[Paraffin oil injecions due to bigorexia may cause hypercalcaemia].

Paraffin oil injections may cause severe hypercalcaemia, likely due to development of granulomas at injection sites, activating 1,25 dihydroxyvitamin D and increasing calcium uptake from gut, kidney and bone. This is a case report of a 39-year-old male with severe hypercalcaemia and renal failure due to paraffin oil injections. He was treated with prednisolone (25-50 mg daily), but the disease recurred the next two summers probably due to erroneous vitamin D supplement and sun exposure. The disease course and prognosis are unknown. Treatment options are discussed, and paraffin oil injections should be avoided.

The selection of skin care products for use in hyperbaric chamber may depend on flammability acceptability indices score.

PURPOSE: Current protocols call for stopping adjunctive skin care treatments during hyperbaric oxygen therapy (HBOT) because the hyperbaric environment is considered unsafe for skin care products. The elevated oxygen fraction and the increased pressure in the hyperbaric chamber dramatically increase the flammability potential of materials, leading to the need for rigorous standards to prevent flame ignition. A scientific method of evaluating the flammability risks associated with skin care products would be helpful. Several skin care products were tested, using established industrial techniques for determining flammability potential with some modification. The information obtained from these tests can help clinicians make more rational decisions about which topical products can be used safely on patients undergoing HBOT. METHODS AND MATERIALS: Wendell Hull & Associates conducted independent studies, comparing the oxygen compatibility for leading skin care products. Oxygen compatibility was determined using autogenous ignition temperature (AIT), oxygen index (OI), and heat of combustion (HoC) testing. AIT, a relative indication of a material's propensity for ignition, is the minimum temperature needed to cause a sample to self-ignite at a given pressure and oxygen concentration. OI, a relative indication of a material's flammability, is the minimum oxygen percentage that, when mixed with nitrogen, will sustain burning. HoC is the absolute value of a material's energy release when burning, if ignition occurs. Products with a high AIT, a high OI, and a low HoC are more compatible in an oxygen-enriched atmosphere (OEA). An acceptability index (AI) based on these 3 factors was calculated for the products, so the testers could rank overall material compatibility in OEAs (Lapin A. Oxygen Compatibility of Materials. International Institute of Refrigeration Commission Meeting; Brighton, England; 1973). RESULTS: Test results for the skin products varied widely. The AIT, OI, HoC, and AI were determined for each product under described circumstances. The AIT results indicate that all products in 99.5% oxygen concentration under pressure will ignite and that a pattern based on the absence or presence of petroleum-based ingredients does not seem to exist. Products containing petrolatum, mineral oil, paraffin, and paraffin wax had a HoC that equaled or exceeded the HoC of gasoline, whereas products without petroleum-based ingredients had a significantly lower HoC. The OI of skin products not containing petrolateum-based ingredients was significantly higher than the OI of products containing it. The AI values the OI as the most important value: the higher the AI, the more acceptable the product is for use with oxygen. The silicone-containing, petroleum-free products received an AI up to 25 times higher than the petrolatum-based products. These findings suggest a wide variation in the safety profiles of skin products. Skin products being considered for use in an OEA should be screened for flammability risks. This screening will allow informed decisions about the fire safety of the products. Further research is indicated.

[Pneumopathies caused by inhalation of hydrocarbons: apropos of 3 cases]. / Les pneumopathies par inhalation d'hydrocarbures. A propos de trois observations.

We report three personal cases of hydrocarbide aspiration pneumonia. High-viscosity non-volatile hydrocarbides (paraffin oil, for instance) cause often pseudotumoral exogenous fat-aspiration lung disease. Low-viscosity volatile hydrocarbides (petroleum, gasoline, white spirit, for instance) cause acute pseudo-infectious lung disease with dyspnea and fever which usually resolves within a few weeks but which may also be life-threatening. Purely symptomatic treatment has greatly progressed with advances in intensive ventilatory assistance. Gastric emptying with emetic agents or lavage procedures is dangerous and must be avoided except for exceptional cases. When required, the airways must be protected with tracheal intubation. Volatile hydrocarbides should be stored in protected areas in containers with safety stoppers which children cannot open.

[Scleroderma and scleroderma-like diseases caused by environmental pollutants]. / Sklerodermie und Sklerodermie-ähnliche Erkrankungen durch Umweltsubstanzen.

For the stimulation of research on scleroderma and the prophylaxis of occupational scleroderma-like diseases and the prevention of iatrogenic injuries, respect., it is important to know the inducing environmental substances. Plastics (vinyl chloride, epoxy resins), solvents (chlorinated, aromatic and aliphatic hydrocarbons), drugs (bleomycin, pentazocine), cocaine (abuse) and contaminated rapeseed oil are more or less able to induce scleroderma-like diseases. Vinyl chloride disease is the best known among these. The toxic oil syndrome represents the most inglorious example of the recent time. Paraffin and silicon can act as adjuvants and induce a progressive systemic sclerosis. In our studies it could be shown, that silica is able to induce not only a silicosis, but also a true progressive systemic sclerosis after long term exposure. Acknowledgment of such cases as an occupational disease is justified and regulated by law in the German Democratic Republic.

Clinical spectrum of connective tissue disease after cosmetic surgery. Observations on eighteen patients and a review of the Japanese literature.

Connective tissue disease has been reported to occur following cosmetic surgery with injection of the foreign substances paraffin and silicone (human adjuvant disease). The clinical findings in 18 such patients and a review of 28 additional cases from the Japanese literature are presented. The patients were classified into 2 major groups: group I consisted of 24 patients with definite connective tissue disease--12 with scleroderma, including 8 with progressive systemic sclerosis (PSS), 6 with rheumatoid arthritis, 5 with systemic lupus erythematosus, and 1 with polymyositis; group II consisted of 22 patients with human adjuvant disease with some symptoms, signs, and laboratory abnormalities suggestive, but not diagnostic of a connective tissue disease. The occurrence of PSS is approximately three-fold greater than expected for all women believed to have undergone such surgery, and PSS developed primarily in individuals injected with paraffin. Prolonged exposure to the injected substance may play a role in the induction of these immunologic disorders.

Scleroderma after cosmetic surgery: four cases of human adjuvant disease.

In 9 cases of human adjuvant disease, 4 cases of scleroderma (3 progressive systemic sclerosis and 1 localized morphea) were observed. Seven to 19 years after injection of foreign substances into the breasts or nose for cosmetic purposes, some patients developed human adjuvant disease. In one case the foreign substances were removed by bilateral mastectomy with no discernible effects on the patient's clinical course. Histopathologic findings of the removed breasts demonstrated foreign body granulomas with calcification. The injected substance was identified as a mixture of liquid and solid paraffin. Human adjuvant disease might be caused by prolonged hypersensitization activated by the injected foreign materials which act as an adjuvant.

Possible role of laxatives in analgesic nephropathy.

Eight out of ten of patients with analgesic nephropathy were regular and usually heavy laxative takers compared with 12 out of 200 controls from the general population and four out of 70 patients attending a renal clinic. The finding that regular laxative taking was greatly increased in patients with analgesic nephropathy suggests that this condition may often be due to the combined abuse of both laxatives and analgesics. In a series of 40 patients with rheumatoid arthritis all were found to have normal renal function and no patient took laxatives regularly. This finding would explain why analgesic nephropathy is so uncommon in patients with rheumatoid arthritis despite the fact that they are regular and heavy analgesic takers.