Publication: Factors that could influence the severity of post-traumatic lung fat embolism — A prospective histological study —
| dc.contributor.author | Nikolić, Slobodan (7102082739) | |
| dc.contributor.author | Micić, Jelena (7005054108) | |
| dc.contributor.author | Savić, Slobodan (7005859439) | |
| dc.contributor.author | Gajić, Milan (55981692200) | |
| dc.date.accessioned | 2025-06-13T00:42:32Z | |
| dc.date.available | 2025-06-13T00:42:32Z | |
| dc.date.issued | 2003 | |
| dc.description.abstract | INTRODUCTION Each frac ture of long or pelvic bones as well as large con tusions of subcutaneous fattis sue cause releasing of fat globules that rapidly penetrate into cir culation through the ruptured veins of the injured tissue, and reach the lung cir culation [1, 2]. During the first phase, fat emboli block the func tional lung cir culation by their mechanical effect in cap illaries pro ducing so called isolated post-traumatic lung fat embolism [3]. The sur face layer of a fat embolus, which is prac tically in liquid state, behaves as a membrane of very high density, i.e., as it is under high pres sure which obstruct the blood stream [4] that is finally stopped at the level of lung blood ves sels with diameter of approximately 20 μ [5]. This pathophysiological mechanism pro duces cor pulmonale acutum, with poor patho logical find ings [8]. Nowadays, the post-mortem diagnosis of lung fat embolism is based on micro scop i cal exam i na tion of tis sue spec i mens, usu ally pre pared with special histological staining (Sudan III) [9]. The grad ing of fat embolism accord ing to Sevitt’s criteria is gen erally accepted [10]. Tak - ing of slices from apicoventral areas of the lungs has been recommended [11]. With lon ger outliving period, the total number of fat emboli in the lung cir culation grad ually decreases, due to their disintegration and resorption. It has been stated that fat glob ules completely disappear about 4-6 weeks after injury, and that they should not be searched for microscopically in this post-traumatic phase [11]. OBJECTIVES The aim of our work was to determine whether the age of injured, their gender, total severity of trauma, out living period, and hypo volemic shock that develops after injuring, may induce development of more severe forms of post-traumatic lung fat embolism. MATERIAL AND METHODS A prospective histological study was per formed on the autopsy material of the Institute of Forensic Medicine in Belgrade. The analyzed sam - plecon sisted of individuals with injuries that might be a source of fat emboli (fractures of long bones, large contusions of subcutaneous fat tissue). The lung slices were systematically taken and stained with special fat staining (Sudan III). In each par ticular case, the grade of lung fat embolism was counted on the basis of microscopical appear ance, according to Sevitt’s cri teria. The total severity of trauma was estimated by cal culation of the Injury Severity Score (ISS) [13, 14]. In no cases from the analyzed sample, the fat embolism was mentioned as either singular or plural cause of death. The obtained results were ana lyzed by means of appropriates statistical methods (ANOVA, LSD-test, χ2 test, Man-Whitney test, Fischer’s test of correctprob ability). RESULTS AND DISCUSSION The ana lyzed sample included 58 fatally injured individuals, 39 males and 19 females. The aver age age was 54.10 years (SD16.56), the average value of ISS was 34.69 (SD5.88), and the average outliving period was 3.74 days (SD5.88). However, all these data look differently when the analyzed sample has been stratified and analyzed according to the estimated grade of lung fat embolism. It was not showed that severity of lung fat embolism depends on sex of the injured (χ2=0.842; p>0.05). The groups with the slightest and the most severe grade of lung fat embolism are statistically significantly differentin relation to age of individuals (ANOVA, p=0.017). By means of LSD test, it has been showed that the group with the most severe grade of lung fat embolism (grade III) is statistically significantly different com paring to other two groups (with grade I and II) in relation to the age of injured (the values are p0.16 and p0.19 respectively, and the both groups are less than p0.05). In the group with the most severe grade of lung fat embo lism, the older indi vid u als are sta tis ti cally significantly represented comparing to other two groups. CONCLUSION The anal ysis of our sample showed that the most severe grade of post-traumatic lung fat embolism (microscopical grade III accord ing to Sevitt’s criteria) was determined in older indi viduals, more severely injured, and with shorter out living period. The sever ity of fat embolism depends neither on sex of the injured, nor on development of post-traumatic hypovolemic shock. The obtained results related to the influence of hypovolemic shock on severity of fat embolism should be accepted with a caution. Namely, some times there is an intention to sim plify a procedure of creating of autopsy conclusion about the cause of death, so that loss of blood is not mentioned at all, in spite of fact that it could have been a con current cause of death, while in other cases exsanguination is designated as a sole cause of death, for getting the pos sibility that fat embolism could have really been the immediate cause of death. © 2014, Serbia Medical Society. All rights reserved. | |
| dc.identifier.uri | https://doi.org/10.2298/SARH0306244N | |
| dc.identifier.uri | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84922687328&doi=10.2298%2fSARH0306244N&partnerID=40&md5=a86398c9324d9670cb5ecee7acf4dcaa | |
| dc.identifier.uri | https://remedy.med.bg.ac.rs/handle/123456789/11206 | |
| dc.subject | Autopsy | |
| dc.subject | ISS | |
| dc.subject | Lung fat embolism | |
| dc.subject | Out living period | |
| dc.title | Factors that could influence the severity of post-traumatic lung fat embolism — A prospective histological study — | |
| dspace.entity.type | Publication |