Injection Injury Research Articles

Forensic Examination of Six Homicide Injection Cases.

To retrospectively analyze homicide cases of death after injection and provide reference for forensic identification. Six homicide cases of death after injection which were investigated by the Criminal Investigation Team of Shanghai Public Security Bureau were collected and analyzed, including case situation, scene investigation, autopsy and other materials. The 6 cases were premeditated crimes, 5 cases took place in private spaces, and 5 cases involved the victims approached by suspects' decoy. There were no obvious abnormalities at the scene of the 6 cases. In 6 cases, the victim's body surface injury was mild or no, lividity color was abnormal, and the needlestick injury showed different manifestations from conventional medical measures. Death after injection is a highly concealed crime and easy to be ignored. For the suspected injection injury found in autopsy, it is necessary to carefully examine, identify and analyze, be alert to the situation of injecting poison (drug) and do a good job in evidence fixation and material extraction.

MR features of high-pressure injection injuries caused by grease and paints

ObjectiveThis study investigates the magnetic resonance (MR) features of high-pressure injection injuries (HPII) caused by grease and paints to detect the presence of foreign material and associated complications. MethodsSixteen rat models with HPII were established by injecting industrial grease and marine paints (n = 8 each) into their thighs. All the rats underwent a 3.0 T MR scanning, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), Fat-suppressed T2-weighted imaging (FST2WI), Susceptibility-weighted imaging (SWI), and Diffusion-weighted imaging (DWI). Follow-up MR scanning was performed from 1st to 4th weeks. ResultsAcute subcutaneous grease and paints appeared as different signal intensity characteristics (grease: T1WI ↑, T2WI =, FST2WI ↓, SWI ↓, DWI ↓; paints: T1WI ↑, T2WI ↑, FST2WI ↑↓, SWI ↓, DWI ↓). As time progressed, the signal intensity of HPII lesions caused by both grease and paints became inhomogeneous. Impurity components of the foreign material appeared as marked low signal intensity on SWI. The signal intensity on DWI significantly increased subsequently due to purulent fluids (confirmed surgically). ConclusionsHPII caused by grease and paints have a characteristic appearance on MR imaging. SWI can detect impurity components of the foreign material, while DWI is highly sensitive to abscesses and helpful in monitoring infections.

Warburg Effect in Anopheles Mosquito Anti‐Bacterial Immunity

Otto Warburg discovered cancer cells favor increased glycolysis with pyruvate being converted to lactate rather than acetyl‐CoA for the tricarboxylic acid cycle, and this is termed the Warburg effect. Warburg metabolism has been found to occur in mammalian rapidly proliferating cancer and immune cells. Anopheles species mosquitoes, the vectors for malaria, rely on their metabolic system to provide energy and intermediates for their innate immune system, so called immunometabolism. We posited Warburg metabolism is involved in Anopheles sp. mosquito’s immune response. We designed an anti‐bacterial immunity model using intrathoracic inoculations of Escherichia coli K12, avirulent bacterium, and Enterobacter sp. Ag1, virulent bacterium isolated from the Anopheles sp. midgut, to test the immunometabolism response. We found a statistically significant doubling in lactic acid upon Ent sp. immune challenge as compared to injection injury controls using a lactate assay (t‐test, p = 0.0016). This provides evidence to support increased Warburg metabolism in immune challenged mosquitoes. We then fed Anopheles sp. mosquitoes dimethyl fumarate (DMF), a GAPDH inhibitor, and challenged the mosquitoes with E. coli. We found a significant mortality was observed in DMF treated mosquitoes compared to control (Mantel‐Cox, p < 0.001). By inhibiting the utilization of glycolysis and Warburg metabolism, decreased survival related to immune challenge is observed, showing Warburg metabolism is crucial for mosquito immunity. We believe current cancer therapeutics targeting Warburg metabolism can be an effective vector control strategy to prevent mosquito‐borne diseases.

A Case Report of the Rapid Evaluation of a High-Pressure Injection Injury of a Finger Leading to Positive Outcomes

A Case Report of the Rapid Evaluation of a High-Pressure Injection Injury of a Finger Leading to Positive Outcomes

A Case Report of the Rapid Evaluation of a High-Pressure Injection Injury of a Finger Leading to Positive Outcomes.

Finger injury, hand injury, high-pressure injection injury.

Восстановительное хирургическое лечение тяжелой инъекционной травмы кисти высоким давлением

Introduction High-pressure injection injuries to the hand result from injection of substances by high-pressure industrial devices. These are rare lesions with high risk of substantial long-term morbidity. Tissue defects resulting from staged debridement require skin grafting or vascularized island flap coverage. Hand therapy is an important part of the complex rehabilitation of such patients. The objective is to present complex surgical reconstruction of severe high-pressure injection injury of the hand aimed at preserving limb function. Material and methods Methods and results of surgical reconstruction of a patient with severe high-pressure injection injury of the hand treated at the Research Institute – S.V. Ochapovsky Regional Clinic Hospital No.1 in 2018–2019. Results Short-term result of surgical treatment demonstrated complete skin restoration and maximum possible preservation of underlying deep anatomical structures of the hand. Subsequent surgical interventions were aimed at restoring the hand function. Conclusion The restorative treatment of a high-pressure injection injury of the hand includes the earliest possible primary surgical treatment of the wound with wide revision, maximum removal of the injected substance and non-viable tissues and prevention of secondary injuries and infection in the wound. Nonfree vascularized flaps, full-thickness free grafts or split-skin autografts are used for skin reconstruction. Restoration of other functionally significant structures can be considered at a long term with wounds healed and autografts completely implanted. Hand therapy is integral to the comprehensive functional rehabilitation of the high-pressure injection injuries to the hand.

Optimal Irrigant in High Pressure Paint Injection Injuries of the Hand.

Background:High pressure injection injury to the hand with paint leads to amputation rates near 48%. Historically, authors utilized saline irrigation alone, but have high reoperation rates. We conducted a cadaveric study to determine the ideal detergent for effective paint removal from the soft tissue.Methods:Two cadaveric hands were amputated from the same cadaver. The left and right hand digits were injected with flat white latex-based paint and flat white oil-based paint, respectively. Each digit received a longitudinal incision and was scrubbed for 120 seconds with 50 mL of a randomly assigned detergent and no detergent (saline) as the control. After achieving a lather, each finger was cleansed with 50 mL saline before being evaluated by two blinded hand surgery faculty. Reviewers assessed the washouts as adequate or inadequate, in order to generate a Kappa statistic and measure inter-rater reliability prior to ranking each digit (1 through 5) (ie, 1 = most paint-free soft tissue).Results:The two hand faculty had an inter-rater reliability of 0.70. Both reviewers ranked povidone-iodine 10% or Johnson & Johnson shampoo as the best irrigant for latex-based paint. In oil-based paint, povidone-iodine 10%, Johnson & Johnson, & Techni-care were ranked as top three. All reviewers reported detergents were better than saline alone.Conclusions:The addition of detergent created an irrigant that removed both latex- and oil-based paint better than normal saline alone. Based on these results, surgeons treating high-pressure injection injury should consider using Povidone-Iodine 10% or Johnson & Johnson baby shampoo for latex- or oil-based paint.

Particular Type of High-pressure Injection Injuries: Oil-based Paint Guns, a retrospective, single center experience

Particular Type of High-pressure Injection Injuries: Oil-based Paint Guns, a retrospective, single center experience

High-Pressure Injection Injury of the Hand: Case Report with Negative Pressure Wound Therapy

High-Pressure Injection Injury of the Hand: Case Report with Negative Pressure Wound Therapy

All aspects of sciatic nerve injection injury: an experiment with 78 rats.

In this study, we evaluate sciatic nerve injuries due to intramuscular injections, which is an important medicolegal problem frequently encountered in medical practice, with an extended experimental rat model of peripheral nerve injury. A total of 78 male Wistar albino rats were divided into five main groups, including a control group, a sham saline group, and groups that received benzathine penicillin G, diclofenac sodium, and dexamethasone, respectively. These pharmaceutical agents were applied to the sciatic nerves of all rats after exploration in the epineurial, endoneurial, and intrafascicular compartments, excluding the control group. Outcomes were evaluated for all rats and their sciatic nerves according to functional, electrophysiological, and histopathological results. Injuries were most evident in the groups that received penicillin G and diclofenac sodium, and this finding was statistically significant. It was also found that endoneurial and intrafascicular injections may cause more harm than epineurial injections. We have demonstrated that any medical injections applied to the epineurial, endoneurial, or intrafascicular compartments of the sciatic nerve may cause functional and electrophysiological loss with or without deterioration of the peripheral nerve architecture.

Optimal Irrigant in High Pressure Paint Injection Injuries of the Hand

INTRODUCTION: High-pressure injection injury (HPII) to the hand with paint leads to amputation rates near 48%. Historically, authors utilized saline irrigation alone, but have high re-operation rates. We conducted a cadaveric study to determine the ideal detergent for effective paint removal from the soft tissue. METHODS: Two cadaveric hands were amputated from the same cadaver. The left and right hand digits were injected with flat white latex-based paint and flat white oil-based paint, respectively. Each digit received a longitudinal incision and was scrubbed for 120 seconds with 50 mL of a randomly assigned detergent and no detergent (saline) as the control. After achieving a lather, each finger was cleansed with 50 mL saline before being evaluated by two blinded hand surgery faculty. Reviewers assessed the washouts as adequate or inadequate, in order to generate a Kappa statistic and measure inter-rater reliability prior to ranking each digit (1–5) (ie, 1 = most paint-free soft tissue). RESULTS: The two hand faculty had an inter-rater reliability of 0.70. Both reviewers ranked Povidone-Iodine 10% or Johnson & Johnson baby shampoo as the best irrigant for latex-based paint. In oil-based paint, Povidone-Iodine 10%, Johnson & Johnson, and Techni-care were ranked as top three. All reviewers reported detergents better than saline alone. CONCLUSIONS: The addition of detergent created an irrigant that removed both latex and oil-based paint better than normal saline alone. Based on these results, surgeons treating HPII should consider using Povidone-Iodine 10% or Johnson & Johnson baby shampoo for latex or oil-based paint.

High-Pressure Injection Injuries of the Hand: A 10-Year Retrospective Analysis at a Single Academic Center.

The incidence of high-pressure injection injuries of the hand is low. Although the occurrence is rare, the precarious progression of the injury exacts prompt surgical evaluation in order to avoid complications and amputation. The current study was devised in order to make comparisons to the current data, in addition to supplementing the literature with observations regarding clinical course and management. A multisurgeon, retrospective chart review from a single institution was performed. Inclusion criteria included cases involving a high-pressure injection injury to the hand that underwent surgical management. Patient demographics, injury details, and hospital course were all reviewed and recorded. This retrospective review identified 20 cases meeting criteria, all of which involved males. The average age at time of injury was 39.7 years (range, 21-71 years). The incidence of injection injuries over a 10-year time period was 2.1 cases per year. The nondominant hand was injured in 11 cases (63%). The most common site of injury was the index finger with 11 recorded incidents (55%). Other reported locations included the metacarpal (40%) and small finger (5%). Occupational data included 10 construction workers, 5 painters, and 2 cleaning crew members, and 3 had nonmanual occupations. Paint was the most commonly injected substance with 17 reported cases (85%). On average, the delay until surgery was observed to be 21.9 hours (n = 16). Only 1 patient underwent surgery at 6 hours after surgery. The average number of procedures performed was 1.8 (range, 1-4). Hospitalization duration was on average 3.9 days (range, 1-9 days), and the average follow-up length was 69 days (range, 7-112 days). There were no identified cases that necessitated amputation. This form of injury most commonly affects male, middle-aged laborers. Our study found very low amputation rates when compared with the current literature, despite observing longer delays to surgery according to current recommendations. Limited comparisons can be made from data regarding clinical course and management because of the small sample size of the current study and the limited published data. This indicates a need for further exploration and collection of data involving parameters such as clinical course and management.

Optimal Ratio of Wnt3a Expression in Human Mesenchymal Stem Cells Promotes Axonal Regeneration in Spinal Cord Injured Rat Model.

ObjectiveThrough our previous clinical trials, the demonstrated therapeutic effects of MSC in chronic spinal cord injury (SCI) were found to be not sufficient. Therefore, the need to develop stem cell agent with enhanced efficacy is increased. We transplanted enhanced Wnt3a-secreting human mesenchymal stem cells (hMSC) into injured spines at 6 weeks after SCI to improve axonal regeneration in a rat model of chronic SCI. We hypothesized that enhanced Wnt3a protein expression could augment neuro-regeneration after SCI. MethodsThirty-six Sprague-Dawley rats were injured using an Infinite Horizon (IH) impactor at the T9–10 vertebrae and separated into five groups : 1) phosphate-buffered saline injection (injury only group, n=7); 2) hMSC transplantation (MSC, n=7); 3) hMSC transfected with pLenti vector (without Wnt3a gene) transplantation (pLenti-MSC, n=7); 4) hMSC transfected with Wnt3a gene transplantation (Wnt3a-MSC, n=7); and 5) hMSC transfected with enhanced Wnt3a gene (1.7 fold Wnt3a mRNA expression) transplantation (1.7 Wnt3a-MSC, n=8). Six weeks after SCI, each 5×105 cells/15 µL at 2 points were injected using stereotactic and microsyringe pump. To evaluate functional recovery from SCI, rats underwent Basso-Beattie-Bresnahan (BBB) locomotor test on the first, second, and third days post-injury and then weekly for 14 weeks. Axonal regeneration was assessed using growth-associated protein 43 (GAP43), microtubule-associated protein 2 (MAP2), and neurofilament (NF) immunostaining. ResultsFourteen weeks after injury (8 weeks after transplantation), BBB score of the 1.7 Wnt3a-MSC group (15.0±0.28) was significantly higher than that of the injury only (10.0±0.48), MSC (12.57±0.48), pLenti-MSC (12.42±0.48), and Wnt3a-MSC (13.71±0.61) groups (p<0.05). Immunostaining revealed increased expression of axonal regeneration markers GAP43, MAP2, and NF in the Wnt3a-MSC and 1.7 Wnt3a-MSC groups. ConclusionOur results showed that enhanced gene expression of Wnt3a in hMSC can potentiate axonal regeneration and improve functional recovery in a rat model of chronic SCI.

Accidental digital epinephrine injection injury: a case of conservative management

The open access to epinephrine autoinjectors has resulted in an increased number of reports related to accidental injection into the digits. The appropriate management after accidental injection remains controversial. This study presents the first case in Saudi Arabia of a young man who accidentally injected epinephrine into the thumb and a literature review of the treatment options available. A 19-year-old man presented with accidental injection of 300 mcg of epinephrine into the volar pulp of his right thumb while treating an allergic reaction. The embedded needle was removed by countertraction and irrigation. The examination results were normal. The patient was discharged with prophylactic antibiotic and analgesia. Later, the puncture wound healed and vascularity and sensation remained intact. Conservative management and observation are advantageous in certain cases if vascular function is uncompromised. This case highlights the importance of education about the correct handling and administration of the epinephrine injection.

Long-term effectiveness of eye movement desensitization and reprocessing in children and adolescents with medically related subthreshold post-traumatic stress disorder: a randomized controlled trial

Medical procedures and hospitalizations can be experienced as traumatic and can lead to post-traumatic stress reactions. Eye movement desensitization and reprocessing (EMDR) shows promising results but very few long-term studies have been published. Therefore, our aim was to test the long-term (8 months post-treatment) effectiveness of EMDR in children and adolescents with medically related subthreshold post-traumatic stress disorder (PTSD). Seventy-four children (including 39 with congenital or acquired heart disease) aged 4-15 (M = 9.6 years) with subthreshold PTSD after previous hospitalization were included into a parallel group randomized controlled trial. Participants were randomized to EMDR (n = 37) or care-as-usual (CAU) (n = 37; medical care only). The primary outcome was PTSD symptoms of the child. Secondary outcomes were symptoms of depression and blood-injection-injury (BII) phobia, sleep problems, and health-related quality of life (HrQoL) of the child. Assessments of all outcomes were planned at baseline and 8 weeks and 8 months after the start of EMDR/CAU. We hypothesized that the EMDR group would show significantly more improvements on all outcomes over time. Both groups showed improvements over time on child's symptoms of PTSD (only parent report), depression, BII phobia, sleep problems, and most HrQoL subscales. GEE analyses showed no significant differences between the EMDR group (nT2 = 33, nT3 = 30) and the CAU group (nT2 = 35, nT3 = 32) on the primary outcome. One superior effect of EMDR over time was found for reducing parent-reported BII phobia of the child. EMDR did not perform better than CAU in reducing subthreshold PTSD up to 8 months post-treatment in previously hospitalized children. Possible explanations and clinical implications are discussed.

Upper extremity high-pressure injection injuries with paint thinner: Case reports with review of the literature

<br><b>Introduction:</b> High-pressure injection injuries are rare traumas of upper extremity which can result in high morbidity incompatible with presentation. Clinical presentation right after the injury can be misleading and might cause underrating of the condition. This may lead to latencies in treatment and might worsen the final prognosis of the patients. Prognosis changes according to the material injected, pressure the material is injected, injection site, and time between the injury and the onset of treatment. Digit amputation rates are between 16% and 48% in literature series, and this seems to decrease with early debridement. <b>Materials and Methods:</b> Emergency department referrals are searched retrospectively for patients with high-pressure injection injuries. Four patients were found that were treated for injured with high-pressure injection gun with paint thinner or mixtures. Relevant literature was searched and discussed. <b>Results:</b> Three out of four patients needed amputations (75%). Two patients needed flap surgery for reconstruction: one interpolation and one free flap. The average time from hospitalization to definitive operation was 9.5 days (minimum 6, maximum 15 days). Fingertip injuries resulted in amputations, and amputation level was more proximal than the injury level which was connected to the dissemination of the injected material. <b>Discussion:</b> High-pressure injection injuries can cause devastating results if neglected, and can be overlooked with inexperienced eyes. Usually, there are minimal complaints from the patients on the onset of the injury, but symptoms exacerbate by time. Early debridement in the first 6 h is crucial for lowering amputation rates. Injected material has a great impact on the outcomes, and organic solvents such as paint thinner, paints, diesel, and engine oil have worse outcomes and higher amputation rates. <b>Conclusion:</b> High-pressure injection injuries need emergency surgical intervention and should not be neglected. Delay in treatment of these cases could cause detrimental outcomes.<br>

Reconstructive surgical treatment of high-pressure injection injury of the hand

Reconstructive surgical treatment of high-pressure injection injury of the hand

遊離皮弁で救指しえた高圧注入損傷の 1 例

遊離皮弁で救指しえた高圧注入損傷の 1 例

Real-Time Injection Pressure Sensing and Minimal Intensity Stimulation Combination During Ultrasound-Guided Peripheral Nerve Blocks: An Exploratory Observational Trial.

Nerve damage can occur after peripheral nerve block (PNB). Ultrasound guidance does not eliminate the risk of intraneural injection or nerve injury. Combining nerve stimulation and injection pressure (IP) monitoring with ultrasound guidance has been suggested to optimize needle tip location in PNB. In this prospective observational study, we hypothesized that measured pairs of IP and minimum intensity of stimulation (MIS) might differentiate successive needle tip locations established by high-resolution ultrasound during PNB. For this exploratory study, 240 observations for 40 ultrasound-guided PNBs were studied in 28 patients scheduled for orthopedic surgery. During the progression of the needle to the nerve observed by ultrasonography, the IP was measured continuously using a computerized pressure-sensing device with a low flow rate of solution. Stimulation thresholds and electrical impedance were obtained by an impedance analyzer coupled to the nerve stimulator at 6 successive needle positions. The median (quartile) or mean (95% confidence interval [CI]) was reported. A mixed model analysis was used, and the sample was also explored using a classification and regression tree (CART) algorithm. Specific combinations of IP and MIS were measured for subcutaneous, epimysium contact, intramuscular, nerve contact (231 mm Hg [203-259 mm Hg] and 1.70 mA [1.38-2.02 mA]), intraneural location (188 mm Hg [152-224 mm Hg] and 0.58 mA [0.46-0.70 mA]), and subparaneural location (47 mm Hg [41-53 mm Hg] and 1.35 mA [1.09-1.61 mA]). The CART algorithm shows that the optimal subparaneural needle tip position might be defined by the lowest pressure (<81.3 mm Hg) and MIS (<1.5 mA) cutoffs. Our exploratory study evaluated concepts to generate hypotheses. The combinations of IP and MIS might help the physician during a PNB procedure. A low IP and low MIS might confirm a subparaneural location, and a high IP and a low MIS might be an alert for the intraneural location of the needle tip.

Study of the dynamics of catalase activity in heart and muscle of rats by mechanical action on the barrier gematologichesky

The hematoophthalmic barrier is one of the mechanisms of resistance that serves to protect the body and prevents homeostasis disorder when the body is affected by factors that can disturb this balance. One of the complications of mechanical trauma of the eye and violation of the hematoophthalmic barrier is the appearance of oxidative stress on the background of the general inflammatory process in violation of cellular structures. Objective: to study the dynamics of catalase activity in the heart and muscle tissue of rats under oxidative stress caused by mechanical action on the hematoophthalmic barrier. Materials and methods. The study was carried out on white neonatal mature healthy male rats of six months of age, weighing 200–220 g and having 150 pieces. The activity of catalase in heart and muscle tissue was studied before the beginning of the experiment, as well as on the 1st, 3rd, 5th, 7th and 14th day of the experiment using the standard Korolyuk M.A. method. The dynamics of catalase activity was evaluated by different methods of treatment of mechanical eye trauma, including the use of quercetin antioxidant. The results of the study. It was found that in addition to the standard therapy of mechanical eye injury injection of quercetin, the activity of catalase in the heart and muscular tissue after falling on the background of induced oxidative stress increases to the values of physiological norm by 14 days, which indicates the effective elimination of oxidative stress. Conclusions. The activity of catalase in rat heart and muscle tissue under oxidative stress caused by mechanical influence on hematoophthalmic barrier is most effectively stabilized under standard therapy of mechanical eye injury with addition of quercetin in the form of injections.