Diffuse idiopathic skeletal hyperostosis: A rare cause of dysphagia

@#Diffuse idiopathic skeletal hyperostosis (DISH) is a disease characterized by massive, non-inflammatory ossification with intensive formation of osteophytes affecting ligaments, tendons, and fascia of the anterior part of the spinal column, mostly in the middle and lower thoracic regions. However, isolated and predominant cervical spinal involvement may occur. It has predilection for men (65%) over 50 years of age and a prevalence of approximately 15-20% in elderly patients.1 A CT scan is one of the diagnostic tools. The radiographic diagnostic criteria in the spine include: 1) osseous bridging along the anterolateral aspect of at least four vertebral bodies; 2) relative sparing of intervertebral disc heights, with minimal or absent disc degeneration; and 3) absence of apophyseal joint ankylosis and sacroiliac sclerosis.2 We present a rare case of dysphagia over 2 years duration due to DISH.

Hoarseness due to cardiovascular disease: Two cases of cardiovocal syndrome

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: To report two cases of cardiovocal syndrome (or Ortner's syndrome) due to cardiovascular disease.</p> <p style="text-align: justify;"><strong>METHODS</strong>:<br /><strong>Design</strong>: Case report<br /><strong>Setting</strong>: Tertiary University Hospital<br /><strong>Subjects</strong>: Two</p> <p style="text-align: justify;"><strong>RESULTS</strong>: Two patients with Cardiovocal syndrome, one due to an aortic saccular aneurysm and the other due to severe mitral stenosis underwent surgery to correct the underlying cardiovascular disease. Post-operatively, the hoarseness resolved completely in the patient with mitral stenosis but persisted in the patient with aortic saccular aneurysm.</p> <p style="text-align: justify;"><strong>CONCLUSION</strong>: Cardiovascular disease should be considered as a differential diagnosis in a patient with hoarseness. A high index of suspicion is needed to make an early diagnosis which can lead to surgical correction of the potentially life-threatening, underlying cardiovascular disease.</p>

Tube extrusion and cheese wiring five years post dacryocystorhinostomy

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: Dacrocystorhinostomy (DCR) with silicone tube stenting is a common procedure for congenital nasolacrimal duct obstruction (NLDO). The incidence of congenital NLDO is about 6% in the newborn. The duration the tube is left in place varies depending on surgeon preference. Cheese wiring is one of the tube-related complications when the tube is left behind for a long duration. The term cheese wiring refers to the silicone stent or tubing cutting through soft tissue close to the punctum or canaliculi like wire cuts through cheese. We present a case of tube extrusion with cheese wiring five years post DCR.</p> <p style="text-align: justify;"><strong>METHODS</strong>:<br /><strong>Design</strong>: Case report <br /><strong>Setting</strong>: Tertiary Referral Center<br /><strong>Patient</strong>: One</p> <p style="text-align: justify;"><strong>RESULTS</strong>: A 16-year-old Indian male with congenital bilateral NLDO underwent right and left DCR at ages 9 and 11, respectively. The patient presented with smelly nasal discharge five years later to the ENT clinic. On initial examination the right tube was in place but the left tube was not visualized. Nasal endoscopy however revealed that both tubes were still there and were subsequently removed.</p> <p style="text-align: justify;"><strong>CONCLUSION</strong>: DCR with silicone intubation is a common practice. Early follow up is essential to prevent complications. If tube extrusion is suspected, early endoscopic examination is essential to confirm it.</p>