ABSTRACT
Three time frames were studied during the 54-year history of the Golden Gate Bridge from 1937 to 1991. During that period of time, there were 918 documented jumps from this majestic structure to the water 250 feet below. The last 15 years provided us with 297 consecutive patients, all brought to one institution, which were retrospectively reviewed and categorized as to site and type of injury for survivors and fatalities. This is the largest high-velocity water impact trauma series in the world. Certain unique characteristics of the Golden Gate Bridge and the San Francisco Bay lend itself to this extremely popular and successful form of suicide. These characteristics, as well as personal factors of free-fall water impact from each patient, are summarized and discussed in this paper.
Subject(s)
Drowning/mortality , Multiple Trauma/mortality , Suicide, Attempted , Suicide , Adolescent , Adult , Aged , Aged, 80 and over , Cause of Death , Drowning/epidemiology , Drowning/etiology , Emergency Medical Services , Female , Hospitals, Military , Humans , Incidence , Male , Middle Aged , Multiple Trauma/epidemiology , Multiple Trauma/etiology , Retrospective Studies , San Francisco/epidemiology , Suicide/statistics & numerical data , Suicide, Attempted/statistics & numerical data , Survival RateABSTRACT
The clinical observation that a laparoscopic cholecystectomy is a minimally invasive operation has not been demonstrated on a biochemical basis. Interleukin-6, a known endogenous pyrogen and hepatocyte-stimulating protein, correlates with the significance of surgical trauma. Utilizing the IL-6 immunoassay, we studied this biochemical parameter of trauma to compare its response in laparoscopic vs open cholecystectomy. Sixteen patients who underwent only laparoscopic cholecystectomy showed peak IL-6 concentrations of 51 pg/ml (22-86) vs a peak IL-6 concentration of 124 pg/ml (56-225) for open cholecystectomy. Six additional patients who underwent an ERCP followed by laparoscopic cholecystectomy showed a dramatic rise in peak IL-6 concentration to 315 pg/ml (15-634). These results biochemically confirm the true minimal invasiveness of laparoscopic cholecystectomy. The findings in the ERCP-followed-by-laparoscopic-cholecystectomy group support the theory that two invasive procedures in close proximity may prime the cytokine system in its response to surgical trauma.
