ABSTRACT
RESUMO A hiperatividade simpática paroxística representa uma complicação incomum, com potencial risco à vida, de lesões cerebrais graves, mais comumente de origem traumática. Seu diagnóstico clínico se baseia na manifestação recorrente de taquicardia, hipertensão, diaforese, taquipneia e, às vezes, febre, além de posturas distônicas. Os episódios podem ser induzidos por estímulos ou ocorrer de forma espontânea. É comum que ocorra subdiagnóstico desta síndrome, e o retardamento de seu reconhecimento pode aumentar a morbidade e a incapacidade em longo prazo. Evitar os desencadeantes e a farmacoterapia podem ter muito sucesso no controle desta complicação. A síndrome da embolia gordurosa é uma complicação rara, mas grave, das fraturas de ossos longos. Sinais neurológicos, petéquias hemorrágicas e insuficiência respiratória aguda são as características que constituem seu quadro clínico. O termo "embolia gordurosa cerebral" é estabelecido quando predomina o envolvimento neurológico. O diagnóstico é clínico, porém achados específicos de neuroimagem podem confirmá-lo. As manifestações neurológicas incluem diferentes graus de alteração da consciência, défices focais ou convulsões. Seu tratamento é de suporte, porém são possíveis desfechos favoráveis, mesmo nos casos com apresentação grave. Relatamos dois casos de hiperatividade simpática paroxística após embolia gordurosa cerebral, uma associação muito incomum.
ABSTRACT Paroxysmal sympathetic hyperactivity represents an uncommon and potentially life-threatening complication of severe brain injuries, which are most commonly traumatic. This syndrome is a clinical diagnosis based on the recurrent occurrence of tachycardia, hypertension, diaphoresis, tachypnea, and occasionally high fever and dystonic postures. The episodes may be induced by stimulation or may occur spontaneously. Underdiagnosis is common, and delayed recognition may increase morbidity and long-term disability. Trigger avoidance and pharmacological therapy can be very successful in controlling this complication. Fat embolism syndrome is a rare but serious complication of long bone fractures. Neurologic signs, petechial hemorrhages and acute respiratory failure constitute the characteristic presenting triad. The term cerebral fat embolism is used when the neurological involvement predominates. The diagnosis is clinical, but specific neuroimaging findings can be supportive. The neurologic manifestations include different degrees of alteration of consciousness, focal deficits or seizures. Management is supportive, but good outcomes are possible even in cases with very severe presentation. We report two cases of paroxysmal sympathetic hyperactivity after cerebral fat embolism, which is a very uncommon association.
Subject(s)
Humans , Male , Adult , Young Adult , Autonomic Nervous System Diseases/etiology , Brain Injuries/complications , Embolism, Fat/complications , Autonomic Nervous System Diseases/diagnosis , Autonomic Nervous System Diseases/physiopathology , Syndrome , Tachycardia/etiology , Embolism, Fat/mortality , Tachypnea/etiology , Hypertension/etiologyABSTRACT
INTRODUÇÃO: Analisar dados da internet relacionados a mortes por embolia gordurosa, inicio da doença, e outras informações podem determinar a realidade atual no Brasil relacionada à incidência da síndrome de embolia gordurosa e qualquer repercussão na mídia, e também revisar as metodologias de prevenção e quais são os melhores métodos disponíveis para tratar a doença. MÉTODOS: Uma pesquisa no google foi conduzida de Janeiro de 2000 a Janeiro de 2014 utilizando os descritores "cirurgia plástica" e "morte". Foram incluídos e revisados artigos contendo as palavras "embolia", "embolia gordurosa" e "complicações em (ou de) cirurgia plástica". RESULTADOS: Incluiu-se 235 matérias novas relevantes ao longo dos 14 anos. Houve 45 casos de óbito relacionados com cirurgia plástica que ofereceu poucos dados para individualização. Desses pacientes, 44 eram mulheres. As causas possíveis mencionadas foram embolia pulmonar (cinco casos), perfuração das vísceras (cinco casos), hipertermia maligna (três casos), anestesia (dois casos), choque anafilático (dois casos), embolia gordurosa (um caso confirmado), e "outros" (cinco casos). CONCLUSÃO: Diretrizes de prevenção para embolia gordurosa em cirurgia plástica são requeridas, porém, há também necessidade de mais estudos baseados em evidência para entender mais claramente quais são os melhores métodos.
INTRODUCTION: To analyze data from the internet on deaths from fat embolism, time of onset, and other information that could determine current reality in Brazil regarding fat embolism syndrome incidence and any ,media repercussions, and also to review methods of prevention and what are the best methods available to treat this disease. METHODS: A Google search was conducted from January 2000 to January 2014 using the keywords "plastic surgery" and "death." We included and reviewed articles containing the words "embolism", "fat embolism" and "complications in (or of) plastic surgery". RESULTS: We included 235 relevant news stories over the 14 included years. There were 45 cases of death related with plastic surgery that offered few data for individualization. Of these patients, 44 were women. Possible causes mentioned were pulmonary embolism (five cases), perforation of viscera (four cases), malignant hyperthermia (three cases), anesthesia (two cases), anaphylactic shock (two cases), fat embolism (one confirmed case), and "other" (five cases). CONCLUSION: Guidelines to prevent fat embolism in plastic surgery are needed, however, there is also the need of more evidence based studies to understand more clearly what methods are best.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , History, 20th Century , Viscera , Evaluation Study , Pulmonary Embolism , Pulmonary Embolism/mortality , Pulmonary Embolism/prevention & control , Surgery, Plastic , Surgery, Plastic/methods , Surgery, Plastic/mortality , Surgery, Plastic/statistics & numerical data , Embolism, Fat , Embolism, Fat/mortality , Embolism, Fat/prevention & control , Anaphylaxis , Anaphylaxis/mortality , Anaphylaxis/prevention & control , Malignant Hyperthermia , Malignant Hyperthermia/mortality , Malignant Hyperthermia/prevention & controlABSTRACT
A cirurgia de lipoaspiração é com alguma frequência relacionada a consequências dramáticas ou fatais, causando grande repercussão no meio médico e principalmente na mídia leiga. Esse fato não deve fazer com que o cirurgião plástico evite essa cirurgia, mas sim estimulá-lo a conhecer profundamente a fisiopatologia inerente ao procedimento, buscando meios embasados de realizá-lo da forma mais segura possível, reduzindo ao máximo os riscos de complicações, principalmente as mais graves. Esse artigo teve o objetivo de realizar uma revisão bibliográfica a respeito especificamente da embolia gordurosa causada pela lipoaspiração, relacionada inúmeras vezes a pós-operatórios dramáticos e fatais. Além disso, ressalta alguns cuidados preventivos para uma maior segurança com esse procedimento.
Liposuction surgery is often associated with severe or fatal consequences, causing great repercussions in the medical field, and especially in the lay media . This should not cause the plastic surgeon to avoid the procedure, but rather should promote deeper knowledge of the basic pathophysiology. All means to accomplish the surgery in the safest possible way should be utilized, to minimize the risk of complications, especially the most severe risks. This article reviews the literature on liposuction-induced fat embolism, which is often associated with severe complications in the postoperative period, and even fatal outcomes. In addition, this study highlights several preventive measures that can be adopted to ensure greater safety of this procedure.
Subject(s)
Humans , History, 21st Century , Postoperative Complications , Surgery, Plastic , Lipectomy , Embolism, Fat , Subcutaneous Fat , Postoperative Complications/surgery , Postoperative Complications/therapy , Pulmonary Embolism , Pulmonary Embolism/surgery , Pulmonary Embolism/complications , Pulmonary Embolism/mortality , Pulmonary Embolism/pathology , Surgery, Plastic/methods , Review Literature as Topic , Lipectomy/methods , Lipectomy/mortality , Risk Factors , Embolism, Fat/surgery , Embolism, Fat/complications , Embolism, Fat/mortality , Embolism, Fat/pathology , Subcutaneous Fat/surgeryABSTRACT
OBJECTIVE@#To analyze the general and forensic pathological characteristics of death due to fat embolism syndrome (FES) and to provide reference data for forensic identification.@*METHODS@#Twenty autopsy cases due to FES were selected from the forensic center of a medical college from 1999 to 2012. The general and forensic pathological characteristics such as the ways and types of injuries, clinical manifestation and the pathological changes were summarized.@*RESULTS@#Fat embolism mainly occurred after long bone fracture or a large area of soft tissue injury with the majority of cases being fat embolism of lung and occasional cases being combined embolisms of lung and brain as well. The onset of symptoms appeared shortly after the injury or surgery. Lipid droplets could be observed within small pulmonary vessels and verified by special staining.@*CONCLUSION@#There are particular characteristics in death due to FES in concern with types of injuries, onset of symptoms and pathological findings. In order to find out the direct evidence of FES, special staining (oil red O staining) can be used in the forensic identification.
Subject(s)
Humans , Male , Middle Aged , Autopsy , Cause of Death , Death , Embolism, Fat/mortality , Forensic Pathology , Fractures, Bone/complications , Pulmonary Embolism/etiology , Soft Tissue Injuries/complicationsABSTRACT
Fat Embolism and the associated Fat Embolism Syndrome is a serious and potentially life threatening condition. It tends to occur usually after fractures or intramedullary instrumentation of long bones. Non-traumatic conditions such as Diabetes Mellitus severe Burns, SLE, sickle cell disease and Pancreatitis can also lead to Fat Embolic syndrome. Young adults are commonly affected. Presentation consists of an asymptomatic interval followed by pulmonary and neurological manifestations combined with petechial haemorrhages. The diagnosis largely depends on high index of suspicion and exclusion of other conditions. Treatment of this condition remains supportive. Mortality associated with this condition is significant, ranging from 10-20%
Subject(s)
Humans , Embolism, Fat/diagnosis , Embolism, Fat/mortality , Embolism, Fat/therapy , Diagnosis, Differential , Neurologic Manifestations , Lung DiseasesABSTRACT
Las complicaciones en los pacientes politraumatizados con fracturas de huesos son muy variadas. Se presenta a un paciente de sexo femenino con politraumatismo, con fractura de fémur, tibia y peroné, a la que se le realiza un bloqueo epidural para la reducción de sus fracturas utilizándose bupivacaína al 0,5 por ciento más fentanilo. A los 75 minutos del intraoperatorio la paciente en forma súbita comienza con disnea, taquipnea, taquicardia, hipotensión e hipoxemia acompañada por posterior deterioro del sensorio. Se procede a soporte ventilatorio con oxígeno al 100 por ciento y máscara, para luego trasladarla a la unidad de cuidados intensivos donde se le diagnostica, mediante elementos clínicos y pruebas de laboratorio, síndrome de embolia grasa seguido de falla multiorgánica.