INTRODUCTION: Retrospective analysis of a set of patients treated for penetrating chest trauma in the Trauma Centre at University Hospital Pilsen over seventeen years. METHOD: Overall, 96 injured with penetrating chest trauma were treated in the study period 2000-2016. Basic demographics, the mechanism, type, location and extent of the penetrating chest trauma, Injury Severity Score, existence of associated injuries, diagnostic procedures, timing and method of the chest trauma treatment as well as any complications and reoperations were identified in the set. Other collected information included deaths of the injured, and the cause and time of death in relation to the time of admission to the Trauma Centre. RESULTS: The most common mechanism of injury was attack by a stabbing weapon (54%) and the most common type of injury was pulmonary laceration (33%). The average Injury Severity Score within the set was 24 points. The most common therapeutic procedure was pleural cavity drainage (47 patients), and less than 40% of the cases required revision surgery by means of thoracotomy or sternotomy. One patient died immediately after being admitted to the Trauma Centre without a chance to apply any therapy; three other patients died during resuscitative thoracotomy or laparotomy. Post-operative complications occurred in 13 patients (13.5%) and required 14 reoperations. CONCLUSIONS: The diagnostic and therapeutic algorithm of penetrating chest trauma is primarily determined by the condition of the injured. Adequate drainage of the relevant pleural cavity is sufficient to treat one half of the patients; on the other hand, 40% of traumas, injuries of the heart, large vessels and gunshot wounds in particular, require urgent revision surgery by means of thoracotomy or sternotomy. If the injured patient is transported to a specialized centre for timely treatment, the prognosis of penetrating chest traumas is quite favourable.Key words: penetrating chest trauma - diagnosis - chest drainage - thoracotomy - sternotomy.

• MeSH
• lidé MeSH
• nemocnice univerzitní MeSH
• poranění hrudníku * diagnóza   chirurgie   MeSH
• retrospektivní studie MeSH
• střelné rány * chirurgie   MeSH
• torakotomie MeSH
• traumatologická centra MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Sometimes intraorbital foreign bodies lead to unexpected findings. A 16-year old boy was referred due to ocular surface trauma. A conjunctival laceration was detected at the level of the left caruncle with associated left exotropia, reduced adduction as well as a preretinal hemorrhage along the nasal periphery of the fundus. A blow-out fracture of the medial orbital wall was suspected and a CT scan of the orbits was scheduled which revealed the presence of a large intraorbital foreign body. The removal of the intraorbital foreign body (which proved to be a bullet) and precautionary laser photocoagulation along the nasal periphery of the left eye were performed. Ocular surface trauma may reveal unexpected findings, such as an intraorbital foreign body, requiring investigation by a CT scan.

• MeSH
• cizí těleso v oku diagnostické zobrazování   MeSH
• lidé MeSH
• mladiství MeSH
• orbita diagnostické zobrazování   MeSH
• penetrující poranění oka diagnostické zobrazování   MeSH
• počítačová rentgenová tomografie MeSH
• střelné rány diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

During the process of treating a complicated gunshot wound of an upper limb, chest, abdomen, and spine, there appeared--sometime after the initial treatment--a necrosis of the right hepatic duct in the bullet path within the liver. Although laparotomy was the life-saving operation during the first and second period, the final diagnosis and solution were based on bypassing the defect, i.e., a combination of a percutaneous and endoscopic approach. The efficiency of this method was also proved by an examination carried out 1 year after the end of the treatment.

• MeSH
• dospělí MeSH
• ductus hepaticus communis diagnostické zobrazování   zranění   chirurgie   MeSH
• endoskopie trávicího systému MeSH
• játra diagnostické zobrazování   zranění   chirurgie   MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• polytrauma diagnostické zobrazování   chirurgie   MeSH
• střelné rány chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The case review describes a shot injury of the thorax (without direct injury of the heart or lungs), with signs of advanced bleeding from the injured carotid artery. Employment of extracorporeal circulation facilitated safe extraction of the projectile and sound revisionining of all traumatized structures and their safe reconstruction.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• poranění arteria carotis * diagnostické zobrazování   chirurgie   MeSH
• poranění hrudníku * diagnostické zobrazování   chirurgie   MeSH
• radiografie MeSH
• střelné rány * diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY Outcome analysis of penetrating cardiac and great vessels injury within the 15-year existence of the cardiac surgery service as a part of the major trauma centre of the University Hospital Olomouc MATERIAL AND METHODS Retrospective analysis of a group of a total of 16 patients who underwent a surgery for penetrating cardiac and great vessels injury since II/2002 to XI/2016. The dominant causes of penetrating trauma were stab injuries (15 patients, 94%), in one patient only (6%) it was a gunshot injury. The mean age of the patients included in the group was 42.9 ± 16.1 years, with men significantly prevailing (13 patients, 81%). A total of 7 injured persons (44%) were haemodynamically stable when admitted, 9 injured persons (56%) were unstable or in critical condition. The average transfer distance was 48.8 ± 34.5 km; the injured were admitted on average 115.9 ± 154.8 minutes after being injured. Preoperatively, all the injured suffered from pericardial effusion (>5 mm) confirmed by TTE (81%) or CTA (19%). In 4 patients (25%) pericardial drainage for cardiac tamponade was performed before surgery. RESULTS All the penetrating cardiac and great vessels injuries were repaired by cardiac surgeon, in one case only (6%) the extracorporeal circulation support was used. The injury of coronary arteries was in one case managed by CABG and in the other case by ligation of the peripheral part of the coronary artery. In 4 patients (25%) also a penetrating injury of other organs was simultaneously managed. The mean ICU stay reached 85.8 ± 91.9 hours, on average 5.6 ± 9.3 units of red blood cells were administered during the in-hospital stay which lasted on average 7.1 ± 2.4 days. In the group a nonsignificant increase of left ventricular ejection fraction (44.1 ± 4.7 vs. 49.3 ± 3.2, p = 0.882) was reported at discharge of the injured patients. One patient died on the 78 th day of hypoxic brain damage (6% three-month mortality). The long-term survival analysis showed 94% one-year and 88% five-year cumulative survival in the group. DISCUSSION The incidence of the penetrating cardiac and great vessels injury is directly dependent on the crime level in the respective countries and regions. A cardiac arrest, severe hemodynamic instability, unconsciousness, serious concomitant injury, gunshot injury, multiple or atrial injury represent independent predictors of death in these injuries. The total three-month mortality in penetrating cardiac and great vessels injury ranges from 18 to 42%, the presence of vital signs at the time of hospital admission is associated with 78-92% probability of survival. The surviving patients show excellent long-term results with the exception of those who suffered a severe damage to valve apparatus or with significantly depressed left ventricular function. CONCLUSIONS Our experience proves a high survival rate of patients with penetrating cardiac and great vessels injury. The centralisation of the care into the major trauma centre with a cardiac surgery background, a unified treatment algorithm, and a vital interdisciplinary cooperation are the key goal of successful management of these injuries. Key words:penetrating injury, cardiac injury, great vessel injury, outcome. Práce byla podpořena programem institucionální podpor.

• MeSH
• bodné rány mortalita   chirurgie   MeSH
• délka pobytu MeSH
• dospělí MeSH
• koronární cévy zranění   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití MeSH
• péče o pacienty v kritickém stavu MeSH
• poranění srdce mortalita   chirurgie   MeSH
• retrospektivní studie MeSH
• střelné rány mortalita   chirurgie   MeSH
• traumatologická centra MeSH
• zločin MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

• MeSH
• dospělí MeSH
• kraniocerebrální traumata chirurgie   MeSH
• lidé MeSH
• metody MeSH
• poranění krku * MeSH
• střelné rány chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

Three cases of suicide by single bullet injury to head by home-made guns with immediate incapacitation are reported in following article. Zip gun (home-made gun) is a improvised firearm, usually a handgun. Home-made guns are almost always single-shot, as the improvised construction sometimes makes them weak enough to be destroyed by the act of firing. Zip guns are mostly smoothbore. Zip gun injuries, although unique today, represent a special category of missile injury with atypical low velocity terminal ballistics.

• MeSH
• kraniocerebrální traumata patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• sebevražda * MeSH
• senioři MeSH
• soudní balistika MeSH
• soudní patologie MeSH
• střelné rány patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• dospělí MeSH
• dura mater krevní zásobení   MeSH
• hemostáza MeSH
• kraniocerebrální traumata chirurgie   MeSH
• lidé MeSH
• metody MeSH
• pokus o sebevraždu MeSH
• senioři MeSH
• šicí techniky MeSH
• střelné rány komplikace   MeSH
• úrazy v domácnosti MeSH
• vény zranění   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

A complex suicide defines a combination of multiple suicidal methods the victim successively or concurrently carries out. We present a case of a 72-year old man found dead on the railtrack, seemingly committing simple train-related suicide. Flobert revolver - a small caliber handgun was found nearby. Herein, we emphasize the significance of a thorough external examination, stress the fact that victim can act after low-energy projectile trauma and match our case to a similar complex suicide.

• Klíčová slova
• Flobert revolver, gunshot wounds, train crash, unplanned complex suicide,
• MeSH
• lidé MeSH
• penetrující poranění hlavy * MeSH
• sebevražda * MeSH
• senioři MeSH
• střelné rány * diagnóza   MeSH
• střelné zbraně * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Scanning electron microscope improves the possibility of investigation of surroundings near of gunshot wounds in forensic medicine, it is the next subsequent method for differentiating of area of entrance and exit wound, supplemental method for determination of firing distance, permit of detection (GSR) on the hand of shooter and ensured describing of samples and their stored. Detection of GSR provides many information about composition of bullet and primer. Authors are demonstrating the possibility of detection of GSR on experimental shooting to the krupon (pigs' skin) in different situation (such as in a room and in outside area) and using of different weapon (hand gun CZ No.75 and machine gun No.58).

• MeSH
• fantomy radiodiagnostické MeSH
• kraniocerebrální traumata patologie   MeSH
• lidé MeSH
• mikroskopie elektronová rastrovací * MeSH
• prasata MeSH
• soudní balistika * MeSH
• soudní patologie MeSH
• střelné rány patologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH