Glass table tops: An unusual source of lethal domestic injury

A 42-year-old woman who fell through a glass tabletop had her lower back pierced by a long shard of glass. She rapidly exsanguinated. At autopsy, a single penetrating wound was present in her left lower back, with complete transection of her left kidney and a 3.5 L haematoperitoneum. Death was due to exsanguination following accidental transection of the left kidney by a penetrating glass injury of the lower back. Glass-topped tables are a well-recognised source of injury in a domestic setting There are far more non-lethal than lethal injuries, many of which involve children. Quite long shards may remain undetected in wounds for considerable amounts of time. Non-tempered glass is a particular risk for breakage. Glass-topped tables should not be used as substitutes for chairs, particularly in overweight or obese individuals.

Self-inflicted neck wounds under influence of lysergic acid diethylamide: A case report and literature review

RATIONALE

Lysergic acid diethylamide (LSD) is a highly potent psychedelic drug derived from ergot alkaloids. The available literature data derived from controlled studies or usage in a medical setting seem reassuring; however the literature contains very rare cases of fatal self-inflicted injuries associated with LSD exposure. The behavioral disorder that created the conditions conducive to death is a maladaptive or irrational response to the psychiatric manifestations induced by the substance.

PATIENT CONCERN

Here, we report the case of a 26-year-old man found dead with large neck wounds in a locked house. No medical history other than recreational use of alcohol and narcotics was reported as well as any history of psychotic disease. The entirety of the other investigations carried out did not demonstrate the presence of a third party at the place of death and a dropper bottle containing LSD was found near the body.

DIAGNOSIS

We report the first case of fatal self-inflicted neck wounds with a cutting instrument in the context of acute exposure to LSD in a patient with no psychiatric history and without suicidal symptoms at the time of the self-aggressive act.

INTERVENTION AND OUTCOMES

In the present work, we used a validated method using liquid chromatography coupled with mass spectrometry for simultaneous quantification of LSD and its metabolites (O-H-LSD and Nor-LSD) in whole blood and urine samples. LSD and O-H-LSD were respectively found at 1460 and 182 pg/mL in blood. In the urine, the concentrations of LSD, nor-LSD, O-H-LSD were, respectively, 3670, 201, and 4890 ng/L.

LESSONS

This observation is particularly relevant in view of the resurgence of interest in the therapeutic use of LSD, notwithstanding the fact that the literature has not demonstrated a link between suicidal risk and acute or chronic exposure to LSD.

The Avocado Hand

Accidental self-inflicted knife injuries to digits are a common cause of tendon and nerve injury requiring hand surgery. There has been an apparent increase in avocado related hand injuries. Classically, the patients hold the avocado in their non-dominant hand while using a knife to cut/peel the fruit with their dominant hand. The mechanism of injury is usually a stabbing injury to the non-dominant hand as the knife slips past the stone, through the soft avocado fruit. Despite their apparent increased incidence, we could not find any cases in the literature which describe the "avocado hand". We present a case of a 32-year-old woman who sustained a significant hand injury while preparing an avocado. She required exploration and repair of a digital nerve under regional anaesthesia and has since made a full recovery.

[The morphological characteristic of the skin lesions inflicted by plastic knives with four cutting edges]

The objective of the present work was to study the morphological features of the skin lesions inflicted by the blades of the Fgx Boot Blade I knives having four cutting edges. The study revealed the signs that can be used to distinguish between morphological characteristics of the stab and lacerated wounds having the primary and secondary incisions made by the four-edge blade.

Large piece of wood board removal and long term survival in a patient with stabbed thoracic wound - case report

Stabbed thoracic trauma is quite common in military practice,but they very rarely occur in civilian life, where they are predominantly accidental injuries. Thoracic stabbed wounds are more commonly observed in men than in women and in younger rather than older people. The management and prognosis depend on the composition, size and location of the foreign body. A 28-year-old Caucasian woman presented to the emergency room with hemorrhagic shock, a large stabbed wound and retention of a large piece of wood board.Less than 10 minutes after arriving to the emergency room she underwent open surgical thoracotomies and resection of the spleen rupture without any significant postoperative complications. At the end of the procedure the left breast was reconstructed. The original aspects of this case are the singularity of the foreign body and its relative harmlessness in spite of its large size.

[Certain peculiarities of trace formation associated with the infliction of stab wounds]

The objective of the present study was to elucidate the detailed morphological picture of stab injuries taking into consideration the design of the piercing objects, conditions of wound infliction, and properties of the affected tissues. The experimental injuries were inflicted either by an impact action or compression at an angle of 90 and 45-60 degrees using sharp (0.01 mm) and blunt (0.5 mm) piercing cylinder-conical bevel-edged (40 mm) objects 7 mm in diameter. A total of 128 skin injuries were available for the examination. It was shown that the shape, length, and orientation of the wounds depended on the sharpness of the injurious agent, the angle at which and the speed with which it was stabbed into the tissue. The new morphological features were identified associated with plastic deformation of the skin, viz. the shape of the wound opening, smoothness or borderline thickening of its edges, flattening and folding of epidermis; conditions for the formation of these features were investigated. These data are of importance for the individual and intra-group expert identification of the putative traumatic agents and reconstruction of the circumstances of a given event or offence.

[Forensic medical expertise of the stab wounds: the current state-of-the art]

This review of special literature encompasses the publications on the injuries inflicted by piercing objects. The results of analysis of these materials indicate that both the mechanisms of formation and the morphological features of stab wounds and damages to the clothes are studied perfectly well. Their shape and morphological patterns are shown to be dependent on the size, shape, and cross-section area of the great variety of the piercing objects. However, investigations carried out thus far did not take into consideration the formation of the signs of skin plastic deformation, such as edge portions of borderline thickening, stretching of epidermis over the walls, transformation of the epidermal network pattern into longitudinal folding, etc. It is concluded that further studies are necessary to better characterize injuries inflicted by piercing objects differing in the sharpness and the shape of cross section and thereby to obtain a deeper insight in the morphological features. It can be expected that such studies will provide a basis for the development of criteria for the individual and intra-group expert identification of the traumatic agents.

[The morphological features of stab-and-slash skin wounds inflicted by the blades with differently shaped tips through the multilayer barrier]

The objective of the present work was to study the shape, size, and morphological features of stab-and-slash skin wounds inflicted by the blades with differently shaped tips taking into consideration the direction of stab through multiple garments (1, 2, and 3 layers). The injuries were inflicted by kitchen knives having the blades of practically identical length and width but differently shaped tips. A total of 480 skin wounds and 720 damaged cloth specimens were available for the examination. The analysis of the data obtained revealed differences between morphological features of the skin wounds. Injuries to the skin unprotected by the cloths had different shape and length of the edge and end portions depending on the shape of the blade tip and the direction of the stab. The length of all wound inflicted through the barrier decreased as the number of layers increased. The wounds had the linear shape, their contusion collar and flattened area became narrower; the shape of the back edges of the wounds inflicted through a three-layer barrier altered. It is concluded that the result of the present study may be useful for the improvement of diagnostics of stab-and-slash skin wounds.

Endovascular stent-graft treatment for a traumatic vertebrovertebral arteriovenous fistula with pseudoaneurysm

The rarely occurring vertebrovertebral arteriovenous fistula (VVAVF) is characterized by abnormal direct communications between the vertebral artery or its branches and the neighboring venous system. We present our experience using a stent graft to occlude a chronic, traumatic VVAVF. A 40-year-old woman with dizziness and loud bruits from the occiput underwent digital subtraction angiography (DSA), which revealed a VVAVF with pseudoaneurysm at the C5-C6 level, with retrograde flow from the right vertebral artery. A stent graft was placed across the fistula after balloon dilation. The fistula and pseudoaneurysm disappeared immediately. After 9 months, the patient remained asymptomatic with a patent stent.

K2 toxicity: fatal case of psychiatric complications following AM2201 exposure

Limited forensic and clinical experience and the lack of confirmatory testing strategies for synthetic cannabinoids (SC) prevent adequate characterization of SC toxicity and the potential impact on public health. A statewide surveillance system identified a fatality involving a 23-year-old man found with a large stab wound to the neck following use of a SC product suspected of containing AM2201. Analytical testing for common SCs, SC metabolites, routine drugs of abuse, and over-the-counter medications was performed on heart blood obtained at autopsy. Additionally, assays were performed on the SC raw material and drug paraphernalia found on the decedent. High concentrations of AM2201 were detected in all samples. AM2201 metabolites were detected in postmortem blood. Other than a trace amount of JWH-073 found in smoke residue, no other substances were detected. Psychiatric complications including self-induced, lethal trauma can occur after the use of SC products.

Aneurysm of the internal carotid artery after minor trauma

We report a rare case of posttraumatic aneurysm of the internal carotid artery. The aneurysm was surgically removed, followed by a simple postoperative course. Such lesions should be highly suspected in cases of penetration into the retroangulomandibular neck region.

[Peculiarities of expert assessment of a wound inflicted by a self-made projectile--a harpoon with the archery broadhead]

An attempt was undertaken to elucidate the concrete mechanism of wound infliction by a self-made projectile, such as a harpoon with the archery broadhead, based on the entire volume of evidence provided by the inquest. The results thus obtained allowed the potential for differential diagnostics of clothes and body damages caused by arrow-headed projectiles to be extended.

[Analysis of stresses developing in the evidence-bearing material affected by a bladed article]

The objective of the present study was to assess the possibility of using the finite element analysis for the elucidation of the mechanism of formation of stab-cutting injuries. Stresses developing in the evidence-bearing material at different stages of penetration of a bladed article are estimated. The three-dimensional modeling program was employed for the purpose. The finite element analysis demonstrated differing stress topography resulting from the prick of the blade and its plunging into the evidence-bearing material.

[Stab wounds in children]

Injuries are the most serious health risk in children. Injuries are the main cause of death and long term disabilities in children. Fortunately, stab wounds in children are very rare in our country, but they are, in most cases, very serious injuries. Presenting 3 case reports, this article aims to show the danger of stab wounds and how easily sharp objects can penetrate human tissue. In two out of the three case reports, a foreign object was remained inside the wound. When dealing with such injuries, this possibility must be considered the wound must be carefully inspected. When a revision is necessary, it should be carried out using minimally invasive methods in order to save the child from suffering extensive wounding which would result from the classical open approach revision.

Penetrating cardiac trauma in children

BACKGROUND

Penetrating cardiac traumas in children are dramatic and fatal. Many of the patients are admitted to hospital either in a state of shock or they are dead at presentation. In this study, we aimed to present our experience in penetrating cardiac trauma in children.

METHODS

Seventeen pediatric cases of penetrating cardiac trauma were retrospectively evaluated. The effects on the results of the demographic characteristics of patients, etiology of penetrating trauma, time of presentation to the hospital, physical examination findings in the emergency department, diagnostic methods used, and the surgical techniques applied were evaluated.

RESULTS

The male to female ratio of the 17 retrospectively evaluated cases was 16:1, with an age range of 3-15 years. The patients' mean age was 12.94+/-3.52 years. In all patients, the penetrating cardiac trauma was due to incisive/penetrating tools. The mean Ivatury physiologic index score was 8.23+/-0.78, whereas the mean cardiac injury organ scale score was 5.00+/-0.00. The hospital mortality rate was 5.9% due to the loss of one patient.

CONCLUSION

Shock may develop in pediatric penetrating cardiac trauma in a short time due to hemorrhage and/or cardiac tamponade. The prime factors for patient survival are early diagnosis and emergency thoracotomy.

Stab wound of the cervical spinal cord and ipsilateral vertebral artery injury

Stab wound of the cervical spinal cord with ipsilateral vertebral artery injury is rare. We report a case of a penetrating injury by scissors to the cervical spinal cord and right vertebral artery. The management is discussed and literature reviewed.

Pistol crossbow injuries

This article describes the wounding potential of pistol crossbows to prepare nurses who may have to provide immediate care for patients with injuries from these inexpensive and readily available weapons.

[Identification of the mode of stab-and-hack wound infliction to the chest based on wound features]

The objective of this study was to obtain morphological characteristics of stab-and-hack wounds inflicted by falling down on the knife blade. A formula is derived based on the results of discrimination analysis that can be used in combination with wound morphological features to differentiate between chest stabbing modes.