V. Petrova, D. Petrova, V. Kornovski, T. Vekov, V. Danov
Abstract The tetralogy of Fallot is the most common form of cyanotic congenital heart malformations. However, its association with Down syndrome is uncommon. We present two patients with uncorrected during childhood tetralogy of Fallot. One of them had also Down syndrome. We performed a complete surgical correction: closure of the inter-ventricular defect, right ventricular outflow tract reconstruction, pulmonary valve prosthesis and pulmonary artery patch repair (in one of the cases). The postoperative period was uncomplicated, patients were discharged on days 12 and 10, and the follow-up showed a significant functional class improvement.
{"title":"Surgical Treatment of Adults with Uncorrected Tetralogy of Fallot: A Clinical Case Series","authors":"V. Petrova, D. Petrova, V. Kornovski, T. Vekov, V. Danov","doi":"10.2478/amb-2022-0008","DOIUrl":"https://doi.org/10.2478/amb-2022-0008","url":null,"abstract":"Abstract The tetralogy of Fallot is the most common form of cyanotic congenital heart malformations. However, its association with Down syndrome is uncommon. We present two patients with uncorrected during childhood tetralogy of Fallot. One of them had also Down syndrome. We performed a complete surgical correction: closure of the inter-ventricular defect, right ventricular outflow tract reconstruction, pulmonary valve prosthesis and pulmonary artery patch repair (in one of the cases). The postoperative period was uncomplicated, patients were discharged on days 12 and 10, and the follow-up showed a significant functional class improvement.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"49 1","pages":"46 - 50"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48910192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The human genome consists of roughly 23000 genes which cannot explain the enormous diversity of proteins or behavior. A second epigenetic code warrants adaptive variation of gene expression. The rationale of this variation are transfer reactions such as methylation, acetylation or phosphorylation of DNA or histones including reverse reactions which are supposed to be altered by electroconvulsive therapy (ECT). The method has been successfully used since the 1930ies but the underlying molecular mechanism of action has not been elucidated yet. The paper discusses the theoretical involvement of epigenetic gene expression as an adaptive process to explain biochemical changes after ECT administration.
{"title":"Possible Hypothetical Mode of Action of ECT (Electroconvulsive Therapy) Based on DNA Dipole Character and Epigenetics","authors":"H. Koch","doi":"10.2478/amb-2021-0049","DOIUrl":"https://doi.org/10.2478/amb-2021-0049","url":null,"abstract":"Abstract The human genome consists of roughly 23000 genes which cannot explain the enormous diversity of proteins or behavior. A second epigenetic code warrants adaptive variation of gene expression. The rationale of this variation are transfer reactions such as methylation, acetylation or phosphorylation of DNA or histones including reverse reactions which are supposed to be altered by electroconvulsive therapy (ECT). The method has been successfully used since the 1930ies but the underlying molecular mechanism of action has not been elucidated yet. The paper discusses the theoretical involvement of epigenetic gene expression as an adaptive process to explain biochemical changes after ECT administration.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"57 - 61"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43812756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Xharra, E. Behluli, A. Moder, H. Nefic, R. Hadziselimovic, G. Temaj
Abstract Male infertility is caused by spermatogenetic failure, clinically noted as oligoor azoospermia. Approximately 20% of infertile patients carry a genetic defect. The most frequent genetic defect leading to azoospermia (or severe oligozoospermia) is Klinefelter syndrome (47, XXY), which is numerical chromosomal abnormality and Y- structural chromosome aberration. The human X chromosome is the most stable of all human chromosomes. The X chromosome is loaded with regions of acquired, rapidly evolving genes. The X chromosome may actually play an essential role in male infertility and sperm production. Here we will describe X chromosome aberrations, which are associated with male infertility.
{"title":"Association of X Chromosome Aberrations with Male Infertility","authors":"S. Xharra, E. Behluli, A. Moder, H. Nefic, R. Hadziselimovic, G. Temaj","doi":"10.2478/amb-2021-0051","DOIUrl":"https://doi.org/10.2478/amb-2021-0051","url":null,"abstract":"Abstract Male infertility is caused by spermatogenetic failure, clinically noted as oligoor azoospermia. Approximately 20% of infertile patients carry a genetic defect. The most frequent genetic defect leading to azoospermia (or severe oligozoospermia) is Klinefelter syndrome (47, XXY), which is numerical chromosomal abnormality and Y- structural chromosome aberration. The human X chromosome is the most stable of all human chromosomes. The X chromosome is loaded with regions of acquired, rapidly evolving genes. The X chromosome may actually play an essential role in male infertility and sperm production. Here we will describe X chromosome aberrations, which are associated with male infertility.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"69 - 72"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45614037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The importance of the dominant psychological and physiological aspects of occupational stress models is a significant topic for researchers working in the field of medicine. Modern society faces significant problems in the detection and management of stress due to its growing impact on the functional state of working individuals. Ensuring safe and healthy working conditions is necessary to deal with the adverse effects of occupational stress on health. Controlling and reducing stress is possible by revealing the causal psychophysiological links in the mechanisms of work-related stress. Scientifically based stress management is based on the categories and concepts underlying occupational stress models. Modern work-related models of stress describe and study not only the adverse characteristics of the work process, but also the factors that stimulate the health and well-being of the individual. Monitoring occupational stress is part of the process of neutralizing and eliminating it. In today’s dynamic world, it is not enough to expect only quality performance of the professional duties of employees, but the commitment of managers working in the field of health care is needed to analyse and manage the dominant psychological and physiological aspects of occupational stress models and prevent adverse aspects of models of this type of stress at work.
{"title":"Significance of the Dominant Psychological and Physiological Aspects of the Occupational Stress Models","authors":"S. Simeonova, R. Nikolova","doi":"10.2478/amb-2021-0046","DOIUrl":"https://doi.org/10.2478/amb-2021-0046","url":null,"abstract":"Abstract The importance of the dominant psychological and physiological aspects of occupational stress models is a significant topic for researchers working in the field of medicine. Modern society faces significant problems in the detection and management of stress due to its growing impact on the functional state of working individuals. Ensuring safe and healthy working conditions is necessary to deal with the adverse effects of occupational stress on health. Controlling and reducing stress is possible by revealing the causal psychophysiological links in the mechanisms of work-related stress. Scientifically based stress management is based on the categories and concepts underlying occupational stress models. Modern work-related models of stress describe and study not only the adverse characteristics of the work process, but also the factors that stimulate the health and well-being of the individual. Monitoring occupational stress is part of the process of neutralizing and eliminating it. In today’s dynamic world, it is not enough to expect only quality performance of the professional duties of employees, but the commitment of managers working in the field of health care is needed to analyse and manage the dominant psychological and physiological aspects of occupational stress models and prevent adverse aspects of models of this type of stress at work.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"33 - 42"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45864679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Recent advances in molecular genetics and the invention of new technologies led to an advance in the development of gene therapy. Gene therapy is used to correct defective genes in order to cure a disease or help the body better fight a disease. It works by restoring or modifying cellular functions through the introduction of a functional gene into the target cell. The concept of gene therapy is simple, but introducing it to routine clinical practice is not. The main concerns are related to some safety issues as well as to the problem that maintaining a stable and prolonged expression in target cells may not be easily achieved. In spite of the difficulties, gene therapy remains a hope for many hematological disorders that cannot be effectively treated so far. This article reviews the current status of gene therapy with a focus on hematological disorders. In addition, clinically applied approaches are presented through particular examples of approved gene therapy drugs.
{"title":"Current Trends in the Gene Therapy of Hematologic Disorders","authors":"D. Nikolova","doi":"10.2478/amb-2021-0048","DOIUrl":"https://doi.org/10.2478/amb-2021-0048","url":null,"abstract":"Abstract Recent advances in molecular genetics and the invention of new technologies led to an advance in the development of gene therapy. Gene therapy is used to correct defective genes in order to cure a disease or help the body better fight a disease. It works by restoring or modifying cellular functions through the introduction of a functional gene into the target cell. The concept of gene therapy is simple, but introducing it to routine clinical practice is not. The main concerns are related to some safety issues as well as to the problem that maintaining a stable and prolonged expression in target cells may not be easily achieved. In spite of the difficulties, gene therapy remains a hope for many hematological disorders that cannot be effectively treated so far. This article reviews the current status of gene therapy with a focus on hematological disorders. In addition, clinically applied approaches are presented through particular examples of approved gene therapy drugs.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"50 - 56"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42120749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Recent advances in molecular genetics and the invention of new technologies led to a development in our knowledge about human microbiota, specifically bacterial one. The microbiota plays a fundamental role in the immunologic, hormonal and metabolic homeostasis of the host. After the initiation of the Human Microbiome Project, it became clear that the human microbiota consists of the 10-100 trillion symbiotic microbial cells harbored by each person, primarily bacteria in the gut, but also in other spots as the skin, mouth, nose, and vagina. Despite of the differences in studying bacterial species, decreased bacterial diversity and persistence has been connected with several diverse human diseases primarily diabetes, IBD (inflammatory bowel disease) and others; attempts were made even to explain psychiatric pathology. Several species emerged as dominant and were clearly linked to certain disorders or accepted as biomarkers of others. The current review aims to discuss key issues of our current knowledge about bacteria in human, the difficulties and methods of its analysis, its contribution to human health and responsibility for human diseases.
{"title":"Current Knowledge About the Implication of Bacterial Microbiota in Human Health and Disease","authors":"D. Nikolova","doi":"10.2478/amb-2021-0047","DOIUrl":"https://doi.org/10.2478/amb-2021-0047","url":null,"abstract":"Abstract Recent advances in molecular genetics and the invention of new technologies led to a development in our knowledge about human microbiota, specifically bacterial one. The microbiota plays a fundamental role in the immunologic, hormonal and metabolic homeostasis of the host. After the initiation of the Human Microbiome Project, it became clear that the human microbiota consists of the 10-100 trillion symbiotic microbial cells harbored by each person, primarily bacteria in the gut, but also in other spots as the skin, mouth, nose, and vagina. Despite of the differences in studying bacterial species, decreased bacterial diversity and persistence has been connected with several diverse human diseases primarily diabetes, IBD (inflammatory bowel disease) and others; attempts were made even to explain psychiatric pathology. Several species emerged as dominant and were clearly linked to certain disorders or accepted as biomarkers of others. The current review aims to discuss key issues of our current knowledge about bacteria in human, the difficulties and methods of its analysis, its contribution to human health and responsibility for human diseases.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"43 - 49"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49296822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Mihaylova, I. Ivanova, A. Alakidi, K. Kilova, M. Liochkova
Abstract A doctrine was established regarding the so called “new beginning” – the transition to the post-retirement period for a full-value experience of the available compensatory reserves and creation of overcoming strategies for opposing and coping with the obstacles in the still uncommon lifestyle of the senior citizen. By outlining the role of physical activity in a synthesized format, a successful attempt for data classification worldwide was made; in one fourth of the elderly people there is insufficient physical activity, more evident in the women and for Bulgaria this percent is higher (95%). The role and effect of categorized physical exercises for mobility, flexibility, and stretching, aerobic and anaerobic movements have been pointed out. Moreover, the review discusses the preventive effects of rehabilitation, including psychological ones and the role of it in helping patients live with socially significant diseases, coping with disability. The contribution of physical activity and rehabilitation as protective factors of non-infectious diseases is associated with good mental health, improved quality of life and well-being. Within this meaning, while contemporary medicine adds years to life, physical activity and mostly rehabilitation is a significant reason for adding a meaningful life in the course of aging and old age.
{"title":"Physical Activity and Rehabilitation – A Key to Healthy Aging","authors":"V. Mihaylova, I. Ivanova, A. Alakidi, K. Kilova, M. Liochkova","doi":"10.2478/amb-2021-0050","DOIUrl":"https://doi.org/10.2478/amb-2021-0050","url":null,"abstract":"Abstract A doctrine was established regarding the so called “new beginning” – the transition to the post-retirement period for a full-value experience of the available compensatory reserves and creation of overcoming strategies for opposing and coping with the obstacles in the still uncommon lifestyle of the senior citizen. By outlining the role of physical activity in a synthesized format, a successful attempt for data classification worldwide was made; in one fourth of the elderly people there is insufficient physical activity, more evident in the women and for Bulgaria this percent is higher (95%). The role and effect of categorized physical exercises for mobility, flexibility, and stretching, aerobic and anaerobic movements have been pointed out. Moreover, the review discusses the preventive effects of rehabilitation, including psychological ones and the role of it in helping patients live with socially significant diseases, coping with disability. The contribution of physical activity and rehabilitation as protective factors of non-infectious diseases is associated with good mental health, improved quality of life and well-being. Within this meaning, while contemporary medicine adds years to life, physical activity and mostly rehabilitation is a significant reason for adding a meaningful life in the course of aging and old age.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"62 - 68"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43895276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Zamanian, A. Janbakhsh, F. Mansouri, B. Sayad, M. Afsharian, S. Vaziri, B. Mahdavian, Z. Afshar, R. Miladi, M. Shirvani, M. Noori, M. Salimi, A. Babazadeh, S. Ebrahimpour
Abstract There are some reports about the neurological manifestations and complications of COVID-19. We present neurological manifestations in 6 hospitalized patients with COVID-19. The patients presented with common symptoms of COVID-19 along with common findings from high-resolution computed tomography (HRCT) scan such as ground-glass opacities (GGOs). Though, RT-PCR testing of SARS-CoV-2 was negative for all 6 cases. In the current report, acute cerebrovascular diseases affected older patients, while dementia, seizure and encephalopathy affected younger ones. Three of the 6 patients had proven strokes based on their neuroimaging. Four of the 6 patients had high d-dimer levels. Two of the cases experienced convulsion. The third patient presented with typical symptoms and signs of neuroleptic malignant syndrome. The sixth case was interesting for transient dementia. Unfortunately, four out of six patients died. The recent case series report the association between neurological involvements and COVID-19 infection. Clinicians should be alert of the neurologic symptoms in the setting of COVID-19, which might even be the first presentations of this infection.
{"title":"Neurological Manifestations of Hospitalized Patients with Covid-19: A Case Series Study","authors":"M. Zamanian, A. Janbakhsh, F. Mansouri, B. Sayad, M. Afsharian, S. Vaziri, B. Mahdavian, Z. Afshar, R. Miladi, M. Shirvani, M. Noori, M. Salimi, A. Babazadeh, S. Ebrahimpour","doi":"10.2478/amb-2021-0035","DOIUrl":"https://doi.org/10.2478/amb-2021-0035","url":null,"abstract":"Abstract There are some reports about the neurological manifestations and complications of COVID-19. We present neurological manifestations in 6 hospitalized patients with COVID-19. The patients presented with common symptoms of COVID-19 along with common findings from high-resolution computed tomography (HRCT) scan such as ground-glass opacities (GGOs). Though, RT-PCR testing of SARS-CoV-2 was negative for all 6 cases. In the current report, acute cerebrovascular diseases affected older patients, while dementia, seizure and encephalopathy affected younger ones. Three of the 6 patients had proven strokes based on their neuroimaging. Four of the 6 patients had high d-dimer levels. Two of the cases experienced convulsion. The third patient presented with typical symptoms and signs of neuroleptic malignant syndrome. The sixth case was interesting for transient dementia. Unfortunately, four out of six patients died. The recent case series report the association between neurological involvements and COVID-19 infection. Clinicians should be alert of the neurologic symptoms in the setting of COVID-19, which might even be the first presentations of this infection.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"41 - 45"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46462864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction: High energy tibial plateau fractures represent a challenge because of the combined bone and soft tissue injury. The iatrogenic impact can further increase the likelihood for crippling complications. Less invasive treatment protocols have been developed to improve the results. Objective: We present the long-term results of limited internal fixation combined with a small wire external fixator. Patients and Methods: Fourteen patients were followed for at least 10 years. Initial and final functional results, complications and presence of joint degeneration were registered according to validated rating scores. Results: Of all patients included in the study, thirteen showed an excellent initial rating and one had an average result at baseline. 10 years later, eight patients still showed excellent grading results, four – good ones, one – average and one – poor results. Ten knees (71%) had osteoarthritis. Postphlebitic syndrome was diagnosed in two cases. Three knees showed medio-lateral instability, one showed a varus and one – a valgus deformity. Knee arthroplasty was performed in one case. Conclusion: The limited internal fixation combined with a hybrid ex fix can be considered as an alternative to the ORIF, especially when the soft tissues are severely compromised. Despite the inevitable joint degeneration, the associated overall morbidity is low and the long term function is quite satisfactory.
{"title":"Complex Tibial Plateau Fractures Treated with a Hybrid External Fixator – Long Term Results","authors":"Y. Andonov","doi":"10.2478/amb-2021-0031","DOIUrl":"https://doi.org/10.2478/amb-2021-0031","url":null,"abstract":"Abstract Introduction: High energy tibial plateau fractures represent a challenge because of the combined bone and soft tissue injury. The iatrogenic impact can further increase the likelihood for crippling complications. Less invasive treatment protocols have been developed to improve the results. Objective: We present the long-term results of limited internal fixation combined with a small wire external fixator. Patients and Methods: Fourteen patients were followed for at least 10 years. Initial and final functional results, complications and presence of joint degeneration were registered according to validated rating scores. Results: Of all patients included in the study, thirteen showed an excellent initial rating and one had an average result at baseline. 10 years later, eight patients still showed excellent grading results, four – good ones, one – average and one – poor results. Ten knees (71%) had osteoarthritis. Postphlebitic syndrome was diagnosed in two cases. Three knees showed medio-lateral instability, one showed a varus and one – a valgus deformity. Knee arthroplasty was performed in one case. Conclusion: The limited internal fixation combined with a hybrid ex fix can be considered as an alternative to the ORIF, especially when the soft tissues are severely compromised. Despite the inevitable joint degeneration, the associated overall morbidity is low and the long term function is quite satisfactory.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"26 - 29"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46536698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Valkov, M. Kovacheva-Slavova, I. Lyutakov, T. Angelov, P. Getsov, B. Vladimirov, P. Penchev
Abstract Diffuse idiopathic skeletal hyperostosis (DISH) is a common but underdiagnosed systemic skeletal disease. It is characterized by calcifications affecting mainly the spinal anterior longitudinal ligament. In the majority of cases, the patients are asymptomatic, but cervical osteophytes can sometimes cause hoarseness, dysphagia (DISHphagia) and even dyspnea. Case description: A 61-year-old man was admitted to our department with complaints of difficulty in swallowing and weight loss. Dysphagia had been increasing gradually for nine months. Barium swallow esophagram revealed asymmetric swallowing with expansion above the upper esophageal sphincter without other abnormalities. The extension was confirmed by esophago-gastro-duodenoscopy (EGD). Furthermore, CT scan of the thorax clearly demonstrated degenerative changes of the cervical and thoracic region, extensive ossification of the anterior longitudinal ligament, and osteophytes from C2-C7 with a forward displacement of the esophagus by 14 mm. The so-called “wax dripping down the candle” phenomenon was as well observed. Conclusion: DISH is a systematic, musculo-skeletal disease of older adults with unknown etiology. Dysphagia is the most common symptom of the disease and might be caused by osteophytes of the cervical region. We presented a case of DISH with a rare localization of the osteophytes in the cervical region C2-C7. Due to the increasing incidence of the Forestier’s syndrome and its associated “DISHphagia”, the gastroenterologist should increase the awareness of this underestimated disease and improve the diagnostic approach.
{"title":"DISHphagia – A Riddle Unwrapped a Clinical Case with Literature Review","authors":"H. Valkov, M. Kovacheva-Slavova, I. Lyutakov, T. Angelov, P. Getsov, B. Vladimirov, P. Penchev","doi":"10.2478/amb-2021-0032","DOIUrl":"https://doi.org/10.2478/amb-2021-0032","url":null,"abstract":"Abstract Diffuse idiopathic skeletal hyperostosis (DISH) is a common but underdiagnosed systemic skeletal disease. It is characterized by calcifications affecting mainly the spinal anterior longitudinal ligament. In the majority of cases, the patients are asymptomatic, but cervical osteophytes can sometimes cause hoarseness, dysphagia (DISHphagia) and even dyspnea. Case description: A 61-year-old man was admitted to our department with complaints of difficulty in swallowing and weight loss. Dysphagia had been increasing gradually for nine months. Barium swallow esophagram revealed asymmetric swallowing with expansion above the upper esophageal sphincter without other abnormalities. The extension was confirmed by esophago-gastro-duodenoscopy (EGD). Furthermore, CT scan of the thorax clearly demonstrated degenerative changes of the cervical and thoracic region, extensive ossification of the anterior longitudinal ligament, and osteophytes from C2-C7 with a forward displacement of the esophagus by 14 mm. The so-called “wax dripping down the candle” phenomenon was as well observed. Conclusion: DISH is a systematic, musculo-skeletal disease of older adults with unknown etiology. Dysphagia is the most common symptom of the disease and might be caused by osteophytes of the cervical region. We presented a case of DISH with a rare localization of the osteophytes in the cervical region C2-C7. Due to the increasing incidence of the Forestier’s syndrome and its associated “DISHphagia”, the gastroenterologist should increase the awareness of this underestimated disease and improve the diagnostic approach.","PeriodicalId":35746,"journal":{"name":"Acta Medica Bulgarica","volume":"48 1","pages":"30 - 33"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48296822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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