Continued:
<6> Authors Rothlin M.Vila A.Trentz O. Title [Results of surgery in
gunshot and stab injuries of the trunk]. [German] Source Helvetica
Chirurgica Acta.60(5):817-22, 1994 Jul. Abstract Between 1981 and 1990,
105 patients suffering from gunshot and stab wounds were admitted to the
Department of Surgery of Zurich University Hospital. There were 17
female and 88 male patients aged 16-74 years (average 31 years) whose
charts were studied retrospectively. 44 patients demonstrated gunshot
injuries, while 60 suffered from stabwounds and 1 patient had both. The
injuries were the result of a crime in 59, a suicide in 33 and an
accident in 11 cases. In 2 patients the cause was not conclusive proven.
Injuries to the lung (n = 54), the liver (n = 27) and to the stomach (n
= 23) were seen most frequently. 45 patients underwent laparotomy, while
16 had a thoracotomy performed. Both thoracotomy and laparotomy were
necessary in 10 cases. Complications were observed in 29.5% of the
cases. They were significantly more frequent in patients with gunshot
injuries (p < 0.0004). Overall mortality amounted to 14.3% (n = 15).
Patients with gunshot wounds had a significantly higher mortality rate
(p < 0.0005). Debridement and selective closure of the wounds (n = 25)
did not result in a higher rate of abscess formation than open treatment
(n = 17).
<7> Authors Coimbra R.Prado PA.Araujo LH.Candelaria PA.Caffaro
RA.Rasslam S. Title Factors related to mortality in inferior vena cava
injuries. A 5 year experience. Source International
Surgery.79(2):138-41, 1994 Apr-Jun. Abstract Forty-nine patients
sustaining Inferior Vena Cava (IVC) injuries, during a 5 year period
were retrospectively analyzed in order to assess those factors related
to early deaths. Mean age was 32 and 45 were male. GSW was the most
frequent mechanism of injury (59.2%), followed by SW (28.6%) and blunt
trauma (12.2%). There were 4 injuries in the supra diaphragmatic IVC, 14
retrohepatic, 16 suprarenal and the remaining 15 were in the infrarenal
portion of the IVC. Twenty patients were in shock and 8 were unstable on
admission. The liver was the most frequently injured organ in
association with IVC and there were also 7 concomitant abdominal
vascular injuries. Venorrhaphy was performed in 28 patients, IVC
ligature in 5, intracaval shunt in 3 and in the remaining 13, only
temporary hemostasis was attempted. Mortality rate was 100% in supra
diaphragmatic injuries, 71.4% in retrohepatic, 68.8% in suprarenal and
33% in infrarenal injuries. There was a significant difference when
comparing mortality rate in stable against shock or unstable patients on
admission (p < 0.001), as well as in those with diaphragmatic IVC
injuries compared with all other injury sites together (p < 0.05).
Hemodynamic instability on admission was the most important cause of
early deaths, and all patients with concomitant abdominal vascular
injuries also died.
<8> Authors Degiannis E.Velmahos G.Krawczykowski D.Levy RD.Souter
I.Saadia R. Title Penetrating injuries of the subclavian vessels. Source
British Journal of Surgery.81(4):524-6, 1994 Apr. Abstract A study was
made of 76 patients with subclavian vessel injury. The mechanism of
trauma was stabbing in 40 patients (53 per cent) and gunshot in 36 (47
per cent). There were marked differences between the two groups in
clinical presentation, operative management and outcome. The group with
gunshot injury was characterized by a more immediate threat to life, and
a greater need for a median sternotomy and use of interposition grafts.
The mortality rate in patients with gunshot wounds was more than twice
that in the group with stab injury.
<9> Authors Tang E.Berne TV. Title Intravenous pyelography in
penetrating trauma. Source American Surgeon.60(6):384-6, 1994 Jun.
Abstract Intravenous pyelograms (IVPs) are routinely used in the workup
of suspected urologic injuries. The indications for obtaining IVPs have
not been well characterized. This study examined 67 patients with
penetrating trauma who received formal IVPs with nephrotomography in the
radiology department. Of 35 stab wounds, 19 patients presented without
hematuria and accounted for only one positive IVP. No intervention was
undertaken in this patient. There were 14 stab wound patients with
microscopic hematuria, with three positive IVPs. No intervention was
necessary in any of these patients. The two remaining stab wound
patients both had gross hematuria and renal injuries requiring
intervention. However, only one of the two had a positive IVP, showing a
blurred kidney margin. One patient had a pseudoaneurysm of a branch of
the renal artery, and the other had an arteriovenous fistula. Of 32
patients with gunshot wounds, 15 presented without hematuria. Of the 15,
one had a positive IVP but did not have a renal injury on exploration.
None of the other 13 patients in this group undergoing exploration had
renal injuries. Of the 11 patients with microscopic hematuria, three had
hematomas and one had gross extravasation on IVP. Of the six patients
with gross hematuria, three had positive IVPs, showing a hematoma, a
renal fracture, and indistinct renal outline, respectively. In this
limited study, omitting IVPs on the patients with negative urinalyses
would not have missed any significant injuries. We suggest that more
study is needed in this area because our present standard may lead to
unnecessary expense and delay.
<10> Authors Velmahos GC.Degiannis E.Souter I.Saadia R. Title
Penetrating trauma to the heart: a relatively innocent injury. Source
Surgery.115(6):694-7, 1994 Jun. Abstract BACKGROUND. The purpose of this
study was to examine the mortality rate of penetrating cardiac trauma in
a large urban hospital. METHODS. This was a retrospective study over a
period of 5 years and 5 months of all patients admitted alive with a
stab or a gunshot cardiac injury. RESULTS. There were 310 patients with
a stab wound and 63 with a gunshot wound. The overall mortality rate was
19%. The mortality rates for the stab and the gunshot groups were 13%
and 50.7%, respectively. In the 296 patients with a cardiac stab wound
confined to a single chamber and with no other associated extracardiac
injury the mortality rate was 8.5%. CONCLUSIONS. An isolated cardiac
stab wound is a relatively innocent injury in a patient at a hospital
accustomed to managing penetrating trauma expeditiously.
<11> Authors Mock C.Pilcher S.Maier R. Title Comparison of the costs of
acute treatment for gunshot and stab wounds: further evidence of the
need for firearms control [see comments]. Source Journal of
Trauma.36(4):516-21; discussion 521-2, 1994 Apr. Abstract Gun control is
proposed primarily to decrease the incidence of injury and death from
gunshot wounds (GSWs). We hypothesize that decreasing the number of GSWs
will also produce significant economic savings, even if personal
violence were to continue at the same rate, maintaining the same overall
incidence of penetrating trauma. We analyzed charges and reimbursements
for the treatment for all patients with GSWs (n = 1116) and stab wounds
(SWs) (n = 1529) admitted to a level I trauma center from 1986 through
1992. Mean and median charges were higher for GSWs ($14,541; $7,541)
than for SWs ($6,446; $4,249) (p < 0.05). There was a 12% per year
increase in the annual number of GSWs (p = 0.001), leading to a
disproportionate increase in the annual total charges for GSWs (p =
0.013), compared with SWs. Public expenditures, including bad debt and
government reimbursement, increased for GSWs (p = 0.019) but not SWs.
Thus, if all patients with GSWs instead suffered SWs, there would be an
annual savings of $1,290,000 overall and of $981,000 of public funds
from this institution alone. Treatment costs for GSWs are higher than
those for SWs and are rising more rapidly, with an increasing amount of
public funds going to meet these costs. Considerable savings to society
would accrue from any effort that decreased firearm injuries, even if
the same level of violence persisted using other weapons.
<14> Authors Rizoli SB.Mantovani M.Baccarin V.Vieira RW. Title
Penetrating heart wounds. Source International Surgery.78(3):229-30,
1993 Jul-Sep. Abstract In 3 years, 26 patients were operated for
penetrating heart wounds at our institution, the majority between 30 to
60 minutes after injury. Twenty-two patients with a possible heart wound
were immediately taken to the operating room for thoracotomy. One
patient initially underwent laparotomy while 2 were observed before
operating-room thoracotomy. One patient underwent emergency-room
thoracotomy. Three patients with no vital signs on admission died, 82.6%
of the remainder survived. Stab wounds determined the best survival
rate: 94%, whereas for gunshot wounds it was only 50%. Our experience at
this Brazilian Trauma Center reveals that delay in reaching the hospital
selected the patients, that clinical condition on arrival, method of
injury (knife or gunshot), emergency room staffed with trauma surgeons
and aggressive operating room treatment for penetrating heart wounds
results in a remarkable survival rate. Emergency-room thoracotomy should
be reserved for patients "in extremis" or when there is no operating
room available.
<16> Authors Macho JR.Markison RE.Schecter WP. Title Cardiac stapling in
the management of penetrating injuries of the heart: rapid control of
hemorrhage and decreased risk of personal contamination. Source Journal
of Trauma.34(5):711-5; discussion 715-6, 1993 May. Abstract The
resuscitation of patients with cardiopulmonary arrest from a penetrating
injury of the heart requires emergency thoracotomy and control of
hemorrhage. Suture control may be technically difficult in patients with
large or multiple lacerations. Emergency cardiac suturing techniques
expose the surgeon to the risk of a contaminated needle stick. After we
determined that rapid control of hemorrhage from cardiac lacerations
could be achieved in anesthetized sheep with the use of a standard skin
stapler, the technique was applied in the clinical setting. Twenty-eight
patients underwent emergency stapling of 33 cardiac lacerations at our
institution from September 1987 to December 1991. Seventy-nine percent
(22) of the patients sustained stab wounds, and 21% (6) were injured by
gunshots. Fifty-eight percent (19) of the injuries involved the right
ventricle, 27% (9) involved the left ventricle, 9% (3) involved the
right atrium, and 6% (2) involved the left atrium. In 93% (26) of the
patients, control of hemorrhage was achieved within 2 minutes of
exposure of the injuries. Both patients in whom control could not be
achieved had sustained large-caliber gunshot injuries. Fifteen (54%) of
the patients survived, including one patient with two cardiac
lacerations and another with three lacerations. Of the surviving
patients, two had mild neurologic deficits. No personal contamination
occurred related to the use of the stapler. We conclude (1) cardiac
stapling is highly effective in the management of hemorrhage from
penetrating injury, particularly in the setting of multiple cardiac
lacerations; (2) the technique may not be effective with certain types
of gunshot wounds; and (3) the use of the stapler for emergency
cardiorrhaphy eliminates the risk of personal contamination from a
needle stick. [Full paper reveals survival rate of 17% for gunshot
wounds and 64% for stab wounds.TL]
<17> Authors Mitchell ME.Muakkassa FF.Poole GV.Rhodes RS.Griswold JA.
Title Surgical approach of choice for penetrating cardiac wounds. Source
Journal of Trauma.34(1):17-20, 1993 Jan. Abstract One hundred nineteen
patients suffered penetrating cardiac trauma over a 15-year period: 59
had gunshot wounds, 49 had stab wounds, and 11 had shotgun wounds. The
overall survival rate was 58%. The most commonly injured structures were
the ventricles. Twenty-seven patients had injuries to more than one
cardiac chamber. Thirty patients had associated pulmonary injuries.
Emergency thoracotomy was performed in 47 patients with 15% survival.
Median sternotomy was used in 30 patients with 90% survival. Seventeen
of the 83 patients with thoracotomies required extension across the
sternum for improved cardiac exposure or access to the contralateral
hemithorax. Only one patient with sternotomy also required a
thoracotomy. All pulmonary injuries were easily managed when sternotomy
was used. We conclude that sternotomy provides superior exposure for
cardiac repair in patients with penetrating anterior chest trauma. We
feel it is the incision of choice in hemodynamically stable patients.
Thoracotomy should be reserved for unstable patients requiring aortic
cross-clamping, or when posterior mediastinal injury is highly
suspected. [Full paper reveals survival rates of 46% for gunshot wounds,
78% for stab wounds, and 36% for shotgun wounds. TL]
<18> Authors Kaufman JA.Parker JE.Gillespie DL.Greenfield AJ.Woodson J.
Menzoian JO. Title Arteriography for proximity of injury in penetrating
extremity trauma. Source Journal of Vascular & Interventional
Radiology.3(4):719-23, 1992 Nov. Abstract Arteriography for proximity of
injury was studied prospectively at a trauma center. Findings in 85
patients with penetrating extremity wounds were analyzed to determine
the prevalence and types of vascular abnormalities seen with these
injuries. Ninety-two limb segments were studied for 77 gunshot and 15
stab wounds. Arteriographic findings were positive in 24% overall but in
only 5% for injuries confined to major vessels. A 60% positive rate was
seen in a small subgroup of 10 patients with fractures due to gunshot
wounds. The most frequently injured vessels were muscular branches of
the deep femoral artery (59%); the most common injury was focal,
non-occlusive spasm (42%). All patients were treated conservatively,
without sequelae at follow-up. In this study, the vascular injuries
found at arteriography for proximity of injury in penetrating trauma due
to bullets of knives, particularly in the thigh, did not require
surgical or radiologic intervention.
<19> Authors Nagel M.Kopp H.Hagmuller E.Saeger HD. Title [Gunshot and
stab injuries of the abdomen]. [German] Source Zentralblatt fur
Chirurgie.117(8):453-9, 1992. Abstract From 1973 to 1991 a total of 422
patients underwent surgery because of an abdominal trauma. 12 patients
had gunshot wounds and 46 patients stab wounds. In a retrospective study
the diagnostic and therapeutic procedure and the indication for surgery
are analysed. After gunshot wounds of the abdomen we always performed a
laparotomy. In 11 od 12 cases we found serious intra-abdominal injuries.
Only in one case the laparotomy was "unnecessary", because of a
tangential wound without penetrating of the abdominal wall. After stab
wounds the diagnostic and therapeutic management was more selective.
Indications for mandatory laparotomy after stab wounds were a manifest
hemorrhagic shock, evisceration and a still left weapon in the abdomen
(n = 22). The first clinical examination was completed by ultrasound or
peritoneal lavage. Pathological findings like free intraperitoneal fluid
or a positive lavage also were indications for laparotomy (n = 9). The
other patients were observed closely, including repeated physical
examination. The indication for surgery then based on the development of
clinical signs. The time between first examination and laparotomy was
never more than 12 hours. 39 patients (84.7%) had injuries of
intraabdominal organs. 5 patients (10.8%) had a negative laparotomy. The
mortality rate was 3.4%, but there was no death as a result of the
selective approach.
<20> Authors Saltzman LE.Mercy JA.O'Carroll PW.Rosenberg ML.Rhodes PH.
Title Weapon involvement and injury outcomes in family and intimate
assaults. Source JAMA.267(22):3043-7, 1992 Jun 10. Abstract
OBJECTIVE--To compare the risk of death and the risk of nonfatal injury
during firearm-associated family and intimate assaults (FIAs) with the
risks during non-firearm-associated FIAs. DESIGN--Records review of
police incident reports of FIAs that occurred in 1984. Victim outcomes
(death, nonfatal injury, no injury) and weapon involvement were examined
for incidents involving only one perpetrator. SETTING--City of Atlanta,
Ga, within Fulton County. PARTICIPANTS--Stratified sample (n = 142) of
victims of nonfatal FIAs, drawn from seven nonfatal crime categories,
plus all fatal victims (n = 23) of FIAs. MAIN OUTCOME MEASURES--Risk of
death (vs nonfatal injury or no injury) during FIAs involving firearms,
relative to other types of weapons; risk of nonfatal injury (vs all
other outcomes, including death) during FIAs involving firearms,
relative to other types of weapons. RESULTS--Firearm-associated FIAs
were 3.0 times (95% confidence interval, 0.9 to 10.0) more likely to
result in death than FIAs involving knives or other cutting instruments
and 23.4 times (95% confidence interval, 7.0 to 78.6) more likely to
result in death than FIAs involving other weapons or bodily force.
Overall, firearm-associated FIAs were 12.0 times (95% confidence
interval, 4.6 to 31.5) more likely to result in death than
non-firearm-associated FIAs. CONCLUSIONS--Strategies for limiting the
number of deaths and injuries resulting from FIAs include reducing the
access of potential FIA assailants to firearms, modifying firearm
lethality through redesign, and establishing programs for primary
prevention of violence among intimates.
<21> Authors Mercer DW.Buckman RF Jr.Sood R.Kerr TM.Gelman J. Title
Anatomic considerations in penetrating gluteal wounds. Source Archives
of Surgery.127(4):407-10, 1992 Apr. Abstract A retrospective study of 81
patients with penetrating gluteal wounds was performed to determine if
the site of penetration was useful in predicting the likelihood of
associated vascular or visceral injury. There were 53 gunshot wounds and
28 stab wounds, including one impalement. The gluteal region was divided
into upper and lower zones by determining whether entry occurred above
or below the greater trochanters. Sixty-six percent of all penetrating
gluteal wounds entered the upper zone. Thirty-two percent of patients
with upper zone penetration had associated vascular or visceral injury.
Only one of 27 patients with lower zone penetration sustained major
injury. The site of entry plays a critical role in determining the
likelihood of serious injury associated with penetrating gluteal wounds.
Wounds penetrating above the greater trochanters demand thorough
evaluation, especially gunshot wounds. Prev by Date: Death rate from gun
assaults vs death rate from knife assaults Next by Date: Death rate from
handgun, long guns and knife wounds
