Cases reported "Exostoses"

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11/17. Cervical spine disease and dysphagia. Four new cases and a review of the literature.

    Four cases of dysphagia associated with disease of the cervical spine have been presented. One of the patients had cervical spondylosis with osteophyte formation while the other three had Forestier's disease or ankylosing hyperostosis. Symptoms of dysphagia dominated the clinical picture and led to their referral for further management. Two patients underwent surgical procedures and one died in the postoperative period. Two patients were managed conservatively, one with antibiotics, and both did reasonably well. The literature of 40 cases published in the last 54 years has been reviewed. We suggest that dysphagia due to cervical spine disease while an uncommon complication of these bony growths, is by no means rare. The dysphagia may be due to bony protuberances into the hypopharynx or into the esophagus and may be accompanied by soft tissue inflammation. Although most patients have been treated surgically, there may be a role for anti-inflammatory or antibiotic therapy in the first instance as surgery is often morbid and sometimes fatal.
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12/17. Massive ankylosis following total hip anthroplasty.

    A total hip arthroplasty was undertaken in a 49-year-old man who had previously spontaneously ankylosed both hips. In addition, the patient possessed hyperostosis of the spine and calf, not characteristic of any previously described spondylitic or hyperostotic syndrome. Nine months postoperatively the patient reankylosed the total hip arthroplasty. This case provides further evidence that total hip arthroplasty must be undertaken with caution in patients with hyperostotic tendencies.
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13/17. Multiple lower limb osteophytosis with macrodactyly: a case report.

    A 39-year-old woman with restriction of movement and macrodactyly of the great toes was found to have severe juxta-articular multiple osteophytosis of the lower limbs. The pathogenesis of this unusual condition is unknown. It may be a variant of diffuse idiopathic skeletal hyperostosis.
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14/17. Sternocostoclavicular hyperostosis: painful swelling of the sternum, clavicles, and upper ribs. Report of two new cases.

    Five patients had persistent, pulling pain in the sternum, clavicles, and upper ribs that was exacerbated by cold and dampness. Clublike, symmetrical enlargement of the clavicles was seen and, in two patients, venous congestion of the upper half of the body. All patients had a constantly elevated erythrocyte sedimentation rate. Radiologically there was symmetrical hyperostosis of the sternal and middle portions of the clavicles, synostosis of the sternoclavicular joints, a widened and thickened sternum, and varying degrees of involvement of the upper ribs. X-ray findings did not change over several years. phlebography showed bilateral subclavian vein occlusion in three patients and unilateral occlusion in one. Biopsies of the clavicles showed a characteristic hyperostotic sclerosis of the spongiosa. The cause of this sternocostoclavicular hyperostosis is unknown, but clinical, radiologic, and histologic findings indicate that it may represent a distinct, hitherto undescribed entity.
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15/17. Proptosis as presenting symptom of orbital foreign body.

    An unusual case of orbital foreign body is presented. The foreign body had penetrated through a small wound of the upper lid and was asymtomatic for two years. Proptosis due to hyperostosis of the orbital roof was a presenting symptom of the foreign body.
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16/17. Ankylosing hyperostosis with cervical spinal cord compression.

    This report describes a patient whose clinical and radiological features conform to those of ankylosing hyperostosis. Posterior bridging osteophytes were also apparent and these have not been previously described in ankylosing hyperostosis. We have considered alternative explanations for this finding and concluded that they were manifestations of the hyperostotic process. This unusual feature occurring in the presence of a comparatively narrow spinal canal resulted in cord compression and a spastic tetraparesis and we would therefore suggest that ankylosing hyperostosis may sometimes have serious neurological consequences.
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17/17. Postoperative heterotopic ossification in patients with ankylosing hyperostosis on the spine (Forestier's disease).

    Heterotopic ossification following hip surgery occurred in three patients with ankylosing hyperostosis of the spine. No technical difficulty during surgery was encountered in these individuals. The occurrence of this postoperative complication, coupled with the appearance of bony outgrowths at sites of ligament attachment throughout the axial and extra-axial skeleton in patients with ankylosing hyperostosis of the spine, suggests the presence of an underlying ossifying diathesis, diffuse idiopathic skeletal hyperostosis (DISH). A significant number of patients with DISH possess the second segregant series antigen, HLA-B27, a feature they share with individuals with other arthropathies characterized by abundant ossification; this gene may be closely related to one which influences bone formation. The possible association of postoperative heterotopic ossification and ankylosing hyperostosis of the spine indicates that a radiographic examination of the vertebral column in patients undergoing hip surgery may be a useful screening procedure.
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