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PubMedDate not supplied

[Thoracic stab wounds].

Stab wounds are the most common cause of open chest wounds in our setting, with an incidence far higher than either wounds caused by firearms or bull horns. We describe a series of 49 patients, 44 (89.8%) men and 5 (10.2%) women. Mean age was 31 years. The 49 patients had suffered 72 stab wounds to the chest, of which 30 (41.6%) were penetrating and 42 (58.3%) were non penetrating. The lesions observed were 11 (22.4%) cases of pneumothorax, 10 (20.4%) of hemopneumothorax, 6 pulmonary lesions, 2 heart wounds and 1 extensively damaged diaphragm. Twenty-four patients with non penetrating wounds and 8 with penetrating wounds were treated conservatively. It was subsequently necessary to drain the chest of only one. Of the remaining penetrating wounds, drains were inserted in six immediately and 11 underwent surgery. Complications developed in only 9 cases. One patient died as a result of abdominal lesions resulting from stab wounds directly to the abdomen. We are in favor of conservative management. Indications for more aggressive intervention are hypovolemic shock, cardiac tamponade or significant loss of fluid through the thoracic drain.

Adolescent↗
PubMed1991

[Morphometric findings of stab wounds].

Stabbing experiments with a single-edged blade on skin preparations taken from three regions of the body (anterior chest wall, abdominal walls, lumbar region) showed the following results: The most gaping stab wounds were found, as anticipated, if the blade was stabbed perpendicular to Langer's lines. If the blade entered parallel to these lines, which depend on the pattern of cutaneous fibres, narrow slit-like wounds were produced; the dimensions of wounds from stabs at an angle of 45 degrees were between the two extreme patterns. The length of the skin wounds in orthograde stabbing (without cutting movement) was greater in the abdominal region than in the chest and lumbar regions, but never reached the full width of the penetrated blade, not even after restoration (by approximating the edges of a gaping wound).

Humans↗
PubMed2005

NG2 proteoglycan-expressing cells of the adult rat brain: possible involvement in the formation of glial scar astrocytes following stab wound.

Stab wound lesion to the adult central nervous system induces strong proliferative response that is followed by the formation of a dense astroglial scar. In order to determine the origin of those astrocytes composing the glial scar, the cell proliferation marker bromodeoxyuridine (BrdU) was administered to lesioned rats that were fixed 3 h or 6 days later. At 3 h after the BrdU administration, labeled nuclei were frequently associated with either NG2(+) cells or microglia/macrophages, but rarely with astrocytes expressing glial fibrillary acidic protein (GFAP). Six days later, by contrast, numerous BrdU-labeled nuclei were associated with astrocytes located along the lesion borders. After the injection of a viral vector of the green fluorescent protein (GFP) into the lesional cavity, GFP was preferentially detected within NG2- or GFAP-labeled cells when lesioned animals were fixed 1 or 6 days after the injections, respectively. The combined detection of glial markers within cells present in the lesioned area indicated that, although they rarely express GFAP, the marker of mature astrocytes, NG2(+) cells located along the lesion borders frequently express nestin and vimentin, i.e., two markers of immature astrocytes. Lastly, chronic treatment of lesioned rats with dexamethasone was found to inhibit the proliferation of NG2(+) cells present within the lesioned area and to subsequently alter the formation of a dense astroglial scar. Taken together, these data strongly suggest that following a surgical lesion, at least a portion of the astrocytes that constitute the glial scar are issued from resident NG2(+) cells.

Animals↗
PubMed1989

[Isolated stab wound without preliminary stab wounds--suicide or homicide?].

The diagnosis suicidal or homicidal stab injury of the heart affords a very close cooperation of the police and the forensic pathologist. In the first six months of 1988 the institut of forensic medicine of the MHH was obliged to four cases of isolated stab wound of the heart without other injuries with the question of suicidal action. The differentiation between suicide and homicide in two fatal cases was possible, considering as well autopsy results, as the facts found at the place of death and surrounding investigation results.

Adult↗
PubMed1981

Effect of ethanol, chlorpromazine and dexamethasone on blood-brain barrier dysfunction to albumin around large cerebral stab wounds.

Stab-wounded ethanol-intoxicated and non-intoxicated albino rats subjected to chlorpromazine or dexamethasone treatment were studied with respect to blood-brain barrier (BBB) dysfunction. Fifteen h after inflicting large cerebral stab wounds (diameter 400 microns), the animals were intoxicated with ethanol by ip injections or kept as non-intoxicated controls. One h later, the animals were either subjected to intravenous injections of chlorpromazine or dexamethasone or kept as non-treated controls. After intravenous injection of Evans blue-labelled albumin (EBA) or bovine serum albumin only, the rats were killed by intra-aortal perfusion and the BBB dysfunction was studied by fluorescence microscopy or measured by rocket immunoelectrophoresis. In the non-intoxicated group, fluorescence microscopy revealed a considerable decreased area showing extravasation of EBA around the stab wound in rats treated with chlorpromazine. In ethanol-intoxicated, compared to non-intoxicated rats, the area showing extravasation of EBA was not enhanced as studied by fluorescence microscopy. This extravasation was substantially decreased by chlorpromazine treatment, but not affected by dexamethasone. Immunoelectrophoretic assays of the amount of albumin extravasated around the stab wound confirmed the effect of chlorpromazine on the blood-brain barrier dysfunction to bovine albumin in both ethanol-intoxicated and non-intoxicated rats.

Alcoholic Intoxication↗
PubMed1993

Isolated paraplegia from a remote stab wound.

A stab wound to the right flank of a 24-year-old man produced immediate paralysis of both legs but spared sensation. Recovery was slow but sufficient to allow walking with a cane. Radicular artery interruption, in combination with systemic hypotension, is presumed to have caused selective watershed infarction of the spinal cord. Strokes of the spinal cord after trauma are rare, and those at a thoracic level usually represent delayed infarctions after pediatric chest or abdominal injuries. Our patient sustained an immediate and highly selective infarction.

Adult↗
PubMed1985

Local wound exploration of anterior abdominal stab wounds.

At least 25% of stab wounds of the abdomen are superficial. This can be determined in the ED by local wound exploration. If there is no penetration of the posterior fascia as determined by the technique herein described, the patient can be discharged from the emergency department after adequate local wound care is given. Because the patient is not admitted if exploration is negative, this is a safe and cost-effective method of managing superficial stab wounds of the abdomen.

Abdominal Injuries↗
PubMed1989

Prospective trial of the six hour rule in stab wounds of the chest.

Stab wounds of the chest may be associated with a spectrum of injuries ranging from the lethal to the insignificant. The management of asymptomatic patients with stab wounds of the chest is controversial. The results of previous reports have asserted that asymptomatic patients with stab wounds of the chest do not have delayed complications develop if roentgenograms of the chest taken six hours after the injury are normal. This "rule" has not been validated. A three year, prospective study of patients with stab wounds of the chest was done. Patients were excluded from the study if they had symptoms on arrival, evidence of physiologic derangement caused by intrathoracic injury, wounds near the subclavian vessels or precordial wounds. Patients with lower thoracic stab wounds were evaluated by diagnostic peritoneal lavage. If findings from lavage were negative, the patients were included in the study. One hundred and five patients met the criteria for inclusion in the study group. All of the patients were hospitalized and examined serially. All had roentgenograms of the chest performed at admission, at six hours and at 24 hours. Four patients had a pneumothorax or hemothorax develop between the time of admission and six hours of hospitalization. In the remaining 101 patients, none had a pneumothorax or hemothorax between six and 24 hours. No patient asymptomatic on admission had a tension pneumothorax develop later. No patient had delayed evidence of abdominal injury. An asymptomatic patient with a stab wound of the chest that is not precordial, not in proximity to the subclavian artery and not suspected of diaphragmatic penetration should be serially examined and have a follow-up roentgenogram of the chest at six hours. If the patient remains asymptomatic and the six hour film is normal, delayed complications are rarely, if ever, encountered and the patient does not require further studies or hospitalization. The six hour rule for stab wounds of the chest is valid.

Adolescent↗
PubMed1992

Selective surgical management of renal stab wounds.

Patients with stab wounds and haematuria were selected for surgical exploration if they had signs of severe blood loss, an associated intra-abdominal laceration or major abnormality on the intravenous urogram (IVU). Patients without these signs were selected for non-operative management, consisting of bed rest, an intravenous antibiotic for 24 h and regular observation. Of 95 patients, 60 (63%) were selected for non-operative management (Group 1) and 35 (37%) were selected for primary surgical exploration (Group 2). At surgery in Group 2, a major renal injury and/or associated intra-abdominal laceration was found in 31 patients. Thus a probably unnecessary operation was performed in only 4 patients (4% of the whole group of 95 patients). Renal complications occurred in 12 of the 60 patients (20%) in Group 1 and consisted mainly of secondary haemorrhage caused by an arteriovenous fistula (AVF) or pseudo-aneurysm. Management of the renal complications included segmental artery embolisation in 6, nephrectomy in 2, heminephrectomy in 1, open surgical ligation of an AVF in 1 and spontaneous resolution in 2 patients. The mean period of hospitalisation was significantly shorter in Group 1 (6.1 days) than in Group 2 patients (9.9 days). Comparing the Group 1 patients who developed renal complications with those who did not, we would recommend more aggressive selection for surgery of those patients exhibiting clinical signs of shock, a fall in haemoglobin during observation, a palpable abdominal mass, a haemothorax and/or pneumothorax ipsilateral to the renal injury, and IVU signs of extravasation, non-function, delayed excretion or hydroureteronephrosis due to blood clots.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

Diagnostic laparoscopy and laparoscopic transdiaphragmatic pericardial window in a patient with an epigastric stab wound: a case report.

Stab wounds to the abdomen can present a diagnostic dilemma to the trauma surgeon, especially in the thoracoabdominal region. Patients with lower chest and upper abdominal stab wounds are at risk for both intraabdominal and cardiac injury. Current options in the evaluation of these patients include mandatory laparotomy, diagnostic peritoneal lavage, thoracoscopy, sonography, and observation. Each has its own inherent advantages and disadvantages, but none of them represents the gold standard. Herein is reported a case of a patient with an epigastric stab wound who underwent diagnostic laparoscopy and laparoscopic transdiaphragmatic pericardial window to rule out both peritoneal penetration and cardiac injury.

Abdominal Injuries↗
PubMed1994

The mechanics of stab wounding.

The dynamics of stab wounds were investigated using a load cell connected to microcomputer-based measuring equipment. Two types of knife blade were attached to the load cell to assess the characteristics of stab wounds caused in pig tissue. The results show that as the blade progresses through the tissue it is resisted mostly by the skin, but a significant secondary resistance exists in the deeper muscle layers.

Animals↗
PubMed1979

Undiagnosed deep ulnar nerve paralysis resulting from stab wounds of the palm.

Stab wounds of the palm may cause laceration of the ulnar deep motor nerve. The acute diagnosis can be very difficult, since had sensation and major tendon function are uninvolved. Three cases are presented with ulnar deep motor paralysis secondary to stab wounds of the palm undiagnosed at the time of injury. The early diagnosis with nerve repair should yield excellent results and prevent permanent paralytic deformity.

Adult↗
PubMed2005

Fascial ultrasound for evaluation of anterior abdominal stab wound injury.

BACKGROUND: Local stab wound (SW) exploration to assess abdominal fascial integrity is a highly invasive procedure frequently performed under demanding circumstances in the Emergency Department (ED). We hypothesized ultrasound (U/S) may be useful in the detection of fascial defects resulting from anterior abdominal stab injury, eliminating the need for local wound exploration METHODS: Thirty-five hemodynamically normal patients evaluated at a Level I trauma center for anterior abdominal stab wounds were examined by U/S (8 mHz probe) for evidence of fascial violation. All patients were subsequently evaluated by local wound exploration RESULTS: Fascial U/S had an overall sensitivity of 59% and specificity of 100%, (PPV 100%, NPV 59%) for detection of fascial SW defects compared with local wound exploration. The sensitivity of fascial U/S for stab wound evaluation varied directly with experience of the sonographer CONCLUSIONS: A positive fascial U/S obviates the need for invasive SW exploration; however, a negative fascial U/S does not preclude the need for local wound exploration. Resident U/S training for specific penetrating injuries may reduce the need for abdominal SW fascial exploration in the ED.

Abdominal Injuries↗
PubMed1988

Stab wounds to the temporal fossa.

Stab wounds to the temporal fossa appear as a characteristic clinical entity. Patients admitted with stab wounds to the head during the period 1970 to 1986 were reviewed retrospectively. Of these, 10 met the criteria of having suffered a stab wound that penetrated the skull and dura mater of the temporal fossa. Injury to the internal carotid artery-cavernous sinus complex (3 patients) or to the basilar artery-pons region (5 patients) was frequent. Two other patients experienced injury to the trigeminal nerve and the petrous ridge. The mechanical, neurological, radiological, and prognostic features of knife wounds to this region are discussed.

Adult↗
PubMed1977

[A possibility for identification of the knife's edge in stab wounds (author's transl)].

It is known from forensic-medical practice that the wound track of stab wounds reflects the form and dimensions of the knife's edge, when there are no supplementary cuts. If the wound channel passes through compact organs (liver, kidney, spleen, etc) it can be exposed for direct observation by removing one of its sides which allows observation of the approximate form and dimensions of the knife's edge. It enables eliminatione of those weapons which do not fit. A case of homicide is described with 9 stab wounds, one of which penetrating the liver, where the above described method was successfully used. A case of an adult man's murder is described with 9 puncture wounds, one of which penetrating the liver, where the above described method was successfully used. A case of an adult man's murder is described with 9 puncture wounds, one of which penetrating the liver, where the above described method has been successfully applied.

Bulgaria↗
PubMed1989

[Clinical study on stab wounds of chest--factors that may influence their mortality].

Stab wounds of the chest occupy an important position in penetrating thoracic injuries in Japan. A retrospective review of 117 patients with stab wounds of the chest admitted to our hospital over the past 12 years (from 1975 to 1987) revealed some factors that might influence their mortality. Seven patients died from trans-diaphragmatic injuries of intra-abdominal organs. The management of intra-abdominal injuries was very important in thoracic stab wounds. Many of the patients with stab wounds of the precordial chest (danger zone) had cardiac or major vascular injuries, and the mortality rate of them was high. The mortality rate of the patients with stab wounds of the right lateral thorax was high, because many of them had trans-diaphragmatic liver injuries. We thought that right lateral thorax as well as precordial chest is the danger zone in thoracic stab wounds. Survival rate in the patients whose circulatory condition had been unstable when they admitted was very low. Five DOA (dead on arrival) patients with stab wounds of the chest required emergency room thoracotomy (ERT). One of them survived. Survival rate in the DOA patients with stab wounds of the chest was higher than that in the DOA patients with blunt thoracic injuries. ERT for cardiac insufficiency following stab wounds of the chest was thought an effective procedure for surviving. Survival rate of the patients with cardiac stab wounds was 63.6 per cent.

Adolescent↗
PubMed2004

Diagnostic value of "superficial" stab wounds in forensic practice.

Although detailed descriptions of important characteristics of stab wounds can be found in textbooks of forensic medical pathology, this case focuses attention on a relatively exceptional type of such wounds: the "superficial" stab wound. The "superficial" stab wound may be useful for considering and identifying the stabbing weapon which created the wounds; it is suggested a superficial stab wound has a shallow wound cavity which runs almost parallel to the surface of the body, thus showing that the incised angle of the stabbing weapon is acute to the body surface and that additionally its wound cavity shape may reflect the original profile of the weapon.

Adult↗