Evan R. Geller

Autologous fibrin gel: bactericidal properties in contaminated hepatic injury.

Fibrin glue is an effective hemostatic agent in a variety of clinical situations; its utility is limited by potential transmission of viral infection. We studied the bactericidal properties of fibrin gel (FG) in a murine contaminated hepatic injury model and in vitro by agar plate culture method. Intra-abdominal abscess formation and adhesion rate were assessed following controlled liver injury in association with abdominal contamination with 10(7) Bacteroides fragilis and hepatorrhaphy (H, n = 15) or FG (n = 12). Animals treated by hepatorrhaphy had a significantly greater intra-abdominal abscess rate (15/15 vs. 4/12, p less than 0.05) and adhesion rate (14/15 vs. 6/12, p less than 0.05) than animals treated with FG. Fibrin gel is bactericidal to Bacteroides fragilis, Enterobacter faecium, Escherichia coli, and Staphylococcus aureus but has no effect against Klebsiella pneumoniae or Pseudomonas aeruginosa; the plasma component appears active. Fibrin gel demonstrates significant improvement in adhesion formation and intra-abdominal abscess rate when compared with suture hepatorrhaphy. Fibrin gel appears protective in contaminated hepatic injury.

Intra-abdominal sepsis following liver trauma.

Of 330 consecutive patients with liver trauma having a celiotomy over a 5-year period, 295 (89%) survived more than 72 hours. Of these 295, 35 (12%) developed sepsis, and 11 (31%) of these septic patients died. The sources of the sepsis in 30 of these patients included: abdominal abscesses--23, pneumonia or empyema--seven, acalculous cholecystitis--two, gangrene of right colon--two, and thigh abscess--one. In five other patients, the source of the sepsis was not found, even at autopsy. The mortality rate in the 30 patients with one or more identifiable foci of infection was 23%. In contrast, when the source of the sepsis could not be found, the mortality rate was 80% (4/5) (p less than 0.05). Factors associated with an increased incidence of abdominal abscess included: splenectomy, 75% (3/4); liver packs, 63% (5/8); 20+ units of blood, 57% (8/14); Class IV-V liver injury, 35% (8/23); 10-19 units of blood, 25% (7/28); colon injury, 19% (7/36); and open (Penrose) drainage of the abdomen, 11% (23/213). None of 82 patients without drains developed an intra-abdominal abscess. Thus early control of an identifiable source of infection provides the best results with sepsis following liver trauma. The most effective method for preventing intra-abdominal abscesses appears to be avoidance of drains in mild (Class I-II) liver injuries. The use of a closed system in the most severe injuries is still controversial and needs to be addressed in a prospective trial.

Analysis of injuries following the crash of Avianca Flight 52

Analyses of injuries sustained in airline disasters have been hampered by the frequent association of burn injury and by poor documentation. This report analyzes autopsy data from the crash of Avianca Flight 52 on Long Island, New York. There were 158 passengers of whom 73 died. The majority of persons had multiple organ injuries (average, 3.8/victim). Severe neurologic trauma included subarachnoid hemorrhage (65%), skull fracture (32%), and brain laceration (22%). Chest injuries included rib fractures (80%: average, 8.3/victim), hemothorax (58%), sternal fracture (22%), and lung contusion (33%). Orthopedic injuries (average, 4.4/victim) included pelvic (22%), tibial (37%), femur (22%), thoracic spine (33%), cervical spine (22%), and lumbar fractures (5%). Cardiovascular injuries included aortic transection (25%), heart laceration (14%), and major vascular injury (10%). Intra-abdominal injuries included liver (10%), spleen (8%), and kidney (10%). Unrestrained infants suffered severe injuries. Deaths in this airline disaster were from severe head and upper body injuries. This report may allow reappraisal of current restraint and safety measures.

Shotgun slug injuries: case report and literature review.

Shotguns are usually used to fire multiple pellets; however, they are capable of firing a single projectile in the form of a slug. Although rare, shotgun slug injuries are severe, producing wounds comparable to those inflicted by high-velocity weapons with the potential for even more tissue destruction because of the slugs size and mass. We report the first survivor of a close range shotgun slug injury, with a review of this weapons unique projectile ballistics and the relevant literature.

Critical analysis of injuries sustained in the TWA flight 800 midair disaster.

BACKGROUND Previous reports of commercial airline disasters have reviewed incidents occurring at takeoff and landing. The purpose of the present study, which represents the first analysis of aviation injuries incurred during a midflight incident, was to examine the injuries sustained by the victims of the TWA Flight 800 disaster and to determine any correlation of injuries with structural damage and seat location. METHODS Complete autopsy records, toxicology screening, and forensic analysis were reviewed. Injuries were assessed by anatomic region and severity by using the Abbreviated Injury Scale. The National Transportation Safety Board report of the investigation was applied to correlate individual injuries with seat location and structural damage. A comparison was performed against injury data from takeoff and landing incidents. RESULTS All 230 passengers of TWA Flight 800 were recovered as fatalities. Head, thoracic, and abdominal injuries were multiple and severe, contributing to the mortality of the occupants. Analysis revealed that the severity of injury and anatomic injury pattern did not generally correlate with seating position or structural damage. A comparison of these injuries with those of takeoff and landing crashes showed differences in injury pattern and severity. CONCLUSION Passengers of Flight 800 sustained instantaneous fatal blunt force injury. Analysis of the data revealed no global correlation between seat position and pattern of injury. In contrast to injuries incurred during crashes at takeoff and landing, these midflight injuries were too extreme to warrant a reappraisal of current passenger protective safety measures or standards.