌变化，结合文献探讨初期外科处理。方法：将17只普通级毕格犬分为海水中致伤组（n=14）和地面致伤组（n=3）。海水组于海水中枪伤后救出，伤后0．6、12、24h进行伤道细菌检测和药敏试验。地面组为观察对照。结果：伤肢肿胀、组织坏死和动物死亡时间，海水组均较地面组严重和提前；海水组革兰氏阳性球菌和革兰氏阴性杆菌较多，以链球菌、金黄色葡萄球菌、大肠杆菌为主的混合感染，头孢菌素、氨基糖甙类对多种细菌敏感。结论：海水中火器伤后细菌数量种类多，感染时间提前且严重，处理更应强调尽早彻底清创、早期使用广谱抗生素。     

火器致胸部穿透伤1例救治分析

介绍1例由枪击所致双胸腔双肺和纵隔穿透伤,在紧急抗休克的同时,经胸骨正中切口,同时修补双侧肺叶,术后加强营养,积极抗感染,抢救成功,未留任何脏器功能不全的后遗症。     

Treatment of extracranial gunshot wounds caused by non-lethal weapon

The deaths happened as a result of wounds caused by non-lethal weapon (NLW) are mainly associated with severe and extremely severe damage of brain. However, vast number of specific problems occurs in cases of extracranial gunshot wounds caused by NLW. Taking into account little physicians' experience, and absence of standard approaches to treatment of these wounds till now. This paper embraces peculiarities of clinical signs, diagnosis and surgical treatment of cervical, truncal, and extremities wounds caused by NLW. Our investigation allowed to draw a conclusion that gunshot wounds caused by NLW have similar characteristics. These ones are the same with signs of wounds caused by small arms. Surgical treatment of wounds caused by NLW is based on the standard approaches to treatment of low-velocity missile wounds.