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1
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Alzayadneh MA, Alsherbini KA. A Rare Case of Progressive Encephalopathy in a Sickle Cell Trait Patient: A Case Report. Cureus 2023; 15:e45936. [PMID: 37766778 PMCID: PMC10520993 DOI: 10.7759/cureus.45936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 09/29/2023] Open
Abstract
Fat embolism syndrome (FES) is one of the underdiagnosed and underrecognized complications that can happen in multiple medical and surgical conditions. FES can manifest in a broad spectrum of signs and symptoms and affect multiple organ systems in the human body. One of the most commonly involved is the central nervous system (CNS), mainly the brain, which can be involved in different ways, and the presenting symptoms can vary in type and severity. One of the most common causes of FES is trauma, mainly a long bone fracture or any orthopedic injury. However, one of the rare causes of FES is sickle cell disease (SCD) and thalassemia. Generalized and vague presenting symptoms, the rarity of FES, and the absence of well-defined diagnostic criteria make it a challenging diagnosis for healthcare practitioners. FES diagnosis is usually made after having a high index of suspicion in patients with underlying risk factors that can precipitate and contribute to the pathophysiology of FES. Moreover, the diagnosis is usually reached after excluding other more common and treatable conditions.
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Affiliation(s)
| | - Khalid A Alsherbini
- Neurology/Neurocritical Care, University of Tennessee Health Science Center (UTHSC), Memphis, USA
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2
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Xu L, Tan X, Chen X, Du S, Yue X, Qiao D. Rare, fatal pulmonary fat embolism after acupuncture therapy: A case report and literature review. Forensic Sci Int 2023; 345:111619. [PMID: 36870177 DOI: 10.1016/j.forsciint.2023.111619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/24/2022] [Accepted: 02/25/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Death from nontraumatic pulmonary fat embolism associated with minor soft tissue contusion, surgery, cancer chemotherapy, hematologic disorders and so on has been reported. Patients often present with atypical manifestations and rapid deterioration, making diagnosis and treatment difficult. However, there are no reported cases of death from pulmonary fat embolism after acupuncture therapy. This case emphasizes that the stress induced by acupuncture therapy, a mild soft tissue injury, plays an important role in pulmonary fat embolism. In addition, it suggests that in such cases, pulmonary fat embolism as a complication of acupuncture therapy needs to be taken seriously, and autopsy should be used to identify the source of fat emboli. CASE PRESENTATION The patient was 72 years old female and experienced dizziness and fatigue after silver-needle acupuncture therapy. She experienced a significant drop in blood pressure and died 2 h later despite treatment and resuscitation. A systemic autopsy and histopathology examination (H&E and Sudan Ⅲ staining) were performed. More than 30 pinholes were observed in the lower back skin. Focal hemorrhages were seen surrounding the pinholes in the subcutaneous fatty tissue. Microscopically, numerous fat emboli were observed in the interstitial pulmonary arteries and alveolar wall capillaries, in addition to the vessels of the heart, liver, spleen and thyroid gland. The lungs showed congestion and edema. The cause of death was identified as pulmonary fat embolism. CONCLUSION This article suggests that high vigilance for risk factors and the complication of pulmonary fat embolism following silver-needle acupuncture therapy should be exercised. In postmortem examinations, it should be pay attention that the peripheral arterial system and the venous system draining from non-injured sites should be examined for the formation of fat emboli, which can help distinguish posttraumatic and nontraumatic pulmonary fat embolism.
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Affiliation(s)
- Luyao Xu
- Department of Forensic Pathology, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Xiaohui Tan
- Department of Forensic Pathology, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Xuebing Chen
- Department of Forensic Pathology, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Sihao Du
- Department of Forensic Pathology, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Xia Yue
- Department of Forensic Pathology, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Dongfang Qiao
- Department of Forensic Pathology, School of Forensic Medicine, Southern Medical University, Guangzhou, China.
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3
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Delanghe JR, Speeckaert MM, Verbeke F, De Buyzere ML. C-Reactive Protein in Neonates and Risk for Autism Spectrum Disorder. Biol Psychiatry 2021; 90:e63. [PMID: 34246463 DOI: 10.1016/j.biopsych.2021.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Joris R Delanghe
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.
| | - Marijn M Speeckaert
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Frederick Verbeke
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Marc L De Buyzere
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
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4
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Watanabe S, Morita M, Hirabayashi N, Yoshida T. Milky fluid elicited by cellulose triacetate membrane dialyzer, hyperlipidemia, and elevated C-reactive protein. Ren Fail 2020; 42:302-303. [PMID: 32312120 PMCID: PMC7191897 DOI: 10.1080/0886022x.2020.1744450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shingo Watanabe
- Medical Engineering Center, Keio University Hospital, Tokyo, Japan
| | - Masanori Morita
- Medical Engineering Center, Keio University Hospital, Tokyo, Japan
| | | | - Tadashi Yoshida
- Apheresis and Dialysis Center, Keio University School of Medicine, Tokyo, Japan
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Viuff BM, Straarup EM, Nowak J, Morgills L, Skydsgaard M, Sjögren I, Wulff BS, Christoffersen BØ. Lipid Embolism in Obese Göttingen Minipigs. Toxicol Pathol 2019; 48:379-392. [DOI: 10.1177/0192623319880464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pigs are used as a model of human obesity, both for metabolic characterization and for evaluation of pharmacological interventions. Over a period of 7 years, acute death or clinical signs requiring immediate euthanasia were observed in 12 obese Göttingen minipigs (GMs) included in different pharmacological studies. The GM were fed ad libitum on normal chow-diet and the unscheduled deaths occurred in animals treated with drug candidates as well as in untreated animals. The most prominent clinical signs requiring euthanasia included varying degrees of respiratory distress; and on histopathological examination, thickening of the alveolar septa due to vacuolation was observed throughout the lung in 10 of the 12 animals. Furthermore, vacuolation in glomeruli of the kidney was detected in 9 of the 10 animals. Oil red O staining of cryosections demonstrated that the vacuoles both in lung and kidney contained lipid, and immunohistochemistry with anti-von Willebrand factor and transmission electron microscopy revealed that the lipid was localized in the lumen of blood vessels establishing the occurrence of fatal pulmonary lipid embolism. Additionally, lipogranulomatous inflammation in the abdominal adipose tissue was observed in all the GMs with lipid emboli.
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Affiliation(s)
| | | | - Jette Nowak
- Global Drug Discovery, Novo Nordisk A/S, Måløv, Denmark
| | - Line Morgills
- CitoxLAB Denmark (A Charles River Company), Lille Skensved, Denmark
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Rosenfeld DM, Smith ML, Seamans DP, Giorgakis E, Gaitan BD, Khurmi N, Aqel BA, Reddy KS. Fatal diffuse pulmonary fat microemboli following reperfusion in liver transplantation with the use of marginal steatotic allografts. Am J Transplant 2019; 19:2640-2645. [PMID: 31012531 DOI: 10.1111/ajt.15399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/29/2019] [Accepted: 04/18/2019] [Indexed: 01/25/2023]
Abstract
Organ shortage is a major cause of delayed liver transplantation and increased waitlist time. The level of donor steatosis is a significant determinant in organ selection. Scarcity of organs has led some programs to expand their acceptable criteria for the percentage of steatosis. We report two cases of liver transplantation of steatotic donor organs that resulted in mortality within hours from transplantation. Postmortem analysis showed evidence of diffuse pulmonary fat microemboli likely originating from the donor organ, with marked preservation reperfusion injury. The mechanism of diffuse fat microemboli in this setting and possible relationship to other perioperative syndromes (transfusion-related lung injury, acute kidney injury, and postreperfusion syndrome) is discussed.
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Affiliation(s)
- David M Rosenfeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona
| | - Maxwell L Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona
| | - David P Seamans
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona
| | - Emmanouil Giorgakis
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Brantley D Gaitan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona
| | - Narjeet Khurmi
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona
| | - Bashar A Aqel
- Department of Medicine, Division of Transplant Hepatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Kunam S Reddy
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, Arizona
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7
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Cantu CA, Pavlisko EN. Liposuction-Induced Fat Embolism Syndrome: A Brief Review and Postmortem Diagnostic Approach. Arch Pathol Lab Med 2018; 142:871-875. [DOI: 10.5858/arpa.2017-0117-rs] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lipoplasty, or liposuction, the surgical process of removing excess fat, is an elective procedure with rising frequency in the United States. Fat embolism syndrome is a clinical diagnosis and is defined as fat in the circulation with an identifiable clinical pattern of signs and symptoms (eg, hypoxemia, respiratory insufficiency, neurologic impairment, and petechial rash) that occur in the appropriate clinical context. Fat embolism syndrome following liposuction is a life-threatening complication, although its incidence is low. Currently, there is no specific therapy for fat embolism syndrome, so prevention, early detection, and supportive therapy are critical. Many cases of fat embolism syndrome are undiagnosed or misdiagnosed; however, postmortem examination can provide the means for appropriate diagnosis. Therefore, a pathologist must keep a keen eye, as microscopic fat emboli are difficult to appreciate with routine tissue processing and staining.
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Affiliation(s)
| | - Elizabeth N. Pavlisko
- From the Department of Pathology, Duke University Health System, Durham, North Carolina
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8
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Short infusion of paclitaxel imbalances plasmatic lipid metabolism and correlates with cardiac markers of acute damage in patients with breast cancer. Cancer Chemother Pharmacol 2017; 80:469-478. [PMID: 28689298 DOI: 10.1007/s00280-017-3384-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Although paclitaxel-based chemotherapy is widely used for treating breast cancer, paclitaxel therapy has been associated with several adverse effects. Such adverse effects have primarily been associated with long-term regimens, but some acute effects are being increasingly reported in the literature. In this context, the present study analyzed the systemic proteomic profiles of women diagnosed with breast cancer at the first cycle of short paclitaxel infusion (n = 30). Proteomic profiles thus obtained were compared with those of breast cancer patients without chemotherapy (n = 50), as well as with those of healthy controls (n = 40). METHODS Plasma samples were evaluated by label-free LC-MS to obtain systemic proteomic profiles. Putative dysregulated pathways were identified and validated by in silico analysis of proteomic profiles. RESULTS Our results identified 188 proteins that were differentially expressed in patients who received a single short paclitaxel infusion when compared to patients who did not receive the infusion. Gene ontology analysis indicated that the cholesterol pathway may be dysregulated by paclitaxel in these patients. Validation analysis showed that paclitaxel treatment significantly reduced plasma high-density lipoprotein levels and increased plasma hydroperoxide levels when compared to breast cancer patients without chemotherapy. Furthermore, augmented C-reactive protein and creatine kinase fraction MB were found to be significantly higher in paclitaxel-treated patients in comparison with healthy controls. CONCLUSIONS Taken together, these data suggest that a single dose of short paclitaxel infusion is sufficient to trigger significant alterations in lipid metabolism, which puts breast cancer patients at risk for increased incidence of cardiovascular disease.
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Chiappa V, Gonzalez RG, Manian FA, Deshpande V. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 23-2016. A 46-Year-Old Man with Somnolence after Orthopedic Surgery. N Engl J Med 2016; 375:370-8. [PMID: 27464205 DOI: 10.1056/nejmcpc1601840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Victor Chiappa
- From the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Harvard Medical School - both in Boston
| | - R Gilberto Gonzalez
- From the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Harvard Medical School - both in Boston
| | - Farrin A Manian
- From the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Harvard Medical School - both in Boston
| | - Vikram Deshpande
- From the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Harvard Medical School - both in Boston
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10
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A fatal case of systemic fat embolism resulting from gluteal injections of vitamin e for cosmetic enhancement. Forensic Sci Int 2016; 259:e1-4. [DOI: 10.1016/j.forsciint.2015.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/16/2015] [Accepted: 11/20/2015] [Indexed: 11/19/2022]
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11
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Schrufer-Poland T, Singh P, Jodicke C, Reynolds S, Maulik D. Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery. AJP Rep 2015. [PMID: 26199788 PMCID: PMC4502621 DOI: 10.1055/s-0034-1394153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality.
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Affiliation(s)
- Tabitha Schrufer-Poland
- Department of Obstetrics and Gynecology, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri
| | - Paul Singh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri
| | - Cristiano Jodicke
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri
| | - Sara Reynolds
- Department of Obstetrics and Gynecology, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri
| | - Dev Maulik
- Department of Obstetrics and Gynecology, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri ; Department of Obstetrics and Gynecology, Truman Medical Center, Kansas City, Missouri ; Department of Maternal Fetal Medicine, Children's Mercy Hospital, Kansas City, Missouri
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12
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Abstract
Acute chest syndrome describes new respiratory symptoms and findings, often severe and progressive, in a child with sickle cell disease and a new pulmonary infiltrate. It may be community-acquired or arise in children hospitalized for pain or other complications. Recognized etiologies include infection, most commonly with atypical bacteria, and pulmonary fat embolism (PFE); the cause is often obscure and may be multifactorial. Initiation of therapy should be based on clinical findings. Management includes macrolide antibiotics, supplemental oxygen, modest hydration and often simple transfusion. Partial exchange transfusion should be reserved for children with only mild anemia (Hb > 9 g/dL) but deteriorating respiratory status. Therapy with corticosteroids may be of value; safety, efficacy and optimal dosing strategy need prospective appraisal in a clinical trial. On recovery, treatment with hydroxyurea should be discussed to reduce the likelihood of recurrent episodes.
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13
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Kanen BL, Loffeld RJLF. Pancreatitis with an unusual fatal complication following endoscopic retrograde cholangiopancreaticography: a case report. J Med Case Rep 2008; 2:215. [PMID: 18577211 PMCID: PMC2443156 DOI: 10.1186/1752-1947-2-215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 06/24/2008] [Indexed: 11/11/2022] Open
Abstract
Introduction Endoscopic retrograde cholangiopancreaticography has been the treatment of choice for stones in the common bile duct. Although the procedure is usually safe, procedure-related complications do occur. Case presentation A case of pancreatitis following endoscopic retrograde cholangiopancreaticography is described in a 55-year-old woman. After an uneventful recovery the patient's condition deteriorated rapidly 16 days after the endoscopic retrograde cholangiopancreaticography, and the patient died within 1 hour. Post-mortem examination revealed massive intrapulmonary fat embolism. The complications of endoscopic retrograde cholangiopancreaticography and pancreatitis are described. Conclusion Fat embolism can occur after the remission of pancreatitis and pancreatic necrosis may be overlooked on contrast-enhanced computed tomography scanning.
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14
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Buckley JD, Ouellette DR, Popovich J. Pulmonary Embolism. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Fat embolism syndrome is a condition of acute respiratory distress following long-bone trauma. This condition may involve not only the lungs but also a number of other body systems. The pathophysiology is not as yet clearly understood, however, intravasation of fat from long-bone fractures may play a role. Early recognition of the severity of injury both on clinical and biochemical grounds and early surgical stabilization of long bones may help to decrease its incidence. However, the best surgical technique with which to do this stabilization has not yet been clearly determined. Surgical and pharmacological techniques have been developed in an attempt to either decrease the intravasation of fat during long-bone stabilization or block the inflammatory cascade with varying degrees of efficacy. Ongoing research focuses on both the prevention and treatment of this condition.
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Affiliation(s)
- Timothy White
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, Canada
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16
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Abstract
OBJECTIVE To report the case of a fatal pulmonary fat embolism as a complication of spinal fusion surgery. DESIGN Case report. SETTING Pediatric intensive care unit at a freestanding tertiary care children's hospital. PATIENT An adolescent female with neuromuscular scoliosis who underwent spinal fusion surgery with instrumentation and suffered a fatal pulmonary fat embolism. CONCLUSION Spinal fusion surgery for neuromuscular scoliosis is a common operative procedure. Pulmonary fat embolism as a complication of this procedure is rare. This case emphasizes the need to be aware of this potentially fatal postoperative complication. Specifically evaluating for this rare complication may lead to understanding cases of unexplained deterioration and death.
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Affiliation(s)
- Michael H Stroud
- Department of Pediatrics, University of Arkansas for Medical Sciences, and Section of Critical Care Medicine, Arkansas Children's Hospital, Little Rock, AR, USA
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Rothmann C, Ruschel N, Streiff R, Pitti R, Bollaert PE. Embolie graisseuse pulmonaire après liposuccion. ACTA ACUST UNITED AC 2006; 25:189-92. [PMID: 16269230 DOI: 10.1016/j.annfar.2005.07.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Accepted: 07/26/2005] [Indexed: 11/25/2022]
Abstract
A 24-year-old woman undergoes buttock's liposuction as an outpatient procedure. As she went back home, progressive dyspnea, respiratory distress and collapse developed. At hospital admission, she was dyspneic with thoracic oppression, tachycardia and anguish. Chest X-ray and thoracic CT scan suggested a pulmonary localisation of fat emboli. Symptomatic treatment allowed complete recovery. This report discusses diagnosis of fat emboli after liposuction as well as epidemiology and physiopathology.
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Affiliation(s)
- C Rothmann
- Service d'Accueil des Urgences, CHR de Metz-Thionville, Hôpital Bon-Secours, 1, place P.-de-Vigneulles, 57038 Metz cedex, France.
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18
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Dang NC, Johnson C, Eslami-Farsani M, Haywood LJ. Bone marrow embolism in sickle cell disease: a review. Am J Hematol 2005; 79:61-7. [PMID: 15849760 DOI: 10.1002/ajh.20348] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The fat embolism syndrome is an important complication of patients with sickle cell hemoglobinopathies because of severe morbidity and mortality. Our recent experience with three cases that survived with intensive supportive care and prompt use of transfusion stimulates this review. A high index of suspicion, prompt use of diagnostic tools, and aggressive clinical management are the keys to a successful outcome.
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Affiliation(s)
- Nghia C Dang
- Department of Medicine, University of California-San Diego, School of Medicine, San Diego, California, USA
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19
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Okura Y, Hayashi K, Shingu T, Kajiyama G, Nakashima Y, Saku K. Diagnostic evaluation of acute pancreatitis in two patients with hypertriglyceridemia. World J Gastroenterol 2004; 10:3691-5. [PMID: 15534935 PMCID: PMC4612021 DOI: 10.3748/wjg.v10.i24.3691] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We present two diagnostically challenging cases of acute pancreatitis with hypertriglyceridemia accompanied with chylomicronemia caused with a deficiency of lipoprotein lipase and with the presence of type V hyperlipidemia. Both cases suffered from acute abdomen following the ingestion of fatty food and revealed the increase in parameters of inflammation without significant elevation of serum amylase levels. The imaging examination of ultrasonography could not detect significant findings of acute pancreatitis and a computer tomography scan eventually confirmed the findings of acute pancreatitis. Both cases responded to a low fat diet and administration of a cholecystokinin receptor antagonist, exhibiting a relief of abdominal symptoms. As in the present cases with acute abdomen following the ingestion of fatty food, the identification of serum hypertriglyceridemia and an abdominal computer tomography scan might be useful in establishing the diagnosis of acute pancreatitis and in developing the therapeutic regimen, when hypertriglyceridemia interferes with the evaluation of pancreatic enzyme activities and ultrasound examination provides poor pancreatic visualization.
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Affiliation(s)
- Yoshifumi Okura
- Division of Cardiology, Department of Internal Medicine, Fukuoka Dental College Hospital, 2-15-1, Tamura, Sawara-ku, Fukuoka 814-0193, Japan.
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20
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Abstract
Complications of orthopedic and spine operations can be life threatening. Proper patient selection, careful planning of patient care, and prophylactic measures are important determinants of a successful outcome. After elective orthopedic surgery such as total joint replacement, the intensivist should be aware of potential systemic complications common to any major surgical intervention (pneumonia, pulmonary embolism, sepsis, myocardial infarction) and also of procedure-specific problems (cement-related cardiac events, fat embolism) and local complications (neurovascular injuries). Patients undergoing spine procedures should have close neurologic monitoring for immediate and delayed deficits.
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Affiliation(s)
- Daniel Nazon
- Department of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
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21
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22
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Affiliation(s)
- D Radrizzani
- Servizio di Anestesia e Rianimazione (II UO), Ospedale San Paolo, Milano, Italy
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23
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Schulz F, Trübner K, Hildebrand E. Fatal fat embolism in acute hepatic necrosis with associated fatty liver. Am J Forensic Med Pathol 1996; 17:264-8. [PMID: 8870880 DOI: 10.1097/00000433-199609000-00016] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report two cases of generalized nonviolent hepatogenic fat embolism. A 63-year-old woman was sent to the hospital with suspected mushroom poisoning. Shock symptoms occurred quickly and could not be treated effectively; the patient died 24 h after admission. Postmortem examination showed acute yellow dystrophy of the liver with a severe preexisting fatty liver. Any intoxication including Amanita phalloides could be excluded. In all probability, a fulminant viral hepatitis caused liver dystrophy, and the decay of the fatty liver cells led to generalized fat embolism as the cause of death. The second patient, a 46-year-old man, was reported to have suffered from an acute illness while in prison and died after having been transferred to the local hospital. Histological examinations showed an acute liver dystrophy probably caused by fulminant viral hepatitis with fatty degeneration. In this case, the cause of death was also found to be generalized fat embolism.
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Affiliation(s)
- F Schulz
- Gerichtsärztlicher Dienst, Behörde für Arbeit, Gesundheit, und Soziales, Hamburg, Germany
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24
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25
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Mimoz O, Edouard A, Beydon L, Quillard J, Verra F, Fleury J, Bonnet F, Samii K. Contribution of bronchoalveolar lavage to the diagnosis of posttraumatic pulmonary fat embolism. Intensive Care Med 1995; 21:973-80. [PMID: 8750121 DOI: 10.1007/bf01700658] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To verify whether the determination of the percentage of cells recovered by bronchoalveolar lavage and containing fat inclusions is a useful diagnostic tool of posttraumatic pulmonary fat embolism. DESIGN Prospective study. SETTING Surgical Intensive Care Units in two university hospitals. PATIENTS 56 successive trauma patients needing prolonged postinjury mechanical ventilation, including 4 with clinical definite fat embolism syndrome, 5 in whom the diagnosis had been clinically suspected but was impossible to confirm or exclude before bronchoscopy, and 47 with no clinical evidence of the syndrome. Control groups included 8 patients without previous trauma who developed ARDS and 6 healthy surgical patients. METHODS Bronchoalveolar lavage was performed within the first post-traumatic 3 days in trauma patients, at the beginning of the pulmonary disease in non trauma ARDS patients and just after anesthesic induction in healthy ortopedic patients. The magnitude of lipid content in alveolar cells was compared with the clinical pattern of the pulmonary fat embolism syndrome retrospectively evaluated at the seventh day postinjury in trauma patients. RESULTS All the patients with definite fat embolism syndrome had more than 70% of lavage cells containing fat droplets. The group of patients in whom the diagnosis of the fat embolism syndrome was suspected had percentages of fat cells above 30% in 4 out of 5 patients. A percentage of fat cells above 30% was only observed in 7 out of the 47 patients without clinical evidence of the syndrome. The percentage varied between 0% to 35% in the group of non trauma ARDS patients and between 0 to 5% in healthy surgical patients. CONCLUSION Lipid inclusions in alveolar cells are common during traumatic and non-traumatic respiratory failure. Determination of the percentage of cells recovered by bronchoalveolar lavage and containing fat droplets may contribute to the diagnosis of the fat embolism syndrome in mechanically-ventilated trauma patients with respiratory failure provided that the significant threshold would be 30%.
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Affiliation(s)
- O Mimoz
- Service d'Anesthesie-Reanimation, Universite de Paris Sud, Hopital de Bicetre, France
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Affiliation(s)
- T M Dudney
- Pulmonary Division, LDS Hospital, Salt Lake City, UT 84143
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Pell AC, Hughes D, Keating J, Christie J, Busuttil A, Sutherland GR. Brief report: fulminating fat embolism syndrome caused by paradoxical embolism through a patent foramen ovale. N Engl J Med 1993; 329:926-9. [PMID: 8123102 DOI: 10.1056/nejm199309233291305] [Citation(s) in RCA: 159] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- A C Pell
- Department of Cardiology, Royal Infirmary, Edinburgh, United Kingdom
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Garnier A, Poizat C, Keriel C, Cuchet P, Vork MM, de Jong YF, Glatz JF. Modulation of fatty acid-binding protein content of adult rat heart in response to chronic changes in plasma lipid levels. Mol Cell Biochem 1993; 123:107-12. [PMID: 8232251 DOI: 10.1007/bf01076481] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of this work was to study in the adult rat heart the effect of modifications of fatty acid (FA) supply on the content of cytoplasmic fatty acid-binding protein (H-FABPc). To modify the amount of circulating lipids, three different treatments were chosen: (i) an hypolipidemic treatment with Clofibrate, administered daily through a gastric tube at a dose of 250 mg/kg per day for one week, (ii) a continuous intravenous infusion of 20% Intralipid, a fat emulsion, for one week at a dose of 96 ml/kg per day, and (iii) a normobaric hypoxia exposure (pO2 = 10%) for three weeks. At the end of each treatment plasma lipids, myocardial H-FABPc content and the activities of three key enzymes (citrate synthase, CS, fructose-6-phosphate kinase, FPK and hydroxy-acyl CoA-dehydrogenase, HAD) were assessed. With each of the three treatments a decrease of plasma cholesterol and phospholipid levels was observed. Plasma FA concentration increased with Intralipid infusion and decreased with chronic hypoxia. The heart H-FABPc content was increased by 20% with Clofibrate, decreased by 20% with chronic hypoxia and remained unaltered upon Intralipid treatment. The induced changes in H-FABPc content were not related directly to changes in plasma lipid levels. CS activity was slightly decreased in the hypoxia group, FPK activity decreased in the Clofibrate group, and HAD activity decreased in the Intralipid group. Among the various groups heart H-FABPc content was related to HAD activity. In conclusion, the H-FABPc content of adult rat heart appears responsive to changes in plasma lipid levels.
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Affiliation(s)
- A Garnier
- Laboratoire de Physiologie Cellulaire Cardiaque, Université Joseph Fourier, Grenoble, France
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Gratadour P, Védrinne JM, Guillaume C, Gagnieu MC, Motin J. [Intra-macrophage lipid particles collected by bronchoalveolar lavage: incidence and diagnostic value]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1993; 12:462-8. [PMID: 8311351 DOI: 10.1016/s0750-7658(05)80992-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study aimed to determine the incidence and diagnostic value of fat-laden alveolar macrophages obtained by bronchoalveolar lavage (BAL). In 128 patients, including 66 patients admitted for multiple trauma, 158 BAL were carried out. However, 41 BAL from 32 patients were excluded because of poor quality of samples (not enough macrophages, too many ciliated cells, or haemorrhage). All the patients were intubated and mechanically ventilated, having pulmonary infiltrates on the chest film. BAL samples were examined after staining with oil-red-O. They were considered to be positive when more than 5% of alveolar macrophages contained fat droplets. Among them 14 out of 47 patients (30%) without multiple trauma were positive; 7/14 had never been given any intravenous lipid infusion, and 5/14 had aspiration pneumonia (as opposed to 3/32 patients with negative BAL). Further 27 patients out of the 49 (55%) with multiple trauma were positive. Among them 10/49 had clinical evidence of fat embolism, however, only 7/10 had positive samples. All these last ten patients had been given intravenous lipid infusions. The rate of positive alveolar macrophages was correlated neither with the plasma triglyceride concentration, nor the Fracture Index Score, nor the delay between the end of the lipid infusion and the BAL. There was no significant difference in PaO2/FIO2 ratio between the patients with positive and negative BAL. Positive BAL was significantly associated with lipid infusions. The data therefore suggest that the presence of fat-laden alveolar macrophages are associated with various pathological pulmonary conditions, particularly aspiration pneumonia and lipid infusions.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Gratadour
- Service d'Anesthésie-Réanimation, Hôpital Edouard-Herriot, Lyon
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Vedrinne JM, Guillaume C, Gagnieu MC, Gratadour P, Fleuret C, Motin J. Bronchoalveolar lavage in trauma patients for diagnosis of fat embolism syndrome. Chest 1992; 102:1323-7. [PMID: 1424844 DOI: 10.1378/chest.102.5.1323] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Fat embolism syndrome (FES) is a rare but serious complication occurring after long bone fractures. Presence of fat droplets in cells obtained by bronchoalveolar lavage has been proposed as a specific tool for FES diagnosis in trauma patients. We evaluated this technique over a 15-month period in 85 patients. Twenty-eight patients were excluded. The remaining 57 patients were divided into three groups: group 1, 26 patients without trauma as control; group 2, 22 patients with trauma but without evidence of FES; and group 3, nine patients with trauma and evidence of FES. Six of 26 patients in group 1 and nine of 22 patients in group 2 exhibited fat droplets in alveolar macrophages, whereas three of nine patients of group 3 had not. This study suggests that (1) presence of fat droplets in alveolar macrophages is not a reliable method for diagnosis of FES after long bone trauma, and (2) many conditions are associated with fat droplets in alveolar macrophages.
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Affiliation(s)
- J M Vedrinne
- Service d'Anesthesie-Reanimation, Hopital Edouard Herriot, Lyon, France
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Zagara G, Scaravilli P, Locati L, Seveso M. C-reactive protein and serum agglutination in vivo of intravenous fat emulsions. Lancet 1989; 1:733. [PMID: 2564549 DOI: 10.1016/s0140-6736(89)92254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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