Tracheobronchopathia osteochondroplastica (TO) is a rare disorder of unknown cause characterized by the presence of multiple submucosal osseous and/or cartilaginous nodules that protrude into the lumen of the trachea and large bronchi. A simultaneous diagnosis of TO and amyloidosis is rarely reported. In this report, a case initially suspected to be asthma bronchiole that could not be treated, was radiologically diagnosed as TO, and also secondary amyloidosis is presented. A 53 years, man patient reported a 3 years history of dyspnea. Pulmonary function tests (PFTs) showed an obstructive pattern. Chest X-rays revealed right middle lobe atelectasis. FOB and CT detected nodular lesions in the trachea and in the anterior and lateral walls of the main bronchi. AA amyloidosis was confirmed by endobronchial biopsy. In the abdominal fat pad biopsy, amyloidosis was not detected. Asthma bronchiole was excluded by PFTs. This case illustrates that it is possible for TO and amyloidosis to masquerade as asthma. TO and amyloidosis should be suspected in patients of older ages with asthma and especially with poorly treated asthmatic patients. Although nodular lesions in the anterior and lateral tracheobronchial walls are typical for TO, a biopsy should be obtained to exclude amyloidosis.
Amyloidosis/complications/*diagnosis/pathology ; Asthma/diagnosis ; Bronchial Diseases/complications/*diagnosis/radiography ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Tracheal Diseases/complications/*diagnosis/radiography

BACKGROUND: Although regional anesthesia is the first choice for patients undergoing total knee arthroplasty (TKA), it may not be effective and the risk of complications is greater in patients who are obese or who have spinal deformities. We compared the success of ultrasound-guided femoral and sciatic nerve blocks with sedoanalgesia versus spinal anesthesia in unilateral TKA patients in whom spinal anesthesia was difficult. METHODS: We enrolled 30 patients; 15 for whom spinal anesthesia was expected to be difficult were classified as the block group, and 15 received spinal anesthesia. Regional anesthesia was achieved with bupivacaine 62.5 mg and prilocaine 250 mg to the sciatic nerve, and bupivacaine 37.5 mg and prilocaine 150 mg to the femoral nerve. Bupivacaine 20 mg was administered to induce spinal anesthesia. Hemodynamic parameters, pain and sedation scores, and surgical and patient satisfaction were compared. RESULTS: A sufficient block could not be obtained in three patients in the block group. The arterial pressure was significantly lower in the spinal group (P < 0.001), and the incidence of nausea was higher (P = 0.017) in this group. Saturation and patient satisfaction were lower in the block group (P < 0.028), while the numerical pain score (P < 0.046) and the Ramsay sedation score were higher (P = 0.007). CONCLUSIONS: Ultrasound-guided sciatic and femoral nerve blocks combined with sedoanalgesia were an alternative anesthesia method in selected TKA patients.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, Spinal* ; Arterial Pressure ; Arthroplasty* ; Bupivacaine ; Congenital Abnormalities ; Femoral Nerve ; Hemodynamics ; Humans ; Incidence ; Knee* ; Nausea ; Nerve Block ; Patient Satisfaction ; Prilocaine ; Sciatic Nerve* ; Ultrasonography

The purpose of this study was to investigate the treatment efficacies of salmon calcitonin (SC) and estrogen in a type-I osteoporotic rat model. Sixty, 3-month-old, female Wistar rats were divided into six groups. The first group was used as the control, and the second a sham, the other four were surgically ovariectomized. 24 hours after the ovariectomy, they were either left untreated (OVX), or treated with an injection of either 17-beta estradiol (E2) 30 mcg/kg/24 hours, low-dose calcitonin (LDC) 10 IU/ kg/48 hours or high-dose calcitonin (HDC) 20 IU/kg/48 hours. 6 weeks later, the bone densities were measured by DEXA, the animals sacrificed and the femurs harvested for histomorphometric evaluation. The bone mineral densities (BMD) of the spine and proximal femur were lower in the OVX group, but only the values of the spine BMD were statistically significant. The BMD of the spine seemed to be preserved with all the treatments. The histomorphometric evaluation revealed that after the OVX the decrease in the trabecular volume was prevented by all the treatments. However, significant changes in the indices of bone formation were not shown. In conclusion, all the treatments prevented bone lost in the ovariectomized rats. Histopathological measurements of bone formation are unlikely to provide any evidence for the effects of these agents on the osteoblastic function. In the animal model of estrogen depletion, our results suggest that the calcitonin provides an important alternative therapy for postmenopausal osteoporosis.
Animals ; Bone Density/drug effects ; Calcitonin/*administration & dosage ; Comparative Study ; Dose-Response Relationship, Drug ; Estradiol/*therapeutic use ; Female ; Osteoporosis/*drug therapy/pathology/physiopathology ; Ovariectomy ; Rats ; Rats, Wistar ; Salmon ; Spine/physiopathology