Penetrating cardiac trauma: analysis of 240 cases from a hospital in Bogota, Colombia.

BACKGROUND: Trauma characteristics and its management is influenced by socioeconomic context. Cardiac trauma constitutes a challenge for surgeons, and outcomes depend on multiple factors including initial care, characteristics of the wounds, and surgical management. METHODS: This is a retrospective cross-sectional case series of patients with penetrating cardiac injuries (PCI) from January 1999 to October 2009 who underwent surgery in a trauma referral center in Bogotá, Colombia. Demographic variables, trauma characteristics, treatment, and outcomes were analyzed. RESULTS: The study included 240 cases: 96.2% males, mean age of 27.8 years. Overall mortality was 14.6%: 11.7% from stab wounds and 41.2% from gunshot wounds. Upon admission, 44% had a normal hemodynamic status and 67% had cardiac tamponade. About 32% had Grade II injuries and 29% Grade IV injuries. In 85% of the cases, there were ventricular compromise and 55% of patients had associated lesions. In 150 cases, a pericardial window was performed. Highest mortality occurred in wounds to the right atrium. In tamponade patients, mortality was 20% being higher for gunshot wounds (54.5%) than for stab wounds (18%) (p = 0.0120). CONCLUSIONS: The study evidenced predominance of stab wounds. Based on characteristics of the trauma, patients, and survival rate, there is most likely a high pre-hospitalization mortality rate. The difference in mortality due to stab wounds and those produced by gunshots was more related to technical difficulties of the surgical repair than with the type of injury established by the Injury Grading Scale. Mortality was higher in patients with cardiac tamponade. Surgical management was satisfactory using pericardial window as the diagnostic method and sternotomy as the surgical approach.

Forensic Veterinary Pathology: Sharp Injuries in Animals.

Sharp-force injuries are injuries caused by a mechanical force using sharp objects against the skin. Sharp-force injuries are mainly classified as stab, incised, chop, and therapeutic wounds and are less frequent than blunt-force injuries in animals. The analysis of the edges of the wound is crucial, especially if more than one type of lesion is involved. It may be difficult to differentiate between sharp trauma and blunt trauma, because lacerations can resemble incised wounds. The accurate documentation and examination of these injuries may indicate the instrument involved, the relationship between the animal and the perpetrator, and the force of the stab. Situations in which this type of trauma occurs may involve social violence, accidents, hunting, veterinary medical management, and religious rituals. The causes of death related to this type of trauma include hypovolemic shock, pneumothorax, or asphyxiation due to aspiration of blood. Necropsy findings should provide objective and unbiased information about the cause and manner of death to aid the investigation and further judgment of a possible crime.

Differences between postmortem computed tomography and conventional autopsy in a stabbing murder case.

OBJECTIVE: The aim of the present work is to analyze the differences and similarities between the elements of a conventional autopsy and images obtained from postmortem computed tomography in a case of a homicide stab wound. METHOD: Comparison between the findings of different methods: autopsy and postmortem computed tomography. RESULTS: In some aspects, autopsy is still superior to imaging, especially in relation to external examination and the description of lesion vitality. However, the findings of gas embolism, pneumothorax and pulmonary emphysema and the relationship between the internal path of the instrument of aggression and the entry wound are better demonstrated by postmortem computed tomography. CONCLUSIONS: Although multislice computed tomography has greater accuracy than autopsy, we believe that the conventional autopsy method is fundamental for providing evidence in criminal investigations.

Differences between postmortem computed tomography and conventional autopsy in a stabbing murder case

Objective: The aim of the present work is to analyze the differences and similarities between the elements of a conventional autopsy and images obtained from postmortem computed tomography in a case of a homicide stab wound. Method: Comparison between the findings of different methods: autopsy and postmortem computed tomography. Results: In some aspects, autopsy is still superior to imaging, especially in relation to external examination and the description of lesion vitality. However, the findings of gas embolism, pneumothorax and pulmonary emphysema and the relationship between the internal path of the instrument of aggression and the entry wound are better demonstrated by postmortem computed tomography. Conclusions: Although multislice computed tomography has greater accuracy than autopsy, we believe that the conventional autopsy method is fundamental for providing evidence in criminal investigations. .

Fatal footsteps: murder of undocumented border crossers in Maricopa County, Arizona.

In the past 5 years, the mortality rate among undocumented workers in Arizona has increased steadily. In 1998-1999, the number of deaths among border crossers was 28. That number increased dramatically in 1999-2000 to 106 and has exceeded 200 in each of the past 2 years. In the past, many immigrant deaths occurred as a result of dehydration and exposure (1). More recently, a new trend has emerged, that is, death of border crossers at the hands of the persons ("coyotes") hired to lead them across the border to safety. In some cases, the smugglers attempt to extort additional money from the families by holding the victims hostage once they have crossed the border into the United States. If the families fail to pay, the hostage is killed. Rival gangs are also murdering one another over their human cargo. Nine recent cases illustrate this trend in Maricopa County. In each example, the victims were bound, shot (or in one instance stabbed) and dumped in a remote desert area. All of the decedents were linked to murder for extortion by the ''coyotes'' or rival gang members.

A survey of cutlass ("Collins") injuries seen in the emergency department of the Queen Elizabeth Hospital in Barbados.

For the period March to November 1998 inclusive, a prospective survey was conducted of all patients who sustained injuries with a cutlass or machete and were admitted to the Accident and Emergency Department of the Queen Elizabeth Hospital. Of the 77 patient admissions, 81% (62/77) were male. The average age was 28.8 years (range 8 to 73 years; standard deviation 13.1). Twenty-two per cent of the patients were less than 20 years old. The most common locations of the lacerations were upper extremity (59 lacerations) and scalp (16 lacerations). Thirty-four per cent of the patients (26/77) sustained lacerations to two or more anatomical locations. There were 23 fractures in 21 patients; skull fractures were the most common fractures (11). Of the 63 patients who responded to the question on whether they knew the identity of their assailants, 51 reported that they were attacked by someone known to them; eight were assaulted by a spouse or known family member. Eighty-six per cent of patients (66/77) were treated in the emergency room and discharged. Of the 11 patients admitted, eight required treatment in the operating theatre. The average length of stay was 3.6 days. There were no amputations or deaths. One patient sustained loss of vision in one eye. In Barbados, most victims of cutlass injuries are males who know their assailants and the morbidity is most often related to head injuries and to short-term physical disability due especially to lacerations of the hand and forearm.

Machete injuries in Haiti.

Machete-related wounds are a source of appreciable morbidity in many developing nations. We describe a case of radial nerve injury resulting from a machete attack in Haiti. Twenty-two additional cases of machete-related wounds treated during a 3-month humanitarian mission to Haiti are reported. Sixty-five percent were accidental in nature, occurring from a variety of routine activities, whereas the remainder were secondary to assaults. The upper extremity was injured in 85% of the cases, often resulting in complicated wounds with nerve, tendon, and joint injuries. A treatment protocol for peripheral nerve injuries incurred in austere conditions is presented.