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Background: Stab wounds are rare, accounting for around 25 % of all spinal cord injuries. They are the most frequent cause of penetrating wounds and occur mainly after an assault or suicide attempt. We report two cases of penetrating stab wounds of the dorsal spine. Case description: A 35-year-old male patient with no known pathological history was admitted for open trauma to the dorsal spine following the stabbing. The diagnosis of a penetrating wound of the dorsal spine responsible for Brown Sequard syndrome was evoked. Magnetic resonance imaging (MRI) showed an intradural hematoma and raised suspicion of an anterior spinal cord contusion opposite D6. The patient underwent a laminectomy, which revealed an anterior intradural hematoma. The postoperative course was marked by full motor recovery.A 31-year-old male patient with no known pathological history was admitted with paraplegia following open trauma to the dorsal and lumbar spine. The diagnosis of a penetrating wound of the dorsal and lumbar spine responsible for terminal cone syndrome was evoked. Magnetic resonance imaging (MRI) suggested a dural hematoma or breach at D10, and spinal cord contusion at L2. The patient underwent laminectomy, with a dural tear of approximately and a spinal cord contusion on the lateral side of the cord at L1 and L2. Postoperative recovery was marked by complete sensory recovery, with no motor recovery. Conclusion: Stab wounds are rare, predominating dorsal spine injuries. MRI is the examination of choice. The prognosis depends on the nature and extent of the injury.

Purpose: The data concerning long-term follow-up and outcomes of penetrating trauma are poorly detailed in the literature. The main objective of our study was to analyze the hospital and extra-hospital follow-up of penetrating trauma victims and to evaluate the late complications and long-term consequences of these traumas. Methods: This work was a retrospective longitudinal monocentric observational study conducted at Laveran Military Hospital, from January 2007 to January 2017. All patients hospitalized for gunshot wound or stab wound management during this period were identified via a retrospective systematic query in the hospital information system using the ICD-10 codes. Epidemiological data, traumatism characteristics, hospital management, follow-up and traumatism consequences (i.e., persistent disability) were analyzed. To improve evaluation of traumatism long-term consequences, extra-hospital follow-up data from general physicians (GP) were collected by phone call. During this interview, 9 closed questions were asked to the GP. The survey evaluated: the date of the last consultation related to injury with the GP, the specific follow-up carried out by the GP, traumatism consequences, and recurrence of traumatism. Descriptive, univariate and multivariate with regression analysis were used for statistical analysis. Results: A total number of 165 patients were included. Median (Q1, Q3) of hospital follow-up was 28 (4, 66) days. One hundred one patients (61.2%) went to their one-month consultation at hospital. GP follow-up was achieved for 76 patients (55.2%). Median (Q1, Q3) of GP follow-up was 47 (21, 75) months. Twenty-four patients (14.5%) have been totally lost to follow up. The overall follow-up identified 54 patients (32.7%) with long-term consequences, 20 being psychiatric disorders and 30 organic injuries. Organic consequences were mainly peripheral nerve damages (n = 20; 12.1%). Most of the psychiatric consequences were diagnosed during GP follow-up (n = 14; 70%). Seventeen cases (10.3%) of recurrence were found and late mortality occurred in 4 patients (2.4%). High injury severity score, older age and gunshot wound were significantly linked to long-term consequences. Data collection and analysis were carried out in accordance with MR004 reference methodology. Conclusion: This study showed a high rate of long-term consequences among patients managed for penetrating injury. If all organic lesions are diagnosed during hospital follow-up and jointly managed by hospital and extra-hospital physicians, most socio-psychiatric consequences were detected and followed by extra-hospital workers. However, for half of the patients, the extra-hospital follow-up could not be assessed. Thus, these consequences are very probably underestimated. It appears imperative to strengthen the compliance and adherence of these patients to the care network. Awareness and involvement of medical, paramedical teams and GP role seems essential to screen and manage these consequences.

Introduction: Despite dramatic advances in the care of trauma patients over the last fifty years, cardiac stab wounds (CSW) remain highly lethal, and the specific relationship between serum lactate level and mortality is unknown. Methods: A retrospective review was conducted on all patients who presented with intraoperatively confirmed CSW from January 2008 to January 2020 at a major trauma centre in South Africa. Admission serum lactate level and patients' clinical outcomes were reviewed. Results: During the 12-year study period, a total of 236 patients were included (84% male, mean age: 28 years). Mean value of admission physiology: Systolic Blood Pressure: 79 mmHg, pH: 7.2, Serum Lactate: 6 mmol/l. Surgical access was via: median sternotomy in 65% (153/236) and the remaining 35% (83/236) via lateral thoracotomy. In 92% (217/236), there was a single cardiac chamber injury; in the remaining 8% (19/236), multiple cardiac chambers were injured. The overall mortality was 18% (43/236). Lactate was a significant predictor of mortality (AUC 93.8, p

Introduction: Penetrating injuries to the sub-diaphragmatic aorta are challenging, with high mortality rates. Most penetrating aortic trauma results from gunshots or stab wounds. This case reports a successful aortic bypass, following partial aortic transection caused by an accidental fall on a utility knife. Report: A healthy 82 year old woman was admitted to the emergency department following penetrating abdominal trauma following an accidental fall on an 18 cm long utility knife. On admission, the patient was haemodynamically stable, with no neurological deficit. Computed tomography angiography revealed multiple abdominal injuries to the stomach, duodenum, L4-L5 left vertebrae, and infrarenal abdominal aorta. The patient underwent urgent midline laparotomy, followed by successful aortic repair using a 14 mm polyester graft. The gastric and duodenal lesions were repaired with an omental patch. The post-operative course was uneventful. Discussion: Penetrating abdominal trauma with visceral lesions and aortic transection are high risk injuries, albeit rarely described in the literature. A low threshold for imaging, and multidisciplinary management by vascular and visceral surgeons are essential for timely recognition and successful intervention.

Pulmonary artery pseudoaneurysm is a very rare complication of penetrating thoracic trauma. We present a case of a 27-year-old woman who developed a 6.5-cm traumatic pulmonary artery pseudoaneurysm after suffering multiple stab wounds to the chest and the abdomen. The pseudoaneurysm was successfully treated endovascularly with vascular plug occlusion and coil embolization.

Cervical stab wounds with a thoracic-inlet esophageal injury are extremely rare. A 30-year-old man presented with dysphagia and stridor. He had attempted suicide by stabbing his neck with a screwdriver followed by jumping from a building 10 days previously, when a cervical tracheal injury was found and surgically repaired. Physical examination was unremarkable. Lateral cervical radiography revealed an air-fluid level within an extensive retropharyngeal pocket. Follow-up radiography showed that the retropharyngeal lesion had shrunk spontaneously. Contrast esophagography demonstrated an extravasation at the thoracic inlet. The patient underwent surgical exploration of the esophagus via a lower neck incision. A thoracic-inlet esophageal slit was found and primary repair was performed. He resumed oral intake uneventfully on the 8th postoperative day. This was a rare case of esophageal injury secondary to cervical stabbing wounds, presenting with delayed occurrence and spontaneously shrunken retroesophageal pocket. Esophageal perforation can be easily missed if tracheal lesion is found. Both bronchoscopy and esophagoscopy are mandatory. In patients highly suspected to have esophageal injury but with a negative esophagoscopy result, contrast esophagography is indicated and can decrease the incidence of false-negative results.

Background: A foreign object penetrating the brain via orbit is a rare occurrence. Accurate diagnosis and immediate intervention is essential to prevent ophthalmic or neurological deficits and to reduce chances of infection or hemorrhage., Case Description: We report 2 cases of transorbital orbitocranial penetrating injury of metal objects in children. Computed tomography scan was obtained to assess the extent of the injury and to locate the objects. According to the trajectory, the best craniotomy approach was performed, and the objects were safely removed without any complication. Our cases are unique because of the absence of any neurological deficit on admission, before and after the removal., Conclusions: The importance of transorbital orbitocranial penetrating injury cannot be neglected because of possible orbital and intracranial damage. Therefore, in this report we aim to heighten awareness of the complexity and severity of transorbital penetrating brain injury., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Gelatin coating of brain implants is known to provide considerable benefits in terms of reduced inflammatory sequalae and long-term neuroprotective effects. However, the mechanisms for gelatin's protective role in brain injury are still unknown. To address this question, cellular and molecular markers were studied with quantitative immunohistochemical microscopy at acute (<2hours, 1, 3days), intermediate (1-2 weeks) and long-term time points (6 weeks) after transient insertion of stainless steel needles into female rat cortex cerebri with or without gelatin coating. Compared to non-coated controls, injuries caused by gelatin coated needles showed a significantly faster resolution of post-stab bleeding/leakage and differential effects on different groups of microglia cells. While similar levels of matrix metalloproteinase (MMP-2 and MMP-9, two gelatinases) was found for coated and noncoated needle stabs during the first week, markedly increased levels of both MMPs was seen for gelatin-coated but not non-coated needle stabs after 2weeks. Neuronal populations and activated astrocytes were largely unaffected. In conclusion, the beneficial effects of gelatin may be the combined results of faster healing of the blood brain barrier curtailing leakage of blood borne molecules/cells into brain parenchyma and to a modulation of the microglial population response favoring restitution of the injured tissue. These findings present an important therapeutic potential for gelatin coatings in various disease, injury and surgical conditions., Statement of Significance: The neural interfaces field holds great promise to enable elucidation of neural information processing and to develop new implantable devices for stimulation based therapy. Currently, this field is struggling to find solutions for reducing tissue reactions to implanted micro and nanotechnology. Prior studies have recently shown that gelatin coatings lower activation of digestive microglia and mitigate the ubiquitous loss of neurons adjacent to implanted probes, both of which impede implant function. The underlying mechanisms remain to be elucidated, however. Our findings demonstrate for the first time that gelatin has a significant effect on the BBB by promoting rapid restoration of integrity after injury. Moreover, gelatin alters microglia phenotypes and modulates gelatinase activity for up to 2weeks favoring anti-inflammation and restoration of the tissue. Given the key importance of the BBB for normal brain functions, we believe our findings have substantial significance and will be highly interesting to researchers in the biomaterial field., (Copyright © 2017 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

Introduction: The selective non-operative management (SNOM) of stab injuries of the anterior abdomen is well established, but its application to the posterior abdomen remains controversial., Materials and Methods: A retrospective review of 1013 patients was undertaken at a major trauma service in South Africa over a five-year period., Results: Ninety per cent of patients were males, and the mean age was 25 years. The mean time from injury to presentation was 4h and 73% of all injuries were inflicted by knives. A total of 9% (93) of patients required a laparotomy [Group A] and 82% (833) were successfully observed without the need for operative intervention [Group B]. CT imaging was performed on 52 patients (5%) who had haematuria [Group C], 25 (3%) who had neurological deficits [Group D], and 10 (1%) with retained weapon injuries [Group E]. The accuracy of physical examination for identifying the presence of organ injury was 88%. All observed patients who required laparotomy declared themselves within 24h. There were no mortalities as direct result of our current management protocol., Conclusions: Selective management based on active clinical observation and serial physical examination is safe, and when coupled with the judicious use of advanced imaging, is a prudent and reliable approach in a resource constrained environment., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Candida albicans spondylodiscitis is a fungal infection of the spine which is still unusual in spite of the increasing frequency of predisposing factors. A 22-year-old man received an abdominal stab wound during a physical assault. Initial medical care included surgery, prolonged use of indwelling vascular catheters with administration of broad-spectrum antibiotics, and hospitalization in intensive care. Two months after the event, the victim experienced back pain in the right lumbar region and septic spondylodiscitis secondary to C. albicans was diagnosed three weeks later. This case is noteworthy because of its clinical forensic context. In France, the public prosecutor orders a medico-legal assessment after an assault for all living victims in order to establish a causal relationship between the assault and its complications. In our case, the patient presented numerous risk factors for candidemia and the forensic specialist reasonably accepted that the causal relationship was certain but indirect. We have only found one published case of spondylodiscitis after an abdominal penetrating injury and the pathogenic agent was not mentioned. We have found no case reported in a forensic context. This unusual observation shows that it may be genuinely difficult to prove the causal relationship between an abdominal penetrating injury and an unusual infectious complication such as fungal spondylodiscitis., (Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Background: Trauma centres vary in their approaches to managing stable patients with anterior abdominal stab wounds (AASWs), with no approach yet proven superior. We sought to evaluate the performance of screening laparoscopy (i.e., parietal peritoneal penetration or not) in determining which patients should undergo laparotomy., Methods: We conducted a retrospective case series study, including all patients with an AASW who presented to U.C. Davis Medical Center from January 2003 through March 2009. We collected data from medical records using a standardised, pre-tested instrument. Among laparoscopically screened cases, we determined the test characteristics of peritoneal penetration for detecting intra-abdominal injury. We sub-classified injuries as "requiring treatment" (e.g., full-thickness enterotomy or active haemorrhage) or not., Results: Of 358 patients with AASWs, 163 underwent screening laparoscopy. Seventy-eight of the 163 (48%) had no peritoneal penetration and six (4%) had peritoneal penetration but a low-risk wound; none of these 84 underwent laparotomy nor had a missed injury. Of 79 patients with peritoneal penetration who underwent laparotomy, 61 had an intra-abdominal injury, of whom 42 were treated intraoperatively. Among these 42, 30 had an injury "requiring treatment." The PPV of peritoneal penetration for an injury requiring treatment was 38% (30/79) (95% CI 27-50%), NPV 100% (84/84) (95% CI 95-100%), sensitivity 100% (30/30) (95% CI 88-100%), and specificity 63% (84/133) (95% CI 54-71%). The negative and positive likelihood ratios were 0 (95% CI 0-0.4) and 2.7 (95% CI 2.2-3.4), respectively., Conclusions: Screening laparoscopic evaluation of the parietal peritoneum results in a negligible rate of missed injury and an approximately 40% rate of finding an injury requiring treatment., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Aortoenteric fistula (AEF) is a rare diagnosis that is often considered only in older patients with histories of abdominal aortic aneurysm., Objectives: To remind emergency physicians that traumatic injury and repair put patients at risk for formation of AEF., Case Report: We discuss the case of a 25-year-old man who developed an aortoduodenal fistula weeks after a stab wound to the abdomen. AEF can occur anywhere along the gastrointestinal tract and can therefore present as either upper or lower tract bleeding. The expected triad of pain, pulsatile mass, and gastrointestinal bleeding is unfortunately rarely present, making diagnosis difficult. Patients often present with a self-limited herald bleed that precedes the fatal exsanguination by hours to days. Diagnosing the fistula at the time of the herald bleed can be difficult but lifesaving. Imaging studies are often misleading and only delay definitive operative treatment. Even with prompt diagnosis and treatment, mortality is high; without repair, it is 100%., Conclusion: This case highlights the importance of suspecting and quickly recognizing AEF based on history and physical examination alone. After extensive preoperative imaging to confirm the diagnosis, this patient nearly died in the operating room as surgeons took down adhesions trying to reach the fistula to repair it., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Ritual homicides may be affective (emotional), but usually they are premediated, instrumental, or predatory. In the case under review, the Facebook profile of the assailant helped to determine the motive of the homicide, which seemed to be ritualistic in nature. Therein, a 56-year-old male sustained 48 stab wounds and other knife injuries. On the wall in a room above the body, a pentagram was drawn with the victim's blood, followed by a few words which can be associated with a "Satanic" ritual. Searching through the Facebook profile of the culprit, Satanism as a leading motive of the homicide was eventually excluded. The most interesting point of this case was the evaluation of a sentence used as a Facebook status, which greatly contributed to confirm the paedophilic nature of the murder., (Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)