Tracheobronchopathia osteochondroplastica (TO) is a rare disorder with unknown aetiology. We report one case of TO in a patient with non-Hodgkin pulmonary lymphoma and benign epidermal and trichylemmal cysts on the periorbital region and scalp. To the authors' knowledge, the coincidence of these processes has never been described before. The case was evaluated with conventional X-ray, computed tomography, magnetic resonance imaging, fibre-optic bronchoscopy with 2 months interval, histopathological evaluation, Tc-99 m MDP bone scintigraphy and microbiological studies including PCR testing of bronchial biopsy and lavage specimens for Mycobacterium tuberculosis. Additionally, case reports of TO in the Turkish literature are summarized.
Frostbite causes injury to the tissue by direct ice-crystal formation at the cellular level with cellular dehydration and microvascular occlusion. Muscle that initially appears viable on reperfusion may subsequently become necrotic because of microcirculatory collapse. Since muscle is a sensitive tissue in frostbite injury, we used technetium-99m-sestamibi limb scintigraphy to assess tissue viability in an experimental rabbit model. Twelve rabbits were used for this investigation. The right hind limb of the rabbits was immersed to the ankle joint in a container filled with 90% ethanol at -25 degrees C for 10 min. Frostbitten limbs were allowed to thaw in air at room temperature. Imaging and pathological examination of the affected limbs were performed 2 h, 24 h, 48 h and 72 h after freezing. In 2-h images, initial hypoperfusion was seen that corresponded to circulatory collapse. In 24-h images, there was hyperperfusion (so-called period of temporary reperfusion), corresponding to circulatory restoration. In 48-h images, a second hypoperfusion corresponded to viable but ischaemic tissue. In 72-h images, there was non-perfusion of the limb that correlated with the pathologically determined diagnosis of necrosis. All scintigraphic patterns correlated with pathological findings. We suggest that these scintigraphic patterns in soft tissue may be helpful in distinguishing between frank infarction and reversible ischemia and therefore may be useful in selecting early therapeutic or surgical interventions to salvage bone and soft tissue. Further studies are needed to show the usefulness of 99mTc sestamibi scintigraphy in clinical frostbite cases.
The role of acromioclavicular (A-C) arthritis in stage 2 and 3 impingement syndromes was investigated in this study. Twenty-seven patients with stage 2 and 3 impingement syndrome were evaluated both clinically and radiologically for the presence of A-C arthritis. Patients with A-C arthritis who were treated by conservative or surgical methods were rated before and after therapy according to the University of California at Los Angeles (UCLA) shoulder rating scale. The follow-up period ranged from 7 to 16 months, with an average of 13 months. A-C arthritis was diagnosed in 21 of 27 patients (one grade 2 and 20 grade 3, according to Kellegren). Clinical and radiological evaluation of these 21 patients revealed A-C joint pain and a positive lidocaine injection test in all (100%), a positive horizontal adduction test in 20 (95.2%), decreased joint space in 18 (85.75%) and osteophytes in 11 (52.4%). Surgical treatment was considered for 12 A-C arthritis patients; and distal clavicle resection was performed in 11 of these cases. The average score measured by the UCLA rating scale increased from 13 to 28 in the group treated with surgery (satisfactory result), and from 10 to 13 in the group treated with conservative therapy (unsatisfactory result). The results of this study may be interpreted as demonstrating that A-C arthritis is a common etiologic factor in chronic impingement syndromes and its co-existence has a strategic importance in the choice of treatment method. Surgical resection of the distal clavicle should be considered in the presence of this pathology since this technique provides excellent results in pain relief and appears to be superior to conservative therapy in these cases.
Reconstruction of bone defects and contour irregularities in the craniofacial region is difficult and often requires complex solutions. This study investigated the tissue response, vascularization and bone ingrowth, in hydroxyapatite, porous polyethylene and silicone elastomer when used as bone graft substitutes. 24 albino rabbits (8 rabbits for each implant) were used in this investigation. Hydroxyapatite 500 particles, silicone rubber and porous high-density polyethylene were placed in the cavities formed with a drill in the rabbit frontal bones. As a part of a prospective study the vascularization rates of all implant materials were analyzed 10 days and 2 months after surgery using 99m Technetium-MDP (Methylene diphosphonate) scintigraphy of the skull. The scintigraphic studies were performed 2 hours after intravenous injection of 4 mCi (148 MBq) 99m Tc-MDP. The frontal bone was excised on the 10th and 60th days. All tissue specimens were placed first in 10% formalin and then in 10% nitric acid solution for decalcification. The vascularization, connective tissue ingrowth, foreign body reaction and bone regeneration around the implant were evaluated. Results of this study suggested that hydroxyapatite and porous polyethylene were stabilized in bone while as expected silicone was mobile, also hydroxyapatite implants are vascularized better and are more biocompatible than porous polyethylene.
Tracheobronchopathia osteochondroplastica (TO) is a rare disorder with unknown aetiology. We report one case of TO in a patient with non-Hodgkin pulmonary lymphoma and benign epidermal and trichylemmal cysts on the periorbital region and scalp. To the authors' knowledge, the coincidence of these processes has never been described before. The case was evaluated with conventional X-ray, computed tomography, magnetic resonance imaging, fibre-optic bronchoscopy with 2 months interval, histopathological evaluation, Tc-99 m MDP bone scintigraphy and microbiological studies including PCR testing of bronchial biopsy and lavage specimens for Mycobacterium tuberculosis. Additionally, case reports of TO in the Turkish literature are summarized.
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