Ballistic trauma caused by military rifles: experimental study based on synthetic skull proxies

Rifles are often involved in violent deaths such as homicide and suicide. Consequently, expert knowledge and experimental forensic investigations are important to clarify the nature of ballistic trauma when applied to the human head and neurocranium. This study investigated differences in entrance wound morphology with Synbone® spheres which are described as being comparable to human flat bones. A series of ballistic experiments were conducted using two different rifle calibers (5.56 × 45 mm and 7.62 × 39 mm Full Metal Jacket (FMJ)). Synbone® spheres were used for close-range 0.3 m simulated executions as well as at 25 m and 35 m to simulate urban and military engagements. Results were compared with previously published experimental studies using similar military ammunition. In our study, entry wound morphology closely resembles real forensic cases compared to exit wound and overall shape morphology independently of the distance and the caliber. Circumferential delamination was clearly visible with full metal jacket (FMJ) rounds, yielding similar damage pattern morphology to the human crania. This study documented the presence of hydraulic burst or shock in all ten rounds from all three distances. Krönlein shots were also observed in some cases. Synbone® spheres constitute an acceptable synthetic surrogate for ballistic experiments. The present study offers new initial data on the behavior of Synbone® proxies in ballistic testing of military ammunitions; FMJ gunshot injuries to the human head, for distances that have not previously been published, suggesting that efficient tests can take place under these conditions. Further research on experimental ballistics with a larger number of controlled factors and multiple repetitions is recommended to verify the results of this pilot study before applied in forensic simulations.

Penetrating Brain Trauma due to Air Gun Shot – a Case Report

Cases of severe injuries caused by air guns are really uncommon, but they can lead to a fatal outcome. Usually, these injuries occur in children due to their not fully developed skull bones or in adults through less resistant and thin regions of the cranium. Most of them are accidental events, followed by low percentage of suicidal attempts. In this paper, we present the case of a 68-year-old man suffering from severe depression, with self-inflicted air gun injury to the head. The patient was admitted to the hospital in a coma with a Glasgow Coma Scale (GCS) score of 8, with severe penetrating head injury manifested with brain contusion and intraventricular bleeding seen at the CT examination. Metal particles from the projectile were seen inside the brain. The entry wound had inverted margins, abraded collar and skin defect. The additional neurological examination of the patient showed symptoms of increased intracranial pressure. The treatment started with the air gun wound care. Craniotomy surgery was also done and bone fragments around the entry wound were successfully extracted with subsequent debridement and duraplasty. The patient was treated with new-generation combined antibiotics for preventing inflammatory complications. On the nineteenth day, the patient was discharged with mild hemiparesis on the left side and with GCS score of 15. Air-gun traumatic cases with head injury or with injury to other parts of the body are often mistaken for firearm accidents, because air guns are seriously underestimated devices. Nevertheless, they could lead to severe health consequences and severe disability. This case highlights the necessity of strict monitoring of air guns by the responsible government institutions which should apply the same regulations in controlling these weapons as they implement in controlling the firearm guns. Presence of severe depression, mental illnesses, and neoplasms are risk factors for committing suicide with this type of weapons and the control over the air weapons in this group of people should be stricter.

The Role of the Gastrointestinal Tract in Toxigenic Clostridium tetani Infection: A Case-Control Study

Tetanus arises from wound contamination with Clostridium tetani, but approximately one fifth of patients have no discernable entry wound. Clostridium tetani is culturable from animal feces, suggesting the gastrointestinal tract could be an endogenous reservoir or direct-entry portal, but human data are lacking. In this study of 101 Vietnamese adults with tetanus and 29 hospitalized control subjects, admission stool samples were cultured for C. tetani. Anti-tetanus toxin antibodies were measured by ELISA. Clostridium tetani toxigenicity was evaluated using polymerase chain reaction and sequencing. Toxigenic C. tetani was cultured from stool samples in 50 of 100 (50%) tetanus cases and 12 of 28 (42.9%) control subjects (P = 0.50), and stool samples of 44 of 85 (52.4%) tetanus cases with clinically identified wounds compared with 6 of 15 (47.6%) patients without clinically identified wounds (P = 0.28). Nine of 12 (75%) control subjects with toxigenic C. tetani in their stool samples lacked protective antibody concentrations. These findings fail to show evidence of an association between gastrointestinal C. tetani and tetanus infection, but emphasize the importance of increasing vaccination coverage.

Retained iron intraocular foreign body with late onset siderotic glaucoma: a clinical challenge

Siderotic glaucoma is a rare and challenging clinical scenario caused by a retained iron intraocular foreign body (IOFB), which results in irreversible vision loss. Presented here is a case of secondary open-angle glaucoma in a 36-year-old man that was refractory to maximal medical therapy. A meticulous history and careful clinical examination revealed that he had a penetrating trauma 15 years ago, a self-sealed corneal entry wound, open angles, a retained encapsulated metallic IOFB and siderosis bulbi. Removal of the foreign body not only controlled intraocular pressure, but also improved vision.

Phakochronology - The Forgotten Science

A 30 year old male, had history of bomb blast injury to the face 24 months ago with multiple foreign bodies perforating the eye (operated for vitrectomy and foreign body explant). The iris entry wound and the cataract caused by one such foreign body is shown in (Figure 1a). The opacity in the lens substance (Figure 1b) is 156 microns behind the anterior lens capsule (Figure 1c) (meaning growth of these much lens fresh clear lens fibres over the time has pushed the lens opacity backwards which earlier would have been on the surface). Calculating by phakochronology [1], we would like to report the in-vivo lens growth in this patient to be 6.5 microns/month.

Graphite Particle in Cornea- An Incidental Finding

An eleven years old female came to Ophthalmology OPD for normal checkup. Her vision was 6/6 in BE's. On Slit Lamp Examination of Anterior Segment, LE Cornea showed crystalline greyish deposits scattered in infero-temporal quadrant mostly suggestive of Pencil Graphite. The rest details were absolutely normal. No entry wound could be made out. The patient and her parents gave no History of any pencil trauma in the past even after. As the particles were inert and patient had no symptom, no active intervention was done (Figures 1 and 2).

Electrical injury - induced atrial fibrillation: A case report

Introduction: Electrical injury can cause various cardiac dysrhythmias such as asystole, ventricular fibrillation, sinus tachycardia, and heart blocks. However, it rarely causes atrial fibrillation. Case report: Patient S.M, born in Nis in 1973, was admitted to the emergency department after receiving an electric shock (<600 V). He subsequently lost consciousness, fell down, and sustained back and head injuries. During the examination heart rate was irregular but with no heart murmurs. There was an entry wound on the front of the left thigh and an exit wound on the front of the neck. An electrocardiogram showed newly appearing atrial fibrillation. The laboratory tests showed no pathological deviation and focus cardiac ultrasound showed that contractile force was preserved with no wall-motion abnormalities and normal left atrium dimensions. The patient was administered low-molecular-weight heparin subcutaneously and propafenone (600 mg) orally. At follow up after 24 hours, an electrocardiogram showed normal sinus rhythm. Conclusion: We report a rare case of an electrical injury-induced atrial fibrillation, which was converted to sinus rhythm by pocket therapy. Although most cases of an electrical injury-induced AF represent benign conditions which are self-limited, cardiac monitoring as a routine measure should be considered.

Study of backspatter using high-speed video of experimental gunshots

Backspatter is biological material that is ejected from the entry wound against the line of fire. This phenomenon was also observed in wound ballistic simulations using so called "reference cubes" (12 cm edge length, 10% gelatin, 4 °C, paint pad beneath the cover). High-speed video records from 102 experimental shots to these target models using full metal jacketed bullets in the calibers .32 auto, .38 special, 9 mm Luger and .357 Magnum were analyzed for chronology, morphological appearance and velocity of fluid ejection. Generally, a short tail splashing of surface material occurred when the bullet was penetrating the target. In 51 shots from distance (≥ 5 cm), regardless of caliber and shot range, a linear jet of fluid started in connection with the first collapse of the temporary cavity. The initial velocity of the jet was measured between 6 and 45 m/s. The jet was streaming on for about 60 to 100 ms with a stochastic deviation of ± 13° to the horizontal. Close range and contact shots showed earlier and faster (up to 330 m/s) backspatter depending on the cartridge and the gap between muzzle and target. Gaseous aerosol-like spray and cone-like spatter indicated an increasing influence of muzzle gases with decreasing shot range. Even under standardized experimental conditions, variations of backspatter were observed in near/contact shots.

Bilateral iPhone Gorilla Glass Intraocular Foreign Bodies in a Pediatric Patient

Purpose: This report discusses a case of a patient with bilateral intraocular foreign bodies after a bullet shattered his iPhone. Methods: A case report is presented. Results: The right eye vision was 20/50 and examination disclosed a limbal entry wound at 6:00, dense traumatic cataract, and vitreous hemorrhage. The left eye was 20/40 and an entry wound located roughly 4 mm posterior to the limbus was noted. Fundoscopy revealed multiple refractile particles with preretinal and vitreous hemorrhage. Computed tomography scan demonstrated hyperdensities in the vitreous cavity bilaterally. Globe closure, cataract removal, vitrectomy, and endolaser were undertaken in the right eye, while only globe closure was performed in the left eye. On latest follow-up, the patient had 20/20 corrected vision without inflammation bilaterally. Conclusion: A conservative approach led to full visual recovery, despite retained intraocular smartphone Gorilla glass.

More to it than meets the eye: a case of retained intraorbital foreign body removed using transcutaneous orbital endoscopic surgery

The possibility of a retained foreign body should always be considered when a patient presents with a history of orbital trauma, especially when the patient is unresponsive or temporarily responsive to treatment. Not all cases of retained foreign body present with decreased vision or restricted mobility or fever. The entry wound is also not apparent on examination in all cases. In summary, meticulous history-taking, thorough examination, high index of suspicion along with a low threshold for imaging studies are essential to make a timely diagnosis of a retained intraorbital foreign body. The prompt removal with the appropriate approach may not only save the eye but also the life of the patient.