Shot Wounds Research Articles

OUTCOMES OF PENETRATING CARDIAC INJURIES – A CARDIAC SURGEON APPROACH TO 22 CASES

Aim: Cardiac traumas are of great danger as they have life threatening potential. Although the patient may have normal vital signs at the time of admission the rate of mortality rate has been reported up to 69%. We believe that conducting the initial evaluation and early intervention by a cardiac surgeon may have an impact on decreased mortality. Material and methods: This study has been conducted with 22 patients that have been admitted with cardiac trauma history. The subjects who were operated after applying to emergency service have been enrolled in this retrospective analysis. İndividuals died due to cardiac arrest at admission have been excluded from the study. The subjects with penetrating cardiac injury who have undergone sternotomy or thoracotomy has been included in the analysis. Results: At the time of admission 4 patients has been presented with shock and 2 patients had been administered resuscitation due to cardiac arrest. The gun shot wound cases were 27% (n=6) and of these cases 3 of them were alive while the remaining 3 died. The stab wound cases were 73% (n=16) withh a higher survival rate of 75% (n=4/16). Thoracotomy has been conducted less than sternotomy as the rate was 13.6% (n=3) versus 86.4% (n=19). The overall rate of mortality has been found as 32% (n=7). Conclusıon: According to the results of this study one can say that conducting initial intervention to cardiac trauma patients by a cardiac surgeon reduced the rate of mortality and morbidity.

TMJ Ankylosis Secondary to Gun Shot Injury: A Rare Case Report

The head and midface areas are very common site of gunshot injury.These gunshot wound generallyleads to major distortion and functional impairment, particularly when the temporomandibular joint (TMJ) is affected or when major anatomical structure such as the facial nerve is damaged.Secondary complications may include mandibular displacement atmaximummouth opening and in protrusion, limited lateral movement of the jaw, limited mouth openinganterior open bite, andrarely,temporoman dibularjoint(TMJ)ankylosis.The current report describes a case of unilateral TMJ ankylosis secondary to gunshot injury, which was treated by pre-auricular approach and interpositionalarthroplasty was done using temporalis fascia under general anesthesia. Post-operative follow up was done for one year and no evidence of re-ankylosis was noted.

Are Psychiatric History and Substance Use Predictors of Mortality in Self-Inflicted Gun Shot Wounds to the Face?

Are Psychiatric History and Substance Use Predictors of Mortality in Self-Inflicted Gun Shot Wounds to the Face?

Pediatric Air Gunshot Penetrating Head Injury with Good Outcome: A Case Report

Abstract: Ball bearing (BB) and pellet guns are non-power guns but their related injuries have been reported worldwide. They represent a significant cause of injury especially among children and teenagers. Their potentially harmful and lethal effects have been well documented in the medical literature since the early 1980s. Fatality rate is closely related to the damaged part of the brain and the level of the damage. In this Case Report we documented a 6-years-old girl was getting shot at the head by herself, who initially want to play around, using her neighbour’s Air gun rifle. The pellet trajectory passed through the left frontal lobe, left temporal lobe, left posterior putamen, posteriorly left crus posterior of internal capsule, left occipital horn of lateral ventricle, left occipital lobe, and ended at left cerebral falx between both medial surfaces of occipital lobes. Directional slope of the pellet was medially upward, with its tracking left Intracerebral Hemorrhage (ICH) with perifocal edema and Intraventricular Hemorrhage (IVH) dominant in the left lateral ventricle. After 8 days management, the patient was discharged from our hospital with stable condition, GCS 15 without any significant neurological deficits. Intracranial intracerebral pellet due to air gun shot injury, may have fatal and lethal manifestation if the pellet damage the eloquent area and/or deep area of the brain (hypothalamus, thalamus and brain stem). If accessible the foreign body or pellet should be removed immediately for better outcome. Keywords: Head Injury, Air Gun Shot, Intracerebral Haemorrhage

Pediatric tracheal injuries: Report on 5 cases with special view on the role of bronchoscopy and management

IntroductionThe purpose of these case reports is to draw the attention to the difficulties of diagnosing trachea injuries in children, who are often part of a polytrauma scenario. MaterialsA retrospective multicenter analysis of 5 cases were analysed. The age of the children was between 1 and 16 years old. Injury mechanism was blunt thoracic trauma, misintubation and shot injury. ResultsCase No.1. a three-year-old child suffered a train accident. Resuscitation and decompression of the tension pneumothorax were performed. CT found a pneumomediastinum and bubbles along the trachea. Thoracolaparotomy was performed. Bronchoscopy could not rule out a tracheal injury. The child died of a cerebral edema. Case No. 2: a 13 month drowned and was resuscitated. A chest drain was inserted to treat the pneumothorax. CT revealed a pneumomediastinum, which was drained and a small tear of the trachea. Bronchoscopy was not preformed. Case No. 3: 9 year-old polytrauma patient was airlifted with bilateral mini thoracostomies and chest drains for pneumothorax. CT revealed bilateral pneumothorax and pneumomediastinum. The chest drains were repositioned oxygenation improved, but some ventilation difficulties remained. CT revealed pneumomediastinum and a tracheal injury. This was bridged by a tube, and the mediastinum drained. The ventilation difficulties were resolved. Case No. 4: an eight-year-old boy was shot on the neck. The region was explored surgically and the laceration of the trachea was sutured. Case No. 5: 12-year-old girl suffered blunt thoracic trauma. CT revealed bilateral pneumothorax and pneumomediastinum. Bilateral thoracic drainage was performed, some ventilation problems persisted. CT and fiberoscopy revealed a rupture of the trachea. Thoracotomy was performed and the laceration was closed. ConclusionPneumomediastinum and persistent ventilation difficulties should raise suspicion of a tracheal injury in a typical clinical scenario. Bronchoscopy is recommended for early diagnosis, despite the possibility of misdiagnosis. In certain cases CT scan only and close observation may be considered.

Rohingya Crisis: An Added Challenge in Neurosurgical Arena of Chattogram Medical College Hospital

Rohingya are the group of people who has an specific ethnic, linguistic and religious group lived in the former Arakan state, renamed as Rakhain state of Myanmar. These people are homeless, stateless and disowned by their own government. Chattogram Medical College Hospital is the only tertiary level government hospital nearest to the Rohingya camp where Rohingya patients are referred from local health care providers. On a cross sectional observational demographic study conducted in the Department of Neurosurgery, CMCH revealed that, total number of admitted patient in CMCH is 757 among which 137 (18.09%) patient was admitted in Department of Neurosurgery since the Rohingya citizens are forcibly displaced from their land. Traumatic brain injury (31) , spinal injury (22) and gun shot wound (3) are the most common presentation as a result of ethnic cleansing. But lack of primary health care support, proper health education leads to development of hydrocephalus (8), meningocele (8), meningomyelocele (1) in children and delayed presentation of ICSOL (15) and Spinal SOL (2) are also observed among the admitted patients. 67 (48.90%) patients were treated conservatively and 70 (51.09%) patients are treated operatively. Despite the existing over crowded patients from the Chattogram Division, these Rohingya patients made an added challenge to the Department of Neurosurgery. Proper strategic plan should be carried out for the management of neurosurgical condition for decreasing mortality and morbidity and thus support humanity above all. Bang. J Neurosurgery 2020; 9(2): 111-116

Morphological specific damage of clothing by shots from a smooth-bore hunting rifle with cartridges of multi shells from various distances

The aim of the work is to study the design features of cartridges with multi shells for a smooth-bore hunting rifle of 12 mm caliber and results of firing these cartridges from various distances. Were revealed the morphological signs and features of injuries to tissue targets hit from a distance of 5-40 m. Was argued a necessity to continue a comprehensive study of the issue with the subsequent development of criteria for differential diagnosis of this type of shot injuries.

1175: Mortality in hospitalizations for gun shot wounds in pregnancy: a retrospective cohort

1175: Mortality in hospitalizations for gun shot wounds in pregnancy: a retrospective cohort

Autologous Saphenous Vein Panel Graft Treatment in Vascular Diseases

Introduction: Autologous vein grafts are extensively used for vascular repairs in various etiologies. In terms of diameter discrepancy between the saphenous vein and targeted vessel, panel vein technique may be used to alleviate this problem. This study aims to present early and mid-term results of vascular reconstruction with saphenous vein panel graft. Methods: Between August 2014 and March 2019, 23 saphenous vein panel grafts were used for vascular reconstruction in 21 patients. Patient data including demographic features, etiology of the vascular pathology, concomitant injury, site of injury, surgical procedure, additional surgical procedure, and hemodynamic status were retrospectively collected and analyzed. The Kaplan-Meier method was used to calculate the patency rates. Results: All patients were male. The average age was 37.6±13.1 years (range, 19-69 years). The most reason for operations was traumatic vascular injuries (most commonly gun shot injury). Mean duration of follow-up was 20.1±15.1 months (range,1-55 months). Two patients was required reoperation for bleeding. Autologous saphenous panel vein grafts were used for arterial reconstruction in 17 patients. Popliteal artery and superficial femoral vein were the the most common repaired vessels with saphenous panel vein. The primary patency rates for all grafts were 86.1% at 1 and 3 years; but all saphenous vein panel graft in venous position were patent during follow-up. Secondary patency rates were 100% and 90.9% at 1 and 3 years, respectively. The mortality rate was 4% with one patient due to multi-organ failure. There was not any deep venous thrombosis, pulmonary embolism, graft infection, anastomotic stenosis, diameter discrepancy and aneurysm formation during late follow-up. Conclusion: The autologous saphenous panel vein graft enables the surgeon to prepare suitable conduits easily with an appropriate diameter and length for vascular reconstruction. This technique provides high patency rates in mid-term follow-up, resistance to infection and low reintervention rates. In conclusion, autologous saphenous vein panel grafts may well be preferred in various vascular disorders. Disclosure: Nothing to disclose

Correction of inertance of temperature sensing devices in high-speed flow

The influence of the thermocouple calibration method on the reconstruction of the real temperature in impulse wind tunnel with operation duration of up to 100 ms is presented. It is shown that in an impulse set-up allow obtaining a stepwise thermal load with long temperature plateau which enough to determination of instrumental function, necessary for temperature reconstruction. To this aim, the developed technique, based on the application of the solution of the convolution integral equation, was used. It was included the information on the instrumental function, which was obtained from the calibration measurements. In the deconvolution procedure, the signal was first smoothed by splines, the convolution kernel was extracted by the differentiation of smoothed function, and regularization was performed by Kaczmarz algorithm with relaxation parameter. A comparison is made of the temperature reconstruction in the regular mode of hot shot wind tunnel with two different methods for measuring the response of thermocouples to the temperature step: measurement behind the shock wave front and rapid immersion in aluminum melt. It is found that the use of the instrumental function obtained in a wind tunnel allows one to more reliably determine the position of the temperature maximum in real experiment, which corresponds to the physical structure of the flow.

TRA 1. Unusual Injury of Common Iliac and Median Sacral Arteries After Airgun Shot With Distal Embolization of the Pellet: A Case Report

We describe a case with distal embolization of a pellet into the popliteal artery after an airgun shot in the abdomen. Airguns produce low-velocity and low-powered shots, which is why many people do not perceive them to be dangerous. However, modern airgun pellets are capable of inflicting serious and sometimes life- threatening injuries. We present a case of a 37-year-old man after an airgun shot to the abdomen. The patient was admitted in hemorrhagic shock to a countryside hospital. General surgeons preformed explorative laparotomy to stop the bleeding but with no success. After this, the vascular surgeon was urgently mobilized from a nearby city. The patient was extremely unstable, with massive blood loss and multiple transfusions (10 units, 400 mL each). Therefore, we decided to perform angiography first. We verified traumatic lesions in the left common iliac and median sacral arteries, so two stent grafts were implanted to stop the bleeding—Advanta V12 (Getinge, Rastatt, Germany) 9/40 for the common iliac artery and Graftmaster (Abbott Vascular, Abbott Park, Ill) 4/19 for the median sacral artery. The pellet was not visible in the abdomen on radiography. The patient was discharged after 10 days. A computed tomography scan at 1-month follow-up showed no signs of endoleak, but the pellet was found in the middle part of the left popliteal artery (Fig 1). The patient had palpable pulses on both pedal arteries without any signs of ischemia. Nevertheless, we extracted the pellet by a posterior approach to the popliteal fossa, but the artery was so damaged that it had to be replaced with a conduit from small saphenous vein (Fig 2). Successful treatment of complex airgun shot injury was accomplished with staged endovascular and open surgery approaches. Firearm injuries of main arteries are not generally common in modern societies. Furthermore, lesions of major arterial vessels by airgun pellets are even rarer. However, these injuries remain concerning because of their small size; they can easily migrate across the entire vascular system. If they are not found within the impact area, they should be meticulously sought elsewhere. Multilevel arterial trauma is challenging for every vascular specialist, but with the advances in the endovascular field, we can perform fast and safe treatment to save the patient’s life.Fig 2Posterior approach to popliteal artery and pellet inside it (A), extracted pellet (B), and interposition of vein conduit to reconstitute popliteal artery (C).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Distance to trauma centres among gunshot wound victims: identifying trauma ‘deserts’ and ‘oases’ in Detroit

IntroductionAmong the factors related to survival among individuals with gun shot wounds (GSW) is distance to trauma care. Relatively little is known about neighbourhood-level patterns of GSW mortality and distance...

Poster 21: Screening for Lead Toxicity after Gun Shot Wound in a Rehabilitation Setting

Poster 21: Screening for Lead Toxicity after Gun Shot Wound in a Rehabilitation Setting

Minimally Invasive Approach for Removal of a Bullet from the Thoracic Aortic Wall after Gun Shot Wound to the Chest

Minimally Invasive Approach for Removal of a Bullet from the Thoracic Aortic Wall after Gun Shot Wound to the Chest

Palatal Drop Augmentation and Tongue Prostheses: A Case Report

Background: After a total glossectomy, one lost the ability to speak and swallow due to the loss of tongue mobility and the increase of space between the palate and tongue remnants. To improve swallowing by creating negative pressure, tongue and palatal drop prostheses can be utilized. This prosthesis does not restore other tongue functions such as mastication, speech articulation and resonance because the prosthesis cannot reproduce natural tongue movements. Purpose: To rehabilitate the tongue deformity due to the gun shot wound. Methods and Materials: The case report revealed the total lost of tongue of a Bangladeshi patient who cannot be able to swallow and speak. The remaining teeth still fully intact but the palatal drop and tongue prosthesis was fabricated with the silicone prosthesis. Results: Both palatal drop prosthesis and tongue prosthesis allowed the patient to increase the capacity to swallow and reduce the remaining odondus space. The speech appeared to be more intelligiable but cannot fully restore. Conclusion: The quality of life of a patient after post operative follow-up appeared to be better; however, the physiologic function of the missing organ cannot fully restored.DOI: http://dx.doi.org/10.3329/cdcj.v10i1.13828City Dent. Coll. J Volume-10, Number-1, January-2013 Retracted: Due to complain

Rehabilitation of Mid Facial Tissue Defects Due to Gun Shot Injury- A Case Report

Rehabilitation of Mid Facial Tissue Defects Due to Gun Shot Injury- A Case Report

Rehabilitation of Mid Facial Tissue Defects Due to Gun Shot Injury- A Case Report

Rehabilitation of Mid Facial Tissue Defects Due to Gun Shot Injury- A Case Report

Rehabilitation of Mid Facial Tissue Defects Due to Gun Shot Injury- A Case Report

Rehabilitation of Mid Facial Tissue Defects Due to Gun Shot Injury- A Case Report

Successful management of a gun shot wound to the mandibular condyle by removal of the condylar head with no hard tissue reconstruction - Lessons for blunt trauma management?

Successful management of a gun shot wound to the mandibular condyle by removal of the condylar head with no hard tissue reconstruction - Lessons for blunt trauma management?

Early CT scanning in the emergency department in patients with penetrating injuries: does it affect outcome?

BackgroundTo be a level I trauma center in the Netherlands a computed tomography (CT) scanner in the emergency department (ED) is considered desirable, as it is presumed that this optimizes the diagnostic process and that therapy can be directed based on these findings. Aim of this study was to assess the effects of implementing a CT scanner in the ED on outcomes in patients with penetrating injuries.MethodsIn this retrospective descriptive study, patients with penetrating injuries (shot and/or stab wounds), presented between 2000 and 2014 were analysed using the hospital’s electronic database, and data from the West Netherlands trauma registry and the financial department.Results405 patients were included: performing a CT scan upon arrival increased significantly from 26.7 to 67.0% (p = 0.00) after implementation of a CT scanner in the ED, with the mean cost of a CT being 96.85 euros. Overall mortality decreased from 6.9 to 3.7%, although not statistically significant. Intensive care unit admission (ICU-admission) and median hospital length of stay (H-LOS) decreased from 30.9 to 24.5% resp. 3.2 to 1.8 days (p ≤ 0.05). Overall mortality, adjusted for injury severity score (ISS), revised trauma score (RTS), and types of injuries, did not change significantly.ConclusionPatients with penetrating injuries more often received a CT scan on admission after implementation of a CT scanner in the ED. Early CT scanning is useful since it significantly reduces ICU-admissions and decreases H-LOS. It is a cheap and non-invasive diagnostic tool with significant clinical impact, resulting in directed treatment, and improvement of outcomes.