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At least one in three women experience intimate partner violence (IPV) in their lifetime. The most commonly sustained IPV-related brain injuries include strangulation-related alterations in consciousness (S-AICs) and traumatic brain injuries (TBIs). Moreover, survivors of IPV-related S-AICs and/or TBIs often demonstrate psychological distress such as depression, anxiety, and post-traumatic stress. However, the co-occurrence of S-AICs and TBIs, and whether such TBIs may be moderate to severe, has not been systematically examined, and most data have been collected from women in North America. The purpose of this study was to examine the co-occurrence of IPV-related S-AICs and TBIs across a range of geographical locations and to determine the extent to which these S-AICs are related to psychological distress. Women who had experienced physical IPV (n = 213) were included in this secondary analysis of retrospectively collected data across four countries (Canada, the United States, Spain, and Colombia). The Brain Injury Severity Assessment (BISA) was used to assess IPV-related BI across all sites. Because various questionnaires were employed to assess levels of depression, anxiety, and post-traumatic stress disorder at each site, we created a standardized composite score by converting raw scores into Z-scores for analysis. Mann-Whitney U tests and chi-square tests were conducted to examine differences between women with and without experience of S-AICs and to discover if there was a relationship between the occurrence of S-AICs and TBIs. Analysis of variance and analysis of covariance (to control for the potential confounding effects of age, education, and non IPV-related TBI) were used to compare levels of psychological distress in women who had or had not experienced S-AICs. Approximately, 67% of women sustained at least one IPV-related BI (i.e., TBI and/or S-AIC). In a subsample of women who sustained at least one IPV-related BI, approximately 37% sustained both S-AICs and TBIs, 2% sustained only S-AICs (with no TBIs), and 61% sustained TBIs exclusively (with no S-AICs). Furthermore, women who had sustained S-AICs (with or without a TBI) were more likely to have experienced a moderate-to-severe BI than those who had not sustained an S-AIC (BISA severity subscale: U = 3939, p = 0.006). In addition, women who experienced S-AICs (with or without a TBI) reported higher levels of psychological distress compared with women who never experienced S-AICs, irrespective of whether they occurred once or multiple times. These data underscore the importance of assessing for S-AIC in women who have experienced IPV and when present, to also assess for TBIs and the presence of psychological distress. Unfortunately, there were methodological differences across sites precluding cross-site comparisons. Nonetheless, data were collected across four culturally and geographically diverse countries and, therefore, highlight IPV-related BIs as a global issue that needs to be aggressively studied with policies established and then implemented to address findings.

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Abstract Objective: Based on scientific evidence, the objective of the present study is to report the possible risks and benefits of the amber teething necklace for children who use it. Data source: This is an integrative literature review, carried out based on the following guiding question: "Does the amber teething necklace have therapeutic properties that justify its usage during tooth eruption?". The consulted databases were LILACS (Latin American and Caribbean Health Sciences Literature) and PubMed (National Center for Biotechnology Information), with the following descriptors: "Amber," "Deciduous teeth," "Strangulation," and "Local symptoms." Data synthesis: A total of five scientific articles were selected, which indicates an insufficient basis regarding the benefits associated with the use of the amber teething necklace. Conversely, there is a convergence regarding the possibility of health risks such as strangulation, asphyxiation, and swallowing of beads. Conclusions: Health professionals should discourage the use of the amber teething necklace by children insofar more studies on the topic are carried out.

Resumo Objetivo: Com base em evidências científicas, a proposta do presente trabalho é relatar os prováveis riscos e benefícios do uso do colar de âmbar pela população infantil. Fontes de dados: Trata-se de uma revisão integrativa da literatura, realizada a partir da elaboração da questão norteadora: "O colar de âmbar apresenta propriedades que justifiquem seu uso durante a erupção dentária?''. As bases de dados utilizadas foram LILACS (Literatura Latino-americana e do Caribe em Ciências da Saúde), PubMed (National Center for Biotechnology Information), por meio dos descritores: Âmbar; Dentes decíduos; Estrangulamento; Sintomas locais. Síntese dos dados: Após a busca dos dados, foram selecionados cinco artigos, os quais apontam insuficiente embasamento científico que comprove os benefícios relacionados ao uso do colar de âmbar. Em contrapartida, existe uma convergência quanto à possibilidade de riscos à saúde, como estrangulamento, asfixia e deglutição das pedras. Conclusões: Conclui-se que os profissionais da saúde devem desencorajar o seu uso por crianças até que pesquisas clínicas bem delineadas sejam disponibilizadas.

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PURPOSE: The implications of bowel obstruction occurring secondary to femoral hernia have not been discussed in the literature recently. Thus, we report our experience of treating patients with femoral hernias complicated by bowel obstruction versus patients with femoral hernias not complicated by bowel obstruction. METHODS: The subjects of this retrospective study were patients admitted to our hospital for the treatment of femoral hernias between 2016 and 2019. We used the Fisher and Student's T test to compare the preoperative characteristics, treatment, and outcomes of patients with bowel obstruction versus those without bowel obstruction. RESULTS: A total of 53 patients (mean age, 66.9 ± 15.1 years) were treated, 18 (33.9%) of whom underwent elective surgery and 35 (66%) of whom required emergency surgery (p = 0.001). The mean time between the development of symptoms and hospitalization was 4.5 ± 3.1 days for the patients with bowel obstruction and 1.6 ± 3.2 days for those without bowel obstruction (p = 0.001). The length of hospital stay was 11.1 ± 21.1 days for the patients with bowel obstruction and 1 ± 1.8 days for those without bowel obstruction (p = 0.028). Overall morbidity and mortality rates were 13.2% and 5.6%, respectively. CONCLUSION: Femoral hernias causing bowel obstruction are associated with greater time between the development of symptoms, hospitalization, and with a longer hospital stay.

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RESUMEN Las asfixias mecánicas son aquellas que resultan del impedimento mecánico a la penetración del aire en las vías respiratorias, suelen clasificarse atendiendo a la naturaleza del medio mecánico que las origina y a su modo de actuar. La estrangulación puede definirse como la constricción del cuello mediante la aplicación de una fuerza activa, ajena al peso del cuerpo, que actúa por intermedio de un lazo, las manos, el antebrazo o cualquier otra estructura rígida. En la estrangulación antebraquial, la constricción del cuello se lleva a cabo normalmente rodeando al individuo con el brazo y el antebrazo. Cuando el mecanismo de la compresión del cuello es lateral, no se afectan las vías aéreas, la compresión de las arterias carótidas hace que se produzca una isquemia cerebral y pérdida de conocimiento en 10-15 segundos. El mecanismo de muerte en estos casos será la anoxia cefálica. Si la compresión del cuello es anterior, actúa ocluyendo las vías aéreas, la presión sobre los cartílagos tiroides y cricoides puede producir fracturas y el mecanismo de muerte será la obstrucción respiratoria. El presente trabajo constituyó un caso poco común de estrangulación, donde se utilizó un mecanismo combinado que llevó al occiso al deceso final. Para la realización de la discusión del caso se tuvo en cuenta los elementos del lugar del hecho, el examen del exterior y el interior del cadáver (AU).

ABSTRACT Mechanical asphyxias are those resulting from the mechanical obstruction of the air penetration in the airways. They are usually classified according to the nature of the mechanical mean producing it and the way it performs. Strangulation may be defined as neck constriction through the application of an active force not proper to the body weight, acting by means of a knot, hands, forearm or any stiff structure. In ante brachial strangulation, neck constriction is normally performed surrounding the individual with the arm and forearm. When the neck constriction mechanism is lateral, the airways are not affected: carotid arteries constriction produces a brain stroke and loss of consciousness in 10-15 s. The death mechanism in these cases will be cephalic anoxia. If the neck compression is anterior, it occludes the airways; the pressure on thyroidal and cricoid cartilages may produce fractures and death mechanism will be respiratory obstruction. The current work deals with an uncommon strangulation case, where a combined mechanism led the person to the final decease. For the case discussion the authors took into account the elements of the place, and the examination of the exterior and the inside of the corpse (AU).

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OBJECTIVE: To compare risk factors for infant sleep-related deaths under the supervision of parents and nonparents. STUDY DESIGN: We conducted a secondary analysis of sleep-related infant deaths from 2004 to 2014 in the National Center for Fatality Review and Prevention Child Death Review Case Reporting System. The main exposure was supervisor at time of death. Primary outcomes included sleep position, location, and objects in the environment. Risk factors for parental vs nonparental supervisor were compared using χ2 and multivariable logistic regression models. Risk factors associated with different nonparental supervisors were analyzed using χ2. RESULTS: Of the 10 490 deaths, 1375 (13.1%) occurred under nonparental supervision. Infants who died under nonparental supervision had higher adjusted odds of dying outside the home (OR 12.87, 95% CI 11.31-14.65), being placed prone (OR 1.61, 95% CI 1.39-1.86) or on their side (OR 1.35, 95% CI 1.12-1.62), or being found prone (OR 1.74, 95% CI 1.50-2.02). Among infants who died under nonparental supervision, those supervised by relatives or friends were more often placed on an adult bed or couch for sleep and bed sharing (P < .0001), and to have objects in the sleep environment (P = .01). CONCLUSIONS: Infants who died of sleep-related causes under nonparental supervision were more likely to have been placed nonsupine. Among nonparental supervisors, relatives and friends were more likely to use unsafe sleep environments, such as locations other than a crib or bassinet and bed sharing. Pediatricians should educate parents that all caregivers must always follow safe sleep practices.

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Resumen El hallazgo de un cadáver con signos de suspensión y en circunstancias dudosas plantea la posibilidad de que la muerte esté relacionada a la intervención de terceros. Presentamos el caso de un varón de 36 años que fue encontrado muerto, con una compresión cervical mecánica extrínseca, en una vía pública, sin testigos del hecho. Inicialmente, se investigó el caso como un homicidio, con diagnóstico diferencial de suicidio. El estudio exhaustivo del sitio de la muerte, más el examen post-mórtem completo, incluyendo: autopsia, histopatología y toxicología, permitió descartar la posibilidad de la acción de terceros y confirmar la hipótesis diagnóstica de una estrangulación autoinducida, de ubicación atípica, ejecutada con lazo.

Abstract Finding a suspended body in doubtful circumstances raises the possibility that the manner of death is homicide. We present the case of a 36 years-old male who was found dead, with extrinsic mechanical cervical compression, on a public place, there were no witnesses of the fact. Initially, the case was investigated as a homicide, with differential diagnosis of suicide. The comprehensive analysis of the scene and a complete post-mortem examination: including autopsy, histopathology and toxicology results, allowed us to rule out the possibility of the action of third parties and confirm the hypothesis of a self-induced atypical strangulation.

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Acute appendicitis is one of the most common surgical emergencies in paediatrics. However, acute appendicitis in early infancy is an uncommon condition. Furthermore, strangulation of the small intestine through appendicular knotting is described as very unusual in the literature and is generally not well-diagnosed in the clinical context. This article reports the case of a 23-month-old girl who entered the emergency department with a three-day history of abdominal symptoms and who died in less than 24 hours without receiving surgical intervention. The case turned judicial at the request of the parents who claimed lack of clarity in the diagnosis. A medico-legal autopsy was ordered to clarify the cause and manner of death. The autopsy documented herniation, strangulation and torsion of a 70 cm segment of the jejunum/ileum through an appendicular knot caused by the attachment of the distal end of the inflamed appendage to the ileum. The case is relevant because it is the first case of death by appendicular knot and strangulation of small bowel in an infant reported in the literature. The importance of autopsy to clarify the clinical diagnosis is noted.

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Resumen:La tasa de suicidio en Costa Rica ha sido históricamente menor a 10 casos por cada 100,000 habitantes y se considera menor que en otros paÍses. Existen múltiples factores de riesgo, tanto sociales (pobreza, desempleo, drogadicción) como psicológicos (depresión, duelo), estos son significativamente frecuentes y podrían incrementar estas cifras.Este estudio hace un análisis actualizado acerca del suicidio en Costa Rica, recopilando el número de muertes suicidas en el año 2015 y 2016, siendo respectivamente 318 y 302 casos, obteniendo un perfil del individuo que logró acabar con su vida.Se trató de víctimas predominantemente de género masculino, en edades económicamente activas, con una mayor tasa de mortalidad por suicidio entre las edades 20-60 en el año 2015 y 20-50 en el 2016. El mecanismo más comúnmente utilizado fue la asfixia por ahorcadura, en los meses de enero, junio y diciembre para el año 2015, enero y agosto para el año 2016.

Abstract:Suicide rate in Costa Rica has being historically fewer than 10 per 100,000 habitants, it is considered lower than other countries. Multiple risk factors such as social (poverty, unemployment, drug addiction) and psychological (depression, grieving) are extremely frequent and can be the cause of rise in these numbers.This study is an actual analysis of suicide cases in Costa Rica in 2015 and 2016, 318 and 302 cases in each year, and an individual profile was obtained.Suicide was more frequent in males, in economically active ages, with a higher rate in the age range from 20 to 60 in 2015 and 20 to 50 in 2016. The most common death mechanism was asphyxia caused by strangulation in January, June and December of 2015, January and August in 2016.

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OBJECTIVE: To investigate practices, knowledge, attitudes, and beliefs regarding infant sleep among adolescent mothers, a demographic at high risk for sudden unexpected infant death, and to identify novel public health interventions targeting the particular reasons of this population. STUDY DESIGN: Seven targeted focus groups including 43 adolescent mothers were conducted at high school daycare centers throughout Colorado. Focus groups were recorded, transcribed, validated, and then analyzed in NVivo 10. Validation included coding consistency statistics and expert review. RESULTS: Most mothers knew many of the American Academy of Pediatrics recommendations for infant sleep. However, almost all teens reported bedsharing regularly and used loose blankets or soft bedding despite being informed of risks. Reasons for nonadherence to recommendations included beliefs that babies are safest and sleep more/better in bed with them, that bedsharing is a bonding opportunity, and that bedsharing is easier than using a separate sleep space. The most common justifications for blankets were infant comfort and concern that babies were cold. Participants' decision making was often influenced by their own mothers, with whom they often resided. Participants felt that their instincts trumped professional advice, even when in direct contradiction to safe sleep recommendations. CONCLUSIONS: Among focus group participants, adherence with safe sleep practices was poor despite awareness of the American Academy of Pediatrics recommendations. Many mothers expressed beliefs and instincts that infants were safe in various unsafe sleep environments. Future study should investigate the efficacy of alternative educational strategies, including education of grandmothers, who have significant influence over adolescent mothers.

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This article reports a case of suicidal strangulation by ligature of a 51-year-old woman with a psychiatric disorder. She had been suffering from depression with a history of previous suicidal attempt. The deceased accomplished self-strangulation using two ligatures, with one placed above the other and consisting of a satin fabric and a shoelace. The underlying shoelace ligature was fastened by a secure fixed square knot at the back of the neck. The overlying fabric piece was tied with a half-knot under the chin and was tightened around the neck manually. A detailed investigation and autopsy examination strongly suggests suicide. The case is of interest due to its rarity and uncommon method of execution.

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Elder homicide is a fatal outcome of elder abuse and neglect. Multifactorial homicidal asphyxia in an elderly man by combination of three different mechanisms is an uncommon incident. This following case demonstrates a very unusual murder of 74-year-old man in his own residence. Crime scene visit and postmortem examination revealed that the victim was killed by combined effect of ligature strangulation, traumatic asphyxia and smothering by plastic bag.

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En Medicina Legal los especialistas se enfrentan a diario con fallecidos que presentan como causa directa de muerte la asfixia mecánica producida por la constricción del cuello, que produce el dogal utilizado en cada caso. La constricción cervical puede ser por ahorcamiento y por estrangulación manual o a lazo. En esta ocasión, se presentó el caso de una anciana de 69 años, que, según datos aportados por la instrucción policial, fue encontrada en su domicilio, y presentaba como signo de violencia en la región del cuello un surco horizontal, de 3 cm de ancho en su parte posterior, de superficie blanda, poco profundo, dirigido de detrás hacia delante, que se interrumpía en la parte anterior del cuello, lo cual corresponde con la posición del nudo. Tenía antecedentes de trastornos psiquiátricos, lo cual justifica su actuación, resultando ser un individuo con incapacidad de adoptar normas de convivencia adecuadas al medio sociocultural en el que se desarrollaba, mostrando con frecuencia tendencias a la depresión.

In Legal Medicine specialists find everyday dead people whose direct cause of death is mechanical asphyxia by neck constriction produced by the halter used in each case. Cervical constriction may be caused by hanging or by hand or loop knot strangulation. This time we presented the case of an elder woman aged 69 years who, according to data brought by police instruction, was found home presenting, as a violence sign, a slightly deep horizontal line in the neck, 3 cm width in its back part, with soft surface, directed from the back to the front, interrupted in the neck frontal part, in correspondence with the knot position. She had antecedents of psychiatric disturbances, justifying her behavior; she was an individual unable to adopt life norms fitting the socio-cultural environment where she used to live, frequently showing tendencies to depression.

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We report a case of watershed ischemic stroke in a 36-year-old male secondary to manual strangulation. The patient presented with a right hemiparesis with grade IV motor deficit and an expressive aphasia. Radiological investigation revealed an ischemic stroke on the left distal middle cerebral artery territory and in watershed areas of the left anterior and posterior cerebral arteries. There was no evidence of injury of cervical vessels. The hemodynamic mechanism and associated brain injury secondary to manual strangulation is described and discussed based on a literature review.

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This article reports a self-strangulation suicide in which a double complex group of ligatures was used. Although similar cases have been referenced in forensic literature, this case is notable because of the unusual method used by the victim. A 61-year-old man was found in a locked room with a double elaborate ligature comprising six wire clothes hangers completely encircling the neck and a black rubber band in a double loop. Autopsy also documented parallel superficial cut lesions in proximal forearm interpreted as hesitation marks. It stresses the importance of characteristics such as analysis of number of ligatures, position of the knots, number of knots and turns of ligature marks and the absence of any defense and relevant internal injuries inherent to suicide ligature strangulation cases.

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OBJECTIVE: To examine whether infants reported for maltreatment face a heightened risk of sudden infant death syndrome (SIDS) and other leading causes of sudden unexpected infant death (SUID). STUDY DESIGN: Linked birth and infant death records for all children born in California between 1999 and 2006 were matched to administrative child protection data. Infants were prospectively followed from birth through death or 1 year of age. A report of maltreatment was modeled as a time-varying covariate; risk factors at birth were included as baseline covariates. Multivariable competing risk survival models were used to estimate the adjusted relative hazard of postneonatal SIDS and other SUID. RESULTS: A previous maltreatment report emerged as a significant predictor of SIDS and other SUID. After adjusting for baseline risk factors, the rate of SIDS was more than 3 times as great among infants reported for possible maltreatment (hazard ratio: 3.22; 95% CI: 2.66, 3.89). CONCLUSION: Infants reported to child protective services have a heightened risk of SIDS and other SUID. Targeted services and improved communication between child protective services and the pediatric health care community may enhance infant well-being and reduce risk of death.

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La obstrucción estrangulante es la combinación de obstrucción simple del tracto gastrointestinal del equino acompañado de bloqueo del abastecimiento circulatorio, lo cual causa severa enfermedad intestinal. Esta afección es comúnmente conocida como Síndrome Abdominal Agudo o Cólico. La incidencia de esta afección es considerada baja con una mortalidad alta dependiendo del segmento anatómico involucrado y del tiempo con que se intervenga quirúrgicamente el paciente. En el presente trabajo se reportan los hallazgos clínicos e histopatológicos, el tratamiento quirúrgico, la evolución clínica y el manejo medico post-quirúrgico de dos casos de obstrucciones estrangulantes del colon mayor en equinos referidos a la Clínica Veterinaria Dr. “Luis Medina”. La historia, sintomatología clínica y pruebas de laboratorio orientaron el diagnóstico, el cual fue confirmado a través de laparotomía exploratoria, la resolución de cada caso fue acompañada con un estudio histológico del segmento intestinal afectado. La resolución en el caso número uno fue por enterotomía de vaciado, mientras que el caso dos fue tratado con reseción del colon mayor con entero anastomosis latero-lateral. Ambos casos sobrevivieron, observándose mejor progreso clínico post-quirúrgico en el caso número dos.

Strangulation obstructions are external vascular constriction with simultaneous blockage of intestinal lumen. It has also been referred cause severe intestinal disease in the horses and commonly related colic. The incidence of this lesion is low with high fatality influenced by anatomic segment involved and rapid surgical intervention at the horse. This paper report the history, clinical signs, histopathologic findings, surgical ma- nagement, clinical progress and post-surgical treatment in two case of strangulation of the large colon in horses sent to the veterinary clinic “Dr. Luis Medina”. History, physical examination, laboratory test and exploratory laparatomy were used for diagnostic purpose. The resolution of each case has been completed with a histopatlogic study of the anatomic segment involved. The resolution in the case number one was for pelvic flexure enterotomy to decompress the colon torsion. The case number two was threatened with large colon resection and sideto-side anastomosis of left dorsal and ventral colons. Both cases survived however the case two have better clinical progress post-surgical.

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O objetivo deste trabalho é descrever a ocorrência de cólica por estrangulação intestinal ocasionada por banda mesodiverticular (BMD) e divertículo de Meckel (DM) em uma égua no terço final de gestação com histórico de 20 horas de cólica moderada contínua sem resposta à administração de analgésicos. Pela celiotomia constatou-se a presença de BMD e DM medindo 15cm a partir da borda anti-mesentérica, ocasionando estrangulação intestinal distante 150cm do orifício ileocecal. Realizaramse enterectomia de 290cm de alça necrosada, drenagem do conteúdo enegrecido e fétido do intestino remanescente, seguida de by pass do ceco por jejuno-colonostomia. Durante o pós-operatório, o quadro se manteve refratário à terapia intensiva instituída. O animal voltou a ter refluxo pela sonda nasogástrica e ocorreu abortamento após seis dias, sendo praticada a eutanásia após 24 horas. A BMD e o DM são estruturas remanescentes dos componentes onfalomesentéricos vitelinos, e sua ressecção deve ser considerada sempre que essas estruturas forem diagnosticadas durante a cirurgia abdominal em equinos. A égua deste relato viveu cinco anos sem consequências aparentes, até que tais alterações provocaram a estrangulação intestinal.(AU)

The objective of this report is to describe the occurrence of intestinal strangulation caused by mesodiverticular band (MDB) and Meckel´s diverticulum (MD) in a mare at the latter third of gestation with a 20 hours history of moderate colic unresponsive to analgesic medication. The celiotomy revealed the presence of 5.9 inches long MD and MDB causing intestinal strangulation 59 inches from the ileocecal valve. It was performed an enterectomy of 115 inches of necrotic loop, drainage of the dark and fetid content of the remaining intestine, followed by cecum bypass through jejunocolostomy. Despite the intensive therapy established during postoperative, the gastric reflux through the nasogastric tube came back, the mare suffered abortion after six days, and the euthanasia was performed after 24 hours. MDB and MD are remaining structures of vitelline omphalomesenteric components and their resection should be considered whenever these structures are diagnosed during abdominal surgery in equines. The mare on this report lived five years without apparent consequences; until the moment these alterations caused intestinal strangulation.(AU)

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O objetivo deste trabalho é descrever a ocorrência de cólica por estrangulação intestinal ocasionada por banda mesodiverticular (BMD) e divertículo de Meckel (DM) em uma égua no terço final de gestação com histórico de 20 horas de cólica moderada contínua sem resposta à administração de analgésicos. Pela celiotomia constatou-se a presença de BMD e DM medindo 15cm a partir da borda anti-mesentérica, ocasionando estrangulação intestinal distante 150cm do orifício ileocecal. Realizaramse enterectomia de 290cm de alça necrosada, drenagem do conteúdo enegrecido e fétido do intestino remanescente, seguida de by pass do ceco por jejuno-colonostomia. Durante o pós-operatório, o quadro se manteve refratário à terapia intensiva instituída. O animal voltou a ter refluxo pela sonda nasogástrica e ocorreu abortamento após seis dias, sendo praticada a eutanásia após 24 horas. A BMD e o DM são estruturas remanescentes dos componentes onfalomesentéricos vitelinos, e sua ressecção deve ser considerada sempre que essas estruturas forem diagnosticadas durante a cirurgia abdominal em equinos. A égua deste relato viveu cinco anos sem consequências aparentes, até que tais alterações provocaram a estrangulação intestinal.

The objective of this report is to describe the occurrence of intestinal strangulation caused by mesodiverticular band (MDB) and Meckel´s diverticulum (MD) in a mare at the latter third of gestation with a 20 hours history of moderate colic unresponsive to analgesic medication. The celiotomy revealed the presence of 5.9 inches long MD and MDB causing intestinal strangulation 59 inches from the ileocecal valve. It was performed an enterectomy of 115 inches of necrotic loop, drainage of the dark and fetid content of the remaining intestine, followed by cecum bypass through jejunocolostomy. Despite the intensive therapy established during postoperative, the gastric reflux through the nasogastric tube came back, the mare suffered abortion after six days, and the euthanasia was performed after 24 hours. MDB and MD are remaining structures of vitelline omphalomesenteric components and their resection should be considered whenever these structures are diagnosed during abdominal surgery in equines. The mare on this report lived five years without apparent consequences; until the moment these alterations caused intestinal strangulation.

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Un equino macho, entero, criollo colombiano de siete años de edad, fue remitido a la clínica de grandes animales del centro de veterinaria y zootecnia CES debido a síndrome abdominal agudo. Al ser evaluado clínicamente presentó depresión, ruidos abdominales disminuidos, deshidratación (6%), frecuencia cardiaca y respiratoria en 40 lpm y 28 rpm, respectivamente, temperatura en 37.1 °C y distensión marcada de intestino delgado evidente mediante palpación rectal y ultrasonografía transabdominal. No hubo respuesta a los analgésicos por parte del equino; los parámetros en líquido peritoneal estuvieron alterados. Se sospechó lesión estrangulante en intestino delgado. La laparotomía exploratoria reveló infarto idiopático de siete metros de yeyuno y la porción proximal del íleon. Fue practicada una yeyunocecostomía latero lateral con grapadora quirúrgica mecánica (GIA 80). El animal permaneció hospitalizado 10 días y la recuperación postquirúrgica fue exitosa. Este caso es el primer reporte en el país de esta cirugía.

A 7- years-old criollo colombiano stallion was referred to the Large Animal Hospital Centro de Veterinaria y Zootecnia CES (Envigado, Colombia) because of an acute abdominal syndrome that had persisted for seven hours despite medical treatment. On physical examination the stallion was depressed, dehydrated (6%), borborygmi were diminished, rectal temperature was � 37.1 °C,hearth and respiration rates were 40 beats/min and 28 breaths/min, respectively. On rectal examination and abdominal ultrasonography small intestine was distended. Peritoneal fluid analysis was altered. Signs of pain were nonresponsive to analgesics. The diagnosis by exploratory � laparotomywas infarctionof small intestine (seven meters of the jejunum and proximal portion of the ileum) of unknown etiology. A jejunocecostomy was done using a GIA 80 surgical stapler (United Surgical). Postsurgical recuperation was successful. This case becomes the first report of a jejunocecostomy in a horse in Colombia.

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RESUMO

Objetivo: describir características de eventos fatales asociados a estrangulación y sofocación no intencional en menores de 15 años. Material y métodos: registros del Servicio Médico Forense. Niños que fallecieron por estrangulación o sofocación no intencional de 01/01/1991 a 31/12/2001. Resultados: 44 sofocaciones o estrangulaciones no intencionales. Mortalidad de 3.62/1 '000,000 años-persona (27.57/1 '000,000 en menores de 1 año, 1.94/1 '000.000 en el resto), 63.6% hombres. Mecanismos más frecuentes: atrapamiento de cuello entre barrotes 18.2%, obstrucción facial por ropa de cama 15.9%, cubierto por escombro, arena o basura 15.9%, estrangulación por cordón, cadena o listón 11.4%, estrangulación por ropa de vestir o cama 9.1%. Conclusiones: casi todas las defunciones registradas podrían haberse prevenido mediante educación, supervisión o modificaciones estructurales del equipo. Las estrategias también deben incluir estándares obligatorios de manufactura y advertencias en eletiquetado de losproductos.

Objective: Our aim was to describe non-intentional strangulation or suffocation suffered by children under 15 years of age. Methods: Records from the Medical Examiner's Office showed child death by non-intentional strangulation or suffocation from January 1, 1991 to December 31, 2001. Results: A total of 44 suffocations or non-intentional strangulations were registered. Overall mortality was 3.62/ 1000,000 persons-year (27.57/1000,000 in children < 1 year of age, 1.94/1000.000 in older children); 63.6% were males. Most frequent mechanisms included neck entrapment between bars 18.2%, facial obstruction by bed clothes 15.9%, being covered by rubble, sand, or garbage 15.9%, strangulation by cord, chain, or strip 11.4%, and strangulation by dress or bed clothes 9.1%. Conclusions: Nearly all registered deaths could be prevented by education, supervision, or structural modifications. Strategies should also include obligatory standards for manufacturing and for warnings on labels.

Assuntos