Therapeutic value of a supporting brassière in mastodynia.

who had sustained fat embolism. For the purposes of the present investigation three blood samples were taken from an arm vein in each patient; the first after the induction of anaesthesia but before insertion of the pertrochanteric needle; the second five minutes after the first injection of contrast material; and the third 20 minutes later. The blood was allowed to clot and the plasma then examined for the presence of fat globules by the method of Gurd.4 This method relies on the separation of the fat globules from plasma by its passage through an 8-jsm pore size micropore filter. Any fat globules from the plasma are trapped on the filter and can be seen under the microscope after staining with Sudan IV. The triglyceride levels are also measured in the filtrate and compared with those measured in the plasma before filtration. A fall in the triglyceride level confirms that fat has been filtered out. This method was validated by examining blood from two patients with known fat embolism and by examining blood to which fat had been added. No evidence of circulating fat globules was detected in the blood of 17 of the 18 patients studied. A few fat globules were found in the two post-injection samples from one patient, but there was no significant difference in the plasma triglyceride levels before and after filtration. All 18 patients remained well after phlebography and none showed any symptoms of a fat embolism syndrome. Multiple fat globules were seen on the filter after passage of plasma from the two patients examined who were known to be suffering from traumatic fat embolism. Conclusion Although one of the 18 patients undergoing phlebography showed evidence of a few circulating fat globules, subclinical fat embolism is not common after pertrochanteric phlebography. About 200 pertro-chanteric phlebograms have been performed at St Thomas's Hospital during the last six years and only one episode of clinically apparent fat embolism has occurred. We believe therefore that while the clinician and the radiologist should be aware of the possibility of its occurrence in patients undergoing intraosseous phlebography, it is not a contraindication to this valuable technique, for which there is sometimes no alternative. We acknowledge the help of the staff of the department of chemical pathology, St Thomas's Hospital, who performed the plasma triglyceride estimations. Pain in the breast is common, and there are relatively few women who do not experience …