[Management of gunshot injuries of the extraperitoneal rectum]

The aim of this study was to analyze and compare the different lines of surgical management and associated complications of extraperitoneal rectal injuries sustained in Aleppo through Syrian war to get the best one of them. This is a prospective study. Between July 2012 and July 2014, 31 patients with gunshot injuries to the extraperitoneal rectum were treated at the Aleppo University Hospital. Patients with only intraperitoneal rectal injuries were not included in the study. The surgical management of rectal injuries was evaluated, specifically looking at the utilization of proximal diversion, distal washout, and presacral drainage. Complications were compared between the different lines of surgical management. Thirty one patients who sustained penetrating rectal injuries were included in this study. Surgical management included diversion and presacral drainage in 17 patients [55%], diversion alone in 9 patients [29%], and diversion, distal washout and presacral drainage in 5 patients [16%]. Complications were identified in 8 patients [26%]. There were two deaths in the study group. In this cohort most cases have been successfully managed by proximal diversion and presacral drainage. We have not seen any additional benefit when distal washout was performed; and we have not closed any extraperitoneal rectal injury because it is unnecessary, very difficult, and may be impossible or cause additional injuries

Falso negativo de actividad de la enzima adenosin deaminasa (ADA) en líquido pleural y falso positivo de tomografía con emisión de positrones 18f-fdg en un paciente con tuberculosis miliar / False negative activity of the enzyme adenosine deaminase (ADA) and false positive pleural fluid positron emission tomography 18f-fdg in a patient with miliary tuberculosis

En 2011, hubo 8,7 millones de nuevos casos de tuberculosis activa en todo el mundo, causando alrededor de 1,7 millones de muertes cada año; el número de nuevos casos (más de 9 millones) es mayor que en cualquier otro momento de la historia a nivel mundial. En muchas regiones en las cuales la tuberculosis es altamente endémica, el diagnóstico sigue basándose en la antigua microscopía de esputo. La determinación de (Adenosin Deaminasa) ADA en líquidos biológicos, especialmente en líquido pleural, ha resultado ser altamente sensible para el diagnóstico de Tuberculosis, con el beneficio, además, de ser una prueba rápida y económica. Presentamos el caso de un paciente masculino de 34 años de edad, con historia de abuso de ilícitos inhalados, hemicolectomia por herida de arma de fuego + colostomía y contacto intradomiciliario de tuberculosis. Cursa con caquexia, astenia, hiporexia, fiebre, tos y disnea. Durante la hospitalización se encontró anemia, trombocitopenia, derrame pleural tipo exudado, mononucleares, ADA negativo, lesiones pulmonares nodulares, y evidencia por estudios de imagen, de afectación ganglionar sistémica y ósea expresados como lesiones osteolíticas por TC y posteriormente con hiperactividad metabólica de la 8FDG por CT-PET. El diagnóstico microbiológico se obtuvo después de 8 semanas de hospitalización y fue infección por Micobacterium tuberculosis.

In 2011, there were 8.7 million new cases of active TB worldwide. this causes about 1.7 million deaths each year and the number of new cases (more than 9 million) is greater than at any other time. In many regions where TB is highly endemic, the diagnosis is still based on the old sputum microscopy. The (Adenosin Deaminase) ADA determination in biological fluids, especially in pleural fluid has proved to be highly sensitive for the diagnosis of tuberculosis, and has the benefit of being a quick and inexpensive test.We report the case of a 34 year-old male patient with abuse of illicit inhaled drugs, a hemicolectomy+ colostomy caused by an old gunshot wound and contact with intradomicilliary TB. He consulted because of cachexia, asthenia, hyporexia, fever, cough and dyspnea. During his hospitalization progressive pancytopenia appeared , as well as exudative pleural effusion with mononuclear cells, a negative ADA, nodular lung lesions, and images of lymph nodes and many bone osteolytic lesions seen by CT. Later metabolic hyperactivity 8FDG by CT-PET was found. The microbiological diagnosisby culture was Mycobacterium tuberculosis after 8 weeks of hospitalization.

Empiema posterior a trauma tóraco-abdominal / Empyema after thoraco-abdominal trauma

Evaluar la posibilidad de empiema en el trauma tóraco-abdominal con lesión de viscera hueca y diafragma. Estudio retrospectivo, descriptivo y transversal, realizado en un período comprendido entre los años 2002 y 2008. De un total de 304 pacientes ingresados con el diagnóstico de trauma tóraco-abdominal, se estudiaron 40 historias clínicas de aquellos que presentaron lesión de diafragma, en las cuales se evaluó el tratamiento efectivo a la lesión toracica y su seguimiento. Hubo 39 pacientes del sexo masculino (97,5 por ciento) y 1 femenino (2,5 por ciento), con edades comprendidas entre 13 y 60 años (promedio 27,9 años). El mecanismo de lesión más frecuente fue las heridas por arma de fuego con 33 casos (82,5 por ciento); arma blanca con 6 (15 por ciento) y trauma cerrado con 1 caso (2,5 por ciento). En todos los pacientes se dejo un drenaje torácico a través de una toracotomía mínima. En 3 de ellos (7,5 por ciento) se realizó la exploración del tórax a través de una toracotomía. Se reportaron 3 casos de empiema, todos en el grupo de toracotomía mínima como manejo de la lesión torácica. Lesiones de viscera hueca, inestabilidad hemodinámica y un ATI > 30 fueron los factores de riesgo más frecuentes asociados a la formación del empiema. En un trauma tóraco-abdominal con lesión de diafragma y viscera hueca, la contaminación del tórax es posible, por lo que sólo un drenaje torácico podría ser insuficiente para una adecuada limpieza de la cavidad pleural.

Application of confocal laser scanning microscope in forensic pathology / 法医学杂志

Confocal laser scanning microscopy(CLSM) is a new technique for microscopic imaging, which can collect the transverse section image of the samples and produce three-dimensional reconstruction and present higher spatial resolution than the conventional light microscope. As a precision instrument for the microscopic image, it plays an important role in forensic pathology. The article reviews the recent research achievements from sudden cardiac death, bullet wound and nervous system damage, etc, and explores the potential applications of the forensic pathology research and forensic practice.

Civilian cranial gunshot wounds: a Jamaican experience

Gunshot injuries are an escalating social and medical dilemma in many Western and some developing countries. Of 40 patients arriving at the University Hospital of the West Indies (UHWI), Jamaica, from 1993 to 1998, with gunshot wounds of the head, 30 were admitted. Six of those admitted died within 24 hours, five with poor Glasgow Coma scores. Ten patients had surgery, two of whom died. Six complications occurred: two patients each developed an infection, cerebrospinal fluid fistula or seizures. All patients were victims of an assault and all had intracranial penetration, the most common sites of which were facial and frontal. Median hospital stay was eleven days. The Glasgow Coma Score on admission was a good prognostic indicator. Fourteen patients had associated injuries, four of which were in the neck. Surgery was considered inappropriate for moribund patients and those with inaccessible bone and bullet fragments. Young males were the most common victims of this devastating form of assault

Clinical features of traumatic corneal endothelial rings

We report the clinical features and the course of traumatic corneal endothelial rings by trauma. Fourteen eyes (of fourteen patients) with traumatic endothelial rings (twelve cases of BB shot injury), were enrolled in this study. With median follow-up interval of 50 weeks, initial and final best corrected visual acuity, presence of combined injuries such as gross hyphema, and time of disappearance of traumatic endothelial rings were recorded. And specular microscopic examination was performed. The duration of existence of traumatic endothelial rings was mean 4.6 days. On the specular microscopic examination, the count of corneal endothelial cells in the injured eye decreased by mean 16.8% (ranged from 1 to 56%) than that in the opposite unjnjured eye. The duration of existence of traumatic endothelial rings was 3.5 days in the group without combined angle recession and was 6.1 days in the group with combined angle recession. We suggest that the possibility of traumatic corneal endothelial rings and resultant endothelial cell loss and their clinical potential should be always kept in mind in ocular trauma, particularly BB shot injury.

Variant pattern, autopsy findings and histopathological changes in suicidal gunshot injuries

The work was performed on 15 cadavers of suicidal gunshot injuries to studythe pattern, autopsy findings and histopathological changes of these cases. Autopsy was done and specimens were taken from the entrance and exit [ifpresent] wounds. Samples were processed and examined by light microscopy. The anatomical sites for the entrance wounds were in the temples [11 cases],the mouth [2 cases], the chin [one case] and the forehead [one case]. Thestudy revealed that most of the cases [73%] had perforating injuries of theskull and brain. Internal ricochet [single or double] was found in 4 cases. There was only marginal fracturing around the bullet holes in 27% of thecases, in the remaining cases [73%] there were secondary fractures mainly inthe orbital roofs. Microscopic examination of entrance and exit gunshotwounds disclose several histopathological changes that distinguish these 2types of injuries and that are often useful in establishing the range offiring

Bullet migration in the spinal subarachnoid space causing radicular symptoms

Bullet migration has been rarely reported. In this case report, we describe a 49-year-old woman who sustained a gun shot injury to the abdomen. After splenectomy for ruptured spleen, she developed weakness of the left lower limb [grade 3] and Babinski sign. Preoperative X-ray and CT scan of the spine showed the bullet at the level of S[1-2]. However, after laminectomy, the bullet was not in place and interoperative X-ray showed it in a new position at L[4-5]. The wound had to be extended and ultimately the bullet was removed. In patients with intraspinal bullets, preoperative fluoroscopy should be performed prior to surgical exploration

Management of hepatic trauma

A review of 32 consecutive patients with liver trauma admitted in two surgical units of Mayo Hospital, Lahore in the year 1994 is presented. Majority of patients were young [mean age 26.5 years] male [90.6%]. Penetrating injuries [81%] were far more common than blunt trauma. Firearm injury was later confirmed at laparotomy except in two stable patients where diagnosis was confirmed on ultrasonography. These patients were managed conservatively. Right lobe [59.4%] was primarily involved in trauma. According to Moore's classification of liver trauma, twenty two patients had Grade-1 and II injuries 9 had Grade III and IV and one had Grade V injury. Eighty percent of patients had associated injuries to other organs. Hepatorrhaphy [64.3%] was the commonest amongst the procedures carried out, others were Hepatoomentorrhaphy, [10.7%] resectional debridement with selective ligation of the vessels [14.3%] perihepatic packing [7.1%] and hepatic lobar resection [3.6%]. Morbidity in this series was 59.5% and mortality 12.5%

Trauma infanto juvenil / Trauma children and adolescents

Presentamos una revisión retrospectiva de los traumatismos en los menores de 18 años en el Hospital "Leopoldo Manrique" entre los años de 1981 a 1991, con el objeto de evaluar este problema de salud pública. Durante este lapso, 231 casos fueron operados por el Servicio de Cirugía, con predominio evidente del sexo masculino; 134 pacientes presentaron heridas por arma de fuego. Las lesiones abdominales fueron las más frecuentes (1991 pacientes), aun cuando muchos pacientes presentaron lesiones multisistémicas. Las vísceras huecas, hígado y vasos fueron la estructuras más comunmente lesionadas. La mortalidad de acuerdo al agente agresor fue de 119 por arma de fuego, cuarenta y nueve por accidentes de tránsito, veintiocho con armas blancas y sesenta y nueve por otras causas diferentes

major mandibular gunshot wound

A serious war-related gunshot wound sustained by a 28 year old Kuwaiti male and causing much loss of hard and soft tissues affecting the mandible, lower lip and tongue described