Donato Morena, Matteo Scopetti, Martina Padovano, Emanuela Turillazzi, Vittorio Fineschi
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Our systematic research has included 58 articles from 1990 to the present on the topic of FE and fat embolism syndrome (FES). From these articles, we identified 45 case reports, from which the authors' descriptions were extracted to provide information on individual cases and the operational methods of forensic pathologists. Additionally, 21 experimental studies were identified, and their key findings have been summarised narratively. It has emerged that both traumatic and non-traumatic cases are frequently reported in the forensic context, with orthopaedic and cosmetic surgery being among the highest-risk specialities. Experimental studies have re-evaluated the role of a patent foramen ovale in the pathogenesis of FE, as well as the impact of cardiopulmonary resuscitation in causing FE severe enough to result in death. Additionally, there are new findings regarding diagnostic techniques, including radiological and immunohistological methods; however, they have not yet fully bridged the reliability gap compared to an accurate autopsy-histological evaluation. The major critical points that emerged include the lack of complete and detailed information on premortem clinical conditions, the underutilisation of grading systems and the methodological heterogeneity applied, resulting in considerable variability regarding the organs studied histologically and the diagnostic techniques used. Despite the limitations associated with the analysis of case reports and the heterogeneity of included experimental studies, we believe that this study can provide a comprehensive overview of the FE topic. 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Additionally, 21 experimental studies were identified, and their key findings have been summarised narratively. It has emerged that both traumatic and non-traumatic cases are frequently reported in the forensic context, with orthopaedic and cosmetic surgery being among the highest-risk specialities. Experimental studies have re-evaluated the role of a patent foramen ovale in the pathogenesis of FE, as well as the impact of cardiopulmonary resuscitation in causing FE severe enough to result in death. Additionally, there are new findings regarding diagnostic techniques, including radiological and immunohistological methods; however, they have not yet fully bridged the reliability gap compared to an accurate autopsy-histological evaluation. 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引用次数: 0
摘要
脂肪栓塞(FE)是法医病理学中一个历史悠久但仍在积极研究的课题。有几个方面仍未完全阐明,如其发病机制、在死亡判定中的因果作用、干扰因素(如心肺复苏或其他医疗程序)的影响,以及临床和法医背景下的定性和定量诊断方法。这些问题因外科医生可能参与非创伤性死亡的因果判定而进一步凸显,这往往会引发专业责任问题。本研究旨在提供与法医病理学相关的最新科学证据的全面和最新概述。我们的系统研究收录了从 1990 年至今有关脂肪栓塞和脂肪栓塞综合症(FES)主题的 58 篇文章。从这些文章中,我们发现了 45 篇病例报告,并从中提取了作者的描述,以提供有关个别病例和法医病理学家操作方法的信息。此外,我们还确定了 21 项实验研究,并对其主要发现进行了叙述性总结。研究发现,法医病例中经常报告创伤性和非创伤性病例,其中整形外科和美容外科是风险最高的专科。实验研究重新评估了卵圆孔未闭在 FE 发病机制中的作用,以及心肺复苏对造成严重到足以导致死亡的 FE 的影响。此外,在诊断技术方面也有新的发现,包括放射学和免疫组织学方法;然而,与准确的尸检组织学评估相比,这些方法尚未完全弥补可靠性方面的差距。出现的主要关键点包括:缺乏有关死前临床状况的完整而详细的信息、分级系统利用不足以及应用的方法不统一,导致组织学研究的器官和使用的诊断技术存在相当大的差异。尽管对病例报告的分析存在局限性,而且所纳入的实验研究也不尽相同,但我们相信本研究能为 FE 课题提供一个全面的概览。它为病理学家提供了最新的综述,有助于临床实践和指导未来的研究趋势,并促进标准化程序的发展。
Fat embolism: a systematic review to facilitate the development of standardised procedures in pathology.
Fat embolism (FE) is a historically recognised but still actively researched topic in forensic pathology. Several aspects remain not fully elucidated, such as its aetiopathogenesis, its causal role in death determination, the impact of interfering factors (e.g. cardiopulmonary resuscitation or other medical procedures) and both qualitative and quantitative diagnostic methodologies in clinical and forensic contexts. These issues are further underscored by the potential involvement of FE in the causal determination of non-traumatic deaths, which often raises questions of professional liability. The present study aims to provide a comprehensive and up-to-date overview of the most recent scientific evidence relevant to forensic pathology. Our systematic research has included 58 articles from 1990 to the present on the topic of FE and fat embolism syndrome (FES). From these articles, we identified 45 case reports, from which the authors' descriptions were extracted to provide information on individual cases and the operational methods of forensic pathologists. Additionally, 21 experimental studies were identified, and their key findings have been summarised narratively. It has emerged that both traumatic and non-traumatic cases are frequently reported in the forensic context, with orthopaedic and cosmetic surgery being among the highest-risk specialities. Experimental studies have re-evaluated the role of a patent foramen ovale in the pathogenesis of FE, as well as the impact of cardiopulmonary resuscitation in causing FE severe enough to result in death. Additionally, there are new findings regarding diagnostic techniques, including radiological and immunohistological methods; however, they have not yet fully bridged the reliability gap compared to an accurate autopsy-histological evaluation. The major critical points that emerged include the lack of complete and detailed information on premortem clinical conditions, the underutilisation of grading systems and the methodological heterogeneity applied, resulting in considerable variability regarding the organs studied histologically and the diagnostic techniques used. Despite the limitations associated with the analysis of case reports and the heterogeneity of included experimental studies, we believe that this study can provide a comprehensive overview of the FE topic. It furnishes pathologists with an updated overview useful for clinical practice and guiding future research trends, as well as facilitating the development of standardised procedures.
期刊介绍:
Histopathology is an international journal intended to be of practical value to surgical and diagnostic histopathologists, and to investigators of human disease who employ histopathological methods. Our primary purpose is to publish advances in pathology, in particular those applicable to clinical practice and contributing to the better understanding of human disease.