We report on a patient with bilateral stress fractures of the tibia who subsequently showed classic biochemical features of oncogenic osteomalacia. Conventional radiographs were normal. MR imaging revealed symmetric, bilateral, band-like low-signal lesions perpendicular to the medial cortex of the tibiae and corresponding to the only lesions subsequently seen on the bone scan. A maxillary sinus lesion was subsequently detected and surgically removed resulting in prompt alleviation of symptoms and normalization of hypophosphatemia and low 1,25-(OH)2 vitamin D3. The lesion was pathologically diagnosed as a hemangiopericytoma-like tumor. Patients with oncogenic osteomalacia may present with stress fractures limited to the tibia, as seen in athletes. The clue to the real diagnosis lies in paying close attention to the serum phosphate levels, especially in patients suffering generalized symptoms of weakness and not given to unusual physical activity.
The complication rate after emergency tracheostomy is two to five times greater than after elective procedures. One of the main causes of the high risk of complications in emergency tracheostomy appears to be the amount of time required to open the trachea. Therefore, simple and fast procedures are mandatory. We have developed a new procedure as follows: A horizontal skin incision is performed. Strap muscles are dissected and retracted laterally. A transverse cut between tracheal rings below the thyroid isthmus is performed up to membranous portion of the trachea. The cut ends of the trachea remain open naturally because of the elasticity of the trachea. Skin and tracheal cut-ends are then joined by interrupted sutures.We have used this procedure during the past three years and have not experienced any major complications. This demonstrates the clear advantage and the more physiological nature of the procedure over various other incisions of the tracheal wall.
We studied the prophylactic and therapeutic effect of ketotifen in patients with Japanese cedar pollinosis.We administratered ketotifen orally to patients before the beginning of the dispersion of pollen.Ketotifen aqueous nasal spray (ketotifen-ANS) was administered to the poor-response groups in the prophylactic and therapeutic group.In the assessment of the final overall prophylactic effect 48.8% of the patients examined during the season showed "marked" or "moderate" effectiveness.The poor-response patients treated with ketotifen-ANS showed marked or moderate effectiveness in 83.2%. The therapeutic results were good in 59.3% of those treated after symptoms had started. Ketotifen-ANS was useful in both the poor-response and the therapeutic groups.The only side effect was sleepiness 7 patients receiving oral ketotifen. No abnormality was observed in those treated with ketotifen-ANS.Oral ketotifen and aqueous nasal spray ketotifen are considered to be excellent for the prophylaxis and therapy of Japanese cedar pollinosis.
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