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At least 19 recordsLinked to original sources
PubMed1982

Ten years' experience with pediatric gunshot wounds.

Gunshot wounds in children have become a significant source of morbidity and mortality in our community in the last 10 yr. One hundred eight children, 16 yr of age and younger, were admitted to the Pediatric Surgical Service for gunshot wounds during this period; only 1 child was admitted for a gunshot wound in the 10 yr preceding this review. Rapid resuscitation and triage of major injuries directly to the operating room achieved a 94% survival. Review of the circumstances of injury revealed that 42% of the gunshot wounds were inflicted by children and 40% were known to have been intentional. Only 20% of the patients had known drug involvement; in general this was involvement in drug selling, not in drug abuse. Social service intervention can offer significant benefit to these children, but ultimately gun control laws with strict enforcement are needed to stop this type of violence toward children.

Accidents↗
PubMed1986

A correlation of response time and results of abdominal gunshot wounds.

Gunshot wounds to the abdomen are an indication for exploratory laparotomy in all cases except those involving the most superficial abdominal wall injuries. The charts of 123 patients admitted for abdominal gunshot wounds were reviewed for times of arrival on the scene by paramedics, in the emergency room, and in the operating room, as well as for number of admissions. Results of therapy were also graded and correlated with response times. The mean paramedic response time was 4 minutes 30 s. An average of 24 minutes 24 s was spent at the scene and in transport. The average delay from admission to arrival in the operating room was 1 hour 49 minutes. Patients who died spent an average of 54.4 minutes in the emergency room prior to surgical intervention. These results may represent justification for regionalization of trauma and direct transport to the operating room for abdominal gunshot wounds.

Abdominal Injuries↗
PubMed1996

In vivo effects of tumor necrosis factor-alpha on incised wound and gunshot wound healing.

Recombinant tumor necrosis factor alpha (TNF-alpha) was applied to incised wounds (adult rats, n = 14) and gunshot wounds (dogs, n = 5). The accumulation of RNA and DNA in regenerative tissue, the wound disruption strength (WDS), and histology were examined. The results showed that a single dose of TNF-alpha in saline with highly purified bovine serum albumin increased the WDS and accumulation of RNA and DNA in regenerative tissue in incised wounds 3 days after surgery (p < 0.05). Also, TNF-alpha promoted the inflammatory reaction in the wounded area of gunshot wounds. Histology revealed increased capillary tube-like structures and collagen formation and fibroblast proliferation in both incised and gunshot wounds treated with TNF-alpha. The results indicated that locally applied TNF-alpha benefited the incised and gunshot wound healing. These mitogenic and inflammatory effects of TNF-alpha may be the synergistic effects with other growth factors such as platelet-derived growth factor (PDGF).

Animals↗
PubMed1999

Digital nerve repair by autogenous vein graft in high-velocity gunshot wounds.

Gunshot wounds to the hands are high-energy injuries that cause widespread tissue damage, including to the nerves. Great difficulty is encountered in later reconstruction with nerve grafting of gaps in these destructive and scarred wounds. We present our experience with three patients with digital nerve repair by autogenous vein graft performed at an early stage in this type of injury. Based on our experience and that of others, this simple and rapid technique suggests a high rate of satisfactory results. It also avoids extensive and destructive late dissection and the morbidity associated with other late reconstructive procedures.

Adult↗
PubMed1981

Management of transmediastinal gunshot wounds.

Gunshot wounds that transverse the mediastinum are major management problems for two primary reasons: (1) multiple injuries to vital structures are common and (2) the operative approach to control hemorrhage may not afford the optimum exposure to repair the various injuries encountered. We devised a management plan whereby patients in hemodynamically unstable condition underwent immediate operation and patients in stable condition underwent a rapid work-up to evaluate the organs at risk for injury including angiography, esophagoscopy, esophagography, bronchoscopy, and pericardial exploratory surgery while under local anesthesia. A total of 76 patients were treated. Thirty-three patients in unstable condition underwent immediate thoracotomy for hemorrhage or shock or median sternotomy for cardiac tamponade. Multiple organs were injured (average 2.7) and the mortality rate was high (12 of 33) because of the severity of the injuries. Twenty-seven of 43 patients in stable condition required operation after the systematic evaluation disclosed injuries to the great vessels (11), esophagus (9), trachea and bronchi (6), and heart (6). Three patients died of delayed complications (6.9%). The 16 patients who were in stable conditions and had no demonstrable injury were closely followed without operation with one complication and one death from an associated abdominal injury. A management plan for this difficult subset of patients with penetrating thoracic trauma is detailed.

Adult↗
PubMedDate not supplied

Extremity gunshot wound and gunshot fracture in civilian practice.

The civilian gunshot wound is a low velocity injury. Temporary cavitation does not occur in the low velocity wound and damage is confined to the projectile pathway. Extensive debridement is not indicated for this injury. Surgical cleansing is used to convert the open, contaminated wound to a clean, closed wound. Reparative and definitive reconstruction then follow to restore form and function with minimized patient hazard.

Fracture Fixation↗
PubMed2006

Practical pathology of gunshot wounds.

CONTEXT: Gunshot wounds are the most common cause of homicidal death in the United States. Analysis and interpretation of fatal gunshot wounds is an important and common practice among forensic pathologists. Additionally, for pathology residents, it is an integral aspect of their training during their rotations at medical examiner or coroner offices. OBJECTIVE: The correct interpretation of gunshot wounds by forensic pathologists not only provides valuable information that can assist law enforcement in their investigation but also is essential for the final determination of manner of death. Discussion of the practical, basic, and essential skills required to interpret gunshot wounds include distinguishing a classic entrance wound from an exit wound; recognizing atypical entrance and exit wounds; utilizing the features of soot and stippling patterns to differentiate among contact, close, and distant range gunshot wounds; understanding of the trauma produced by gunshot wounds; and understanding the importance of recovering and documenting/handling any projectiles recovered at autopsy. DATA SOURCES: This article reviews numerous standard forensic pathology textbooks and the pertinent literature to formulate practical guidelines to assist the pathologist in the performance of forensic autopsies and the investigation of gunshot wound fatalities. CONCLUSIONS: Pathologists who perform investigations and autopsies to determine the cause and manner of death in gunshot wound cases must be aware of the implications, requirements, and pitfalls in interpretation of the injuries so that the examination fulfills its expectations to the community and the justice system.

Autopsy↗
PubMed1998

Selective management of renal gunshot wounds.

BACKGROUND: Gunshot wounds to the kidney have been managed traditionally by surgical exploration. Concerns over increased nephrectomy rates and unnecessary explorations have placed this method under scrutiny. Selective renal exploration based on solid clinical and radiographic criteria may be a safer alternative and deserves evaluation. METHODS: The medical records of 52 consecutive patients with renal gunshot wounds, who were managed between September 1994 and August 1995 by a protocol of selective exploration, were reviewed. Renal injuries were explored only if they involved the hilum or were accompanied by signs of continued bleeding. Main outcome measures were the numbers of kidneys lost, as well as the morbidity and mortality related to the management of the renal injury. RESULTS: Three patients died from associated injuries shortly after admission. Fifteen patients suffered complications but only two had complications directly associated with the renal injury. Thirty-two patients underwent renal exploration and 17 of them required nephrectomy for major renovascular or parenchymal trauma (grade IV and V). Renal exploration was successfully avoided in the remaining 20 patients. No kidneys were lost unnecessarily as a result of this policy. CONCLUSION: Mandatory exploration of all gunshot wounds to the kidney is not necessary. Injuries that produce stable peripheral haematomas do not require exploration.

Adolescent↗
PubMed1994

Suicidal gunshot wounds.

Suicidal gunshot wounds were reviewed for a 6 year and 6 month period with respect to age, sex, type of firearm, anatomical location of the entrance wound, alcohol use, location of the event and the presence of a suicide note. There was a total of 64 suicidal gunshot wounds, the majority of which were found in males. The most frequently used firearm was a shotgun, and the entrance wound was typically the head, the mouth being the most common although the exact location varied with the type of weapon used. Concomitant alcohol use was higher than in the overall suicide population. Most victims committed suicide in or around their dwelling and the majority failed to leave a suicide note.

Abdominal Injuries↗
PubMed1990

Cranial gunshot wounds.

Cranial gunshot wounds frequently produce devastating injuries to central nervous system structures. This article reviews pertinent principles of ballistics to explain several mechanisms of injury to the brain. A series of 21 consecutive cases of cranial gunshot wounds is presented outlining a protocol for management and identifying factors of prognostic significance.

Adolescent↗
PubMed1984

Biomechanics of femur fractures secondary to gunshot wounds.

Nonlethal gunshot wounds to the femur produce four classical types of fractures. The 'drill-hole,' incomplete, and 'butterfly' fractures have been described in both clinical and experimental settings. The remote spiral fracture, sometimes attributed to the fall on the femur after wounding, is unique to the weight-loaded femur. A mathematical model relying on the beam in bending and the mechanics of a cylindrical shell is offered. An experimental method utilizing an apparatus (the 'osteoclast') designed to apply torsion, bending, or combined forces to cadaveric long bones is discussed. Femur failure proximal or distal to the impact site of a projectile is a function of stress risers operating at relatively great distances. Predictable primary and secondary peak moment locations for fracture are illustrated.

Adult↗
PubMed2003

Penetrating chest gunshot wounds: conservative treatment.

Gunshot wounds, and in particular chest gunshot wounds, are becoming a growing problem in daily practice at many hospitals. Many authors propose a conservative attitude in certain cases. We present a patient with a chest gunshot wound successfully solved under conservative means and videothoracoscopic removal of the bullet.

Adult↗
PubMed2004

Ventricular injury following cranial gunshot wounds: clinical study.

Gunshot wounds to the head are usually fatal injuries, despite all medical and surgical interventions. Ventricular injury is a poor prognostic factor-for penetrating cranial gunshot wounds. Intraventricular hemorrhage and ventricular lacerations are the main components of such injuries. The incidence, management, and outcomes of cases of ventricular injury secondary to cranial gunshot wounds that were treated during a 9-year period at Gülhane Military Medical Academy were examined. The study group consisted of 67 consecutive patients who were admitted to the Department of Neurosurgery with the diagnosis of ventricular injury, with different penetration sites. The patients had been injured by either bullets or shrapnel. Surgical treatment was performed for all patients with ventricular injuries and 22 (32.8%) died. Ventricular injury in cranial gunshot wounds is a complex severe type of trauma that requires serious treatment. Early radiological diagnosis and accurate treatment frequently had lifesaving roles for these patients.

Adult↗
PubMed1997

Who fired the gun? A casuistic contribution to the differentiation between self-inflicted and non-self-inflicted gunshot wounds.

A fatal gunshot wound to the thorax from a .357 Magnum revolver is reported. The entrance wound was located dorsally at the transition of the right shoulder and the upper arm, the exit wound below the left axilla and a re-entry at the medial aspect of the left upper arm. A friend of the victim, who was present when the gunshot was fired, stated that it was a self-inflicted accident. But the inclusion of both upper arms in the trajectory allowed a comparison between the posture of the upper arms at the moment the gunshot was fired and the posture of the upper arms necessary for a self-inflicted gunshot wound. This reconstruction, which is presented in detail, definitely excluded a self-inflicted wound. The friend then confessed that he had fired the gun accidentally.

Accidents↗
PubMed1997

[Gunshot wounds of rectum].

The experience of treatment of 73 wounded with gunshot injuries of the rectum is reviewed. Classification of gunshot injuries of the rectum is proposed which permits to choose rational surgical policy depending on the location of the rectal injury is proposed. Terms of closing colostomas in remote periods after operation were determined. The authors believe that because of the complicated anatomo-topographic characteristics of the rectum and frequency of the combined injuries it is advisable to perform operations bor gunshot wounds of the rectum as an urgent specialized aid.

Emergency Treatment↗