The authors analyzed 115 cases of head injury surgically treated in the Department of Neurosurgery, Yonsei University Medical College, in 1978. Among them, 18 patients had another significant combined injury in the body. Mortality of them was twice more than of the group without combined injury. Protection of brain from circulatory disturbance, hypoxia, fat embolism, etc. is chief point of early treatment of multiply injured patients. The most common cause of multiple injuries involving head injuries was traffic accident. Mortality of the group diagnosed with CT scan was lowest. Intervals between the injury and operation were within 24 hours in almost them.
Accidents, Traffic ; Anoxia ; Brain ; Craniocerebral Trauma ; Embolism, Fat ; Humans ; Intracranial Hemorrhage, Traumatic* ; Mortality ; Multiple Trauma ; Neurosurgery ; Tomography, X-Ray Computed

Diffuse alveolar hemorrhage (DAH) is a rare manifestation of trauma or long bone fracture. A relationship between fat embolism and DAH has been reported. A 73-year-old female developed sudden cardiac arrest during a femur fracture operation. Cardiopulmonary resuscitation (CPR) was repeated for about 130 minutes. During CPR, blood was detected in the endotracheal tube. Diffuse patch ground glass opacity appearance and increased pulmonary artery with bulging of interventricular septum toward the left ventricle were detected on a chest computed tomography scan. After full supportive care including ventilator therapy, the patient's condition became stabilized and she was extubated after 7 days. We report a case of DAH in the course of a suspected fat embolism during femur fracture operation. Although DAH is a rare manifestation of fat embolism, early diagnosis and aggressive treatment likely can decrease morbidity and mortality.
Aged ; Cardiopulmonary Resuscitation ; Death, Sudden, Cardiac ; Early Diagnosis ; Embolism ; Embolism, Fat ; Female ; Femur ; Fractures, Bone ; Glass ; Heart Ventricles ; Hemorrhage ; Humans ; Mortality ; Pulmonary Artery ; Thorax ; Ventilators, Mechanical

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.
Autopsy ; Cause of Death ; Death ; Embolism, Fat/mortality* ; Forensic Pathology ; Fractures, Bone/complications* ; Humans ; Male ; Middle Aged ; Pulmonary Embolism/etiology* ; Soft Tissue Injuries/complications*

OBJECTIVETo improve the diagnosis and treatment of severe cerebral fat embolism (SCFE).

METHODSThe data of nine patients with SCFE were retrospectively analyzed. The manifestations of the central nerve system, respiratory system and hemorrhage were recorded, at the same time, accessory examination including arterial oxygen, fat macroglobules in venous blood and image examination was adapted. The patients were treated with exopexy, pharmocotherapy and oxygentherapy.

RESULTSTwo of the nine patients died of severe complications, the other seven recovered without severe sequela.

CONCLUSIONSGurd standard should be improved for early diagnosis of SCFE. If svere complications can be prevented, patients who receive early treatment will have favourable prognosis.

Accidental Falls ; Accidents, Traffic ; Adolescent ; Adult ; Cause of Death ; China ; Combined Modality Therapy ; Embolism, Fat ; diagnosis ; mortality ; therapy ; Female ; Humans ; Intracranial Embolism ; diagnosis ; mortality ; therapy ; Male ; Middle Aged ; Multiple Trauma ; Retrospective Studies ; Risk Assessment ; Sampling Studies ; Severity of Illness Index ; Survival Analysis