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. Exostosis presenting as solitary loose body in the ankle of two children.

    Two children, aged 5 and 11 years, presented clinically with ankle pain and a mobile bony hard lump in the ankle. Radiological examination revealed a large radio-opaque shadow in relation to the talus. Intraoperatively, a loose body was found. It resembled a detached exostosis with cartilaginous cap and was confirmed histologically as an osteochondroma. In the older child, there was a remnant stalk attached to the lateral surface of the talus. In the younger child, the exostosis probably came from the talus as the osteochondroma could not originate from the epiphyses that form the ankle mortise.
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14/17. Intermittent axillary nerve palsy caused by a humeral exostosis.

    We report an uncommon case of intermittent axillary nerve palsy caused by a humeral exostosis in an 11-year-old boy. After excision of the cartilagenous exostosis of the proximal end of the left humerus, the pre-operative symptoms of axillary nerve compression were alleviated.
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15/17. Subungual exostosis.

    This report is intended to focus attention on the often occurring, but seldom reported, subungual exostosis. Familiarity with its clinical characteristics should enable the physician to make a preoperative diagnosis or at least include it in the differential diagnosis of any subungual growth. Establishing the practice of x-raying all subungual tumors may save the physician's ego from the trauma of a missed diagnosis. More importantly, however, it may save the patient from unnecessary and at times even unnecessarily drastic surgery.
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16/17. Deep venous thrombosis caused by femoral exostosis.

    OBJECTIVE: To present the first case of deep venous thrombosis caused by femoral exostosis reported in australia. CLINICAL FEATURES: An 11-year-old prepubertal Caucasian girl had a two-year history of a posterior femoral exostosis. She then presented with a deep venous thrombosis 24 hours after riding a horse for the first time. The deep venous thrombosis was diagnosed by Doppler ultrasound, which showed an intimate relationship between the femoral exostosis and the femoral vein. Coagulation abnormalities were excluded. INTERVENTION AND OUTCOME: The patient was given anticoagulation therapy with heparin intravenously and warfarin orally. The popliteal vein recanalised within two days. The exostosis was excised 10 weeks after initial presentation, with warfarin being continued for four weeks postoperatively. Two months after excision the patient was symptom free. CONCLUSIONS: It is possible for venous compression by an exostosis to result in thrombosis in a patient with no underlying coagulation abnormality. palpation and plain radiography of the region will demonstrate the exostosis; ultrasound is the next investigation of choice.
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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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