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Tsitsipanis C, Papadimitriou I, Tsoukaras I, Moustakis N, Lazarioti S, Theofanopoulos AK, Kritikou G, Ntotsikas K, Simos P, Kokkinakis E, Karabetsos D, Vakis A. Remarkable Recovery After Severe Gunshot Brain Injury: A Comprehensive Case Study of Functional Rehabilitation. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e941601. [PMID: 38859569 PMCID: PMC11180484 DOI: 10.12659/ajcr.941601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
BACKGROUND Penetrating traumatic brain injury (TBI) caused by gunshots is a rare type of TBI that leads to poor outcomes and high mortality rates. Conducting a formal neuropsychological evaluation concerning a patient's neurologic status during the chronic recovery phase can be challenging. Furthermore, the clinical assessment of survivors of penetrating TBI has not been adequately documented in the available literature. Severe TBI in patients can provide valuable information about the functional significance of the damaged brain regions. This information can help inform our understanding of the brain's intricate neural network. CASE REPORT We present a case of a 29-year-old right-handed man who sustained a left-hemisphere TBI after a gunshot, causing extensive diffuse damage to the left cerebral and cerebellar hemispheres, mainly sparing the right hemisphere. The patient survived. The patient experienced spastic right-sided hemiplegia, facial hemiparesis, left hemiparesis, and right hemianopsia. Additionally, he had severe global aphasia, which caused difficulty comprehending verbal commands and recognizing printed letters or words within his visual field. However, his spontaneous facial expressions indicating emotions were preserved. The patient received a thorough neuropsychological assessment to evaluate his functional progress following a severe TBI and is deemed to have had a favorable outcome. CONCLUSIONS Research on cognitive function recovery following loss of the right cerebral hemisphere typically focuses on pediatric populations undergoing elective surgery to treat severe neurological disorders. In this rare instance of a favorable outcome, we assessed the capacity of the fully developed right hemisphere to sustain cognitive and emotional abilities, such as language.
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Affiliation(s)
- Christos Tsitsipanis
- Department of Neurosurgery, General University Hospital of Heraklion, Heraklion, Greece
- School of Medicine, University of Crete, Heraklion, Greece
| | - Ioanna Papadimitriou
- Department of Endocrine Surgery, Uppsala University Hospital (Akademiska), Uppsala, Sweden
| | - Ioannis Tsoukaras
- Department of Neurology, General University Hospital of Heraklion, Heraklion, Greece
| | - Nikolaos Moustakis
- Department of Neurosurgery, General University Hospital of Heraklion, Heraklion, Greece
| | - Sofia Lazarioti
- Department of Neurosurgery, General University Hospital of Heraklion, Heraklion, Greece
| | | | - Georgia Kritikou
- Department of Surgical Oncology, General University Hospital of Heraklion, Heraklion, Greece
| | | | - Panagiotis Simos
- Division of Psychiatry, Developmental Neuropsychology, School of Medicine, University of Crete, Heraklion, Greece
| | - Emmanouil Kokkinakis
- Department of Anesthesiology, General University Hospital of Heraklion, Heraklion, Greece
| | - Dimitris Karabetsos
- Department of Neurosurgery, General University Hospital of Heraklion, Heraklion, Greece
| | - Antonis Vakis
- School of Medicine, University of Crete, Heraklion, Greece
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Edwards D, Isa M. Effects of kinetic energy and firearm-to-target distance on fracture behavior in flat bones. J Forensic Sci 2024; 69:400-414. [PMID: 38251809 DOI: 10.1111/1556-4029.15462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/02/2024] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
This research implements a fractographic approach to investigate the relationships between kinetic energy, firearm-to-target distance, and various aspects of fracture behavior in gunshot trauma. Gunshot experiments were performed on pig scapulae (n = 30) using three firearms generating different muzzle (initial) kinetic energies, including a 0.32 pistol (103 J), 0.40 pistol (492 J), and 0.308 rifle (2275 J). Specimens were shot from two distances: 10 cm (n = 15) and 110 cm (n = 15). Features evaluated in fractographic analysis such as cone cracks, radiating cracks, crack branching points, and circumferential cracks could be easily identified and measured in flat bones and allowed for statistical comparison of crack propagation behavior under different impact conditions. Higher-energy bullets produced more radiating cracks, more crack branching points, and longer fracture lengths than lower-energy bullets. Distance had no significant effect on fracture morphology at the distances tested. That quantitative measures of crack propagation varied with energy affirms that kinetic energy transfer is important in determining the nature and extent of fracture in gunshot wounds and suggests it may be possible to infer relatively high- versus relatively low-energy transfer using these features. Ranges obtained with the three firearms exhibited considerable overlap, however, indicating that other variables such as bullet caliber, mass, and construction influence the efficiency of energy transfer from bullet to bone. Therefore, fracture morphology cannot be used to identify a specific firearm or to directly reconstruct the muzzle (initial) kinetic energy in forensic cases.
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Affiliation(s)
- Delaney Edwards
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, Lubbock, Texas, USA
| | - Mariyam Isa
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, Lubbock, Texas, USA
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Ząbkowski T, Brzozowski R, Durma AD. Renal injuries in conflict zones: a 6-year study of traumatic cases in Afghanistan. Confl Health 2024; 18:6. [PMID: 38183150 PMCID: PMC10770980 DOI: 10.1186/s13031-023-00566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE During hostilities, gunshot wounds are the most common cause of penetrating injuries. In 8-10% of abdominal injuries kidneys are involved. The treatment method include surgical or conservative treatment (fluids + blood components). METHODS Of 1266 combat trauma cases treated during 6 to 14 rotation of the Polish Military Contingent in Afghanistan, we extracted a subgroup of 44 kidney injuries. Corelation of trauma mechanism, PATI score, treatment methods, and outcomes was evaluated. RESULTS Out of the 41 renal injuries, 20 considered left, 18 right, and 3 both kidneys. There were no statistical significancy in injury lateralization (p = 0.669), and no differences regarding side of a trauma and quantity of blood component used for the treatment (p = 0.246). Nephrectomy was performed on 17 patients (13 left vs. 4 right). A significant correlation between PATI score and the need for a nephrectomy (p = 0.027) was confirmed. Penetrating trauma recquired higher number of blood components comparing to blunt trauma (p < 0.001). The renal salvage rate was in study group was 61.36%. The overall survival (OS) rate was 90.25% - 4 patients died due to trauma. CONCLUSIONS The damage side does not result in a statistically significant increase in the need for blood transfusions or differences in the PATI score. The mechanism of trauma does, however, affect the number of blood components required for treatment, particularly in cases of penetrating trauma. With the introduction of proper treatment, the overall survival rate exceeds 90%, even when opting for conservative treatment.
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Affiliation(s)
- Tomasz Ząbkowski
- Department of Urology, Miliary Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Robert Brzozowski
- Department of General and Oncological Surgery, 5th Military Clinical Hospital with Polyclinic, Cracov, Poland
| | - Adam Daniel Durma
- Department of Endocrinology and Radioisotope Therapy, Miliary Institute of Medicine - National Research Institute, Warsaw, Poland.
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Lee Young JT, Jarvis JK. Management of a Transaxial, Tricompartmental Gunshot Injury in a Low-Resource Tertiary-Care Center in the Anglosphere Caribbean. Cureus 2023; 15:e47516. [PMID: 38021818 PMCID: PMC10664692 DOI: 10.7759/cureus.47516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Trauma, both penetrating and blunt, consists of a significant percentage of surgical admissions in Caribbean hospitals. Due to financial constraints, ideal resources for optimal surgical management are not always available. Despite these disadvantages, successful outcomes for complex, emergent cases are achieved through a combination of timely clinical assessment, intervention, and ingenuity in using the resources at hand. In this case report, we describe a 17-year-old male who suffered major visceral injuries and presented in extremis from a single gunshot wound. While fleeing the scene of a crime, he was shot in his right pelvis, with the projectile exiting his left thorax. Injuries matching a transaxial gunshot trajectory that crossed the diaphragm and involved the pelvic, abdominal, and thoracic cavities were found on exploratory laparotomy. He survived through prompt surgical intervention and aggressive resuscitation during his postoperative intensivist care, a resource often unavailable in this setting. The patient's prognosis would have been guarded even in a developed country setting. This case highlights the potential that Caribbean healthcare institutes possess, and that given an improvement in resources, we can aim to match a developed country's standard of healthcare.
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Raza S, Thiruchelvam D, Redelmeier DA. Costs for Long-Term Health Care After a Police Shooting in Ontario, Canada. JAMA Netw Open 2023; 6:e2335831. [PMID: 37768661 PMCID: PMC10539992 DOI: 10.1001/jamanetworkopen.2023.35831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Importance Police shootings can cause serious acute injury, and knowledge of subsequent health outcomes may inform interventions to improve care. Objective To analyze long-term health care costs among survivors of police shootings compared with those surviving nonfirearm police enforcement injuries using a retrospective design. Design, Setting, and Participants This population-based cohort analysis identified adults (age ≥16 years) who were injured by police and required emergency medical care between April 1, 2002, and March 31, 2022, in Ontario, Canada. Exposure Police shootings compared with other mechanisms of injury involving police. Main Outcomes and Measures Long-term health care costs determined using a validated costing algorithm. Secondary outcomes included short-term mortality, acute care treatments, and rates of subsequent disability. Results Over the study, 13 545 adults were injured from police enforcement (mean [SD] age, 35 [12] years; 11 637 males [86%]). A total of 13 520 individuals survived acute injury, and 8755 had long-term financial data available (88 surviving firearm injury, 8667 surviving nonfirearm injury). Patients surviving firearm injury had 3 times greater health care costs per year (CAD$16 223 vs CAD$5412; mean increase, CAD$9967; 95% CI, 6697-13 237; US $11 982 vs US $3997; mean increase, US $7361; 95% CI, 4946-9776; P < .001). Greater costs after a firearm injury were not explained by baseline costs and primarily reflected increased psychiatric care. Other characteristics associated with increased long-term health care costs included prior mental illness and a substance use diagnosis. Conclusions and Relevance In this longitudinal cohort study of long-term health care costs, patients surviving a police shooting had substantial health care costs compared with those injured from other forms of police enforcement. Costs primarily reflected psychiatric care and suggest the need to prioritize early recognition and prevention.
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Affiliation(s)
- Sheharyar Raza
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Ontario, Canada
| | - Donald A. Redelmeier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Ontario, Canada
- Institute for Health Policy Management and Evaluation, Ontario, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
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Konoplitskyi V, Dmytriiev D, Sidoryk M, Dobrovanov O, Vidiscak M. A 16-Year-Old Ukrainian Boy Shot at Close-Range to the Back of the Neck with a Handgun Who Required Surgical Removal of a 9×18-mm Bullet Shell from the Left Posterior Maxilla and Recovered Following Physical Therapy. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e939413. [PMID: 36928329 PMCID: PMC10030061 DOI: 10.12659/ajcr.939413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/13/2023] [Accepted: 01/26/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND The conflict in Ukraine during the past year has resulted in increased deaths and injuries to soldiers and civilians from military weapons and large and small caliber firearms. Unlike clinicians in some Western countries, until recently, clinicians working in Ukraine hospitals had little experience managing patients with gunshot wounds. CASE REPORT A 16-year-old boy was admitted as an emergency following a gunshot wound to the back of the neck from a Makarov pistol. The gun was reported to have been fired at a distance of more than 15 cm. Imaging showed the 9-mm bullet hit the cervical spine, causing nerve root involvement at C4 to C7, traveled upwards, and lodged in the left posterior maxilla. On examination, the patient had facial asymmetry and paralysis of the left shoulder, arm, hand, and wrist and was in pain and shock. Intubation and emergency surgery were performed, with the removal of a 9×18-mm bullet shell from the pterygopalatine fossa, deep to the infratemporal fossa, and posterior to the maxilla. The patient underwent postoperative physical therapy and continues to improve his physical function. CONCLUSIONS This report has shown the importance of immediate evaluation of gunshot wounds so that surgery can be planned and performed rapidly, with a view to postoperative recovery and active physical therapy.
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Affiliation(s)
- Viktor Konoplitskyi
- Department of Pediatric Surgery, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Dmytro Dmytriiev
- Department of Pediatric Surgery, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Mykola Sidoryk
- Department of Pediatric Surgery, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Oleksandr Dobrovanov
- A. Getlik Clinic for Children and Adolescents, Slovak Medical University and University Hospital, Bratislava, Slovakia
- Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Marian Vidiscak
- A. Getlik Clinic for Children and Adolescents, Slovak Medical University and University Hospital, Bratislava, Slovakia
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Motamedi DS, Fitzgerald ZT, Schmit B, Mushtaq R. Spectrum of injuries with "less-lethal" beanbag weapons: pictorial essay. Emerg Radiol 2023; 30:119-126. [PMID: 36401711 DOI: 10.1007/s10140-022-02104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
Beanbag weapons are gaining popularity with increasing daily use as a non-lethal or less-lethal alternative to traditional firearms. While these are considered "less-lethal," these are associated with a spectrum of serious injuries. We present a pictorial essay of these injuries ranging from mild skin contusions to more severe solid organ injuries.
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Affiliation(s)
- Damon Salar Motamedi
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Berndt Schmit
- Department of Radiology, George Washington University, Washington, DC, USA
| | - Raza Mushtaq
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA.
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