Gunshot Lesions Research Articles

Investigating Two Mass Grave Sites of WWII POW Camps in Lithuania

Abstract In 2020, archaeological excavations, exhumations, and field research were conducted at two mass grave sites near Zokniai and Armalėnai (Fig. 1) in order to locate, exhume, document, identify where possible, and respectfully bury the human remains. Archaeological field methodology was employed during the excavation and exhumation phases; the visual examination data, supplemented by osteological data obtained using anthropological methodology, was separately recorded for each individual using a standardized format. A total of 1927 individuals were exhumed, documented, and buried. The Zokniai investigation revealed that the burial site originated in late 1941 and contained POWs who were either in transit or performing harsh labour at the airport; many had died from gunshot lesions and mistreatment. The stationary camp inmates at Armalėnai were buried in late 1942 - early 1943, their deaths presumably being the result of exhaustion and disease. Both investigations illustrate how interdisciplinary collaboration between archaeology and anthropology can offer forgotten people greater respect and recognition.

IDEAS OF ACADEMICIAN O. O. SHALIMOV I N LIFE

Summary. The paper presents a clinical observation that can be an example of the use of vagotomy as an alternative method of reducing the secretory activity of the stomach in massive multiple gunshot lesions of the gastrointestinal tract due to the absence of antacid drugs. The impetus for this was the possessions and teachings of Academician O. O. Shalimov on the introduction of vagotomy into surgical practice, whose ideas live on to this day and are worthily continued by surgeons — our contemporaries and compatriots.

Influence of PNF Therapy on the Active Range of Motion in Proximal Humerus Gunshot Injury Patients

The use of Proprioceptive Neuromuscular Facilitation (PNF), namely relaxation techniques, rhythmic initiation, a combination of isotonics, stabilizing and dynamic reversing, rhythmic stabilization and motor patterns, al- lows to improve motor function and to achieve active participations of patients with musculoskeletal injuries in the process. Therefore, the purpose of the study was to evaluate the effect of proprioceptive neuro-muscle facilitation techniques on index goniometry in individuals with gunshot lesions of the proximal humerus. The study involved 56 middle-aged men, who were randomized to two levels by group size. Investigation group (n=28) received proprioceptive neuromuscular facilitation, control group (n=28) received standard kinesiother- apy program and massage. Goniometry was performed on all participants for physical therapy on 28, 56 and 84 days of the treatment. Limits of movement amplitude were fixed in all three planes, which respond to the nature of the arthrogenic contracture. The total dynamics of increase in the amplitude of active movements in the shoulder complex in participants under the influence of proprioceptive neuromuscular facilitation, not- ed higher (p=0.038; t=6.94) than in control group which underwent kinesiotherapy and massage. Therefore, positive changes were observed under the influence of PNF in the active amplitude of movement in men with gunshot lesions of the proximal humerus; this in turn allowed to break the circle of pain and improve the func- tionality of the upper extremity.

Killing methods in Sicilian Mafia families.

The Sicilian Mafia is a criminal organisation founded in Sicily which is an island south of the Italian mainland in the Mediterranean Sea. Until recently, this organization was responsible for many murders and bombings. However, recently, based on the investigations known as the "Mare Nostrum" operation, the Supreme Court convicted 67 people and sent them to prison. Some defendants were found guilty of as many as 39 murders. This article reviews the forensic analysis that was used when investigating responsibility for these Mafia murders. Our review is based on the court documents and the ballistic investigations which were carried out to evaluate the reliability of "repented" or "pentiti" statements. The murder victims were almost all men but one was a woman all of whom had gunshot lesions; in many cases, the fatal injuries were to the head and face. Ballistic analysis showed that in more than half of these murders, more than one weapon was used. In conclusion, the forensic analysis of the murders shows the Sicilian inter-families' dynamics and their characteristic operating methods.

Актуальні питання фізичної терапії при вогнепальних ушкодженнях діафізу плеча

Sergiy Kalmykov & Yuliya KalmykovaPurpose: to consider the features of physical therapy for gunshot lesions of the diaphysis of the shoulder. Material & Methods: theoretical analysis and generalization of modern scientific and methodological literature data on the features of the use of rehabilitation equipment for gunshot shoulder injuries. Results: the peculiarities of the application of physical therapy devices after gunshot lesions of the shoulder diaphysis are determined, the features of the application of kinesitherapy, therapeutic massage and physiotherapeutic treatment at different periods of the pathological process. Conclusion: physical therapy is an integral part of the medical rehabilitation of the wounded with gunshot injuries of the shoulder and depends on the amount of damage to the muscular apparatus, the immobilization method, the severity of the general condition of the wounded and the period of the pathological process and rehabilitation measures.

Penetrating aortic injury left untreated for 20\xa0days: a case report

BackgroundPenetrating aortic trauma remains one of the most challenging injuries with a high mortality rate if left untreated, or if the surgical treatment is delayed. We present an uncommon case of a late diagnosed abdominal firearm injury, in which the bullet partially penetrated the wall of the aorta, creating a plug that prevented immediate death due to massive bleeding.Case presentationA 26-year-old Libyan man was a victim of a firearm wound, with a bullet penetrating his abdominal wall from the left to right side. After the assault, the victim, spent up to 20 days crossing the Mediterranean Sea to leave his country of origin. Abdominal radiography revealed the presence of a bullet located anteriorly to the second lumbar vertebra, while computed tomography angiography, unexpectedly, demonstrated that the bullet penetrated partially into the aortic wall at the level of the left renal artery. The bullet penetrated the aortic wall for half of its length, creating a plug that avoided immediate life-threatening bleeding at the time of the gunshot injury. The bullet was removed and the aortic lesion was repaired. The patient was discharged 6 days after the surgical procedure, in good health.ConclusionsWe presented a very rare case of late diagnosis of aortic injury caused by a gunshot lesion, in which the particular trajectory of the bullet helped avoid immediate life-threatening bleeding and, probably, saved the patient’s life.

Endovascular Treatment of Gunshot Cervical Injury

Background: The best approach for the treatment of gunshot wounds involving the cervical region remains controversial. Endovascular therapy of this type of pathology has become relevant in the last years due to the development of new devices and, consequently, to the lower incidence of procedure complications. Objective: The aim of this study was to define the role of endovascular treatment of gunshot cervical lesions. Methods: Seventy-six patients suffering from gunshot lesions in the cervical region underwent angiography of the supra-aortic vessels to decide the therapeutic approach. Results: Among the 76 patients included in the study, 47 (61.8%) presented a pathologic angiography and endovascular treatment of the lesion was decided in 26, with 1.1 stent implant per patient. Average in-hospital stay was 10.4 days. At 30 days of follow-up, 2 patients presented neurological sequels and one evolved with sepsis. In the long-term follow-up with an average of 4 years, one death was registered 117 days after the procedure. Conclusions: Endovascular treatment has achieved a predominant role with the development of new devices to treat ever increasing complex pathologies and reduce the time of in-hospital stay, as well as procedure-related complications.

Lead Toxicity Risks in Gunshot Victims.

BackgroundGunshot wounds require surgeons to decide whether to remove or leave bullet fragments in the body. Surgeons also decide how to follow up with patients who have lead fragments retained in their body. Current literature recommends to remove only intra-articular fragments without the need for a follow-up for patients with the metal retained. Therefore, this study investigates chronic lead toxicity for gunshot wounds.MethodsThe study was performed in the metropolitan area of Rio de Janeiro/Brazil, between 2013 and 2015. It was a case-control study that included 45 victims of gunshot lesions with metallic fragments retained for more than 6 months. The 45 controls were matched for gender, age, and race. We compared the lead blood levels and frequency of symptoms.ResultsThe control group had average blood lead levels of 2.17 μg/dL (95% Confidence Interval [CI]; 1.71–2.63) and median 2.1 μg/dL. The case group had average values of 9.01 μg/dL (CI; 6.07–11.96) and median values of 6.5 μg/dL with p-values < = 0.001. The case group reported the following more frequently: irritancy, bad mood, headache, memory losses, daylight drowsiness, myalgia, weakness, abdominal pain, joint pain, trembling, tingling limbs. There was statistical significance for the differences of symptoms frequencies and for odds ratio between groups.ConclusionsAlthough the mean lead levels found were lower than the current laboratory references, low levels have been associated with both rising morbidity and mortality. The WHO stated: “There is no known level of lead exposure that is considered safe”. In conclusion, this work showed that bullets retained in the body are not innocuous. There are impacts in the blood lead levels and symptoms related to it, even with few fragments, extra-articular located or existing with low blood lead levels.

An osteological revisitation of autopsies: Comparing anthropological findings on exhumed skeletons to their respective autopsy reports in seven cases

Forensic anthropologists and pathologists are more and more requested to answer questions on bone trauma. However limitations still exist concerning the proper interpretation of bone fractures and bone lesions in general. Access to known skeletal populations which derive from cadavers (victims of violent deaths) who underwent autopsy and whose autopsy reports are available are obvious sources of information on what happens to bone trauma when subjected to taphonomic variables, such as burial, decomposition, postmortem chemical and mechanical insults; such skeletal collections are still however quite rare. This study presents the results of the comparative analysis between the autopsy findings on seven cadavers (six of which victims of blunt, sharp or gunshot wounds) and those of the anthropological assessment performed 20 years later on the exhumed dry bones (part of the Milano skeletal collection). The investigation allowed us to verify how perimortem sharp, blunt and gunshot lesions appear after a long inhumation period, whether they are still recognizable, and how many lesions are no longer detectable or were not detectable at all compared to the autopsy report. It also underlines the importance of creating skeletal collections with known information on cause of death and trauma.

Scanning electron microscope analysis of gunshot defects to bone: an underutilized source of information on ballistic trauma.

Recent years have seen increasing involvement by forensic anthropologists in the interpretation of skeletal trauma. With regard to ballistic injuries, there is now a large literature detailing gross features of such trauma; however, less attention has been given to microscopic characteristics. This article presents analysis of experimentally induced gunshot trauma in animal bone (Bos taurus scapulae) using full metal jacket (FMJ), soft point (SP), and captive bolt projectiles. The results were examined using scanning electron microscopy (SEM). Additional analysis was conducted on a purported parietal gunshot lesion in a human cranial specimen. A range of features was observed in these samples suggesting that fibrolamellar bone response to projectile impact is analogous to that observed in synthetic composite laminates. The results indicate that direction of bullet travel can be discerned microscopically even when it is ambiguous on gross examination. It was also possible to distinguish SP from FMJ lesions. SEM analysis is therefore recommended as a previously underexploited tool in the analysis of ballistic trauma.

Chromatic Variation of Soot Soiling: A Possible Marker for Gunshot Wounds in Burnt Bone

Soot soiling is a crucial forensic parameter around gunshot lesions. Carbonization, however, can severely alter human tissues and mimic such clues. This study aims at evaluating the survival of soot soiling even after carbonization in bone. A total of 36 bovine ribs (half fleshed and half defleshed) were shot with two types of bullet (both 9-mm; full metal-jacketed and unjacketed) with a near-contact range. With unjacketed bullets, the shot left in every case a clear, black, and roughly round soot stain around the entrance wound, whereas full metal-jacketed bullets left no signs of soot. Every specimen then underwent calcination in an oven at 800°C. The analysis of the charred samples clearly showed the survival of the soot soiling in both fleshed and bony samples, with a clear correspondence with the former position, but with a different color (yellow). Thus, soot soiling may survive, although with a different color, even after charring.

Specific characteristics of gunshot lesions of biological objects in case of shots with 9 mm pistol ammunitions “9x18 mm prs” equipped with bullets with the antiricochet ability through glass barriers

The paper presents the specific characteristics of gunshot lesions of the thoracic skin in case of shots with pistol ammunitions “9*18 mm PRS” equipped with bullets with the antiricochet ability through barriers of glass from a diverse distance.

Detection of Blunt, Sharp Force and Gunshot Lesions on Burnt Remains

The study of skin and bone lesions may give information concerning type and manner of production, but in burnt material modification of tissues by the high temperatures may considerably change the morphological characteristics of the lesions. This study aims at pointing out the effects of burning head of pigs with several types of lesions (blunt trauma, sharp force, and gunshot lesions) on soft tissues and bones, both from a morphological and chemical point of view. Results show that the charring process does not completely destroy signs of lesions on bones, which can often be recovered by cleaning bone surface from charred soft-tissue residues. Furthermore, neutron activation analysis test proved that antimony may be detectable also on gunshot entry wounds at the final stages of charring process.

Macroscopic, Microscopic, and Chemical Assessment of Gunshot Lesions on Decomposed Pig Skin

Very little literature exists on gunshot wounds on decomposed material. In this study, seven pig heads underwent a shooting test. Entrance wounds from the first head underwent neutron activation analysis (NAA) and histological testing immediately after the firing test; the other six heads were exposed to two different environments (open air and soil) and analyzed by radiochemical and histological tests every 15 days. Gunshot wounds in air maintained their morphological characteristics, and those in soil showed severe alteration after 5 weeks. Microscopic testing verified positive results for lead in all gunshot wounds in open air, whereas in most of those in soil lead could not be detected. Radiochemical analysis performed by NAA yielded for all gunshot wounds but one antimony quantities in the range of 0.07-13.89 microg. In conclusion, it may be possible to detect residues of antimony even in degraded tissues.

Computerized Tomography Used as a Routine Procedure at Postmortem Investigations

This is a prospective investigation of a consecutive series of 250 deceased individuals who were computerized tomography (CT)-scanned and autopsied. In 13% of patients, important findings at the CT-scanning were not found at the autopsy, and in 48% of patients, important autopsy findings were not found at the CT-scanning. The cause of death could be established by CT in 31%, by autopsy in 74%, and by toxicology in 22%. CT combined with data from the inquest could establish the cause of death in a majority of deaths due to severe trauma, but only in a minority of deaths caused by disease or poisoning. We found the Siemens Somatom Spirit dual-slice CT-scanner cost effective, quick, and well suited as a supplement to the routine autopsy. CT is useful in identifications, gunshot lesions, and traffic accidents. CT allows investigation of anatomic regions that are not easily available by autopsy and allows fractures and inner organs to be seen "in situ." CT provides documentation in digital form - easily stored - permits review by others and provides pictures that may be more suitable for presentation in court than autopsy photos.

Gunshot wounds in brains of children: prognostic variables in mortality, course, and outcome.

A retrospective study of 51 children presenting with craniocerebral gunshot lesions was carried out to identify predictors of outcome. The patients ranged in age from 2 months to 17 years, with a mean of 14.5 years. The outcome was good in 20 patients, and seven and four were moderately and severely disabled, respectively. Twenty patients died. Statistical analysis showed prognostic significance of the admission Glasgow Coma Score (GCS), computerized tomographic findings of intraventricular hemorrhage and midline shift, and metabolic abnormalities, including hypokalemia and hyperglycemia. These prognostic factors may have implications regarding counseling of families, utilization of resources, and organ transplantation.

TRAUMATIC INJURIES OF PERIPHERAL NERVES: II. AN ANALYSIS OF THE INCIDENCE IN 301 CONSECUTIVE CASES OF PERIPHERAL NERVE INJURIES

Summary An analysis has been made of the incidence and distribution of the lesions occurring in 301 cases of peripheral nerve injuries. Reference should be made to the text for detailed information relating to the incidence and distribution of the lesions in individual nerves. The following significant points have emerged from this analysis: 1 In the upper limb injuries of single nerves outnumbered combined lesions by six to one. 2 Lesions in the upper limb were approximately three times as numerous as in the leg. 3 With the exception of brachial plexus lesions, gunshot lesions greatly outnumbered those due to other causes, though in the case of single lesions in the upper limb the former did not predominate to the extent that might be anticipated. 4 Gunshot lesions of the brachial plexus and those due to other causes occurred in about equal proportions, but whereas the former were three times as numerous on the right, the latter occurred twice as frequently on the left. 5 Gunshot lesions of the sciatic nerve were approximately nine times as numerous as those due to other causes, where, incidentally, the incidence was very low. 6 The percentage incidence of concomitant bone injury in the various lesions was as follows: radial, 52; median, 25; ulnar, 38; and sciatic, 37. 7 Lesions due to gunshot wounds: (a) Ulnar nerve lesions predominated. This nerve was more frequently the common factor in combined lesions than either the radial or median nerve. (b) Lesions of the radial, median and sciatic nerves occurred in about equal proportions. (c) The incidence was approximately the same on the two sides for the radial and median nerves, but was greater on the left for the ulnar, posterior interosseous and sciatic, and on the right for the brachial plexus. (d) Gunshot lesions, when totalled, occurred with equal frequency on the two sides in the upper limb, but in the leg they were twice as numerous on the left. (e) The number of radial nerve lesions, single and combined, associated with a fracture greatly exceeded that in which there was no bone injury, while the reverse obtained in the case of the median, ulnar and sciatic nerves. 8 Lesions due to other causes: (a) Lesions of the ulnar nerve were double those of the median or radial nerves, which were involved in about equal proportions. (b) In combined lesions the radial, median and ulnar nerves were involved in approximately equal proportions. (c) Lesions occurred more frequently on the right in the case of the radial, median and ulnar nerves and on the left in plexus lesions.

Gunshot Wounds and Lesions Produced by Shell and Shrapnel in the Jaws and Face

Gunshot Wounds and Lesions Produced by Shell and Shrapnel in the Jaws and Face