RESUMO
This article presents both a fatal suicide incident by Flobert 9 mm-type smoothbore weapon with a single-shot projectile and a nonfatal case of a suicide attempt by the same weapon type with a dispersion cartridge from the authors' forensic record. A retrospective study was conducted examining 84 cases involving cases of headshots inflicted by all kinds of weapons deriving from the broader region of Eastern Macedonia and Thrace (Northern Greece) between 2000 and 2015, among which only 1 involved lethal wounding by a Flobert 9 mm (1.19%). Only a single case report of a fatality with such a weapon has been described throughout international literature. A comparative study also follows between the 3 incidents. The authors argue that a prerequisite for the lethal outcome of the shooting is the absolute contact of the weapon to the head as well as its placement at an anatomical point where the bone resistance is relatively lower, so that the intracranial entry of the projectile is possible. It is also more harmful if the cartridge contains a single-shot projectile rather than multiple projectiles of smaller diameter.
Assuntos
Armas de Fogo , Traumatismos Cranianos Penetrantes/patologia , Ferimentos por Arma de Fogo/patologia , Idoso , Balística Forense , Humanos , Masculino , Suicídio , Tentativa de Suicídio , Adulto JovemRESUMO
STUDY DESIGN: Case report. OBJECTIVE: To report a case and review the literature on glioblastoma multiforme (GBM) with drop-like metastasis to the spine. SUMMARY OF BACKGROUND DATA: GBM constitutes the most common adult malignant brain tumor with poor prognosis. Spinal metastases of this malignancy are quite rare and dissemination usually occurs late in the course of the disease. However, recent advances in cancer treatment prolongate survival and provide adequate time for these metastases to give clinical symptoms. METHODS: We hereby present a case of a 57-year-old woman with a history of pineal GBM treated by stereotactic biopsy, chemotherapy, and radiotherapy, readmitted 38 months later due to gait disturbance, spastic paraparesis, edema of lower limbs, bilateral positive Babinski response, and loss of bladder control. A contrast-enhanced magnetic resonance imaging demonstrated an intramedullary lesion extending from C7 to T3 level. A T1 and T2 laminectomy was undertaken followed by extensive biopsy. RESULTS: Histologic examination was consistent with GBM. No further treatment was given, and the patient died 2 months after the diagnosis of the spinal metastasis. CONCLUSION: Spinal metastases should be commonly suspected in patients with a history of intracranial GBM who complain about symptoms not explained by the primary lesion.Glioblastoma multiforme (GBM) was first described by Rudolph Virchow in 1863 and represents the most common and most malignant tumor of the cerebral hemispheres, usually arising between the ages of 40 and 60 years. The incidence in Europe and North America is 2 to 3 cases/100,000 per year, and 75% of the patients die within 18 months after diagnosis. It is an infiltrating malignancy that recurs locally and it may spread along compact fiber pathways such as corpus callosum, optic irradiation, anterior commisure, and fornix or via cerebrospinal fluid (CSF) pathways. However, when GBM is under apparent control, spinal metastases are clinically rarely detected. Although involvement of the spinal cord (SC) has been noted with increasing frequency in recent years, literature provides only a few well documented cases.
Assuntos
Neoplasias Encefálicas/patologia , Glioblastoma/secundário , Glândula Pineal/patologia , Neoplasias da Coluna Vertebral/secundário , Evolução Fatal , Feminino , Glioblastoma/cirurgia , Humanos , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/cirurgiaRESUMO
Since 1905, the abdominal cavity has been used for absorption of cerebrospinal fluid in patients with hydrocephalus. We report a case of a 33-year-old female, in which a spontaneous extrusion of the peritoneal catheter of a ventriculo-peritoneal shunt through the intact abdominal wall occurred. We suggest that the rather hard peritoneal catheter eroded the abdominal wall, caused local inflammation, and then extruded through the skin. Additionally, the intestinal peristaltic movements, the omental activity and the intraabdominal pressure could play an adjuvant part, pressing direct the foreign body from the peritoneal cavity toward the skin.
RESUMO
BACKGROUND: The phenomenon of the spontaneous disappearance of herniated discs is well known. CASE REPORT: The case of a 74-year-old male presenting with a large disc herniation at L5-S1, experiencing moderate sciatic pain, and having the straight-leg-raising test positive at 30 degrees is presented. The disc herniation was documented by computed tomography. He was treated conservatively with medication and physical therapy. One year later the patient was clinically reevaluated. He proved to be symptom-free and the follow-up computed tomography revealed spontaneous disappearance of the herniated disc fragment. The disc regression could have been due to dehydration, resorption as a result of an inflammatory reaction, or retraction into the intervertebral space. CONCLUSIONS: This report discusses the three aforementioned possible explanations and underlines the need for limiting surgical treatment strictly to patients with neurological deficits, severe unremitting leg pain despite conservative measures, and repeated time loss from work.