The Chinese investigators separated bullet wounds into three zones in the beginning of 1980s: a primary wound tract, a contusion zone adjacent to prinary wound tract, and a concussion zone neighboring the contusion zone. Basing on the research results by MRI scan and pathological observation, the author and his coworkers recently proposed that the gunshot wounds should be divided into four consecutive zones: a primary wound tract, a zone of coagulative necrosis, a zone of muscle disruption, and a zone of muscle distortion. A zone of coagulative necrosis plus a zone of muscle disruption equals to a contusion zone, they are separately named because the former is irreversibly devitalized and the latter still has the ability to recover. The sectionalized method shows the range of debridement and provide reference for the conservative treatment or thoroughly debridement. However, the mechanism of each zone need to be further studied.
Debridement ; Humans ; Necrosis ; Wounds, Gunshot ; pathology ; surgery ; therapy

Migration of a bullet to a distant part of the body after a gunshot is rarely observed in the clinical setting, and migration to the heart is even rarer. There are usually no clear symptoms or signs from migration of a bullet. The bullet can be easily missed and sometimes identified in a review examination. A case of bullet migration to the heart 2 months after a gunshot to the left knee was reported.
Adult ; Heart Injuries ; etiology ; pathology ; Humans ; Knee ; pathology ; Male ; Wounds, Gunshot

Animals ; Biological Warfare ; Burns ; pathology ; Burns, Chemical ; pathology ; Chemical Warfare ; China ; Humans ; Military Medicine ; Radiation Injuries ; pathology ; Wounds, Gunshot ; pathology

We report the clinical features and the course of traumatic corneal endothelial rings by trauma. Fourteen eyes (of fourteen patients) with traumatic endothelial rings (twelve cases of BB shot injury), were enrolled in this study. With median follow-up interval of 50 weeks, initial and final best corrected visual acuity, presence of combined injuries such as gross hyphema, and time of disappearance of traumatic endothelial rings were recorded. And specular microscopic examination was performed. The duration of existence of traumatic endothelial rings was mean 4.6 days. On the specular microscopic examination, the count of corneal endothelial cells in the injured eye decreased by mean 16.8% (ranged from 1 to 56%) than that in the opposite unjnjured eye. The duration of existence of traumatic endothelial rings was 3.5 days in the group without combined angle recession and was 6.1 days in the group with combined angle recession. We suggest that the possibility of traumatic corneal endothelial rings and resultant endothelial cell loss and their clinical potential should be always kept in mind in ocular trauma, particularly BB shot injury.
Adolescent ; Adult ; Aged ; Child ; Cornea/*injuries ; Endothelium, Corneal/*pathology ; Eye Injuries/*pathology ; Human ; Male ; Retrospective Studies ; Wounds, Gunshot/pathology

Confocal laser scanning microscopy(CLSM) is a new technique for microscopic imaging, which can collect the transverse section image of the samples and produce three-dimensional reconstruction and present higher spatial resolution than the conventional light microscope. As a precision instrument for the microscopic image, it plays an important role in forensic pathology. The article reviews the recent research achievements from sudden cardiac death, bullet wound and nervous system damage, etc, and explores the potential applications of the forensic pathology research and forensic practice.
Calcium/metabolism* ; Craniocerebral Trauma/pathology* ; Death, Sudden, Cardiac/pathology* ; Forensic Pathology/methods* ; Humans ; Image Processing, Computer-Assisted ; Microscopy, Confocal ; Myocardium/ultrastructure* ; Sensitivity and Specificity ; Trauma, Nervous System/pathology* ; Wounds and Injuries/pathology* ; Wounds, Gunshot/pathology*

OBJECTIVETo investigate the surgical treatment methods and evaluate the outcome of gunshot wounds combining with seawater immersion in rabbits' femoral arteries.

METHODSOne hundred healthy New Zealand white rabbits (either sex, 3.14 kg+/-0.61 kg in weight) were randomly divided into a seawater immersion group (n=50) and a simple injury group (n=50). The unilateral femoral arteries of all the rabbits were injured by 0.38 g steel spheres with velocity of 600-800 m/s fired by a 7.62 mm rifle. The rabbits in the seawater immersion group were immersed in seawater (saline content of 2.54%, pH 8.2-8.4, and at 21 degrees C) for 60 minutes but those in the simple injury group were not. After the injured segment (observed by naked eyes) of the femoral artery was excised, the blood flow restoration was reconstructed by direct end-to-end anastomosis, reversed autogenous venous grafting or cryopreserved arterial allografting, according to the length of the arterial defects. At 24 hours, and 7, 14 and 21 days after operation, the blood flow was examined. Operative exploration was performed for the animals with partly or fully obstructed blood flow. The tissues around the anastomosis sites and the grafts were harvested for pathological observation under a light microscope and an electron microscope.

RESULTSIn the rabbits with completely transected injury, the unobstructed rates in the first 3 weeks after operation were 80.00% in the seawater immersion group and 86.67% in the single injury group, and no significant difference was found between the two groups (P>0.1). In the rabbits with arterial contusion injury, the unobstructed rates in the first 3 weeks after operation were 86.67% in the seawater immersion group and 82.35% in the single injury group, and no significant difference was found between the two groups (P>0.1). Most thrombosis occurred in the first operative week. Atypical endothelial cells were detected at the anastomosis sites at the first operative week, and the anastomosis sites were lined with endothelial cells in 3 weeks postoperatively.

CONCLUSIONSDuring the surgical treatment for gunshot wounds combining with seawater immersion, resection of the grossly-injured artery and routine artery reconstruction can obtain satisfactory outcome. Homologous artery is a kind of vascular graft with certain applied value.

Animals ; Disease Models, Animal ; Female ; Femoral Artery ; diagnostic imaging ; injuries ; pathology ; surgery ; Hydrotherapy ; methods ; Male ; Rabbits ; Radiography ; Random Allocation ; Seawater ; Treatment Outcome ; Wound Healing ; Wounds, Gunshot ; diagnostic imaging ; pathology ; therapy

OBJECTIVETo investigate pathological characteristics of gunshot wounds concomitant seawater immersion in rabbits' femoral arteries.

METHODSThirty rabbits were divided randomly into 3 groups: simple gunshot-wound group (Group I, n = 10), gunshot wound with seawater immersion for 30 mins (Group II, n = 10), and 60 mins group (Group III, n = 10). Femoral arteries were impacted by 0.38 g steel spheres fired with a 7.62 mm rifle. After being wounded, rabbits in Groups II and III were immersed in seawater for 30 or 60 mins, but those in Group I were not. At 2, 4, 6, 8, 12 hours following injury, a 40 mm segment of the artery on each side of the gunshot point were excised and observed by light and electron microscopy.

RESULTSThe patterns of arterial injuries were mainly contusion and transection. Completely transected artery was classified as primary-wound-tract area, contused area and shocked area. Compared with those in Group I, the primary-wound-tract and contused areas in Group II manifested obvious swelling in the arterial wall especially at the outside 2/3 of the media. Vacuolar structures were often seen in smooth muscle cells of the media. Intercellular space among the smooth muscle cells were filled with homogeneous acidophilic substances. Deep rugae among endothelial cells flattened or rugal folds lost their longitudinal orientation, and marked fibrin and platelet deposition were noticed. No significant difference was detected between Group II and III. The pathological changes in the shocked area were similar in 3 groups.

CONCLUSIONSFor gunshot wounds concomitant seawater immersion in rabbits' femoral arteries, there was a marked swelling of cells and intercellular space in primary-wound-tract area and contusion area. The influence of these pathological changes on surgical reparation deservers further study.

Animals ; Biopsy, Needle ; Disease Models, Animal ; Female ; Femoral Artery ; injuries ; pathology ; Immersion ; Immunohistochemistry ; Male ; Microscopy, Electron, Scanning ; Rabbits ; Random Allocation ; Seawater ; adverse effects ; Sensitivity and Specificity ; Wound Healing ; physiology ; Wounds, Gunshot ; microbiology ; pathology

OBJECTIVETo investigate the therapeutic effect of nanometer silver impregnated dressing on gunshot wounds after being immersed in brine and tapwater in rabbits.

METHODSRabbits were randomly divided into two groups after receiving gunshot wounds in both lower limbs. In group 1, the wounded limbs on the experimental side were immersed in brine for 5 h; in group 2, the wounded limbs on experimental side were immersed in tapwater for 5 h. All the wounds were treated with nanometer silver impregnated dressing on the experimental sides, while those of the control sides were treated with vaseline dressing. Biopsy was done after 30 min and 1, 2, 3, 4, 5 h, respectively.

RESULTSIn group 1, the onset of inflammation around the wounds of the experimental sides was delayed, the inflammatory response was less serious, and the wounds were dry with less exudation compared to the controls. The mean healing time of the entry wounds on experimental and control sides was (29.4 +/- 6.6) d and (36.3 +/- 6.0) d (P < 0.01), respectively, and that of the exit wounds on experimental and control sides was (20.1 +/- 6.0) d and (27.3 +/- 5.7) d (P < 0.01), respectively. In group 2, only one of the experimental wounds showed mild inflammation, while all of the control wounds showed serious inflammation with much exudation. The mean healing time of the entry wounds on experimentsides was (13.0 +/- 1.52) d, while that on control sides was (16.0 +/- 3.10) d (P < 0.01). The mean healing time of exit wounds on experimental sides was (11.0 +/- 2.75) d, and those of the control sides was (15.6 +/- 2.85) d (P < 0.01).

CONCLUSIONThe nanometer silver impregnated dressing can control infection and accelerate healing in gunshot wounds in rabbits.

Animals ; Bacterial Infections ; etiology ; prevention & control ; Bandages ; Female ; Immersion ; Male ; Models, Animal ; Nanotechnology ; Rabbits ; Random Allocation ; Salts ; adverse effects ; Seawater ; adverse effects ; Silver ; pharmacology ; therapeutic use ; Treatment Outcome ; Water ; adverse effects ; Wound Healing ; drug effects ; Wounds, Gunshot ; microbiology ; pathology ; therapy

PURPOSE: Gunshot wounds are the second leading cause of spinal cord injuries. Surgical intervention for gunshot injury to the spine carries a high rate of complications. There is a scarcity of data on civilian gunshot injuries to the spine in Pakistan. Approximately 60 cases over the last 10 years have been recoded, with unusual presentation and neurological recovery. Thus it is imperative to fill this gap in data, by reviewing cases of civilian gunshot injuries to spine presenting at a tertiary care hospital (Aga Khan University Hospital, Karachi). METHODS: This is a retrospective cohort study. Patients of all ages who presented to the emergency department of Aga Khan University Hospital, with gunshot injuries to spine between January 2005 and December 2016 were included in the study. Data were collected on neurological status (American Spinal Injury Association score was used for the initial and follow-up neurological assessment), extent of cord transection, motor and sensory deficits. The patients were further grouped into those with cord transection, and those with fractures of the bony spine but an intact spinal cord. These patients were then followed and the outcomes were recorded. RESULTS: A total of 40 patients were identified. The mean ± SD of patients age was (30.9 ± 9.5) years. Of the 40 patients with gunshot wounds, 31 had the medical imaging performed at the facility, and hence they were included in this categorization. The remaining 9 patients were excluded from this additional grouping. Thirteen patients were managed surgically and 27 patients underwent the conservative management. The mean ± SD of follow-up was (8.7 ± 7.2) months. In our study, the thoracic spine was the most commonly injured region in gunshot injuries. Of the 31 patients with medical imaging performed at our institute, 17 (54.8%) had cord transection, of whom 8 (47%) ultimately developed paraplegia. CONCLUSION The prognosis of gunshot injuries to the spine can be varied depending on whether the spinal cord is intact or transected. This will help healthcare providers to plan the further management of the patient and counsel them accordingly.
Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Motor Disorders/etiology* ; Pakistan ; Prognosis ; Retrospective Studies ; Sensation Disorders/etiology* ; Spinal Cord/pathology* ; Spinal Cord Injuries/surgery* ; Wounds, Gunshot/surgery* ; Young Adult

OBJECTIVETo comparatively study the effects and mechanisms of burn-blast combined injury and burn-firearm combined injury complicated with seawater immersion on vascular endothelial cells.

METHODSA total of 40 healthy adult hybrid dogs of both sexes, weighing 12-15 kg, were used in this study. Randomly-selected 20 dogs were established as models of burn-blast combined injury (the burn-blast injury group) and the other 20 dogs as models of burn-firearm combined injury (the burn-firearm injury group). Then the wounds of all the dogs were immediately immersed in seawater for 4 hours, and then they were taken out from the seawater. Blood samples were withdrawn from the central vein of the dogs before injury, and at 4, 7, 10, 20, and 28 hours after injury to measure the circulating endothelial cells and the von Willebrand factor.

RESULTSCirculating endothelial cells increased significantly at 4 hours after injury in all the dogs. But they reached peak at 7 hours after injury in the burn-blast injury group and at 28 hours after injury in the burn-firearm injury group. The changes of circulating endothelial cells in the burn-blast injury group were significantly different from those in the burn-firearm injury group at 4, 7, 20, and 28 hours after injury (P < 0.01). The von Willebrand factor reached peak at 4 hours after injury in the burn-blast injury group and at 28 hours in the burn-firearm injury group. The changes of von Willebrand factor in the burn-blast injury group were significantly different from those in the burn-firearm injury group at 4, 20, and 28 hours after injury (P < 0.01).

CONCLUSIONSIn burn-blast injury combined with seawater immersion, the vascular endothelial cells changed most significantly at 4 hours or 7 hours after injury, while burn-firearm injury combined with seawater immersion have the same at 20 hours or 28 hours after injury.

Animals ; Blast Injuries ; pathology ; physiopathology ; Burns ; pathology ; physiopathology ; Disease Models, Animal ; Dogs ; Endothelial Cells ; physiology ; Female ; Immersion ; Injury Severity Score ; Male ; Multiple Organ Failure ; physiopathology ; Multiple Trauma ; pathology ; physiopathology ; Probability ; Random Allocation ; Seawater ; Sensitivity and Specificity ; Wound Healing ; physiology ; Wounds, Gunshot ; pathology ; physiopathology