Case report: Death caused by multi-organ metastatic calcifications as a result of intramuscular injections with paraffin oil.

In this forensic case report, we present autopsy findings from a young male in his thirties who had been self-injecting paraffin oil into his upper extremities 8 years prior to death. The injections induced an inflammatory response, leading to granuloma formation. This, in turn, resulted in severe hypercalcemia. The external autopsy examination revealed gross macroscopic ulcerations and enlargement of upper extremities, while calcifications of ligaments, heart, kidneys and dura mater was revealed on postmortem CT-scans. Histopathological examination showed extensive multiorgan metastatic calcifications in several tissues including the lungs, heart and kidney. Cause of death was estimated to be the extensive calcific deposits in the heart likely resulting in cardiac arrest. To our knowledge this is the first case reporting findings from an autopsy in which the cause of death was linked to cosmetic oil injections.

Comment on: "Bone marrow embolism: should it result from traumatic bone lesions? a histopathological human autopsy study".

Farid et al., described how 8 of 11 cases of Bone Marrow Embolism were found to be non-traumatic. In our research group we found several shortcomings in the methodology, and within our own Institute we could not replicate the results.

The influence of assisted ventilation and recumbency on cardiorespiratory physiology in the anesthetized freshwater turtle Trachemys scripta scripta.

The use of assisted ventilation is required in anesthetized reptiles as their respiratory drive is lost at surgical depths of anesthesia. The minute volume of the assisted ventilation influences arterial blood gases and acid-base regulation. Meanwhile, the ventilatory pattern may also affect hemodynamics in chelonians, which, given their large capacity for cardiac shunts, may impact the efficacy of the ventilation in terms of gas exchange. Hence, there is a need for primary information on the influence of assisted ventilation on chelonian physiology, and we, therefore, performed a randomized study into the effects of recumbency and maximum airway pressure on pressure-cycled ventilation in nine female Trachemys scripta scripta. Pronounced effects of ventilation pressure on arterial PCO2 and pH regardless of recumbency were revealed, whilst dorsal recumbency led to a larger Arterial-alveolar (A-a) O2 difference, suggesting compromised pulmonary gas exchange. Plasma [Na+] and [K+] balance was also significantly correlated with maximum airway pressure. Computed tomography (CT) scanning at a range of end-inspiratory pressures and ventral and dorsal recumbencies in eight T. scripta scripta showed that lung volumes increase with maximum ventilatory pressure, while recumbency did not influence volume at pressures above 5 cmH2O. Static compliance of the lungs was influenced by recumbency at neutral pressures. In conclusion, dorsal recumbency reduces pulmonary efficacy during positive pressure ventilation and tends to lower lung volume when ventilation is not provided. However, lung volumes and function - even in dorsal recumbency - can be adequately supported by assisted ventilation, and an end inspiratory pressure of 10 cmH2O at 4 breaths min-1 provided the most physiologically appropriate ventilation of anesthetized T. scripta scripta.

Does pain and hip function improve 2 years after reverse periacetabular osteotomy? A follow-up study of 74 patients.

Data on outcome in patients with acetabular retroversion (AR) treated with reverse periacetabular osteotomy (reverse PAO) are sparse. The aim of the study was to investigate changes in pain and hip function among patients with AR 2 years after reverse PAO and to examine whether changes in pain were associated with changes in hip function. In addition, to evaluate patient satisfaction and changes in quality of life (QoL). We present a prospective follow-up study with patient-reported outcome data from Aarhus University Hospital in Denmark. Pain at rest and during activity was measured with a Visual Analogue Scale (VAS), hip function with the Hip disability and Osteoarthritis Outcome Score (HOOS) and QoL with the Short-Form 36, pre-operatively and 2 years after reverse PAO in 74 patients. Changes were analysed using paired t-test and multiple linear regressions. Significant and clinically relevant mean improvements in pain and hip function were found. The numbers of responders achieving a minimal clinically important difference varied from 51 to 73%. Positive significant association between changes in pain and changes in hip function were found. Significant mean improvement in QoL was found. The study had a loss to follow-up of 23%. Two years after reverse PAO, patients diagnosed with AR showed significant and clinically relevant mean improvements in pain and hip function. Decreased pain was significantly associated with improved hip function. The majority of patients were satisfied with the result of surgery and QoL was similar to the Danish background population.

What level of pain reduction can be expected up to two years after periacetabular osteotomy? A prospective cohort study of 146 patients.

Periacetabular osteotomy (PAO) corrects underlying anatomical anomalies, reduces pain and may postpone or even prevent osteoarthritis onset in patients with symptomatic acetabular dysplasia. Current evidence is based on immediate post-operative pain levels, but knowledge on pain levels in the period after PAO is scarce, and the association between pain score and acetabular angles at PAO is unknown. This study had two aims. First, we studied pain level and patient-reported outcome scores pre- and postoperatively; second, we analysed the association between acetabular angles and pain level. From our database, 426 patients operated from June 2012 to November 2015 were analysed; 127 were excluded. Patients were invited to complete standardized questionnaires preoperatively and postoperatively at 6 and 24 months. Pain was measured using visual analogue scale (VAS). Multiple regression analysis was used to investigate the association between change in centre edge (CE) and acetabular index (AI) angle and pre/postoperative pain levels. Mean (standard deviation, SD) VAS pain at rest before surgery and at the 6- and 24-month follow-up were 35 (24), 14 (20) and 14 (19), respectively. Mean (SD) VAS pain at activity were 69 (22), 41 (29) and 41 (30), respectively. Both VAS pain at rest and at activity fell from the preoperative level to 6 months post-surgery with no further change at 24 months. Patients reported significant improvement in outcomes after 6 months and no further change at the 24-month follow-up. There was no significant association between change in CE/AI angles and VAS pain, either during rest or activity.