[Fat embolism after intrapenile injection of sweet almond oil]. / Embolie graisseuse après injection intrapénienne d'huile d'amande douce.

We report a case of fat embolism following self injection of vegetable oil in the penis, to treat an impotence. The patient developed respiratory failure and neurological disorders as confusion. A chest roentgenogram revealed diffuse alveolar infiltrate. Initially, he presented an hemoconcentration, and fat globules in his urine. The outcome was favourable in 72 hours, with oxygen and hydration. The diagnosis of fat embolism was made after neurological improvement: the patient admitted to injection his penis with vegetable oil, in his corpus cavernosum.

Reducing pain of first trimester abortion under local anaesthesia.

The study aimed to estimate the pain related to first trimester abortion under local and general anaesthesia. One hundred and eighty-one women undergoing abortion of first trimester under local anaesthesia and 198 under general anaesthesia were interviewed 1 h after the end of the procedure. About 50% of all women described their experience as less painful than expected. Over 50% of the women described the pain during the procedure as mild or moderate according to the verbal rating scale. The step-up logistic regression analyses identified four important variables: time interval less than 2 min from local anaesthesia injection to the beginning of the procedure (RR = 3), lack of choice between local and general anaesthesia (RR = 1.9), history of frequent use of analgesics (RR = 1.9) and nulliparity (RR = 1.7). These data indicate that skillfully performed abortion with local anaesthesia is a procedure tolerated by most women. Moreover, because it carries lower risk of complications and costs less, its use should be encouraged.

PIP: The World Health Organization has urged a reduction in the number of first-trimester induced abortions performed under general anesthesia. To determine the implications of this recommendation for pain control, 181 women undergoing first-trimester abortion under local anesthesia and 198 aborted under general anesthesia at University Hospital in Rome, Italy, were interviewed 1 hour after the procedure. Pain intensity was assessed through both the visual analogue and verbal rating scales. Women who selected or were assigned to general anesthesia tended to be younger (mean age, 27 years) and nulliparous. Over 50% of local anesthesia patients described their pain during the procedure as mild or moderate, 30% rated it severe, and 18% characterized it as distressing but time-limited. 60 minutes after the abortion, pain scores were higher in the general anesthesia group. Logistic regression analysis identified four significant predictors of pain: time interval less than 2 minutes from local anesthetic injection to the beginning of the procedure (relative risk (RR), 3.0), lack of choice between general or local anesthesia (RR, 1.9), history of frequent use of analgesics (RR, 1.9), and nulliparity (RR, 1.7). 91% of general anesthesia and 73% of local anesthesia patients stated they would recommend their method of anesthesia to a friend undergoing abortion. These findings suggest that local anesthesia, less costly and with a lower risk of complications than general anesthesia, is feasible for pain control, especially if administered 2-5 minutes before the procedure begins.