The case we bring to our service today is that of a man with an arpoximate age of forty years, a member of the Security Forces of the State, who enters the left parietal wound service of the Hospital in a state.
In the right parietal region, a blunt, irregular, irregular wound with an anfractuous cavity due to the discharge of teguments is observed, with some star deposits.
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In the left parietofrontal zone there is another oval wound, of approximately one centimeter in diameter and the edges slightly everted.
Other associated injuries are spectacle hematoma and epistaxis.
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During the autopsy, a radial fracture of the right parietal bone was observed, which converged on a rounded hole with sharp edges on the external table of the bone.
The internal table was beveled as a truncated cone with base to the interior of the skull.
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Another orifice in the parietofrontal region was observed in the left hemicrania, with the external table bevelled with the widest area externally.
The internal table showed the edges of the sharp orifice.
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COMMENTS:
In Spain, the suicide rate in the decade between 1990 and 1999 was 4.63 per thousand inhabitants [1], being the fourth leading cause of death among young men with ages between 25 and 34 years [2].
The mode of suicide depends on numerous factors; among which are the availability and easy access to the means to use, previous pathology, influence of the environment, etc. Smith [3] finds a positive relationship between access to firearms and the proportion of suicide.
In relation to pathology, an editorial of the Revista Panamericana de Salud [4] indicates as major risk factors for suicide drug consumption, alcoholism, personality disorders, schizophrenia in men and organic psychosis.
The influence of the environment also plays an important role, increasing the proportion of suicides to 50.3% in young people with mental disorders 20 residents in the USA, using firearms in the United States and increasing from 0.1% [6] in the continent.
There are various kinds of wounds that allow us to label a suicide attempt in the case of firearm wounds.
Among them we find the location of the wound, the number of wounds, the direction of the shot, signs of powder in the hand and the distance to which the shot was made [7].
To consider a suicide death, the shot must be done at a short distance, with a trajectory compatible with the access of the hand.
The input orifice configuration will provide valuable data to determine the firing distance.
In general, the entrance orifice of a projectile is usually circular or small ovoid, except in the following cases [8]:
● Dispatch your concerned or very near stump in an area on a bony plane.
● Dispare your head with a high-speed cartridge (with high kinetic energy) or semi-blinded or hunting guns.
● Using a custom-made trigger before impacting the victim, whether by rebounding or interposition of some material.
When the firing takes place in a relative gun, the entrance wound consists of a blunt, irregular, star-shaped wound on an anfractuous cavity due to the discharging of the metal walls wrinkles [9].
Gas pressure and skin overstretching also influence wound configuration [10].
Finally, shot direction should be compatible with the suicide mechanism.
A right-handed subject usually shoots right to left.
The configuration of the entrance and exit orifice in the bone will be essential for the interpretation of the firing direction.
When the bullet hits the skull, the confrontation of the holes constitutes a faithful index of what is the entrance orifice and which is the exit orifice.
In the study of the two tables of the cranial dipple, the second component [11] presents a greater and more irregular orifice, adopting the typical image of the truncated cone with the base pointing out the exit.
