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Oliva A, Grassi S, Grassi VM, Pinchi V, Floris R, Manenti G, Colosimo C, Filograna L, Pascali VL. Postmortem CT and autopsy findings in nine victims of terrorist attack. Int J Legal Med 2021; 135:605-618. [PMID: 33420525 DOI: 10.1007/s00414-020-02492-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/17/2020] [Indexed: 12/26/2022]
Abstract
In a foreign country, a religious terrorist group raided a restaurant, using pipe bombs, sharp-edged weapons, and various types of firearms (handguns, submachine guns, and AK-47 assault rifles) loaded with normal and prohibited bullets to kill foreigner customers, some of whom were Italian tourists. Local pathologists performed forensic autopsies on the bodies, but we were asked to perform additional external examinations, postmortem computed tomography (PMCT) scans, and then a second round of complete autopsies on nine victims (5 females and 4 males). Four victims had slash wounds inflicted by sharp-edged weapons, mostly localized in the head and neck. All but two victims had gunshot wounds. Finally, three casualties had injuries caused by the explosion of improvised explosive devices. In all cases, PMCT was a reliable source of information and provided strategic guide during autopsies, helping identify and describe the injuries and thus reconstruct the events. Therefore, in these cases, we suggest integrating the autopsy findings with the postmortem radiological data.
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Affiliation(s)
- Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.
| | - Simone Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo M Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Vilma Pinchi
- Section of Forensic Medical Sciences, Department of Health Sciences, University of Florence, Florence, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Rome, Italy
| | - Guglielmo Manenti
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Rome, Italy
| | - Cesare Colosimo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Diagnostic Imaging Area, Fondazione Policlinico, Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Filograna
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Rome, Italy
| | - Vincenzo L Pascali
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
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Spanyer JM, Lands HM, Kelly SC, Page PS, Yakkanti MR. Understanding Nail Gun Injuries in Orthopedics: Mechanisms and Treatment. Orthopedics 2019; 42:e410-e414. [PMID: 31408523 DOI: 10.3928/01477447-20190812-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 10/25/2018] [Indexed: 02/03/2023]
Abstract
Nail gun injuries are common among users, and most frequently involve the hands and lower extremities. A wide variation in costs and time are missed from work due to these injuries, and training on the proper use of nail guns has been shown to decrease workplace-related injuries. Minimal long-term disability can be expected, and orthopedic evaluations provide an opportunity to inform patients on proper use of these devices. In this article, management of nail gun injuries is discussed, including the necessity for a high suspicion for wound contamination because foreign material is often deposited with the nail, as well as treatment with debridement and antibiotics. [Orthopedics. 2019; 42(5):e410-e414.].
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Watson E, Heng HG. FORENSIC RADIOLOGY AND IMAGING FOR VETERINARY RADIOLOGISTS. Vet Radiol Ultrasound 2017; 58:245-258. [PMID: 28233422 DOI: 10.1111/vru.12484] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 12/12/2022] Open
Abstract
Imaging studies are often of evidentiary value in medicolegal investigations involving animals and the role of the veterinary radiologist is to interpret those images for courts as an expert or opinion witness. With progressing interest in prosecuting animal crimes and strengthening of penalties for crimes against animals, the participation of veterinary radiologists in medicolegal investigations is expected to increase. Veterinary radiologists who are aware of radiographic and imaging signs that result in animal suffering, abuse, or neglect; knowledgeable in ways radiology and imaging may support cause of death determinations; conversant in postmortem imaging; comfortable discussing mechanisms and timing of blunt or sharp force and projectile trauma in imaging; and prepared to identify mimics of abuse can assist court participants in understanding imaging evidence. The goal of this commentary review is to familiarize veterinary radiologists with the forensic radiology and imaging literature and with the advantages and disadvantages of various imaging modalities utilized in forensic investigations. Another goal is to provide background information for future research studies in veterinary forensic radiology and imaging.
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Affiliation(s)
- Elizabeth Watson
- Department of Pathology, Immunology, and Laboratory Medicine, Veterinary Forensic Sciences, University of Florida College of Medicine, Gainesville, FL, 32610
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences, Purdue University, 625 Harrison Street, West Lafayette, IN, 47907
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Forbes JA, Laughlin I, Newberry S, Ryhn M, Pasley J, Newberry T. Stratification of risk to the surgical team in removal of small arms ammunition implanted in the craniofacial region: case report. J Neurosurg 2016; 125:661-6. [PMID: 26832604 DOI: 10.3171/2015.6.jns15779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In cases of penetrating injury with implantation of small arms ammunition, it can often be difficult to tell the difference between simple ballistics and ballistics associated with unexploded ordnances (UXOs). In the operative environment, where highly flammable substances are often close to the surgical site, detonation of UXOs could have catastrophic consequences for both the patient and surgical team. There is a paucity of information in the literature regarding how to evaluate whether an implanted munition contains explosive material. This report describes a patient who presented during Operation Enduring Freedom with an implanted munition suspicious for a UXO and the subsequent workup organized by Explosive Ordnance Disposal (EOD) Company prior to surgical removal. Clinical risk factors for UXOs include assassination attempts and/or wartime settings. Specific radiological features suggestive of a UXO include projectile size greater than 7.62-mm caliber, alterations in density of the tip, as well as radiological evidence of a hollowed-out core. If an implanted UXO is suspected, risks to the surgical and anesthesia teams can be minimized by notifying the nearest military installation with EOD capabilities and following clinical practice guidelines set forth by the Joint Theater Trauma System.
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Affiliation(s)
- Jonathan A Forbes
- Department of Neurological Surgery, David Grant Medical Center, Travis AFB, Davis, California
| | - Ian Laughlin
- United States 47th OD CO (EOD), Fort Hood, Killeen, Texas
| | - Shane Newberry
- Department of Radiology, San Antonio Military Medical Center, Lackland AFB, San Antonio, Texas
| | - Michael Ryhn
- Department of Oral Maxillofacial Surgery, Tripler Medical Center, Honolulu, Hawaii
| | - Jason Pasley
- Department of Surgery, University of Maryland, CSTARS-Baltimore RA Cowley Shock Trauma, Baltimore, Maryland; and
| | - Travis Newberry
- Department of Otolaryngology, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas
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Ling SNJ, Ong NCY, North JB. Eighty-seven cases of a nail gun injury to the extremity. Emerg Med Australas 2013; 25:603-7. [DOI: 10.1111/1742-6723.12143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - John Bevan North
- Orthopaedics; Princess Alexandra Hospital; Brisbane Queensland Australia
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