Extrinsic lipoid pneumonia (ELP) results from the aspiration of lipid-containing substances. Tissue or cell histopathology after Oil-Red-O staining can confirm the diagnosis, which requires proper tissue handling and preparation during bronchoscopy. Here, we report a case of ELP in a quadriplegic patient with a long history of dysphagia and polyethylene glycol consumption. Computed tomography (CT) of the chest revealed multiple, progressively enlarging, fat-attenuated, nodular pulmonary lesions. Bronchoscopy with bronchoalveolar lavage (BAL) and a transbronchial forceps biopsy confirmed the diagnosis of lipoid pneumonia. We discuss the clinical, radiological, and pathological features of ELP and highlight the preparatory steps required for obtaining a successful diagnosis.

Hypercalcemia is a frequent condition in clinical practice and when the most frequent causes are excluded, etiological diagnosis can be challenging. A rare cause of PTH-independent hypercalcemia is described in the present case report. A male adult with a history of androgenic-anabolic steroids abuse, and injection of mineral oil and oily veterinary compound containing vitamins A, D and E into muscles for local hypertrophy presented with hypercalcemia, nephrocalcinosis, and end-stage renal disease. On physical examination, the presence of calcified subcutaneous nodules and calcification of musculature previously infused with oily substances drew attention. Laboratory tests confirmed hypercalcemia of 12.62 mg/L, low levels of PTH (10 pg/mL), hyperphosphatemia (6.0 mg/dL), 25(OH)D of 23.3 ng/mL, and elevated 1,25(OH)2D (138 pg/mL). Imaging exams showed diffuse calcification of muscle tissue, subcutaneous tissue, and organs such as the heart, lung, and kidneys. The patient was diagnosed with PTH-independent hypercalcemia secondary to foreign body reaction in areas of oil injection. The patient underwent treatment with hydrocortisone for 10 days, single dose zoledronic acid and hemodialysis. He evolved with serum calcium levels of 10.4 mg/dL and phosphorus of 7.1 mg/dL. In addition, sertraline and quetiapine were prescribed to control body dysmorphic disorder. The medical community should become aware of new causes of hypercalcemia as secondary to oil injection since this should become increasingly frequent due to the regularity with which such procedures have been performed.

Exogenous lipoid pneumonia is a rare and frequently misdiagnosed lung disease. It occurs as an inflammatory reaction secondary to either aspiration or inhalation of lipids. Our patient had a history significant for recurrent pneumonia and the use of mineral oil for chronic constipation. A chest computed tomography showed multifocal consolidative opacities with areas of low attenuation, highly suspicious of exogenous lipid pneumonia. The diagnosis was confirmed with combined bronchoalveolar lavage and transbronchial lung biopsy that showed lipid-laden macrophages consistent with exogenous lipoid pneumonia. After thorough medication review, apart from mineral oil, no other contributing factors were found. A diagnosis of exogenous lipoid pneumonia associated with the use of mineral oil made and successfully managed by stopping the offending agent and supportive antibiotics.

Here we reported a case of exogenous lipoid pneumonia from Peking University Third Hospital. A 62-year-old male presented with chronic cough and expectoration for 8 years, without chest pain, hemoptysis or short of breath. He was an ex-smoker. In his past medical history, the patient reported chronic rhinitis sicca for 20 years. Chest computed tomography (CT) showed patchy ground glass opacities in his bilateral lower lobe. In recent 3 years, his symptoms showed slowly deteriorative changes, as did his chest CT findings. No improvement of the patient\'s symptoms was observed, although he had been treated with many antibiotics. Then he was referred to our hospital for a detailed investigation for interstitial lung disease. On admission, the physical examination showed no abnormal findings except for inspiratory fine crackles in his bilateral lower lung field on auscultation. The results of the laboratory analysis, including complete blood cell count, biochemistry, arterial blood gas, urinalysis, antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA) and tumor markers were all within normal ranges. To exclude the possibility of infectious or malignant conditions, bronchoscopy was performed. Secretions from the left lower lobe bronchus were collected for bacterial, fungal and fast-acid cultures, which were all negative. A bronchoalveolar lavage (BAL) was performed in the left lower lobe with a 30% recovery. The total cell count of the BAL fluid was 6.5×104/mL, and the cellularity differential revealed increased neutrophils (20%) and lymphocytes (17%). The cytological examination in the BAL fluid showed no malignant cells. All the clinical data above did not reveal any conclusive information. However, the pathological findings of his transbronchial lung biopsy (TBLB) were highlighted with lipid-laden macrophages engulfed by large vacuoles occupying almost completely the cytoplasm of the cells, which were consistent with those of exogenous lipoid pneumonia. Given these findings, it emerged that the patient was taking twice daily inhalations of a compound menthol nasal drops (essential oil of camphor, menthol and liquid paraffin) for his chronic rhinitis sicca for at least 10 years. Then he discontinued oil nasal sprays and showed gradual improvement 3 months later without intensive treatment. The presenting case report emphasizes the fact that chronic inhalation of nasal sprays and decongestants containing mineral oils was a cause of exogenous lipoid pneumonia, and clinicians should bear it in mind.

Lipoid pneumonia (LP) is an uncommon form of pneumonia that is characterized by the presence of intra-alveolar lipid and lipid-laden macrophages on microscopy. It categorized as exogenous lipoid pneumonia (ExLP) and endogenous lipoid pneumonia (EnLP). Exogenous lipoid pneumonia caused by inhalation of liposuction substances (animal fat, vegetable oil, or mineral oil), mostly, in adult cases, they were medicines for constipation or rhinopharyngitis. Most of these patients showed mild clinical manifestations, and chronic medical condition. There were reports of lipoid pneumonia being successfully treated with corticosteroids, immunoglobulins and whole lung lavage. We report a case of exogenous lipoid pneumonia characterized by high fever and acute medical condition. A 77-year-old woman with hypertension and diabetes mellitus, accepted paraffin oil treatment for \"incomplete intestinal obstruction\", then, an accident of aspiration happened, as she went through the history of coughing while eating, followed by persistent hyperthermia and increases of white blood cells (WBC). Chest CT showed progressive ground-glass opacities, accompanied with fusion of consolidation, her sputum etiological examination was negative, and the therapy of broad-spectrum antibiotic was invalid. The patient was subjected to bronchofibroscopy with bronchoalveolar lavage (BAL). The bronchoalveolar lavage fluid (BALF) appeared colorless and transparent, and did not show a milky appearence. Total cell count of the BALF was 2.0×109 cell/mL, including 7.2% macrophages and 92.8% neutrophils. Cultures of the BALF were negative for bacterial, fungal, and mycobacterial pathogens. The BALF cytologic findings showed vacuolated lipid-laden macrophages (Oil Red O staining). These findings revealed exogenous lipoid pneumonia. There were reports of lipoid pneumonia being successfully treated with corticosteroids, immunoglobulins, and whole-lung lavage. So this patient was treated with methylprednisolone 120 mg/d for 3 days and 80 mg/d for 6 days, at the same time, immunoglobulins was given to infusion, but the daily peak temperature of the patients fluctuated between 38 and 39 degrees. Then, whole lung lavage was performed 28 days after admission. Unfortunately, acute pulmonary edema occurred during the operation, as the tracheal intubation problems, and 6 days later, the patient died at last. The clinical manifestations of exogenous lipid pneumonia vary greatly, from asymptomatic to life-threatening symptoms, and as febrile low fever is the main manifestation, but hyperthermia may also be the remarkable presentation.

UNASSIGNED: To improve the penile contour, some men choose to undergo implantation or injection of nonbiological materials. Foreign body reactions in penile tissue may produce scarring, deformity, ulceration, necrosis, and even gangrene. Consensus is lacking regarding the most effective surgical procedure for reconstruction of these penile lesions.
UNASSIGNED: The authors describe one case study and the first systematic review focusing on reconstructive surgical management for penile lesions secondary to foreign body reaction.
UNASSIGNED: PubMed, Medline, and Cochrane databases were queried for publications written in English, French, Portuguese, and Spanish from 1951 to May 2017. Multiple search terms were applied.
UNASSIGNED: Of the 3304 articles identified, 51 were included in the systematic review. All were retrospective studies, case series, or case reports. A total of 260 patients underwent surgical procedures, and the complication rate was 37.3%. The scrotal flap technique was performed most frequently (43.4%) and resulted in 65.6% of the total complications observed. One Brazilian case study was also described with an extensive and circumferential ulcer after six mineral oil bolls implant in the penile subcutaneous tissue.
UNASSIGNED: Restoration of the penile shape preserving the functionality and maintaining a good physician-patient relationship may be a challenge. The scrotal pouch may be advantageous for patch grafting of penile soft-tissue lesions, owing to its skin laxity and good blood supply. A less aggressive surgical approach has the benefits of shorter healing time and fewer early complications. Penile injuries are best treated by experienced surgeons on a case-by-case basis with care given to identify the most appropriate treatment.
UNASSIGNED:

Migration due to indirect contact with packaging caused several major sanitary crises, including the spread contamination of dry food by mineral oils and printing ink constituents from cardboard. The issues are still not fully resolved because the mechanisms have been insufficiently described and the relationship between design, contamination level, type of contaminant, and conditions of storage (time and temperature) are poorly understood. This study proposes a forensic analysis of these phenomena when food is separated from cardboard by a plastic layer. Practical relationships and advanced simulation scenarios were devised and validated against the long-term migration between 20 and 60°C of 15 substances. They were chosen to be representative of the main contaminants of cardboard: aliphatic and aromatic mineral oils, photo-initiators and plasticisers. Data were summarised as iso-contamination curves and iso-contamination times up to 2 years. Simple rules are illustrated to extrapolate the results to arbitrary conditions in order to identify critical substances and to estimate the plastic film\'s thickness to keep the contamination within acceptable limits. Recommendations for the risk management of contamination routes without contact are finally drafted.

Four captive raptors, an American kestrel ( Falco sparverius ), peregrine falcon ( Falco peregrinus ), golden eagle ( Aquila chrysaetos ), and barn owl ( Tyto alba ), were diagnosed with ventricular and/or proventricular foreign material impactions consisting of artificial turf substrate, paper and plastic substrate, grass, and newspaper. Partial or total anorexia was reported in all birds and decreased casting in 2 birds. Survey radiographs confirmed presence of gastric enlargement in all 4 birds. The kestrel and eagle were treated unsuccessfully with gastroscopy and gastric lavage, respectively, followed by surgical intervention to remove the ventricular impactions. Both birds died of undetermined causes after surgery. The peregrine falcon died before medical or surgical intervention was started, and the owl was managed successfully with oral mineral oil and liquid diet to facilitate egestion of the foreign material as a pellet. Lead poisoning was suspected as the predisposing cause for foreign body ingestion in the eagle, but underlying causes for pica in the other birds were not determined. Radiographs can provide useful diagnostic information in sick raptors that exhibit vomiting or changes in appetite or casting frequency, and may help guide treatment decisions of impacted birds. Careful consideration of substrate, enrichment items, and access to potential foreign material that could be ingested may be the best pre-emptive management strategy in captive raptors.

Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high-viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non-medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America.

BACKGROUND: Extensive hot tar burns are relatively uncommon. Management of these burns provides a significant clinical challenge especially with respect to tar removal involving a large total body surface area (TBSA), without causing further tissue injury.
METHODS: We report a case of an over 40-year old male construction worker who was removing a malfunctioning cap from broken valve. This resulted in tar spraying over the anterior surface of his body including legs, feet, chest, abdomen, arms, face and oral cavity (80% TBSA covered in tar resulting in a 50% TBSA burn injury).
RESULTS: Initially, petrolatum-based, double antibiotic ointment was used to remove the tar, based on our previous experience with small tar burns. However, this was time-consuming and ineffective. The tar was easily removed with mineral oil without irritation. In order to meet the demand for quantity of mineral oil, the pharmacy suggested using mineral oil Fleet enema (C.B. Fleet Company, Inc., Lynchburg, Virginia, USA). The squeezable bottle and catheter tip facilitated administration of oil into the patient\'s construction boots and under clothing that was adhered to the patient\'s skin.
CONCLUSIONS: Tar removal requires an effective, non-toxic and non-irritating agent. Mineral oil is such an agent. For patients that may present with a large surface area tar burn, using mineral oil Fleet enema is a viable option that facilitates application into difficult areas. Grant Support: The Firefighters\' Burn Fund (Manitoba) supported this project.