Sternoclavicular joint osteophytosis: a difficult diagnosis to swallow

Unexplained dysphagia requires prompt investigation to rule out a possible underlying malignancy. We describe the case of a 60-year-old man who presented to his family practitioner with a 1-year history of increasing dysphagia with associated pain over the front of his chest. He was referred on to an ear, nose and throat specialist where no obvious laryngeal pathology was found at direct laryngoscopy, but an ‘indentation’ of the right anterior larynx, which increased with external pressure on the sternoclavicular joint (SCJ), was noted. A subsequent CT scan of his neck demonstrated osteoarthritis of the right SCJ with an abnormally large posterior osteophyte. The patient was subsequently referred on to an orthopaedic surgeon specialising in SCJ surgery and underwent an arthroscopic excision of his right SCJ. Soon after surgery, the patient’s dysphagia had settled and his symptoms remain resolved 1 year post surgery.

from #ENT-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2sSW7iE

Cupping at the ends of ribs is not always rickets

Description

A 7-week-old baby boy presented with a history of cough, loose stools and respiratory distress since last 7 days. At admission he had a respiratory rate of 64/min, a heart rate of 144/min and an oxygen saturation of 56%. Chest examination revealed crepitations in both lung fields. Rest of the examination was unremarkable. Investigations revealed haemoglobin 82 g/L; white cell count 11.2x10⁹/L (differential counts: polymorphs 68%, lymphocytes 1%, monocytes 26% and eosinophils 5%); absolute lymphocyte count 0.11x10⁹/L; platelet count 102x10⁹/L and C reactive protein 239 g/L. Chest X-ray showed non-homogenous opacities in bilateral lung fields (more on right side) with an absent thymic shadow, cupping at the anterior end of ribs (black arrow, figure 1), flattening of lower end of the right scapula (white arrow, figure 1) and a spur at the inferior-lateral angle of the left scapula (white arrow head, figure 1). These characteristic radiological changes (ie, cupping at...

from #ENT-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2tnJ6kE

Isolated insulin-derived amyloidoma of the breast

Isolated amyloidomas derived from insulin are extremely rare, and there is only one reported case to date of insulin-derived amyloidoma in the breast.

We present the case of a 36-year-old woman reporting a lump in the right breast. It was clinically assessed as a probable fibroadenoma but was removed surgically given the size of the lesion. On histological analysis, the lesion had features consistent with amyloid. Further investigations showed the amyloid to be derived from insulin. The lump was removed in its entirety, and the patient made a full recovery.

from #ENT-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2sSKybA

Evolution of the Oral Microbiome and Dental Caries

Abstract

Purpose of Review

Our paper reviews how dietary changes during human evolution have contributed to the increased incidence and prevalence of dental caries in modern populations by shifting the oral microbiome from a “healthy” to “carious” state. We addressed two questions: (1) what is the microbial difference between the states of health and caries, and (2) how has the development of an agricultural diet impacted the oral microbiome?

Recent Findings

The application of next-generation sequencing has revealed the complexity of the oral microbiome and lack of a simple compositional difference between health and caries. Genetic analysis of the oral microbiome from contemporary and ancient humans has shown that the introduction of agriculture was associated with increased frequency of caries-related bacteria and the evolution of the key carious pathogen, Streptococcus mutans.

Summary

The adoption of an agricultural diet has contributed to a modern rise in caries by changing the oral microbiome ecology. Identification of evolutionary factors that have influenced the oral microbiome in health and caries, and how the two states differ functionally, as opposed to compositionally, may help to reduce the current burden of caries.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2sN4bql
via IFTTT

Bilateral interstitial keratitis with anterior stromal infiltrates associated with reactive arthritis

A previously healthy 48-year-old man presented with a 1-week history of migrating polyarthropathy preceded by a viral illness, dysuria and bilateral red eyes. Ocular examination revealed anterior and interstitial stromal keratitis. He was systemically well but had raised erythrocyte sedimentation rate and C reactive protein and was positive for human leucocyte antigen B27 on extensive infective, rheumatological and autoimmune investigations. Although the exact triggering pathogen was not identified, clinical findings were consistent with reactive arthritis. Bilateral interstitial keratitis is a rare manifestation of reactive arthritis which, along with the anterior stromal keratitis, responded well to topical prednisolone sodium phosphate 0.5%. Systemic joint symptoms improved on oral sulfasalazine, non-steroid anti-inflammatory agent and low-dose prednisolone.

from #ENT-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2tngcBe

Cancer therapies and the problem of me too many

Publication date: Available online 6 July 2017
Source:Seminars in Oncology
Author(s): Tito Fojo




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2sw7kGB
via IFTTT

Evolution of the Oral Microbiome and Dental Caries

Abstract

Purpose of Review

Our paper reviews how dietary changes during human evolution have contributed to the increased incidence and prevalence of dental caries in modern populations by shifting the oral microbiome from a “healthy” to “carious” state. We addressed two questions: (1) what is the microbial difference between the states of health and caries, and (2) how has the development of an agricultural diet impacted the oral microbiome?

Recent Findings

The application of next-generation sequencing has revealed the complexity of the oral microbiome and lack of a simple compositional difference between health and caries. Genetic analysis of the oral microbiome from contemporary and ancient humans has shown that the introduction of agriculture was associated with increased frequency of caries-related bacteria and the evolution of the key carious pathogen, Streptococcus mutans.

Summary

The adoption of an agricultural diet has contributed to a modern rise in caries by changing the oral microbiome ecology. Identification of evolutionary factors that have influenced the oral microbiome in health and caries, and how the two states differ functionally, as opposed to compositionally, may help to reduce the current burden of caries.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2sN4bql
via IFTTT