Lesiones mortales por armas traumáticas: reporte de caso / Fatal injuries due to traumatic weapons: Case report

Introducción. Las armas de energía cinética son diseñadas para generar lesiones dolorosas y superficiales. Sin embargo, las lesiones asociadas causan confusión al ser abordadas como heridas por proyectil de arma de fuego, convirtiendo el enfoque y el manejo correcto en un desafío. El caso presentado describe un paciente herido en el cuello por arma traumática con el objetivo de analizar factores que permitan identificar este tipo de heridas y sus implicaciones en el manejo. Caso clínico. Paciente masculino de 31 años que ingresó con intubación orotraqueal, remitido de una institución de nivel 2, con herida por aparente proyectil de arma de fuego con trayectoria transcervical. Se encontró hemodinámicamente estable, pero con dificultad para la valoración clínica, por lo que se realizaron exámenes complementarios que descartaron lesión aerodigestiva. La tomografía de cuello reportó proyectil alojado en musculatura paravertebral izquierda, descartando trayectoria transcervical. Discusión. El comportamiento de las lesiones asociadas a los proyectiles de armas depende de varios factores, como el tipo de material del proyectil, su velocidad y las propiedades del tejido impactado. Se presentó un caso en que inicialmente se sospechaba una lesión transcervical, pero con la evaluación se identificó el proyectil cinético en la musculatura paravertebral. Conclusión. En el abordaje de un paciente con sospecha de herida por proyectil de arma de fuego se debe considerar ante todo la respuesta clínica y la correlación del supuesto vector del proyectil con las lesiones sospechadas. La evaluación imagenológica permite identificar oportunamente los proyectiles y evitar procedimientos o terapias innecesarias que forman parte del manejo convencional del paciente con trauma penetrante

Introduction. Kinetic energy weapons are designed to produce superficial and painful injuries. Nevertheless, the approach of these patients in the emergency department can be confusing as they can be managed as gunshot wounds. This case describes a patient with an injury in the neck caused by kinetic energy gun. In addition, we analyzed factors that might identify these wounds and their implications in the management. Clinical case. A 31-year-old male patient who presented to the emergency department referred from a second level hospital with gunshot wound with suspected trans-cervical trajectory. They performed orotracheal intubation and transferred to our institution. Due to the patient ́s hemodynamic stability and impossibility for clinical evaluation, test and radiology tests were performed. These ruled out any aero-digestive injuries. The CT-scan reported a bullet hosted in the left paravertebral muscles, ruling out a trans-cervical trajectory. Discussion. Several factors contribute to the injuries produced by kinetic energy weapons. The injury patterns may vary according to the bullet material, muzzle velocity and impacted tissue characteristics. In this case, an initial trans-cervical injury was suspected and due to clinical evaluation we identified the bullet hosted in the paravertebral muscles. Conclusion. In the approach of a patient with suspicion of gunshot wound, as surgical team we must consider clinical manifestations and the correlation of the vector with suspected injuries. Evaluation of diagnostic imaging allows the identification of traumatic bullets, avoiding unnecessary procedures in the conventional management of patients with penetrating trauma

Physical violence in children and adolescents: a retrospective study of injuries to the head and neck region

Aim: This study aimed to investigate the prevalence of physical violence and head and neck injuries among children and adolescents who suffered physical aggression, firearm aggression, and white gun aggression referred to the Legal Medical Department in a southern city in Brazil. Methods: This study was performed at Legal Medical Department in the city of Pelotas, RS, Brazil, from January 2011 to December of 2015. Data were collected from medical reports of children and adolescents (0-19 years old). Demographic information such as sex, age, and skin color was collected. Data were submitted to Chi-square test and multivariate Poisson regression analysis. Results: In this study, 2,716 physical examination reports were analyzed, with a total of 2,171 exams resulting from violence; lesions that had physical aggression as their etiology (1,951) had a higher prevalence. The analysis of the exams revealed that the majority were adolescents (90,05%), white (84.09%), and female (50.21%). The head and neck regions were affected in most cases of violence (57.90%). In the adjusted model, the occurrence of injuries in the head and neck region was higher in males (PR 1.16, CI 95% 1.08 - 1.25), among adolescents (PR 1.28, CI 95% 1.10 - 1.48) and in victims of physical aggression compared to victims of the firearm (2.81, CI 95% 1.79 - 4.40). Conclusion: The results revealed a high prevalence of head and face injuries in victims of violence and that there was a greater prevalence of physical violence among adolescents compared to children and males

Unraveling quad fever: Severe hyperthermia after traumatic cervical spinal cord injury / 中华创伤杂志(英文版)

PURPOSE@#There are many infectious and inflammatory causes for elevated core-body temperatures, though they rarely pass 40 ℃ (104 ℉). The term "quad fever" is used for extreme hyperpyrexia in the setting of acute cervical spinal cord injuries (SCIs). The traditional methods of treating hyperpyrexia are often ineffective and reported morbidity and mortality rates approach 100%. This study aims to identify the incidence of elevated temperatures in SCIs at our institution and assess the effectiveness of using a non-invasive dry water temperature management system as a treatment modality with mortality.@*METHODS@#A retrospective analysis of acute SCI patients requiring surgical intensive care unit admission who experienced fevers ≥ 40 ℃ (104 ℉) were compared to patients with maximum temperatures < 40 ℃. Patients ≥18 years old who sustained an acute traumatic SCI were included in this study. Patients who expired in the emergency department; had a SCI without radiologic abnormality; had neuropraxia; were admitted to any location other than the surgical intensive care unit; or had positive blood cultures were excluded. SAS 9.4 was used to conduct statistical analysis.@*RESULTS@#Over the 9-year study period, 35 patients were admitted to the surgical intensive care unit with a verified SCI. Seven patients experienced maximum temperatures of ≥ 40 ℃. Six of those patients were treated with the dry water temperature management system with an overall mortality of 57.1% in this subgroup. The mortality rate for the 28 patients who experienced a maximum temperature of ≤ 40 ℃ was 21.4% (p = 0.16).@*CONCLUSION@#The diagnosis of quad fever should be considered in patients with cervical SCI in the presence of hyperthermia. In this study, there was no significant difference in mortality between quad fever patients treated with a dry water temperature management system versus SCI patients without quad fever. The early use of a dry water temperature management system appears to decrease the mortality rate of quad fever.

Incidence and pattern of traumatic spine injury in a single level I trauma center of southern Iran / 中华创伤杂志(英文版)

PURPOSE@#Spine injury is one of the leading causes of death and mortality worldwide. The objective of this study was to determine the incidence, pattern and outcome of trauma patients with spine injury referred to the largest trauma center in southern Iran during the last 3 years.@*METHODS@#This is a cross-sectional study conducted between March 2018 and June 2021 in the largest trauma center in the southern Iran. The data collection form included the age, sex, injury location (cervical, thoracic, and lumbar), cause of injury (traffic accidents, falls, and assaults), length of hospital stay, injured segment of spine injury, severity of injury, and outcome. Statistical analyzes were performed using SPSS software version 24.@*RESULTS@#Totally 776 cases of spine injury were identified. The spine injury rate was 17.0%, and the mortality rate was 15.5%. Cervical spine injury (20.4%) more often occulted in motorcycle accident, and thoracic spine injury (20.1%) occulted in falls. The highest and lowest rates of spine injurys were related to lumbar spine injury (30.2%) and cervical spine injury (21.5%), respectively. There was a statistically significant relationship between the mechanism of injury and the location of spine injury (p < 0.001). And patients with lumbar spine injury had the highest mortality rate (16.7%). Injury severity score (OR= 1.041, p < 0.001) and length of stay (OR = 1.018, p < 0.001) were strong predictors of mortality in trauma patients with spine injury.@*CONCLUSION@#The results of the study showed that the incidence of traumatic spine injury rate was approximately 17.0% in southern of Iran. Road traffic injury and falls are the common mechanism of injury to spine. It is important to improve the safety of roads, and passengers, as well as work environment, and improve the quality of cars. Also, paying attention to the pattern of spine injury may assist to prevent the missing diagnosis of spine injury in multiple trauma patients.

Conducta selectiva en trauma penetrante de cuello / Selective management in penetrating neck trauma

Objetivo: evaluar la incidencia de hallazgosquirúrgicos positivos en pacientes con diagnóstico de traumapenetrante de cuello de dos instituciones hospitalariascapitalinas, sometidos a exploración quirúrgica inmediatao conducta selectiva. Métodos: en un estudio descriptivo,cuantitativo y transversal, se evaluaron 22 heridos condiagnóstico de lesiones penetrantes de cuello entre años 2017y 2021. Se dividieron en dos grupos de acuerdo al tipo deconducta aplicada. Las distintas frecuencias fueron expresadas ennúmero y porcentaje. Resultados: Grupo A, ocho heridos (36,4%), siete ingresaron con signos duros sometidos a exploraciónquirúrgica inmediata, el 87,5 % presentó hallazgos positivos ala cervicotomía; dos fueron incluidos en un esquema de cirugíade control de daños. Grupo B, catorce lesionados con signosblandos admitidos para conducta selectiva mediante observaciónfrecuente y realización de diversos estudios paraclínicos (63,6%),tres requirieron intervención operatoria por la presencia deenfisema subcutáneo expansivo después de las primeras 48 horas;se identificó una lesión esofágica, que se reparó con cierreprimario y rotación de colgajo muscular. Conclusión: En elpresente estudio, la incorporación de la conducta selectiva enel manejo multidisciplinario del trauma penetrante de cuellopermitió incrementar el número de exploraciones positivas yreducir las negativas. Nuevas estrategias como la cirugía decontrol de daños y la zona cero han sido incluidas en algunasheridas vasculares o lesiones extensas(AU)

Objective: To evaluate the incidence of positiveexplorations in patients with penetrating neck trauma oftwo capitals hospitals underwent to immediate surgicalexploration or selective management. Method: Studydescriptive, quantitative and transversal of twenty-two patientswith penetrating neck trauma since years 2017 to 2021. Distribute in two groups in the basis of the management.Different frequency express in frequency and percentages.Results: Group A, eight injured, 36.4 %. Seven with hardsigns, underwent immediate surgical exploration of the neck.the 87.5 % had positive explorations. Two were included in ascheme of surgery damaged control. Evidenced injuries extentsand for high velocity projectile. Group B, fourteen wounded,63.6 %. three required surgical intervention for the presence ofpersistent emphysema. One occult esophagical injury, repairedwith suture and muscular rotation. Conclusion: In the present study the selective management of penetrating neck traumapermit increase the number of positive explorations and reducethe negatives. this alternative was viable and secures(AU)

Hipertiroidismo transitorio posterior a trauma cuello en accidente de tránsito Reporte de caso con enfoque Médico Legal / Transient hyperthyroidism after neck trauma in a traffic accident. Case report with a Legal Medical approach

Resumen El hipertiroidismo transitorio posterior a un trauma de cuello es un hecho infrecuente. Se presenta el caso de una femenina de 23 años, quien sufrió un accidente de tránsito presentando trauma en cuello al golpearse con la manivela de una motocicleta, posteriormente presentó supresión de TSH y elevación de T4 circulante, con ultrasonido y TAC que descartaron hematomas o rupturas de la glándula, que luego de manejo conservador presentó normalización de las hormonas tiroideas y evolucionó sin secuelas. Se hizo una revisión de la literatura sobre tiroiditis e hipertiroidismo transitorio post trauma de cuello.

Abstract Transient hyperthyroidism after neck trauma is not common. The case of a 23-year-old female is presented, who suffered a traffic accident presenting trauma to the neck when hitting with the crank of a motorcycle, subsequently presented suppression of TSH and elevation of circulating T4, with ultrasound and CT that ruled out bruises or ruptures of the gland, which after conservative management presented normalization of thyroid hormones and evolved without sequelae. A review of the literature on thyroiditis and transient hyperthyroidism after neck trauma was conducted.

Manejo quirúrgico de heridas por mordeduras de perro en pacientes pediátricos: nuestra experiencia en 8 años / Surgical management of dog bite wounds in pediatric patients: our experience in 8 years

Introducción. Hasta un 90% de las mordeduras de animales son producidas por perros. Los niños son la población más vulnerable frente a las mordeduras ya que suelen afectar una mayor proporción de superficie corporal. Objetivo. Analizar la casuística de mordeduras de perro y su repercusión en nuestro entorno. Métodos. Estudio observacional, descriptivo, retrospectivo de un período de 8 años, que incluyó a todos los pacientes de 0 a 18 años con diagnóstico de mordedura de perro. Resultados. Se incluyeron 183 pacientes con diagnóstico de mordedura de perro. El promedio de edad fue de 6,1 años, y el grupo etario más afectado fue el de los niños de 3 a 5 años (38,3%). El tratamiento quirúrgico fue dividido en pacientes que requirieron rafia por planos (84,6%), colgajos (11,4%), injertos (3,4%) y puntos de aproximación (1%). Se reportaron 8 pacientes con complicaciones (4,4%). Conclusión. Los niños de 3 a 5 años son los más afectados por mordeduras de perro y la zona de cabeza y cuello es la más común. Un porcentaje importante de pacientes requirieron colgajos e injertos con buenos resultados.

Introduction. Up to 90% of animal bites are produced by dogs. Children are the most vulnerable population because bites tend to affect greater body surface area. Outcome. Analyze dog bites cases and their impact on our environment. Methods. An observational, descriptive, retrospective study during an 8 year period was carried out, which included all patients from 0 to 18 years with a diagnosis of dog bite. Results. A total of 183 patients with a diagnosis of dog bite were found. The average age was 6.1 years, and the age group most affected was children from 3 to 5 years old (38.3%). Surgical treatment was divided into: patients who required suture by planes (84.6%), flaps (11.4%) and grafts (3.4%) and approximation stitches (1%). Complications were reported in 8 patients (4.4%). Conclusion. Children from 3 to 5 years old are the most affected by dog bites, the head and neck area is the most common. A significant percentage of patients required flaps and grafts with good results.

Head and neck injuries after leopard attack: Presentation and management / 中华创伤杂志(英文版)

Leopard attacks on humans are reported most often from the Indian subcontinent. The bite wounds are complex injuries infected with polymicrobial inoculum and may present as punctures, abrasions, lacerations or avulsions. The presentation and acceptable treatment of these injuries vary according to the wound. We hereby describe the clinical presentation and treatment of a male victim with leopard bite injuries on the head and neck region. As bite injuries are commonly found on and around the face, maxillofacial surgeons should be familiar with the therapy. Through thorough clinical and radiological examination, it is essential to prevent missing any hidden injuries, which can easily turn lethal. To benefit the rural population, more health facilities need to be established in remote areas.

Characteristics and Forensic Identification of Blunt Vertebral Artery Injury / 法医学杂志

Blunt vertebral artery injury occurs frequently in forensic practice. However, injuries of the vertebral artery are easily ignored or overlooked because of its relatively deep location. Through literatures review, this paper finds that the manners of blunt vertebral artery injury are varied and one or more injury mechanisms may be involved simultaneously. Patients often undergo immediate or delayed cerebral apoplexy as well as compression and injury of surrounding structures, due to direct injury or secondary aneurysm or dissection, resulting in disability or death. Diseases such as, vertebral atherosclerosis and dysplasia can increase the disability and death risk and the difficulty of forensic identification. In forensic identification, the details of the case should be considered. For cases of suspected vertebral artery injury, in addition to routine examination of intracranial segment, attention should be paid to the examination of extracranial segment. If conditions permit, angiography can be used prior to or during the autopsy to improve the identification efficiency and accuracy of opinions.

Prevalência de lesões cervicais não cariosas na dentição decídua / Prevalence of non-carious cervical lesions in the primary dentition

Objetivo: Determinar a prevalência de lesões cervicais não cariosas em crianças na dentição decídua e possíveis fatores etiológicos associados. Métodos:Após a aprovação do Comitê de Ética ­ CEP/UESPI (3.289.732), o estudo transversal foi realizado em 360 crianças com idade entre 2 a 6 anos, de escolas públicas e privadas, divididas em dois grupos: G1 (com lesões cervicais) e G2 (sem lesões cervicais). Foi aplicado um questionário aos pais, seguido do exame clínico das crianças. Foram consideradas lesões detectadas pelo tato e visualmente. Foram realizadas avaliações das médias e dos desvios padrão para variáveis quantitativas. Obteve-se porcentagens e frequências, realizando-se análises de associação entre as variáveis qualitativas a partir do qui-quadrado e comparação da idade média a partir do teste t (p < 0,05). Resultados: Somente lesões do tipo abfração foram encontradas na amostra (5%) e os indivíduos de raça branca apresentaram uma maior prevalência em relação aos demais (55,5%). Houve diferença estatisticamente significativa (p < 0,001) e essas lesões foram identificadas somente em escolas privadas. Quanto ao sexo, em G1, houve diferença estatisticamente significativa, (p = 0,01) com maior prevalência no masculino (66,7%). Os dentes mais acometidos em ordem decrescente foram os caninos e incisivos centrais superiores seguidos dos caninos e incisivos centrais inferiores. Conclusão: A prevalência de lesões cervicais não cariosas, do tipo abfração, em crianças de 2 a 6 anos de idade foi de 5%, tendo sido encontradas somente em escolas privadas, com predominância no sexo masculino. Houve associação entre a abfração e o tipo de escova utilizada na escovação dentária, apresentando maior frequência de lesões quando escovas duras eram utilizadas e escovação forte era executada.

Aim:To determine the prevalence of non-carious cervical lesions in children in the primary dentition and possible associated etiological factors. Method: After approval by the Ethics Committee - CEP / UESPI (3,289,732) ­ this cross-sectional study was carried out on 360 children, from 2 to 6 years of age, from public and private schools, divided into two groups: G1 (with cervical lesions) and G2 (without cervical lesions). A questionnaire was applied to the parents, followed by the children's clinical examination. Lesions detected by touch and visually were considered. Evaluations of means and standard deviations were performed for quantitative variables. Percentages and frequencies were obtained, analyzing the association between qualitative variables based on the chi-square test and comparing the average age using the t test (p < 0.05). Results:Only abfraction-type lesions were found in the sample (5%), and white individuals presented a higher prevalence in relation to the others (55.5%). There was a statistically significant difference (p < 0.001), and these lesions were found only in private schools. As for sex, in G1, there was a statistically significant difference (p = 0.01) with a higher prevalence in males (66.7%). The most affected teeth in decreasing order were the canines and upper central incisors, followed by the canines and lower central incisors. Conclusion: The prevalence of non-carious cervical lesions of the abfraction type in children from 2 to 6 years of age was 5%, which was only found in private schools, with a predominance in males. An association was found between the abfraction and the type of brush used in toothbrushing, with a higher frequency of lesions when hard brushes were used and strong brushing was performed.

Disnea por rotura espontánea traqueal en ancianos / Dyspnea due to spontaneous tracheal rupture in the elderly

Tracheal rupture is an infrequent complication with high morbidity and mortality, of multifactorial etiology, being orotracheal intubation its main cause. Spontaneous tracheal rupture usually occurs after severe coughing and/or vomiting over a weakened trachea. The diagnosis is non-specific, based on highly suggestive signs and symptoms such as subcutaneous emphysema, pneumomediastinum and respiratory distress, and its confirmation requires the performance of a bronchoscopy. The location and extent of the rupture determines the clinic. This implies the importance of an early diagnosis to avoid a poor prognosis. We present the case of an elderly male patient with a spontaneous tracheal rupture without apparent cause

La rotura traqueal es una complicación infrecuente de etiología multifactorial, con una elevada morbimortalidad, la intubación orotraqueal es su principal causa. La rotura traqueal espontánea suele producirse luego de toser o presentar vómitos intensos, sobre una tráquea debilitada. El diagnóstico es inespecífico, se basa en signos y síntomas altamente sugestivos como enfisema subcutáneo, neumomediastínico y dificultad respiratoria y su confirmación exige la realización de una broncoscopia. La localización y extensión de la rotura determinan la clínica. Esto implica la importancia del diagnóstico precoz para evitar un pronóstico infausto. Se presenta el caso de un paciente varón, de edad avanzada. con una rotura espontánea traqueal sin causa aparente

Scapulothoracic dissociation and blunt vertebral vascular injury: case report / > Disociación escapulo-torácica y trauma cerrado de arteria vertebral: reporte de un caso

Abstract Case Description: A 24-year-old male suffers from a motor vehicle accident with penetrating neck trauma and concomitant closed left cervicothoracic trauma. Clinical Findings: High impact trauma causing hypovolemic shock, left zone I penetrating neck trauma, ischemia due to blunt trauma to the axillary vessels, and brachial plexus injury. Transection of the vertebral artery on angiotomography. Diagnosed with scapulothoracic dissociation and vertebral artery trauma. Treatment and outcome: Axillary arteriovenous reconstruction, fasciotomies, non-surgical approach of the vertebral artery trauma, and deferred treatment of the brachial plexus trauma were performed. Survival of the patient and his limb, with major neurologic sequelae Clinical Relevance: The case presented here is an example of scapulothoracic dissociation with associated trauma to the vertebral artery, injuries that are uncommon and associated with high morbidity and mortality. Early recognition of the injuries and a multidisciplinary approach for this complex case by surgical board reviews at various levels within the course of care were key determinants in the patient's improved prognosis. This case report presents an analysis of the diagnostics, treatment, and course; considering in-hospital care and the decision-making process as determinants for the prognosis in a polytrauma patient.

Resumen Descripción del caso: Varón de 24 años que sufre accidente automovilístico con trauma penetrante de cuello y trauma cerrado cervico torácico izquierdo concomitante. Hallazgos clínicos: Shock hipovolémico, trauma en zona I cuello izquierdo, isquemia por trauma cerrado de vasos axilares y lesión por trauma cerrado del plexo braquial; producto de trauma de alto impacto. Sección de arteria vertebral por angiotomografia. Se diagnostica disociación escapulo-torácica y trauma de arteria vertebral. Tratamiento y resultado: Reconstrucción vascular arterio-venosa axilar, fasciotomías y abordaje no operatorio del trauma de arteria vertebral, con manejo diferido del trauma del plexo braquial. Sobrevida del paciente y su extremidad, con secuelas neurológicas mayores. Relevancia clínica: Es un caso de disociación escapulotorácica y lesión de arteria vertebral concomitante, siendo esta una asociación infrecuente y de alta morbi-mortalidad. El reconocimiento temprano de las lesiones y un abordaje multidisciplinario de este escenario de complejidad por medio de juntas quirúrgicas en varios niveles del proceso de atención, fueron determinantes para cambiar el pronóstico del paciente. Se presenta un análisis del diagnóstico, manejo y evolución; considerando el proceso de atención hospitalaria, toma consensuada de decisiones y el pronóstico en un paciente politraumatizado.

Doble mecanismo de estrangulación. A propósito de un caso / Double mechanism of strangulation. Apropos of a case

RESUMEN Las asfixias mecánicas son aquellas que resultan del impedimento mecánico a la penetración del aire en las vías respiratorias, suelen clasificarse atendiendo a la naturaleza del medio mecánico que las origina y a su modo de actuar. La estrangulación puede definirse como la constricción del cuello mediante la aplicación de una fuerza activa, ajena al peso del cuerpo, que actúa por intermedio de un lazo, las manos, el antebrazo o cualquier otra estructura rígida. En la estrangulación antebraquial, la constricción del cuello se lleva a cabo normalmente rodeando al individuo con el brazo y el antebrazo. Cuando el mecanismo de la compresión del cuello es lateral, no se afectan las vías aéreas, la compresión de las arterias carótidas hace que se produzca una isquemia cerebral y pérdida de conocimiento en 10-15 segundos. El mecanismo de muerte en estos casos será la anoxia cefálica. Si la compresión del cuello es anterior, actúa ocluyendo las vías aéreas, la presión sobre los cartílagos tiroides y cricoides puede producir fracturas y el mecanismo de muerte será la obstrucción respiratoria. El presente trabajo constituyó un caso poco común de estrangulación, donde se utilizó un mecanismo combinado que llevó al occiso al deceso final. Para la realización de la discusión del caso se tuvo en cuenta los elementos del lugar del hecho, el examen del exterior y el interior del cadáver (AU).

ABSTRACT Mechanical asphyxias are those resulting from the mechanical obstruction of the air penetration in the airways. They are usually classified according to the nature of the mechanical mean producing it and the way it performs. Strangulation may be defined as neck constriction through the application of an active force not proper to the body weight, acting by means of a knot, hands, forearm or any stiff structure. In ante brachial strangulation, neck constriction is normally performed surrounding the individual with the arm and forearm. When the neck constriction mechanism is lateral, the airways are not affected: carotid arteries constriction produces a brain stroke and loss of consciousness in 10-15 s. The death mechanism in these cases will be cephalic anoxia. If the neck compression is anterior, it occludes the airways; the pressure on thyroidal and cricoid cartilages may produce fractures and death mechanism will be respiratory obstruction. The current work deals with an uncommon strangulation case, where a combined mechanism led the person to the final decease. For the case discussion the authors took into account the elements of the place, and the examination of the exterior and the inside of the corpse (AU).

Correção cirúrgica de fístula carotídeo-jugular traumática / Surgical repair of a traumatic carotid-jugular arteriovenous fistula

Resumo Traumatismos cervicais penetrantes podem ser potencialmente fatais. Em cerca de 25% dos casos, há lesão vascular associada, que pode evoluir para fístulas arteriovenosas. Os autores apresentam um caso de correção tardia, por cirurgia aberta, de uma fístula carotídeo-jugular e fazem uma breve revisão sobre o diagnóstico e opções de tratamento dessa condição.

Abstract Penetrating neck injuries can be life threatening. In about 25% of cases there are vascular injuries, which can progress to formation of arteriovenous fistulas. The authors present a case of delayed open surgery to repair a carotid-jugular fistula and briefly review the diagnosis and treatment options for this condition.

Caracteristicas clinicas y epidemiologicas de lesiones cervicales no cariosas / Clinical and epidemiological characteristics of non-carious cervical injuries / Características clínicas y epidemiológicas de lesões cervicais não cariosas

Las lesiones cervicales no cariosas consisten en la pérdida de estructura dentaria en la región cervical de la superficie vestibular de los elementos dentarios, no relacionados con caries. Objetivo: Verificar las características clínicas, epi-demiológicas y los factores de riesgo de lesiones cervicales no cariosas. Materiales y métodos: Fueron evaluados 300 elementos dentarios en 96 individuos adultos que fueron sometidos a entrevista y examen clínico intra-oral. Resultados: Se encontró una razón de prevalencia en la que 0,87 de los pacientes usan prótesis. Respecto a hábitos de higiene oral, 0,51 utilizan cepillo suave; 0,52 se cepillan tres veces por día y, 0,68 utilizan dirección de cepillado combinado. En los pacientes, se evaluó que 0,56 tenían antecedentes de trastornos gastrointestinales; el 40% toman medicamentos; 0,36 presentan desoclusión en guía canina. Con relación a las características de la lesión, 0,40 presentan tipo de contacto A; 43% con profundidad inferior a 1 mm; 0,13 son portadores de prótesis parcial removible. En cuanto a hábitos alimenticios 0,93 toman bebidas cítricas; 0,15 son fumadores. Referente a los hábitos parafuncionales, 0,35 aprietan los dientes; 0,36 son bruxistas; 0,10 muerden objetos. Estas lesiones presentan una mayor prevalencia en premolares 0,54. Conclusiones: Verificando las características clínicas y epidemiológicas, y los factores de riesgo de las lesiones cervicales no cariosas, se concluye que predominan en premolares, el factor determinante para el surgimiento de estas lesiones es multifactorial, predominando la inestabilidad oclusal, ingestión de bebidas cítricas, uso de prótesis, trastornos gastrointestinales y hábitos parafuncionales.

Non-carious cervical lesions result from the loss of tooth structure in the cervical region of the vestibular surface of the dental elements, not related to caries. With the objective to verify the clinical and epidemiological features and risk factors of these injuries were evaluated 300 dental elements on 96 adult patients that were subjected to interview and intraoral clinical examination. The results presented a prevalence ratio in which the 0,87 of patients evaluated are prosthetic users. In oral hygiene habits, 0,51 use soft brush, 0,52 brush three times a day and 0,68 use brushing direction combined. Was evaluated in these patients that 0,56 have a history of gastrointestinal pathologies; 40% made use of medications and 0,36 have disocclusion characteristics in canine guide. In relation to the characteristics of the lesion, 0,40 have type of contact, 43% with a depth less than 1 mm and 0,13 are retainers of removable partial denture. As for the eating habits, 0,93 con-sume citrus fruits and 0,15 are smokers. Regarding parafunctional habits, 0,35 clench your teeth; 0,36 have bruxism and 0,10 bite objects. These lesions showed a higher prevalence in premolars 0,54.Verified the clinical and epidemiological features and risk factors of non-carious cervical lesions, we conclude that the determining factor for the emergence of these lesions has shown characteristics multifactorial, with highest percentage for patients with occlusal instability, intake of acidic drinks, prosthesis, gastrointestinal diseases and parafunctional habits.

As lesões cervicais não cariosas residem da perda de estrutura dentária na região cervical da superfície vestibular dos elementos dentários, não relacionados com a lesão de cárie. Objetivo: verificar as características clinicas e epidemiológi-cas, e os fatores de risco destas lesões. Materiais e métodos: foram avaliados 300 elementos dentários em 96 indivíduos adultos que foram submetidos a entrevista e exame clinico intra-oral. Resultados: se encontrou uma razão de prevalência em que 0,87 dos pacientes avaliados são usuários de prótese. Em hábitos de higiene oral, 0,51 utilizam escova macia, 0,52 escovam três vezes ao dia e 0,68 utilizam direção de escovação combinada. Avaliou-se nos pacientes que, 0,56 apresentam histórico de patologias gastrointestinais; 40% faziam uso de medicamentos e 0,36 apresentam características de desoclusão em guia canino. Com relação as características da lesão, 0,40 apresentam tipo de contato A, 43% com profundidade menor que 1mm e 0,13 são retentores de prótese parcial removível. Quanto aos hábitos alimentares, 0,93 consomem bebidas cítricas e 0,15 são fumantes. Referente aos hábitos parafuncionais, 0,35 apertam os dentes; 0,36 possuem bruxismo e 0,10 mordem objetos. Estas lesões apresentaram uma maior prevalência em pré-molares 0,54. Verifi-cado as características clinicas e epidemiológicas, e os fatores de risco das lesões cervicais não cariosas, conclui-se que o fator determinante para o surgimento destas lesões demonstrou características multifatoriais, com maior percentual para pacientes com instabilidade oclusal dental, ingestão de bebidas ácidas, usuários de prótese, patologias gastrointestinais e hábitos parafuncionais.

Retrospective Analysis of 73 Hanging and Ligature Strangulation Cases / 法医学杂志

Objective To retrospectively analyze 40 cases of hanging and 33 cases of ligature strangulation in Kunming, to explore the neck injury characteristics and similarities and differences of related asphyxia signs of corpses in hanging and ligature strangulation cases, in order to provide reference for forensic identification. Methods Statistics of hanging and ligature strangulation cases accepted by Kunming Municipal Public Security Bureau from 2000 to 2017 were collected. Data including the gender, age, injury tool, neck injury and related asphyxia signs of the deceased in hanging and ligature strangulation cases were statistically tested by SPSS 23.0. Results There were more males in hanging cases than females. However, there were more females than males in ligature strangulation cases. In hanging cases, suicide was common, while homicide was rare. In ligature strangulation cases, homicide was common, while suicide or accidental death was rare. The average age of the deceased in hanging cases were older than those in ligature strangulation cases. The ligature mark in hanging was usually above the thyroid cartilage. The ligature mark in ligature strangulation was usually at the same level of the thyroid cartilage. The most common vital reactions were exfoliation and subcutaneous hemorrhage at the ligature mark, common among the deceased in hanging cases. Hyoid fracture rate of the deceased in ligature strangulation cases was more common than those in hanging cases. Conclusion The gender, age distribution, position of ligature mark, detection rate of vital reactions at the ligature mark and hyoid fracture rate of the deceased can help distinguish hanging from ligature strangulation.

O esportista e a prevalência de trauma bucomaxilofacial: conhecimento e uso de protetor bucal, hábitos e respiração na prática esportiva / The athlete and the prevalence of maxillofacial trauma: knowledge and use of mouth guard, habits and breathing in sports practice

O trauma buco maxilo facial (TBMF) relacionado à prática esportiva tem aumentado nos últimos anos, portanto é fundamental investigar os esportes de maior ocorrência, a saúde bucal dos atletas e a adoção de medidas preventivas. O objetivo neste estudo foi verificar a prevalência de trauma buco-maxilo-facial (BMF) em atletas; a relação com a modalidade esportiva praticada, bem como conhecimento e uso de protetores bucais, hábitos de higiene bucal, hábitos sociais e de hidratação. Trata-se de um estudo transversal, descritivo, envolvendo 647 atletas praticantes de diferentes esportes em um município do Brasil. Os participantes responderam a um questionário que abordava como desfecho primário a ocorrência de trauma na região da cabeça e pescoço durante atividades esportivas e o conhecimento e uso de protetores bucais. As seguintes variáveis também foram investigadas: esporte praticado, região afetada, escovação, uso do fio dental, consumo de refrigerantes, bebidas alcoólicas, tabagismo, hidratação e a respiração durante a prática esportiva. Do total, 148 atletas (22,87%) sofreram TBMF e os esportes de maior ocorrência foram o basquetebol e o futebol. Houve associação significativa entre ocorrência de TBMF e desconhecimento sobre protetores bucais (p=0,0042) e modalidade esportiva (p<0,0001). A boca foi o local mais acometido (30,40%), a cotovelada foi a principal causa (32,54%). O protetor bucal era conhecido por 538 atletas (83,15%), no entanto, apenas 169 (26,12%) utilizavam, sendo 13 (7,69%) deles personalizados. Verificou-se que 313 atletas (48,53%) respiravam pela boca durante a prática esportiva, 381 (58,89%) não ingeriam refrigerantes, 618 (95,52%) não fumavam e 98 (15,15%) consumiam bebidas alcoólicas ao menos duas vezes por semana. A maioria dos atletas (n=554; 85,63%) ingeria apenas água, enquanto 138 (21,33%) consumiam energéticos durante o exercício. O fio dental não era usado por 212 (32,77%) atletas e 606 (93,67%) escovavam os dentes 2 a 3 vezes ao dia. A maioria dos atletas conhecia os protetores bucais, no entanto, poucos faziam uso. Grande parte dos atletas apresentava respiração bucal durante a prática esportiva e embora todos realizassem a escovação dentária, uma parcela considerável não fazia uso de fio dental. O consumo de refrigerante, bebidas alcoólicas e cigarros foi baixo(AU)

Buccomaxillofacial trauma (TBMF) related to sports practice has increased in recent years, so it is essential to investigate the sports with the highest occurrence of TBMF, the oral health of athletes and the adoption of preventive measures. The aim of this study was to verify the prevalence of buccomaxillofacial trauma (BMF) in athletes; the relationship with the sport practiced, as well as knowledge and use of mouthguards, oral hygiene habits, social habits and hydration. This is a cross-sectional, descriptive study, involving 647 athletes practicing different sports in a municipality in Brazil. Participants answered a questionnaire that addressed the occurrence of trauma in the head and neck during sports activities and the knowledge and use of mouthguards as the primary outcome. The following variables were also investigated: sport practiced, affected region, brushing, flossing, consumption of soft drinks, alcoholic beverages, smoking, hydration and breathing during sports practice. Of the total, 148 athletes (22.87%) suffered TBMF and the most frequent sports were basketball and football. There was a significant association between the occurrence of TBMF and lack of knowledge about mouthguards (p=0.0042) and sports (p <0.0001). The mouth was the most affected site (30.40%), the elbow was the main cause (32.54%). The mouthguard was known by 538 athletes (83.15%), however, only 169 (26.12%) used it, 13 (7.69%) of whom were personalized. It was found that 313 athletes (48.53%) breathed through the mouth during sports, 381 (58.89%) did not drink soft drinks, 618 (95.52%) did not smoke and 98 (15.15%) consumed drinks alcoholic at least twice a week. Most athletes (n = 554; 85.63%) drank only water, while 138 (21.33%) consumed energy drinks during exercise. The dental floss was not used by 212 (32.77%) athletes and 606 (93.67%) brushed their teeth 2 to 3 times a day. Most athletes knew about mouthguards, however, few used them. Most of the athletes had mouth breathing during sports practice and although all of them performed tooth brushing, a considerable portion did not use dental floss. The consumption of soft drinks, alcoholic beverages and cigarettes was low(AU)

Perfil das vítimas de suicídio necropsiadas no núcleo de medicina e odontologia legal de João Pessoa ­ PB ­ Brasil / Profile of necropsied victims in the nucleus of forensic medicine and dentistry of Joao Pessoa ­ PB ­ Brazil

Introdução: A incidência de suicídio vem crescendo no Brasil e no mundo, apresentando-se como problema de saúde pública. Objetivo: Traçar o perfil das vítimas de suicídio da cidade de João Pessoa/PB ­ Brasil. Material e Métodos: Estudo transversal, descritivo e de abordagem quantitativa por meio da avaliação de dados presentes nas Declarações de Óbito de vítimas de suicídio nos anos 2015 e 2016 emitidas pelo Núcleo de Medicina e Odontologia Legal da cidade de João Pessoa/PB ­ Brasil. Os dados foram fornecidos pela Vigilância Epidemiológica da Secretaria Municipal de João Pessoa. As variáveis estudadas foram sexo, idade, escolaridade, estado civil, ocupação, local do suicídio, se houve atendimento médico e causa básica da morte (de acordo com a Classificação Internacional de Doenças ­ CID-10). Procedeu-se a análise estatística descritiva e inferencial, adotando nível de significância de 5,0%. Resultados: 105 pessoas morreram vítimas de suicídio, com prevalência do sexo masculino (75,2%), entre 20 e 39 anos (41,9%), sendo a residência (73,3%) o local de eleição para a prática suicida. Quanto à forma, o enforcamento foi mais comum entre homens (57,1% e p=0,006) e a autointoxicação e o enforcamento (10,5% e p=0,006) entre mulheres. Não houve diferença estatisticamente significante quando o sexo foi relacionado ao estado civil (p=0,381), escolaridade (p=0,051) e ocupação (p=0,628). Conclusão: O perfil das vítimas de suicídio em João Pessoa nos anos de 2015 e 2016 foi de homens, adultos, solteiros, com baixa escolaridade, profissão relacionada à agricultura, ocorrendo, em sua maioria, na residência, por enforcamento (homens) e enforcamento e autointoxicação (mulheres)

Introduction: Suicide has been increasing in Brazil and worldwide, presenting itself as a public health problem. Objective: Outline the suicide victims profile in the city of João Pessoa/PB, Brazil. Material and Methods: Cross-sectional, descriptive and quantitative-approach study, through the evaluation of data presented in the Death Certificates of suicide victims in the years 2015 and 2016 issued by Nucleus of Forensic Medicine and Dentistry of João Pessoa city/PB ­ Brazil. The data were provided by the Epidemiological Surveillance of the Municipal Secretariat of João Pessoa. The variables studied were sex, age, schooling, marital status, occupation, place of suicide, if there was medical attention and basic cause of death, according to the International Classification of Diseases (ICD-10). Descriptive and inferential statistical analysis were used, with a significance level of 5.0%. Results: 105 people died of suicide, showing prevalence of males (75.2%), between 20 and 39 years (41.9%), and residence as being the place of choice for suicidal practice (73.3%). Regarding the method, hanging was more common among men (57.1% and p = 0.006) and autointoxication and hanging (10.5% and p = 0.006) among women. There was no statistically significant difference when genre was related to marital status (p = 0.381), schooling (p = 0.051) and occupation (p = 0.628). Conclusion: The suicide victims profile in the city of Joao Pessoa in the years 2015 and 2016 was man, adult, single, with low schooling, agriculture-related profession, mostly occurring in the residence, by hanging (men) and hanging and autointoxication (women)

Restorative Rehabilitation of a Patient with Generalized Non-Carious Cervical Lesions: Case Report / Rehabilitación restaurativa de un paciente con lesiones cervicales no-cariosas generalizadas: Reporte de un caso

ABSTRACT Non-Carious Cervical Lesions (NCCL) are a current problem of multifactorial origin that is associated with the loss of vertical occlusal dimension, hypersensitivity, loss of teeth, fractures, and many other pathologies that affect the masticatory function of the oral cavity. Identification of the etiological factors of NCCL comprises a key piece for the solution of the problem. Based on clinical scientific evidence related with the diagnosis, a restorative treatment must be planned according to the loss of dental structure in order to return function and aesthetics. The purpose of this case report was to describe a 54-year-old male patient who was diagnosed with generalized NCCL combined with occlusal vertical dimension loss. The protocol of the treatment process is described.

RESUMEN Las lesiones cervicales no cariosas (LCNC) son una problemática actual de origen multifactorial, la cual se ve asociada a la pérdida de dimensión vertical oclusal, hipersensibilidad, pérdida de dientes, fracturas y muchas otras patologías que afectan la función masticatoria de la cavidad bucal. La identificación de los factores etiológicos de las LCNC son piezas claves para la solución del problema. Basados en la evidencia científica clínica relacionado con el diagnóstico, se debe planificar un plan de tratamiento restaurativo que depende de la pérdida de la estructura dentaria para devolver la función y estética. El objetivo de este reporte de caso es describir a un paciente masculino de 54 años a quien se le diagnosticó LCNC generalizadas combinado con una pérdida de dimensión vertical oclusal. El protocolo de plan de tratamiento es descrito paso a paso.