Fat Embolism Research Articles

MANAGEMENT OF PULMONARY CEMENT EMBOLI AFTER KYPHOPLASTY

MANAGEMENT OF PULMONARY CEMENT EMBOLI AFTER KYPHOPLASTY

Clinical evaluation of corrective effect of infraorbital depression by fat granule auto-transplantation via oral mucosa incision

Moderate facial depression is an important manifestation of aging, and traditional fat grafting is filled through the skin approach, and there may be damage to the terminal branch of the surface artery, thereby increasing the risk of fat embolism, so there is a safety implication. Therefore, a safe and effective filling pathway is a key point in the study of facial fat grafting in the suborbital area. Based on the results of anatomical research, this study looks for the filling level of non-well-known blood vessels, improves the path and surgical method of suborbital fat grafting in the suborbital region, and discusses the treatment of intraoral fat grafting through oral incision in the suborbital region Efficacy and safety. In this study, 107 patients who visited our hospital from January 2017 to January 2022 all had local depressions in the suborbital area and facial asymmetry, requiring fat grafting to improve. The age range of patients is 28-50 years, with an average age of 38 years. The effectiveness of the operation is assessed based on the patient's self-evaluation and a comparison of preoperative and postoperative photographs. A grading scale is used in the first half of the postoperative period for patient satisfaction assessment. A total of 107 patients were followed for 6 to 24 months, with an average follow-up time of 12 months, 67.3% of patients said "very satisfied", 29.0% of patients said "satisfied", 3.7% of patients said "average", and no patients rated the results as "not satisfied". No complications such as skin ulcers, infections, local indurations, and fat liquefaction occurred after surgery. Fat grafting through oral incision is a safe and effective way to improve fat depression in the suborbital area, in addition, it is necessary to pay attention to preoperative and postoperative oral disinfection and care during this operation to prevent the occurrence of complications such as fat infection.

Cerebral Fat Embolism in the Absence of Intracardiac Shunting

Cerebral fat embolism (CFE) is a rare phenomenon in paediatric settings and is usually seen post-trauma in patients with pre-existing intracardiac shunting. We present a rare case of CFE in the absence of cardiac anomaly.

Incidence, Mechanisms, Treatment, and Outcomes of Coronary Artery Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention

Coronary artery perforation is a feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Our objective was to describe the incidence, mechanisms, treatment, and outcomes of coronary artery perforation during CTO PCI. We analyzed the baseline clinical and angiographic characteristics and procedural outcomes of 10,454 CTO PCIs performed in 10,219 patients between 2012 and 2022. The incidence of coronary perforation was 4.9% (n=503). Patients who experienced coronary perforation were older and were more likely to have had previous coronary artery bypass graft surgery. Procedures that resulted in perforation were more complex, with higher Japanese CTO and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) scores. Technical (66% vs 87%, p <0.001) and procedural (55% vs 87%, p <0.001) success rates were lower in perforation cases. The CTO target vessel was the most common perforation site (66%). The retrograde approach was responsible for the perforation in 47% of cases, and guidewire exit was the most common perforation mechanism. The proportion of Ellis class 1, 2, 3, and 3 -"cavity spilling" coronary perforations was 20%, 41%, 28%, and 11%, respectively. In 52% of perforations, 1 or more interventions were required: prolonged balloon inflation (23%), covered stent deployment (21%), coil embolization (6%), and/or autologous fat embolization (4%). Tamponade requiring pericardiocentesis occurred in 69 patients (14%). The incidence of major adverse cardiovascular events was higher in perforation cases (18% vs 1.3%, p <0.001). In conclusion, coronary artery perforation occurred in 4.9% of CTO PCIs performed by experienced operators and was associated with lower technical success and higher in-hospital major adverse cardiovascular events.

Brazilian Butt Lift-Associated Mortality: The South Florida Experience.

Brazilian butt lift (BBL) surgery has been the fastest growing aesthetic surgical procedure over the past decade. By 2017, the risk of death from pulmonary fat (PFE) was identified, earning the BBL the highest mortality rate of any aesthetic surgical procedure. South Florida carries the highest BBL mortality by far in the nation. The purpose of this study was to explore the factors involved in making South Florida an outlier in terms of BBL mortality. The anatomic findings of the gluteal dissections from 11 post-BBL surgery autopsies (22 hemibuttocks) were assessed for commonalities. The public records of patients who died from BBL-related fat emboli were examined to determine commonalities. All BBL PFE cases had fat grafts injected into the gluteal musculature in multiple different levels. Another commonality involved the location where the surgery took place, with the great majority of patients (92%) undergoing surgery at high-volume, budget clinics located in South Florida. Short surgical times of approximately 90 minutes appeared to be the norm for these cases. South Florida has experienced 25 BBL-related fat emboli deaths between 2010 and 2022; however, 14 of these occurred after publication of the Aesthetic Surgery Education and Research Foundation's 2018 guidelines and the 2019 Florida Board of Medicine's BBL "subcutaneous-only" rule. The working environment at the clinics, and the short surgical times for these cases, may be the most important contributors to the BBL mortality in South Florida.

Fat Embolism Syndrome Complicated by Acute Pulmonary Thromboembolism after Bilateral Femoral Shaft Fractures: Two Nightmares in The Same Patient

Fat embolism syndrome (FES) is an uncommon but fatal complication usually in orthopedic trauma especially after a long bone fracture. A high level of suspicion should be kept in mind when a patient of long bone fracture develops hypoxia, confusion or rash in the absence of infection and other causes of respiratory failure. Concomitant FES and pulmonary thromboembolism (PTE) is a more rarer entity in comparison to FES and pulmonary thromboembolism as separate entities. There are few cases reported in literature wherein patients developed concomitant FES and pulmonary embolism. Almost in all cases fat embolism syndrome and pulmonary embolism occurred either simultaneously or pulmonary thromboembolism was complicated by FES. We report a case wherein patient initially developed FES pre-operatively which was later on complicated by acute pulmonary thromboembolism in the post-operative period.

Fat Embolism Syndrome and in-Hospital Mortality Rates According to Patient Age: A Large Nationwide Retrospective Study.

IntroductionFat embolism syndrome (FES) is a rare life-threatening condition that can develop after traumatic orthopedic injuries. Controversy remains concerning the epidemiology in the elderly population. Therefore, this study aims to report FES related to in-hospital mortality stratified by age.MethodsA retrospective trauma cohort study was conducted using data from the National Trauma Data Bank (NTDB) from 2007 to 2014. All FES cases were included in the study with the diagnosis of FES (ICD9 958.1). Death on arrival cases were excluded. Patients were stratified by age cohort: less than 40 (G1), 40–64 (G2), and greater than 65 (G3) years of age. The primary outcome evaluated was in-hospital mortality. Multivariable regression models were performed to adjust for potential confounders.ResultsBetween 2007 and 2014, 451 people from a total of 5,836,499 trauma patients in the NTDB met the inclusion criteria. The incidence rate was 8 out of 100,000. The inpatient mortality rate was 11.8% for all subjects with the highest mortality rate of 17.6% in patients over 65. Multivariable analyses demonstrated that age greater than 65 years was an independent predictor of mortality (aOR 24.16, 95% CI 3.73, 156.59, p=0.001), despite higher incidence and injury severity of FES among patients less than 40. No significant association with length of hospital stay, length of intensive unit care, or length of ventilation use was found between the groups. Subgroup analysis of the elderly population also showed a higher mortality rate for FES in femoral neck fracture patients (18%) than other femoral fractures (14%).ConclusionIn this retrospective cohort analysis, old age (≥ 65 years) was found to be an independent risk factor for in-hospital mortality among fat embolism syndrome patients. Elderly patients specifically with femoral neck fractures should be monitored for the development of FES.

Syndrome thoracique aigu chez les patients drépanocytaires adultes

Sickle cell disease is a frequent genetic condition, due to a mutation of the β-globin gene, leading to the production of an abnormal S hemoglobin and characterized by multiple vaso-occlusive events. The acute chest syndrome is a severe complication associated with a significant disability and mortality. It is defined by the association of one or more clinical respiratory manifestations and a new infiltrate on lung imaging. Its pathophysiology is complex and implies vaso-occlusive phenomena (pulmonary vascular thrombosis, fat embolism), infection, and alveolar hypoventilation. S/S or S/β0-thalassemia genotype, a history of vaso-occlusive crisis or acute chest syndrome, a low F hemoglobin level (<5%), a high steady-state hemoglobin level (> 10 g/dL), or a high steady-state leukocytosis (>10 G/L) are the main risk factors. Febrile chest pain, dyspnea, sometimes cough with expectorations are its main clinical manifestations, and bi-basal crackles are found at auscultation. Inferior alveolar opacities with or without pleural effusions are identified on chest X-ray or CT-scan. Management of the acute chest syndrome should be prompt and implies, besides the recognition of severity signs, a multimodal analgesia, oxygen supplementation, sometimes a parenteral antibiotic treatment and the frequent use of blood transfusions especially in the most severe cases. Prevention is important and includes a regular monitoring of hospitalized patients and the use of incentive spirometry.

Surgical Treatment of Closed Fractures of Long Bones of Extremities with Polytrauma

The purpose of the study was to improve the functional results of treatment of patients with closed fractures of long bones of the extremities with polytrauma. Materials and methods. The results of treatment of 95 patients with fractures of long bones of the extremities with polytrauma were analyzed. Among them there were 70 (73.9%) men and 25 (26.1%) women. The victims had one or more closed fractured of the long bones of the limbs. Persons of young and able-bodied age from 31 to 50 years old prevailed – 47 (48.9%) patients. Results and discussion. Active restorative treatment was started on the second and third days after the operation at the beginning of passive movements in the joints then, as the postoperative wound healed, on the sixth and seventh days, it was active. Depending on the nature of the fractures various implants were used, in most cases, low-contract ones, which in a particular case allow achieving maximum anatomical reposition and achieving stable fixation of fragments, which provides the possibility of an early start in the development of the joint. In the immediate postoperative period in 11 patients with open fracture type B3, superficial suppuration of the soft tissues around the pins was noted, which was easily dealt with using a device for injecting drugs into the infected pin channel. Four patients with granulating wounds of the lower leg underwent autodermoplasty with a free skin graft, all 100% were healed. Phlebothrombosis developed in three patients with hip fractures: they underwent an urgent operation by angiosurgeons – vessel plexization. Long term results of treatment in terms of 8 months to 5 years were studied in 76 patients. Treatment outcomes were assessed with some criteria (union, neuro vascular disorder, varus or valgus, rotation, shortening of the limb, movement in the knee and hip joint, pain, walking hanging activity). Four patients developed chronic osteomyelitis, they underwent seguestrectomy with sub segment recovery. Delayed consolidation was noted in six patients with complex fractures (type C). Two patients developed a defect in the bones of the lower leg up to 5 sm, they subsequently underwent lengthening of the segment. Post-traumatic contracture was noted in four patients. Three patients had persistent leg edema, chronic post-traumatic thrombophletitis, equinus deformity of the feet, significant chromate – the result was rated as “poor”. According to the results of ratings as “excellent”, “good”, “satisfactory” and “poor”, quantitative designations were assigned as 5, 4, 3, 2 points, respectively. In the 76 patients studied, the long-term results were assessed as follows: in 24 (31.6%) patients the result was regarded as excellent (5 points), in 37 (48.7%) patients it was good (4 points), in 12 (15.8%) %) – satisfactory (3 points), in 3 (3.4%) – poor (2 points). Conclusion. As a result of the use of low-contact on-bone plates in the osteosynthesis of complex comminuted fractures of long bones, with combined injuries, 90.3% gave excellent and good functional results. With a combined chest injury, intramedullary osteosynthesis with a pin with reaming is contraindicated, due to the risk of developing fat embolism. In these patients, it is necessary to operate with bone plates

Fat embolism after intraosseous catheters in pediatric forensic autopsies

In our center, we performed the autopsy of a child who died from drowning and presented, at autopsy, a major pulmonary fat embolism (PFE). A cardiopulmonary resuscitation (CPR) was performed, including infusion by intraosseous catheter (IIC). No other traumatic lesions and diseases classically related to a risk of PFE were detected. According to some animal studies, we considered the IIC as the only possible cause for PFE. However, we could not find literature to confirm this hypothesis in humans, especially in a pediatric population. To verify the occurrence of PFE after IIC in a pediatric population, we retrospectively selected 20 cases of pediatric deaths autopsied in our center, in which a CPR was performed, without bone fractures or other possible causes of PFE: 13 cases with IIC (group A) and 7 cases without IIC (group B). Several exclusion criteria were considered. The histology slides of the pulmonary tissue were stained by Oil Red O. PFE was classified according to the Falzi scoring system. In group A, 8 cases showed PFE: 4 cases with a score 1 of Falzi and 4 cases with a score 2 of Falzi. In group B, no case showed PFE. The difference between the two groups was statistically significant. The results of our study seem to confirm that IIC can lead to PFE in a pediatric population and show that the PFE after IIC can be important (up to score 2 of Falzi). To the best of our knowledge, our study is the first specifically focused on the occurrence of PFE after IIC in a pediatric population by using autoptic data.

A comparative study between cemented and un-cemented hemiarthroplasty management of fracture neck of femur in elderly patients

Background: Cementation of prosthesis achieves a good initial fix in an osteoporotic bone, however, arthroplasty using a cemented implant may be associated with increased mortality compared with an arthroplasty using an uncemented implant, as it has the risk of bone marrow and fat embolization with resulting intraoperative hypotension and increased incidence of deep vein thrombosis. This aim of the study was to evaluate the complications, morbidity, and mortality rates associated with each of the procedures and study the radiographic changes, recovery to physical independence and advantages encountered in each of the procedures, and achieve stable fixation and early mobilization.Methods: Pre-operative and a postoperative assessment was done on patients who underwent Cemented and Uncemented for femoral neck fractures. After the procedure, the frequent follow-up was carried out. Clinical evaluation was done for limb length discrepancy, thigh pain, rotation of the limb, gait pattern, and range of movements.Results: The incidence of postoperative complications was higher in the uncemented group than in the cemented group. The cemented group showed significantly better results than the uncemented group regarding walking distance. There was a statistically significant difference between the two groups regarding Harris hip score.Conclusions: For elderly patients with a displaced femoral neck fracture a cemented hemiarthroplasty is favorable compared to an uncemented stem. There was no significant overall difference in mortality rate, cardiovascular and cerebrovascular complications, general complications, local complications, and reoperation rate.

Ex Vivo Versus In Vivo Liposuction Hemolysis Index in High-Definition Liposuction and Body Contouring

Background: Ex vivo liposuction is a novel technique wherein tissues that are preoperatively planned for excision can be liposuctioned in a sterile manner after removal from the patient. Excised tissues are routinely obtained during a tummy tuck or variant, lateral thigh tuck, buttock tuck, brachioplasty, upper body tuck, and medial thigh tuck. These tucking procedures are performed when moderate to severe skin redundancy is present in patients undergoing body contouring. Traditionally, these tissues were first liposuctioned prior to being excised, termed in vivo liposuction. However, we have developed ex vivo liposuction protocols wherein the tissues are liposuctioned after they have been excised off the patient. Routine processing of harvested fat focuses on minimizing blood products in the aspirate prior to injection. This is because blood products are felt to contain pro-inflammatory products that negatively affect fat graft take. We hypothesized that fat collected by ex vivo technique provides a less bloody harvest than fat collected by in vivo technique. Materials and Methods: We quantitated blood concentrate of ex vivo versus in vivo fat aspirate by comparing the hemolysis index in 14 consecutive patients undergoing high-definition liposuction and body contouring. Results: Comparison of hemolysis index demonstrated significant reduction in blood concentrate in ex vivo versus in vivo fat aspirate. In vivo hemolysis index demonstrated a larger median than ex vivo hemolysis index. These results confirm our clinical observation that fat harvested by ex vivo liposuction is cleaner and less blood-tinged than fat harvested by in vivo liposuction. Conclusion: No patients experienced complications related to fat graft infection nor fat emboli. Ex vivo liposuction has proven a safe and less blood-tinged technique for harvesting fat in patients who require excisional procedures.

Clinical outcomes of gastrointestinal bleeding management during anticoagulation therapy.

Acute gastrointestinal (GI) bleeding is not an uncommon complication of oral anticoagulation (OAC) therapy that requires medication cessation. However, drug cessation may cause fatal stroke or systemic embolization in patients at high thromboembolic risk. Here we sought to find an appropriate anticoagulation cessation strategy in cases of GI bleeding during OAC therapy. This single-center retrospective cohort analysis was performed between 2010 and 2018. Patients were enrolled if the following three consecutive conditions were met: 1) electrocardiography electrocardiography-proven atrial fibrillation; 2) OAC therapy; and 3) GI bleeding. We divided the drug cessation strategy into the continuation and discontinuation groups. During 1-year follow-up, the rates of major thromboembolic and rebleeding events were calculated. One hundred and forty-six patients (continuation [n = 54] vs. discontinuation [n = 92] group) were enrolled. Patients in the discontinuation group were more likely to be older (69.8 ± 9.0 yrs vs. 74.9 ± 8.9 yrs, p = 0.001), while patients in the continuation group were more likely to have undergone cardiac valve surgery (51.9% vs. 20.7%, p<0.001). The presence of a mechanical mitral valve was a determinant of continuation strategy (38.9% vs. 7.5%, p<0.001). However, the mean CHA₂DS₂-VASc (3.4±1.3 vs. 4.1±1.6, p = 0.010) and Glasgow-Blatchford (8.0±2.4 vs. 8.9±2.5, p = 0.037) scores were higher in the discontinuation group. Two major embolic strokes occurred in each group (3.7% vs. 2.2%, p = 0.585). Four of 54 (7.4%) and five of 92 (5.4%) patients had rebleeding events during follow-up (p = 0.632). One embolic event in the continuation group and one rebleeding event in the discontinuation group were fatal. The Glasgow-Blatchford score was a predictor of 1-year rebleeding events (odds ratio [OR], 1.36; 95% confidence interval [CI], 0.68-2.20; p = 0.028). The high CHA₂DS₂-VASc score showed a strong trend (OR, 1.71; 95% CI, 0.92-3.20; p = 0.089) in 1-year thromboembolic events. No single risk factor or drug cessation strategy was attributed to adverse clinical events after GI bleeding. The risk of future thrombotic or rebleeding events should be individualized and controlled for based on a pre-existing stratification system.

Early Total Care Versus Damage Control Orthopedics in Floating Knee Injury: Analysis of Radiological and Functional Outcomes

IntroductionFloating knee injury (FKI) occurs as a result of a high-velocity impact. We assessed the radiological and functional outcomes of FKIs treated by various fixation methods, by damage control orthopedics (DCO) or early total care (ETC).Materials and methodsWe investigated 46 patients with FKI who were operated on between January 2013 and January 2018 at the RL Jalappa Hospital and Research Center, Kolar, India. Functional assessments were evaluated using Karlström and Olerud’s criteria (KOC). Based on their treatments, the patients were divided into the damage control orthopedics group (n = 21) and the ETC group (n = 25). Statistical analyses were used to obtain and compare summary data.ResultsThe data of 46 patients were collected. Fractures were classified using the modified Fraser’s classification. Five patients were not included in the final analysis because of death due to complications in the immediate postoperative period. In patients managed by DCO, after radiological union, the functional outcome was excellent in three cases, good in eight, fair in seven, and poor in two. The average time required for radiological union of the femur was 10.75 ± 1.482 months (P = 0.001); for tibia union, it was 10.25 ± 1.682 months (P = 0.011). The average range of knee flexion was 85°± 16.059° (P = 0.001), which was statistically significant. In patients managed by ETC, there were six cases with an excellent functional outcome, 13 with a good outcome, and two with a fair outcome. The average time required for radiological union of the femur was 9.29 ± 1.765 months (P = 0.006); for the tibia, it was 9.05 ± 1.161 months (P = 0.012). The average range of knee flexion was 100° ± 10.954° (P = 0.001), which was statistically significant. Fat embolism was noted in eight cases; four of these patients died due to multiorgan dysfunction. This was the major life-threatening complication in the early definitive fixation group. In the DCO group, only three cases had fat embolism, with one death due to multiorgan dysfunction. Early postoperative infection was a concern in the ETC group, evident in six cases.ConclusionThe classification system for FKI needs further research, which must include multiple parameters. Fracture classification and patient selection are crucial considerations in deciding the best treatment for a particular fracture.

28-Year-Old Man With Joint Pain

28-Year-Old Man With Joint Pain

CTPA imaging findings, beyond pulmonary embolism, in patients with Severe Acute Respiratory Syndrome Corona Virus-2 infection and their relation to clinical outcome - a single center experience.

The aim of our study was to investigate a potential association between the severity of COVID-19 disease and related 28-day mortality, with the presence of mediastinal lymphadenopathy, the extension of lung parenchymal infiltrates, the presence of pulmonary embolism, the density and distribution of mediastinal and subcutaneous fat, the inflammatory markers and the direct and indirect radiological signs of right heart overload and strain. We retrospectively included patients diagnosed with SARS-CoV-2 infection, who were admitted to the Departments of Internal and Respiratory Medicine of Patras University Hospital during the second pandemic wave (February 2021 up to July 2021) and underwent CTPA for routine diagnostic workup. Demographic characteristics, routine laboratory, radiological parameters and 28-day mortality were also recorded. Fifty-three consecutive patients were included. The mean age was 64.47±17.1 years and 64,1% (n=34) were males. Pulmonary embolism (PE) (p=0.019), Right Ventricle-to-Left Ventricle Diameter (RV/LV) Ratio>1 (p<0.01), Reverse Flow in Hepatic Veins (RFHV) (p=0.019), higher density in subcutaneous fat (-99 HU vs. -104HU, p=0.016), increased Lactic Dehydrogenase (LDH), Polymorphonuclear cells (PMN), ferritin, and d-dimer levels (534 vs. 367 U/L, p=0.001, 9220 vs. 5660 Κ/μL, p=001, 956 vs. 360 ng/ml, p=0.005 and 2300 vs. 1040 μg/ml, p=0.003, respectively) were statistically significant related with worse 28-day mortality. Binomial multivariate regression analysis revealed that only RV/LV diameter>1, higher subcutaneous fat density and higher LDH values were independently associated with increased 28-day mortality (OR: 82.9, 95%CI: 1.334-5158, p=0.036, OR: 1.2, 95%CI: 1.016-1.426, p=0.032 and OR:1.016, 95% CI:1.004-1.029, p=0.011, respectively). Subgroup analysis revealed that mediastinal lymph node enlargement (EML) and PE were associated to increased Pulmonary Disease Severity Index (PDSI) score (p=0.042 and p=0.007, respectively), but not to mortality. Our study showed that right heart strain as depicted by a RV/LV diameter>1, higher subcutaneous fat density and higher LDH values are independently associated with an increased 28-day mortality in our SARS-COV2 patient group.

P117 INCIDENTAL FINDING OF A PAPILLARY FIBROELASTOMA WITH UNCOMMON LOCATION: CASE REPORT

Abstract A 64–year old man with no cardiological history came to our laboratory to perform a transthoracic echocardiogram because of increased blood pressure. Patient was asymptomatic. Echocardiogram revealed the presence of a small mass attached to the proximal part of the interventricular septum (IVS) (Fig. 1), characterized by high mobility within the left ventricular outflow tract (LVOT). Transesophageal echocardiogram confirmed the presence of a 8 mm pedunculated mass with implant base on IVS, 2 cm below the aortic valve and oscillating in LVOT (Fig. 2). The high risk of peripheral embolization led the Heart team to propose cardiac surgery. The operation was conducted through a J–ministernotomy on a fourth intercostal space, cannulation of ascending aorta and right atrium, transverse aortotomy and identification of the mass via the transaortic route. The appearance of the mass, glossy brown and with a gelatinous consistency, first appeared to be attributable to papillary fibroelastoma. The histological investigation (Fig. 3) confirmed the diagnosis. Postoperative course was regular and the patient was discharged on fifth postoperative day. Discussion Papillary fibroelastoma is the third most common primary cardiac tumour, after myxoma and lipoma, with an incidence of around 10%. In 90% of the cases the origin is from the valvular endocardium (the aortic and mitral valve surfaces are the most affected sites), while the origin from the endocardium of left ventricle, as in the case of our patient, is much more rare (less than 10% of cases). Atypical locations, in addition to IVS, are papillary muscles, tendinous chords and atrial endocardium. Although most patients are asymptomatic, consequences related to peripheral embolization can be very serious (neurological complications, acute coronary sindrome, peripheral ischaemia, pulmonary embolism). Mobility rather than size appears to be an indipendent predictor of death and non fatal embolization; for this reason, in the presence of mobile and pedunculated mass, surgical intervention is always reccomended. Surgical excision is associated with a low operative risk and the minimally invasive approach, as in our case, allows for a rapid recovery.

Akinetic Mutism Resulting from Cerebral Fat Embolism from Underlying Hemoglobin SC Disease Crisis (P1-1.Virtual)

Akinetic Mutism Resulting from Cerebral Fat Embolism from Underlying Hemoglobin SC Disease Crisis (P1-1.Virtual)

Distinct Responses in the Brain Compared to Lung in a Rat Model of Fat Embolism Syndrome

Fat embolism syndrome (FES) caused by release of emboli into the bloodstream after surgery or injury, can lead to severe neurological complications. We have previously shown that FES induced in rats by intravenous injection of triolein (T) causes pulmonary pathology after 48 hours that persists up to 10 weeks. Elevated expression of markers in the Renin Angiotensin System (RAS) are associated with pulmonary damage, and RAS inhibitors reduce pulmonary damage 1‐4. All components of the system (renin/ACE/AngII/AT1R) have been reported in the Central Nervous System and shown to be involved in neuroinflammation and eventual neurodegeneration5. To investigate the role of the brain RAS in response to FES, brains of T treated, and control rat models were examined for markers of RAS and neural pathology.Methodology24 rats received intravenous 200ul of T or Saline (S). Organs were processed at 48 hours or 10 weeks, sectioned, and immunostained with antibodies to Renin and Prorenin receptors in RAS; Glial Fibrillar Acidic Protein and Ib1a to identify makers of inflammation; Parp1 and Phospohistone S10 to identify cell death and proliferation respectively. Images were coded, blinded and quantified and statistically compared using GraphPad software.ResultsAs previously reported, lungs exhibited inflammation, vasculitis, and fibrosis at 48 hours and 10 weeks1,2. A significant increase in fat emboli was observed in the brain at 48 hours with persistence of micro‐emboli up to 10 weeks (S, N=6, relative emboli proportion (REP) = 7.2; FES N=5, REP = 11.0, p&lt;0.001). Contrary to the lung, vasculitis was not observed in the brain after 48 hours or 10 weeks (S, vs FES, 48 hours, p&lt;0.25; 10 weeks p&lt;0.35). Regional differences (hippocampus, cerebellum, cerebral cortex, hypothalamus) in expression of markers of RAS and markers of inflammation were observed in T versus S samples at 48 hours and 10 weeks.ConclusionThis study highlights differences in organ responses to FES and identifies distinct regions in the brain that may be susceptible to FES. Adaptations of components of brain RAS have been linked to increased oxidative stress through activation of NADPH oxidase and production of reactive oxygen species in the brain5. Release of reactive oxygen species and activation of inflammatory mediators is shown to be associated with progression of neurodegeneration and cognitive dysfunction5. Understanding the acute and long‐term impacts of FES on localized brain RAS, could provide further insight into the susceptibility and resistance of other organs RAS response.

Cardiac and pulmonary expression of renin, prorenin, mast cells and macrophages in a rat model of fat embolism syndrome

Fat embolism induced in rats by intravenous injection of triolein(T) causes pulmonary inflammation, fibrosis, and vasculitis after 48 hours ort 10 weeks. Administration of Aliskiren, Captopril and Losartan drugs, which interfere with the renin angiotensin aldosterone system, ameliorates the pulmonary damage. Macrophages and mast cell number decreased with drugs administration. Hearts do not exhibit inflammation or vasculitis although significant emboli are detected at 48 hours. Pulmonary expression of renin, prorenin(R/P) positive cells are also increased after T injection. This study investigates whether the presence of R/P cells correlates with macrophages and mast cell invasion in the hearts and lungs.Methodology24 Sprague Dawley rats were divided into four groups and treated with 0.2 ml of T or Saline. Lungs and hearts from 3 animals from each group that were sacrificed 48 hours or 10 weeks, fixed in formalin and stained with Hematoxylin‐Eosin, Trichrome or immunostained with antibodies to CD117, CD68 to identify mast cells and macrophages. Sections of the heart and the lung were evaluated at 400X magnification. Cells were counted, histopathology examined and statistical significance evaluated using GraphPad software.ResultsWhile the lungs showed the previously reported, histopathological damage caused by the inflammation, vasculitis, fibrosis and cell necrosis, the hearts did not show such damage, thus confirming previous observations.Contrary to the lungs where the number of CD117, CD68 and R/P positive cells was significantly increased at both interval times, no difference in CD117, CD68, R/P positive cell numbers were observed in the heart. In the lungs, two distinct types of macrophages were identified, one large and the second one of normal size. Such histopathological changes were not observed in the hearts. Hearts exhibited distinct locations of CD117 and CD68 positive cells, with multiple cells located primarily near the myocardium and few in the adventitia of the coronary arteries, in contrast to lungs where the cells were mostly located around the arteries.ConclusionThe study confirms the previously reported histopathological difference of the T induced damage in the lungs compared to that of the hearts in this model of fat embolization. This finding highlights the variation in cellular response of diverse organs to fat embolism. This difference is not only related to the number of the inflammatory cells but also to their location in different organs as evidenced by the difference in the distribution and location of R/P cells in hearts and lungs. Future studies will investigate the underlying mechanisms that lead to pulmonary susceptibility while preserving cardiac integrity in response to a FE induced inflammatory response in order to better design a therapeutic intervention for the fat embolism syndrome.