Penetrating Stab Wounds Research Articles

Endovascular Treatment of Lower Limb Penetrating Arterial Traumas

The purpose of this study was to evaluate the effectiveness of percutaneous arterial embolization in patients with penetrating peripheral arterial trauma. Twelve patients with penetrating peripheral arterial trauma were treated with percutaneous arterial embolization between 2002 and 2007. All injuries were secondary to penetrating stab wounds. Active bleeding (eight patients), recurrent bleeding episodes (one patient), persistent pain and mass (one patient), leg edema, claudication, swelling (one patient), local hyperemia, and pain (one patient) were the presenting symptoms. Microcatheter systems were used for catheterization. We used n-butyl cyanoacrylate mixture as the embolizing agent in all patients. On angiograms the inferior gluteal artery (one patient), internal pudendal artery (one patient), perforating branch of the profundal femoral artery (six patients), superficial femoral artery (one patient), peroneal artery (two patients), and anterior tibial artery (one patient) were found to be injured. In all patients, the source of arterial bleeding could be reached, and a safe embolization was achieved. Nontarget embolization due to backflow of n-butyl cyanoacrylate mixture was detected in two patients and inguinal hematoma at the puncture site occurred in one patient. We conclude that embolization-particularly n-butyl cyanoacrylate embolization-is technically feasible in patients with penetrating peripheral arterial trauma.

Decision making in head injury management in the Edwin Smith Papyrus

✓The Edwin Smith Papyrus (circa 1650–1550 BC) is a didactic trauma treatise of major interest to neurosurgery, as it deals primarily with cranial and spine injuries. Information regarding the patient's condition is conveyed in the papyrus with sufficient clarity to allow a clinical assessment of each injury. The ancient Egyptian physician/teacher lists the key diagnostic elements in each case, and then pronounces his opinion of the treatment potential in one of three verdicts: 1) “a medical condition I can treat;” 2) “a medical condition I can contend with;” or 3) “a medical condition you will not be able to treat.” The structural organization of the text according to regional injuries of increasing severity permits analysis of sequential cases, and makes it possible to determine which clinical features led the ancient Egyptian physician to give the first or second verdict in the less severe injuries, but the third in the worst cases. Interestingly, the ancient physicians were not deterred from contending with injuries in the presence of basilar skull fractures, traumatic meningismus, skull perforation without overt neurological deficit, drowsiness, limited facial fractures, or closed head injuries without depressed fragments. Factors identified as determinant for the third verdict in head injuries are depressed skull fragments, dura laceration with exposed brain, infected cranial wounds/tetanus, major craniofacial fractures, deep skull–penetrating stab wounds, and aphasia. This study describes three case sequences of head injuries.

Virtopsy: Fatal stab wounds to the skull – The relevance of ante-mortem and post-mortem radiological data in case reconstructions

Homicides with a survival of several days are not uncommon in forensic routine work. Reconstructions of these cases by autopsy alone are very difficult and may occasionally lead to unsatisfying results. For the medico-legal reconstruction of these cases, ante-mortem and post-mortem radiological imaging should always be included in the expertise. We report on a case of fatal penetrating stab wounds to the skull in which a case reconstruction was only possible by combining the radiological ante- and post-mortem data with the autopsy findings.

Seudoaneuisma postraumático de la arteria cerebral posterior

We present the case of a traumatic posterior cerebral artery pseudoaneurysm of a 29-year-old man due to a penetrating stab wound to the brain. The patient was brought to the emergency room in coma. The neurological examination revealed a Glasgow Coma Scale Score of 8 and left hemiplegy. The initial CT scan showed right temporal lobe haemorrhage with penetration in the lateral ventricle and subarachnoid haemorrhage. The cerebral angiography performed after three weeks, revealed a high PCA pseudoaneurysm. After surgery, a pseudoaneurysm was demonstrated in the histological study.

THE COMPARISON OF THE EFFICACY AND SAFETY OF TUBE THORACOSTOMY INSERTION VIA 2ND AND 5TH INTERCOSTAL SPACES FOR THE TREATMENT OF STAB WOUND PNEUMOTHORAX

PURPOSE: Pneumothorax is a common complication of chest trauma that can progress rapidly to the life-threatening tension pneumothorax. Treatment of pneumothorax is tube thoracostomy insertion via 2nd or 5th intercostals spaces. We design this study to compare these two spaces for duration of hospitalization and rate of complication in Penetrating stab wound pneumothorax.

Astrogliosis is delayed in type 1 interleukin-1 receptor-null mice following a penetrating brain injury

The cytokines IL-1α and IL-1β are induced rapidly after insults to the CNS, and their subsequent signaling through the type 1 IL-1 receptor (IL-1R1) has been regarded as essential for a normal astroglial and microglial/macrophage response. To determine whether abrogating signaling through the IL-1R1 will alter the cardinal astrocytic responses to injury, we analyzed molecules characteristic of activated astrocytes in response to a penetrating stab wound in wild type mice and mice with a targeted deletion of IL-1R1. Here we show that after a stab wound injury, glial fibrillary acidic protein (GFAP) induction on a per cell basis is delayed in the IL-1R1-null mice compared to wild type counterparts. However, the induction of chondroitin sulfate proteoglycans, tenascin, S-100B as well as glutamate transporter proteins, GLAST and GLT-1, and glutamine synthetase are independent of IL-1RI signaling. Cumulatively, our studies on gliosis in the IL-1R1-null mice indicate that abrogating IL-1R1 signaling delays some responses of astroglial activation; however, many of the important neuroprotective adaptations of astrocytes to brain trauma are preserved. These data recommend the continued development of therapeutics to abrogate IL-1R1 signaling to treat traumatic brain injuries. However, astroglial scar related proteins were induced irrespective of blocking IL-1R1 signaling and thus, other therapeutic strategies will be required to inhibit glial scarring.

Acute Traumatic Renal Artery to Inferior Vena Cava Fistula Treated with a Covered Stent

A 34-year-old man presented within hours of suffering a penetrating stab wound and was diagnosed with a right renal artery to inferior vena cava fistula. Initial attempts at excluding the fistula with a balloon were unsuccessful. He was subsequently treated with a covered stent inserted into the right renal artery which successfully excluded the fistula.

Unnecessary laparotomy by using physical examination and different diagnostic modalities for penetrating abdominal stab wounds

Background: The modern management of penetrating abdominal trauma has decreased the incidence of unnecessary laparotomy by using selective non-operative management protocols. However, the real benefits of physical examination and different...

A polymeric membrane dressing with antinociceptive properties: analysis with a rodent model of stab wound secondary hyperalgesia

The putative antinociceptive properties of a commercially available polymeric membrane dressing were tested by using a hind limb penetrating stab wound model in which secondary hyperalgesia could be evaluated from the hind paw. We examined the responses to mechanical and thermal stimuli applied to the hind paw remote to 2 small penetrating stab wounds of the calf. Application of the polymeric membrane dressing, but not gauze dressing, significantly reduced the development of both mechanical and thermal hyperalgesia induced by the penetrating stab wounds. In addition, animals with stab wounds showed a significant decrease in cage activity, and this decrease was prevented by application of the polymeric dressing. Analysis of spinal cord Fos expression demonstrated that the polymeric membrane, but not gauze, dressing significantly decreased stab wound–induced Fos expression in laminae I to VI of the ipsilateral L3-L5 cord segments. In addition, application of the polymeric membrane, but not gauze, dressing to the hind limb of naïve animals elicited Fos expression in laminae III and IV of the lumbar spinal cord. The data indicate that this model might be useful for evaluation of the mechanisms underlying deep tissue injury–induced secondary hyperalgesia, but they also demonstrate that the polymeric membrane dressing tested is capable of significantly reducing secondary hyperalgesia. Perspective Surgery and other types of penetrating wounds cause pain that is not always relieved by opioids and/or less potent analgesics. The present results suggest that the polymeric membrane dressing tested here may be used alone or in conjunction with analgesics to relieve pain caused by penetrating tissue injury.

Primary Repair of Penetrating Stab Wounds of the Colon; is it Safe ?

Primary Repair of Penetrating Stab Wounds of the Colon; is it Safe ?

Evaluation of Selective Non-Operative Approach to the Penetrating Stab Wounds of the Abdomen: A Retrospective Study

Evaluation of Selective Non-Operative Approach to the Penetrating Stab Wounds of the Abdomen: A Retrospective Study

The pathophysiology and management of bowel and mesenteric injuries due to blunt trauma

Historical accounts of small bowel injuries from blunt abdominal trauma are numerous and date from as early as Aristotle in 350 b.c. [1,2]. The majority of reports of gastrointestinal tract injuries (GITIs) relate experiences dominated by penetrating trauma. Injuries to the gastrointestinal tract resulting from penetrating trauma are common, with 80% of gunshot wounds to the abdomen and 30% of fully penetrating stab wounds causing significant injury to the GIT [3–5]. GITIs are much less common following blunt trauma. There are few reports in the literature which describe reports of the management and outcome from these injuries [6–14]. Nevertheless, the GIT is the third most commonly injured abdominal organ in blunt trauma [6,15–17] with major GITIs found in 5–17% of laparotomies for blunt trauma [7,9,16,18–24] and 0.35–2% of blunt trauma admissions having a major GITI [9,15,23,25,26]. The incidence of GITIs rose steeply with the introduction of high speed travel after World War II [16,27] and was then documented to increase further with the introduction of seat belts [15]. The mechanism involved with seat belts is believed to be the creation of closed loops of bowel as a result of compression and subsequent rupture from increased intraluminal pressure [7,15,16]. Blunt GITIs are undoubtedly injuries of young males [6,8,10,12,19,20,22,25,8–31]. The incidence of major blunt GITIs amongst paediatric admissions for blunt abdominal trauma has been reported to be greater than for adults [32–34]. Motor vehicle occupants account for rates of 70–85% of patients with major GITIs [6,10,12,19,30,34,35]. In such cases, the rapid deceleration results in multiple serious injuries. The reported incidence of non-vehicular blunt trauma as a cause of GITI is 5–32% [6,9,10,19,36]. Non-vehicular trauma includes assaults, falls, industrial accidents, blasts,

Expression of pituitary adenylate cyclase-activating polypeptide (PACAP) and the PACAP-selective receptor in cultured rat astrocytes, human brain tumors, and in response to acute intracranial injury.

Pituitary adenylate cyclase-activating polypeptide (PACAP) is a bioactive peptide with diverse activities in the nervous system. In addition to its more classic role as a neurotransmitter, PACAP functions as a neurotrophic factor. PACAP exerts these activities by binding to PACAP-selective (PAC1) or nonselective (VPAC1, VPAC2) receptors (-R). Glial cells also exhibit PACAP binding, which is associated with the increased proliferation of astrocytes. The present report demonstrates a distinct spatiotemporal regulation of PACAP, PAC1-R, VPAC1-R, and VPAC2-R expression in primary cultured rat astrocytes. To determine the role of PACAP and PAC1-R expression on glial proliferation, two in vivo models were examined--human brain tumors of glial origin and the reactive gliosis induced by a penetrating stab wound to the mature rat brain. Relative to normal human brain, PAC1-R expression is significantly upregulated in glioma, particularly oligodendrogliomas. While similar polymerase chain reaction (PCR) analysis does not detect PACAP expression, in situ hybridization studies reveal PACAP expression in a limited number of cells within the tumor. In sharp contrast, neither PACAP nor PAC1-R expression are upregulated consequent to injury. These results suggest a distinct role for PACAP and PAC1-R in glioma development and nervous system response to injury.

口底貫通よく創の１例

口底貫通よく創の１例

Expression of stem cell factor and c-kit receptor in neural cells after brain injury.

Previously it has been shown that c-kit receptor (c-kitR) and its ligand, stem cell factor (SCF), are expressed in the central nervous system. We have reported that SCF in cultures regulates mouse microglial function. Here we demonstrate that SCF/c-kitR signaling also takes place in situ. We used a penetrating stab wound injury as a model and analyzed the SCF and c-kitR expression in neural cells by immunohistochemistry and in situ hybridization. We found that microglia activated by injury up-regulated c-kitR expression, whereas some astrocytes in the vicinity of the wound expressed SCF mRNA in addition to neurons. This observation suggests that SCF/c-kitR signaling between neurons, astrocytes and microglia also occurs in situ.

The treatment of stabbed chests at Ngwelezana hospital, KwaZulu - Natal

A study was undertaken at Ngwelezana hospital to determine the requirements for a cost effective physiotherapy service for patients with stabbed chests. Forty male patients between the ages of 16 and 60 who had sustained unilateral penetrating stab wounds to the chest which required intercostal drainage were randomised into one of two groups on admission to Ngwelezana hospital.The patients in group I received physiotherapy immediately after insertion of the intercostal drain, while the patients in group 2 received physiotherapy 12 to 24 hours after insertion of the drain. Mean duration of intercostal drainage in group I was 2.35 days while that of group 2 was 7.55 days. This represented a significantly shorter drainage time for the patients who had been treated immediately after insertion of the drain. Patients were discharged from hospital on the day that the intercostal drain was removed. No complications were experienced by the patients in group 1 while four patients in group 2 developed an empyema.The cost of the patients in group 2 exceeded the costs of those in group 1 by R78 728.00. It is thus imperative that patients admitted with stabbed chests should have physiotherapy immediately after insertion of the intercostal drain.

Delayed, traumatic intercosto-diaphragmatic hernia of colon

Stab wounds of the lower chest and upper abdomen can cause potentially lethal injuries depending upon the site and degree of penetration. Clinical examination and the chest X-ray can be deceptively normal in these cases’,“. Local wound exploration and peritoneal lavage have their limitations’,3. Isolated diaphragmatic injuries due to stab wounds of the left lower chest can remain asymptomatic and present as gastrointestinal obstruction4. To prevent complications, routine laparotomy in all penetrating wounds of the lower chest and upper abdomen has been recommended’,2. We report a case of a penetrating stab wound of the left lower chest which presented 20 years later with intercostodiaphragmatic hemiation of the splenit flexure of the colon. To the best of our knowledge, this report is the first of its kind.

The optimal physiotherapeutic approach to penetrating stab wounds of the chest.

Penetrating injuries to the chest are among the most common injuries seen in the casualty department at Hillbrow Hospital, Johannesburg.Opinions regarding the surgical handling of patients with penetrating chest trauma continue to differ. The purpose of this study was to determine whether there would be a difference in outcome in patients who receive chest physiotherapy immediately after insertion of the intercostal drain versus those patients who receive chest physiotherapy nine to twelve hours later.In an effort to optimise the physiotherapy management of patients with penetrating stab wounds to the chest, a comparative study was conducted at Hillbrow Hospital, Johannesburg. Twenty-six male patients between the ages of eighteen to thirty years were randomly allocated to one of two groups on admission to the Hospital.The patients in Group I received chest physiotherapy immediately after insertion of the intercostal drain while patients in Group II received chest physiotherapy nine to twelve hours later. Mean duration of time of intercostal drainage in Group I was 40 hours and in Group II 65,92 hours. Patients in Group I had a mean hospital stay of 43,96 hours, while patients in Group II had a mean hospital stay of 77,53 hours. The prevalence of patients with spiking temperatures was also significantly lower in Group I than in Group II. This study suggests that the protocol of an aggressive approach of immediate chest physiotherapy in these patients has definite beneficial results.

Usefulness of transesophageal echocardiography in the early diagnosis of penetrating stab wounds to the heart

Cardiac injury by a penetrating instrument is not always limited to the free wall of the heart or the great arteries, but may also involve the interventricular and interatrial septae, as well as the cardiac valves, coronary arteries and conduction system. 1 Rapid and accurate diagnosis is essential in these patients, because mortality is high. 1 The use of color flow Doppler in conjunction with 2-dimensional echocardiographic imaging has greatly expanded our ability for noninvasive investigation of these patients. More recently, transesophageal echocardiography (TEE), with its higher resolution and definition of cardiac structures, has proved to be an excellent imaging modality. In the present study, we summarize our experience with penetrating cardiac injuries and emphasize the role of TEE in the early diagnosis of complex cases.

1. An Autopsy Case of Suicide by Hanging with Multiple Stab Wounds of the Neck and Chest

We report, from the aspect of 'acting' capability, an autopsy case of suicide by hanging in which multiple deep stab wounds were observed in the neck and chest. A 49-year-old man was found dead in a state typical of hanging. His car was found about 100m away with a blood-stained climber's knife on the seat. Multiple incised and stab wounds were in the neck, with a lesion of the right inner jugular vein. Three penetrating stab wounds of the chest punctured the lungs, with pooling of about 500ml of blood in the left thorax and about 100ml in the right. Two other shallow stab wounds were in the chest. All the above wounds were explainable as self-inflicted. From the autopsy findings and the circumstantial evidence, it was concluded that he walked approximately 100m after stabbing his neck and chest and finally committed suicide by hanging.