Car surfing: an uncommon cause of traumatic injury.

Car surfing is an infrequent cause of traumatic injuries treated by emergency physicians. This very dangerous activity can result in serious injury or death. We report 5 cases of injuries caused by car surfing seen at our hospital during 1996 and 1997. All involved head injuries after a fall from a moving motor vehicle. There were 3 male and 2 female patients, and 3 cases were fatal. Health care providers should be aware of this type of injury and support efforts to prevent it.

Traumatic injury to the azygous vein: case report.

Injury to the azygous vein is rare in blunt chest trauma. A review of the world's literature revealed only 10 cases of trauma-related azygous vein injury. We report another patient who survived azygous vein rupture secondary to thoracic rib injury. With prompt recognition, emergency thoracotomy and proper therapy, patients with azygous vein injury have a high survival rate.

Specificity of bronchoalveolar lavage for the diagnosis of fat embolism syndrome.

The diagnosis of fat embolism syndrome (FES) is relatively difficult because simple, quantitative criteria have been lacking. The results of a recent study, however, suggest that the diagnosis of FES can be made if more than 5 per cent of the cells in fluid obtained by bronchoalveolar lavage are lipid-laden. Our study was designed to assess the specificity of this lipid staining test of bronchoalveolar cells for diagnosing FES in a series of patients coming to the pulmonology clinic. Thirty-four consecutive patients with suspected pulmonary diseases, but not FES, underwent routine bronchoscopy. Bronchoalveolar fluid was applied to slides, fixed with formalin, and stained with oil red 0. Three hundred consecutive cells of each specimen were observed for red-staining droplets. More than 5 per cent of bronchoalveolar lavage cells stained for lipids in 25 of the 34 subjects. The calculated specificity, assuming a negative finding is defined as < or = 5 per cent lipid-laden cells in the sample, was 26.5 per cent. We conclude that staining of bronchoalveolar lavage cells for lipids is not a specific test for FES.

Use of skin staplers in experimental gastrointestinal injuries.

Undocumented reports exist concerning use of skin staplers to close small perforations of the gut. This study examined use of this device in experimental gastrointestinal injuries in dogs. In 18 anesthetized mongrel dogs, matching uniform perforations were made with a sterile leather punch; one perforation of each pair was closed with 3-0 silk and the other with a skin stapler. A total of 80 stomach, 238 small intestine, and 140 colon perforations were created. Hole sizes progressed from 1.9 to 5.0 mm. Unrepaired intestinal wounds leaked and were lethal. No leaks were identified in wounds closed with either sutures or staples provided that closure was complete. Speed of staple closure was faster than that of suture closure (1.2 vs. 16.0 seconds), but ease of closure was similar. It is concluded that skin staplers are safe for repair of small wounds, created under ideal conditions, in canine gastrointestinal tracts. Similar injuries in traumatized humans deserve study, but existing skin staplers may be ineffective for human intestine since gut wall thickness in humans is less than that in dogs.