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Introduction Laryngeal trauma can be an immediately life-threatening entity. Failure to recognize such injuries and delay in securing the airway may have fatal results. Early diagnosis and accurate evaluation with proper treatment is vital. Materials and Methods Fifteen patients with laryngotracheal injuries were analyzed prospectively. The outcome was assessed both in terms of voice and airway, on short term and long term basis. Result Commonest cause of injury was suicidal followed by road traffic accidents and strangulation. The main presenting symptoms and signs were stridor, hoarseness, haemoptysis and odynophagia. Five patients suffered penetrating trauma and ten patient sustained blunt trauma. Sites of laryngeal injury included; hyoid bone fracture, mixed soft tissue and cartilaginous injuries, thyrohyoid membrane and cricothyroid membrane injuries. Eleven patients presented within 24 hours of the injury. Outcome (airway and voice) was good in ten patients whereas it was poor in three patients. Poor results were seen in patients who had delayed surgical intervention. Conclusion Early surgical intervention is recommended for traumatic laryngeal injuries to ensure a good outcome; which further depends upon patient’s condition, injury and treatment-specific factors.

Introduction Laryngeal trauma can be an immediately life-threatening entity. Failure to recognize such injuries and delay in securing the airway may have fatal results. Early diagnosis and accurate evaluation with proper treatment is vital. Materials and Methods Fifteen patients with laryngotracheal injuries were analyzed prospectively. The outcome was assessed both in terms of voice and airway, on short term and long term basis. Result Commonest cause of injury was suicidal followed by road traffic accidents and strangulation. The main presenting symptoms and signs were stridor, hoarseness, haemoptysis and odynophagia. Five patients suffered penetrating trauma and ten patient sustained blunt trauma. Sites of laryngeal injury included; hyoid bone fracture, mixed soft tissue and cartilaginous injuries, thyrohyoid membrane and cricothyroid membrane injuries. Eleven patients presented within 24 hours of the injury. Outcome (airway and voice) was good in ten patients whereas it was poor in three patients. Poor results were seen in patients who had delayed surgical intervention. Conclusion Early surgical intervention is recommended for traumatic laryngeal injuries to ensure a good outcome; which further depends upon patient’s condition, injury and treatment-specific factors.

Introduction Laryngeal trauma can be an immediately life-threatening entity. Failure to recognize such injuries and delay in securing the airway may have fatal results. Early diagnosis and accurate evaluation with proper treatment is vital. Materials and Methods Fifteen patients with laryngotracheal injuries were analyzed prospectively. The outcome was assessed both in terms of voice and airway, on short term and long term basis. Result Commonest cause of injury was suicidal followed by road traffic accidents and strangulation. The main presenting symptoms and signs were stridor, hoarseness, haemoptysis and odynophagia. Five patients suffered penetrating trauma and ten patient sustained blunt trauma. Sites of laryngeal injury included; hyoid bone fracture, mixed soft tissue and cartilaginous injuries, thyrohyoid membrane and cricothyroid membrane injuries. Eleven patients presented within 24 hours of the injury. Outcome (airway and voice) was good in ten patients whereas it was poor in three patients. Poor results were seen in patients who had delayed surgical intervention. Conclusion Early surgical intervention is recommended for traumatic laryngeal injuries to ensure a good outcome; which further depends upon patient’s condition, injury and treatment-specific factors.

Traumatic lethal injuries caused by crossbows are a rarity in forensic pathology. They occur as accidents, suicide and, more rarely, as murders. We report a case of murder received at the Institute of Legal Medicine in Milan carried out by two weapons – a crossbow and a hunting knife – that resulted in multiple thoraco-abdominal wounds. The case is also rare because of the unique circumstances involving the victim – a local service psychiatrist – and the perpetrator – a former medical specialist in psychiatry, suffering from a delusional psychotic disorder. The crossbow was the decisive instrument in the realization of the murder; it was chosen with premeditation for its high destructive capacity and the fact that it was easily obtainable, and it was used with darts that were specially modified to increase its harmful capacity. The presented case, as well as providing an opportunity to highlight the damaging effects of a rarely used weapon, stresses the problems inherent with access to tools such as the crossbow that are used in sport, and which are potentially dangerous but easily accessible, even to those with serious mental disorders, rendering them legally unfit for using firearms.

Vibrio alginolyticus is a halophilic Gram-negative bacterium normally present in seawater. Vibrios are not capable of cutaneous invasion through intact skin and their isolation from extraintestinal sites is uncommon. However, interruptions in skin integrity (cuts or abrasions) can allow these bacteria to cause complicated skin and soft tissues infections. This case study describes the clinical assessment and management of a nonhealing traumatic wound, sustained in a coastal area during the winter months, in a healthy 70-year-old man. Culture results were positive for V. alginolyticus. Appropriate antibiotic treatment and topical wound care successfully resolved the infection. V. alginolyticus infections are usually benign; respond well to treatment, even with local therapy only; and tend to result from contact with warm ocean water. The clinical characteristics of the wound prompted a suspicion of a Vibrio infection even though the wound was sustained in the winter time and the patient did not have direct contact with ocean water. Although other case studies of Vibrio infections in the absence of direct contact with ocean water have been published, increased ocean temperatures due to global climate changes may explain the out-of-season infection in this patient. Clinicians should monitor the progression of wound healing and be prepared to modify treatment based on individual circumstances, especially in the case of unusual wound presentation, nonhealing, or a progressing wound infection.

We report an unusual suicide, committed with a common pencil. A 72-year-old male inflicted himself a penetrating thoracic wound while being hospitalized for a hip prosthesis operation. Although the patient was immediately operated, the cardiac injury appeared to be fatal. Cases of suicidal penetrating wounds of the anterior chest wall are rare and they are mostly inflicted by knives, glass fragments, or other sharp instruments. The potential danger of a pencil should be taken into consideration, especially in psychiatric hospitals and imprisonment facilities. We examined the legislation in Italy and Finland concerning the regulation of privacy in special care institutions. Copyright © 2005 by ASTM International.

Right ventricular perforation by a temporary endocardial pacing electrode can be fatal and needs to be detected promptly. This usually symptomatic situation is diagnosed by X-ray or echocardiographic findings. We present the case of a patient with an asymptomatic right ventricular perforation, in whom serial electrocardiograms enabled us to detect the displacement of the right ventricular lead.

Craniofacial traumas often involve the orbital region. This report describes an unusual case of penetration of an object into the left upper oral vestibule up to the left medial-upper orbital wall. The object was an indicator switch. A multidisciplinary approach was necessary to make a correct diagnosis and to apply the best surgical treatment. The object was surgically removed, and rigid internal fixation was used to reconstruct the inferior and medial orbital walls. The aesthetic and functional results were good. One year later, the patient showed a slight enophthalmos with normal ocular motility.

The case of a 75-year-old women with probable tracheal laceration and tension pneumomediastinum after intubation is reported. A dramatic reduction of tracheal caliber was observed during fiberoptic bronchoscopy. Despite severe dyspnea, the patient healed with conservative measures. We conclude that aggressive surgical treatment for tracheal laceration is not always necessary.

This prospective study assessed the role of Doppler pressure indices (Ankle-Brachial Index [ABI] or Brachial Brachial Index [BBI]) in the evaluation for occult arterial injury from penetrating proximity extremity trauma (PET). A total of 258 patients with 323 PETs were evaluated by physical examination and Doppler pressure (ABI/BBI) determination. An ABI/BBI of < 0.9 was considered abnormal. The findings were compared with those of arteriography in all patients. Eleven injuries (3.4%) found on arteriography were associated with normal indices. Five of these injuries were treated by repair (4 patients) or angiographic embolization of a bleeding vessel (1 patient), all in lesions proximal to the knee or elbow joints. The other six lesions were observed without intervention. All of the 29 injuries associated with abnormal indices had positive arteriographic findings. The 4 lesions that were treated operatively were proximal and the remaining 25, all with distal penetration, were observed without observation. As compared to angiography, Doppler indices yielded the following results: 283 true-negative, 11 false-negative, 29 true-positive, and 0 false-positive, for a sensitivity of 72.5%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 96%. These data suggest that Doppler indices should be an integral part of the physical examination and can screen patients with proximal injuries for further studies such as duplex sonography or arteriography.

Woodcut printed by Johann Grüninger, artist unknown., A young man sitting in a chair with four arrows lodged into his body. A teacher and two students stand looking at him, and a landscape and town can be seen through the windows in the background.--Cf. Schramm., A composite image, with the left side also appearing in other prints from Grüninger., Title from Schramm.