Advances in Research of Post Embolism Syndrome after Transarterial Chemoembolization(TACE)for Hepatocellular Carcinoma

This article reviews the concept and clinical manifestations of post embolism syndrome after transarterial chemoembolization(TACE),and the prevention or timely intervention of post embolism syndrome in advance is expected to reduce its incidence and degree in clinical treatment,and to improve the quality of treatment of Hepatocellular Carcinoma Carcinoma(HCC).

Early acute fat embolism syndrome caused by femoral fracture: A case report

BACKGROUND Fat embolism syndrome(FES)is a rare complication caused by the presence of fat particles in the microcirculation,which usually occurs within 12-72 h after trauma.At present,there have been few cases of fat embolism presenting within 3 h after trauma.Here,we report a case of femoral fracture complicated with an acute fat embolism caused by a car accident.CASE SUMMARY A 29-year-old woman with pain,swelling and limited movement of her left lower limb after a car accident was taken by ambulance to our hospital.X-ray examination showed fracture of the middle and lower part of the left femur and fracture of the base of the left fifth metatarsal bone.She was hospitalized and admitted to the orthopedic ward.After the attending doctor performed tibial tubercle bone traction,the patient became confused,followed by respiratory distress.Finally,she was transferred to the intensive care unit.After nearly a month of treatment in the intensive care unit,the patient's cognitive function gradually recovered over 6 mo.CONCLUSION For patients with early traumatic fractures,young emergency physicians and orthopedics should be aware of the possibility of FES.

Postoperative complications of concomitant fat embolism syndrome, pulmonary embolism and tympanic membrane perforation after tibiofibular fracture: A case report

BACKGROUND Fat embolism syndrome(FES)is a rare disease characterized by pulmonary distress,neurologic symptoms,and petechial rash and seriously threatens human life and health.It is still neglected clinically because of the lack of verifiable diagnostic criteria and atypical clinical symptoms.No studies on FES with pulmonary embolism(PE)and tympanic membrane perforation have been reported to date.Here,we report a rare case of concomitant FES,PE and tympanic membrane perforation after surgery in a patient with a tibiofibular fracture.CASE SUMMARY A 39-year-old man presented with right lower extremity pain due to a car accident while driving a motorbike on the road.X-ray and computed tomography scans revealed a fracture of the right mid-shaft tibia and proximal fibula categorized as a type A2 fracture according to the AO classification.A successful minimally invasive operation was performed 3 d after the injury.Postoperatively,the patient developed sudden symptoms of respiratory distress and hearing loss.Early diagnosis was made,and supportive treatments were used at the early stage of FES.Seven days after surgery,he presented a clear recovery from respiratory symptoms.The outcome of fracture healing was excellent,and his hearing of the left ear was mildly impaired at the last follow-up of 4 mo.CONCLUSION Concomitant FES,PE and tympanic membrane perforation are very rare but represent potentially fatal complications of trauma or orthopedic surgery and present with predominantly pulmonary symptoms.Early diagnosis and treatment can reduce the mortality of FES,and prevention is better than a cure.

EXPERIMENTAL STUDY OF FAT EMBOLISM SYNDROME

To find the diagnostic methods for snbclinical stage fat embolism syndrome (FES), we established an experimental animal model, using fat intravenous injection. The fat was obtained from the long bone marrow cavity of homologous dogs. Fourteen healthy mongrel dogs received 0.7 ml / kg fluid marrow fat injection and all of them developed FES within 48 hours. The blood samples collected from the pulmonary vessels by floating catheter and peripheral vein at different time intervals were subjected to blood gas analysis and were frozen sectioned rapidly. The sections were stained with oil red 'O'. Positive result was seen 2 hours after fat injection in both pulmonary and peripheral blood. Computer image analysis showed that the number and diameter of fat droplets in pulmonary vascular blood were obviously higher and larger than those in peripheral vein blood. These findings were correlated well with blood gas changes and clinical features. The demonstration of fat droplets from pulmonary or peripheral blood by oil red 'O' staining combined with blood gas changes (PaO2<7.99 kPa, P(A-a)O2 > 6.09 kPa) may be rapid and specific for early diagnosis of FES. In the treatment of FES, dexamethason can stabilize the cellular membranes and inhibit the neutrophil response to fatty acid and the release of phospholipase A2, arachidonic acid and platelet aggregation.

Simultaneous bilateral floating knee:A case report

BACKGROUND The phrase “floating knee is a flail knee joint,” referring to ipsilateral femoral and tibial fractures,was first used by Blake and Mc Bryde in 1975.This condition is often caused by a high-energy trauma with often extensive injury to the soft tissues,and is accompanied by life-threatening systemic complications,including head,chest or abdominal injuries and a high incidence of fat embolism.Floating knee is a severe and uncommon injury pattern.CASE SUMMARY A 27-year-old man sustained multiple injuries when the electric motorcycle he was riding was hit by a van.His injuries included traumatic hypovolemic shock,comminuted and open type II fractures of the left femoral shaft,fracture of the right femoral shaft,comminuted fracture of the bilateral tibial and fibular shaft,and multiple lacerations and abrasions on his forehead,lower lip,neck and limbs.The diagnosis was simultaneous bilateral floating knee complicated with soft tissue injuries.After emergency treatment and the exclusion of life-threating complications,open reduction and internal fixation were successfully performed using plates and screws in the bilateral femoral and tibial shafts.CONCLUSION Simultaneous bilateral floating knee is a rare and severe injury pattern.The treatment is challenging,and complications.We present a case report of a young adult who suffered from bilateral floating knees during road traffic accident.We also offer our treatment experience of this complex injury and review past literature.

Contrast-induced acute kidney injury:A review of practical points

Contrast-induced acute kidney injury(CI-AKI) is oneof the most common causes of AKI in clinical practice.CI-AKI has been found to be strongly associated with morbidity and mortality of the patients.Furthermore,CI-AKI may not be always reversible and it may be associated with the development of chronic kidney disease.Pathophysiology of CI-AKI is not exactly understood and there is no consensus on the preventive strategies.CI-AKI is an active research area thus clinicians should be updated periodically about this topic.In this review,we aimed to discuss the indications of contrastenhanced imaging,types of contrast media and their impact on nephrotoxicity,major pathophysiological mechanisms,risk factors and preventive strategies of CI-AKI and alternative non-contrast-enhanced imaging methods.

Is obstructive sleep apnea syndrome a risk factor for pulmonary thromboembolism？

Background In many studies, obstructive sleep apnea （OSA） has been shown to be an independent risk factor for cardiovascular disease. Conversely, there are few reports establishing possible relation between OSA and venous thromboembolism （VTE）. In this study, the aim is to evaluate OSA via polysomnography in patients with pulmonary embolism and drawing the attention of clinicians to the presence of obstructive sleep apnea syndrome （OSAS） may be a risk factor for pulmonary embolism. Methods Fifty consecutive patients who were diagnosed with pulmonary embolism （PE） were evaluated prospectively for OSAS. Polysomnographic examination was conducted on 30 volunteer patients. The frequency of OSAS in PE was determined and PE cases were compared to each other after being divided into two groups based on the presence of a major risk factor. Results The study consisted of a total of 30 patients （14 females and 16 males）. In 56.7% of the patients （17/30）, OSAS was determined. The percent of cases with moderate and severe OSAS （apnea hipoapnea index 〉15） was 26.7% （8/30）. Patients who had pulmonary thromboembolism （PTE） without any known major VTE risk （n=20）, were compared to patients with VTE risk factors （n=10）, and significantly higher rates of OSAS were seen （70% and 30% respectively; P=0.045）. The mean age of the group with major PE risk factors was lower than the group without major PE risk factors （52 years old and 66 years old, respectively; P=0.015）, however, weight was greater in the group with major PE risk factors （88 kg and 81 kg, respectively; P=-0.025）. By multivariate Logistic regression analysis, in the group without any visible major risk factors, the only independent risk factor for PE was OSAS （P=0.049）. Conclusions In patients with PTE, OSA rates were much higher than in the general population. Moreover, the rate for patients with clinically significant moderate and severe OSA was quite high. PTE patients with OSA symptoms （not syndromes） and without known major risk factor should be examined for OSA. There seems to be a relationship between OSA and PTE. However, whether this relationship is a causal relationship or a relationship due to common risk factors or long-term complications of OSA is not clear. Further comprehensive studies on those special topics are needed to clarify these points.

Cholesterol crystal embolization following plaque rupture： a systemic disease with unusual features

Cholesterol crystal embolic （CCE） syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals that perforate and tear the fibrous cap. Embolizing cholesterol crystals then initiate both local and systemic inflammation that eventually lead to vascular fibrosis and obstruction causing symptoms that can mimic other vasculitic conditions. In fact, animal studies have demonstrated that cholesterol crystals can trigger an inflammatory response via NLRP3 inflammasome similar to that seen with gout. The diagnosis of CCE syndrome often requires a high suspicion of the condition. Serum inflammation biomarkers including elevated sedimentation rate, abnormal renal function tests and eosinophilia are useful but non-specific. Common target organ involvement includes the skin, kidney, and brain. Various testing including fundoscopic eye examination and other non-invasive procedures such as trans-esophageal echocardiography and magnetic resonance imaging may be helpful in identifying the embolic source. Treatment includes aspirin and clopidogrel, high dose statin and possibly steroids. In rare cases, mechanical intervention using covered stents may help isolate the ruptured plaque. Anticoagulation with warfarin is not recommended and might even be harmful. Overall, CCE syndrome is usually a harbinger of extensive and unstable atherosclerotic disease that is often associated with acute cardiovascular events.