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A 30-year-old man presented to the emergency department (ED) after hitting his head against a boulder when he fell from a motorbike. The primary survey was normal. On secondary survey revealed multiple lacerations on the face and severe left eyelid oedema. Since the patient could not open his left eye, an emergency bedside ocular ultrasonography was performed (figure 1). Figure 1 Ocular ultrasonography showing a thin rim of hypoechoic retrobulbar structure. What is the most appropriate diagnosis and its management? 1. Diagnosis: foreign body in the retrobulbar space. Management: surgical removal …

Bear attacks are rare, although global incidents have been increasing. Injury patterns of bear attacks against humans consistently include injuries to the face, head, neck, chest, and upper extremities. Here, we have a brief report of a 59-year-old male hunter who was attacked by a grizzly bear in Wyoming. He sustained multiple lacerations to his face which included an avulsion of his nose and upper lip, as well as extensive associated facial fractures. Additional injuries included soft tissue and bony injuries to the upper extremities. He underwent 53 operations during his first hospitalization, primarily of facial reconstruction, which required nose and upper lip replant to his arm. His course was complicated by pressure ulcers, bacteria, acute kidney injury, and a urinary tract infection. After successful coordinated multidisciplinary care and a prolonged hospitalization, he was ultimately discharged to his home.

Animal inflicted fatal or near fatal injuries are well described in the forensic literature, with the most frequently described cases involving dogs, large cats and bears. To our knowledge, a deer inflicted fatality has not been described in the forensic literature previously. This article reports a case of a 64-year-old male, who was found lying in a pool of blood near an enclosure for stags and hinds at the end of October. There were mechanical defects on his jacket and trousers, which appeared to be torn or penetrated, as well as multiple lacerations and stab wounds in different parts of his body. The type and location of the injuries the man had sustained strongly suggested that another person had been involved in the incident that had led to his death. The cause of death was deemed as external exsanguination due to multiple stab wounds to large vessels. After evaluating all of the information regarding the circumstances around the death, the case was classified as a deer attack related fatality, and the manner of death was determined to be accidental. The man was most probably attacked by one of the deer while he was refilling the animal feeder. A substantial increase in the levels of selected hormones, especially testosterone, during the rutting season explains the increased levels of aggression shown by the deer that led to a fatal outcome for the decedent.

We report the case of a 65-year-old man who was attacked and killed by a female elephant that had previously escaped from a nearby circus. According to a witness the man was lifted up by the tusks, flung into the air and stomped upon. At autopsy the body showed signs of severe blunt force trauma and impalement, including multiple lacerations of the skin, a crushed thorax, a spinal fracture and a fractured humerus. The spinal cord and the major abdominal vessels were severed. There have been very few elephant attacks in Europe; this is the first reported case in Germany.

A 38 year old lady sustained an injury to her left ring finger from an electric whisk which became intertwined around the pulp and nail complex, causing multiple lacerations, with ischaemia of the tip of the digit, in a previously undescribed pattern of injury. The apparent complexity of the wire loops led to initial uncertainty as to whether to remove the whisk in the Emergency Department. However, following consultation with the plastic surgery on-call team, wire cutters were used to divide the metal loops and remove the whisk under digital block, and perfusion returned immediately, preserving the digit. Despite initial concerns regarding the possible role for reconstruction or revascularisation, minimal surgical intervention was required as a daycase.

We present a case of traumatic rupture of the spleen in a man with cleidocranial dysplasia. The computed tomography imaging showed multiple low-grade lacerations of the spleen which initially led to conservative patient management. However, with clinical deterioration, the patient underwent an emergent splenectomy. Post-operative histology revealed splenic peliosis with multiple lacerations. The radiological and surgical management of post-traumatic splenic peliosis may differ from those with an otherwise normal spleen.

WOS:000344217100001, PubMed ID: 25135014, BACKGROUND: This study was planned to analyze the internal and external anatomical findings of cardiac injuries and the presence of accompanying pulmonary injuries in intentionally inflicted thoracic injuries to swine models. METHODS: We inflicted a penetrating heart injury in six suis domesticus female swine models. Two cardiac injuries, one on the left paratracheal of fourth intercostal space (ICS) and the other on the right side were inflicted on each model by the same researcher using a 20-cm long scalpel. All animals were then sacrificed for morphological evaluation. RESULTS: After strikes to the left fourth ICS, external evaluation showed that 50% of the subjects suffered a single laceration and that 33% suffered multiple lacerations. Internal evaluation showed additional intracardiac injuries in all five subjects. However, the subject that suffered a single laceration on the outer surface of the heart had multiple internal injuries while another subject that had multiple outer lacerations had only one intracardiac injury. Only three subjects suffered cardiac injuries and only two out of those three with pulmonary injuries after right fourth intercostal intrusions. CONCLUSION: This experiment has shown that external evaluation of the heart tissue may not alone be sufficient to determine the extent of cardiac injuries and accompanying pulmonary injuries caused by penetrating thoracic injuries.

Deliberate self-harm is an extreme reaction to psychological stress. It remains the strongest known risk factor for imminent suicide. There is a dearth of information on the extent of risk, especially in this environment. Psychiatric treatment should commence as soon as the patient is clinically stable. This is to report a case of deliberate self-harm with multiple lacerations in a depressed 23-year-old male with a history of cannabis abuse. The case is a 23-year-old male student with a history of cannabis abuse and depression following psychological stressors who sustained multiple self-inflicted deep lacerations to his neck and phallus. He had multidisciplinary management by the surgical and psychiatric teams. Reducing the risk of suicide by psychotherapy and treatment of underlying psychiatric conditions should be the mainstay of management in cases of deliberate self-harm beyond treatment of injuries sustained, irrespective of their severity.

The relationship between external injuries and internal injuries was investigated, with the aim of determining whether potentially lethal internal injuries could be reliably inferred from external findings alone. From a database of post-mortem reports, 291 were extracted and examined. The external and internal injuries were coded according to region, type and severity. Analysis of the data consisted of Spearman correlations for severity and positive predictive values for internal injuries of high lethality. Overall, the correlation between external and internal injuries was poor. The most predictive external injuries were multiple lacerations, large abrasions with lacerations, and gross distortions. Predictably, the most severe external injuries were the most reliable predictors of lethal internal injuries. External injuries of the head were more predictive of internal damage than external injuries elsewhere. Minor external injuries (such as bruises, small abrasions or small lacerations) did not predict lethal internal injuries. In conclusion, external examination findings are largely unreliable as markers of lethal internal injuries in the forensic investigation of victims of motor vehicle trauma, especially in situations where the external injuries are minor. Further research into non-invasive methods of forensic investigation is warranted.

It’s Saturday night at 3 AM and a 24-year-old heavily pierced and tattooed man presents to triage with multiple lacerations on his arms and legs. In obtaining the initial history, it is found that he was undergoing a body suspension at a local club and “the hooks ripped out.” He indicates that he was advised to “get some stitches” for the wounds. Your mind is trained to ask questions such as, “When was your last tetanus shot?” and you are mentally preparing yourself by considering what hidden injuries may be present. However, the question you are dying to ask is, “Why was he hanging by hooks in the first place?” What follows are some questions and answers that focus on the aspects of suspensions from the perspective of the body piercer and the health care professional. Are Body Suspensions a New Fad?

An unusual accidental death due to acute massive occlusion of the right pulmonary arteries by liver tissue is reported. A 17-year-old motorcyclist was run over by a heavy truck, resulting in multiple injuries. Multiple lacerations of the liver and tears in the wall of the inferior vena cava resulted in the complete occlusion of the right pulmonary artery by liver tissue. Although the victim sustained other potentially lethal injuries, the final mechanism of death is attributed to pulmonary embolism.

Chromobacterium violaceum is a gram-negative rod and is isolated from soil and water in tropical and subtropical regions. The species have pigmented and nonpigmented colony types. Infections caused by nonpigmented strains are rare. We report on two cases of infection caused by both pigmented and nonpigmented strains of C. violaceum . Two 24-year-old Korea Airline stewardesses were admitted to Inha University Hospital, Inchon, South Korea, on 9 August 1997, 3 days after an airplane accident in Guam. Both had multiple lacerations on exposed parts of their bodies. There was swelling, tenderness, and pus discharge. The wounds contained many small fragments of stones and weeds. A pigmented strain was isolated from the left hand and a nonpigmented strain was isolated from the left knee of one patient. For the other patient only a nonpigmented strain was isolated from a foot wound. The nonpigmented colonies from the left-knee and the left-foot wounds did not produce any pigment even after an extended period of incubation. The biochemical characteristics were the same for each strain except for oxidase and indole reactions. The pigmented strain was oxidase negative and indole positive, whereas the nonpigmented strains were oxidase positive and indole negative. The patients were successfully treated by debridement and with appropriate antibiotics.

This report describes a case of isolated denervation of the extensor pollicis longus (EPL), which has not previously been reported. The patient was a healthy 13-year-old boy who sustained multiple lacerations to the left forearm secondary to a dog bite. No motor responses were evident in the EPL, but the remainder of the exam findings were normal. Electromyography confirmed complete isolated denervation of the EPL. This patient was managed nonoperatively and had no significant functional deficits at final follow-up.

It is a good surgical axiom that a penetrating injury should not be dealt with simply on the grounds of its appearance. When assessing a patient with a single or multiple lacerations, one must take into account the mode and force of the injury, along with the clinical signs gleaned from an adequate examination. A working knowledge of the underlying anatomy is obviously essential for this. A case is reported of an apparently superficial injury which on closer inspection had potentially fatal consequences.

The boundaries of simulation and dissociative amnesia are thin and not rarely unclear. Diagnostic criteria and a thorough clinical history are sometimes not enough to shed light on the nature and essence of one's will and conduct. Throughout history, psychiatry has been challenged to testify before society over patients’ truth and deceit. Do they share common grounds or must we accept that uncertainty is the inevitable price of truth?The authors present a clinical case of a young man coming to the emergency services with multiple lacerations in the upper abdomen and limbs, referring “amnesia” for the last five years of his life. The patient had no previous psychiatric record or any known family or social dysfunction. Approach, management and diagnosis are discussed.

Injuries caused by glass occur frequently, in particular in children, and make up an estimated 3% to 5% of all emergency visits, most frequently involving lacerations of hands, feet, and face. About 30% to 40% of glass injuries occur at home and often involve so-called architectural glass or bottles and glass containers. Accidents reported in association with showering mostly refer to falls or scalding by hot water. However, an increasing number of shower screens are made of tempered glass, which may potentially brake. Such injuries may be potentially severe, causing laceration of extremity arteries; requiring hospitalization or outpatient treatment for injuries; causing absence from work. These injuries are likely underreported in the medical literature but could have potential medicolegal consequences for the patient. We report a case of multiple lacerations developed in a third-trimester pregnant woman caused by the spontaneous shattering of a shower screen glass and discuss the apparent unawareness to this potential hazard in the scientific literature.

SUMMARY:A five-year-old boy succumbed 24 days following an unusual farm accident in which considerable manure was deposited in multiple lacerations.Death was due to an extensive meningo-encephalomyelitis caused by a nematode that is ordinarily saprophagous.

The purpose of this paper is to review our experience with the treatment of nerve injuries in the upper extremity. Since 1950 We have had an opportunity to treat 325 cases of this type. Tables 1, 2, and 3 summarize the nerves which were injured and the level of the injury. In those cases in which more than one nerve was injured, as in multiple lacerations of the digits or combined median and ulnar nerve lesions in the Wrist, the injury is counted as a single case. This group of patients was treated between January, 1950, and January, 1957. The follow-up period varies from one to seven years. Age and Sex One hundred ninety-five of these patients Were men and eighty-one women. There is no difference in the results of nerve repair attributed to the patient's sex. Forty-nine of the patients were 14 years of age or younger (Table 4).

One of the most interesting phases of proctology is the subject of foreign bodies. The literature contains numerous reports of the recovery of these objects from the rectum and the sigmoid, where either they gain entrance by ingestion, by introduction through the anal canal or by perforation from an adjacent viscus, or they form in situ. Of these the oral route is the commonest, and though the ingestion is usually accidental it may be intentional for purposes of concealment, suicide or entertainment. In many instances the patient is conscious of the fact that he swallowed the object, but often he is unaware of this for it may occur during anesthesia, intoxication or other semistuporous states. One is amazed by the variety and number of ingested objects that have been removed from the rectum. Gant 1 mentions more than fifty different kinds, and a complete list very likely would include many

The recent race riot presented the staff of the City of Detroit Receiving Hospital with the problem of caring for 433 new patients in twenty-four hours. In addition, the load of new patients during the six to twelve hour periods immediately preceding and following these twenty-four hours was heavier than usual. We do not intend to give a detailed account of the diagnosis and treatment of these cases but rather to discuss the organization for the handling of such a large number of cases. The rioting began late Sunday, June 20, 1943 but patients were not admitted in large numbers until midnight. Of the 433 admitted to the emergency ward (table) from midnight Sunday to midnight Monday, June 21, 101, or approximately 24 per cent, were hospitalized. The remaining 332 patients required some sort of treatment, in many instances the suturing of multiple lacerations. Many of these patients who were

THE manner of handling the administration of parenteral fluid needed during the early care of a series of closely observed battle casualties constitutes the basis for this report. The casualties occurred in the New Guinea, Bismarck Archipelago and Philippine areas. Observations were conducted mainly aboard an LST acting as a casualty ship during the early phases of amphibious operations. Casualties were received from ships damaged during the landing phases and from troops landed on the invasion beaches. TYPES OF CASES An analysis of cases of 345 patients will be made (6.8 per cent of the total patients treated). Tables 1, 2 and 3 contain information concerning the types of injuries encountered. In table 1 the frequency of the types of injuries is given. Outside the group with burns 51.2 per cent of the patients sustained multiple injuries, that is, multiple lacerations of skin, muscles or other parts, with or without

T was approximately four o'clock in the afternoon when I first saw John Smith, a six-year-old boy who lay very still in his hospital bed. One hour before his admission to the pediatric ward, John had been struck by a truck. He was semicomatose and his skin was pale and cold. He had a contusion of the right zygoma, and multiple lacerations of the right groin and perineum. His abdomen was tender, distended, and "board-like." The doctors thought that some internal organ had been ruptured and that surgery would probably be necessary. John was given intravenous plasma and penicillin, and a specimen of blood was taken for crossmatching. A routine blood count and urinalysis were also done. Within a few hours time John's symptoms became more marked, his abdomen was rigid, and his blood pressure was gradually falling. The doctors decided not to wait any longer. John was taken to the operating room where a one-half inch tear was found in both the left and the right lobes of the liver. These were re