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[A clinical case of upper airway obstruction, dysphagia caused by diffuse idiopathic skeletal hyperostosis].

Diffuse idiopathic skeletal hyperostosis (DISH, Forestier's disease) is a rare non-inflammatory degenerative-dystrophic disease of the musculoskeletal system, characterized by calcification of ligaments and tendons, in particular the anterior longitudinal ligament. It is rare, more often among men over 60 years old. When the cervical spine is affected, DISH manifests itself as neck pain, stiffness of movement, dysphagia and, in some cases, difficulty breathing. The main goal of surgical treatment of Forestier's disease is the removal of the osteophyte complex, however, with severe compression …

[Ultrasound examination of nerves of the upper extremities].

The ultrasound examination of peripheral nerves has been further developed in recent years and is recognized as an independent discipline by the German Society of Ultrasound in Medicine (DEGUM). A systematic ultrasound examination of the musculoskeletal system is not limited to the joints, muscles and bones but should also include the examination of nerves and blood vessels. Therefore, in the practice of ultrasound examination every rheumatologist should have at least a basic knowledge of the ultrasound examination of the peripheral nerves. In this article the authors present a landmark-based …

Musculoskeletal Effects of Cancer and Cancer Treatment.

Improvements in cancer treatment have led to prolonged survival and increased rates of cure. An estimated 14 million cancer survivors live in the United States. The cornerstones of cancer treatment, including radiation, chemotherapy, and surgery, give rise to a host of chronic health conditions, some of which affect the musculoskeletal system. As survivorship continues to improve, orthopaedic surgeons across all subspecialties will be tasked with managing these complications of treatment. This article reviews orthopaedic health concerns secondary to cancer treatment that are likely to present …

Analogs of C-type natriuretic peptide as a potential new non-surgical treatment strategy in knee osteoarthritis.

Osteoarthritis (OA) is a common, chronic, progressive, and multifactorial musculoskeletal system disease affecting millions of people around the world. Despite the use of several treatment modalities, the search for a disease modifying drug continuous. Recent evidence suggest involvement of C-type natriuretic peptide (CNP) signaling in induction of chondroprotective pathways. A CNP analog (BMN 111) with an extended plasma half-life due to its neutral-endopeptidase resistance has shown to be pharmacologically active in achondroplasia enabling to hypothesize that BMN 111 may also be used as a tr…

Sacroiliitis during isotretinoin treatment: Causal association or coincidence?

Isotretinoin, a retinoid derivate used in acne treatment, has a variety of side effects involving the musculoskeletal system; however, sacroiliitis is rarely observed. Our aim was to present nine cases of sacroiliitis in patients being treated with isotretinoin. Sacroiliitis was identified and monitored using magnetic resonance imaging (MRI). Clinical symptoms were resolved with nonsteroidal anti-inflammatory drug therapy after isotretinoin treatment was ceased. Different from the other cases, follow-up MRI was done. Follow-up MRI revealed improvement in some patients. Although the association…

Epithelioid sarcoma of the plantar fascia mimicking Morbus Ledderhose - A severe pitfall for clinical and histopathological misinterpretation.

Plantar fibromatosis, also known as Morbus Ledderhose, is a well known and frequently encountered disorder of the planta pedis. When conservative treatment fails, surgical therapy with complete resection is the therapeutical procedure of choice. Soft tissue sarcoma is a heterogeneous and rare malignant disease of the musculoskeletal system with over 50 histopathological subtypes which can potentially arise in any localization but is most commonly found at the extremities. Here, we report the case of an epithelioid sarcoma of the sole of the foot which was initially and repeatedly clinically an…

Paraneoplastic Sarcoidosis in Multiple Myeloma.

Sarcoidosis predominantly affects the lungs, intrathoracic lymph nodes, and eyes; it less frequently affects the musculoskeletal system. We herein report a case of paraneoplastic sarcoidosis in a patient presenting with multiple myeloma. The patient developed ocular sarcoidosis and showed an increased 18F-fluorodeoxyglucose uptake in the mediastinal lymph nodes and vertebral column. A lymph node specimen showed the histological features of sarcoidosis, while an examination of the vertebral tumor revealed myeloma. Although the simultaneous occurrence of sarcoidosis and myeloma is extremely rare…

Other Risks/Possible Benefits of Obesity.

Obesity is not a cosmetic or social issue; it is an animal health issue. The metabolic effects of obesity on insulin resistance and development of hyperlipidemia and the mechanical stress excess weight places on the musculoskeletal system are well established in the literature. Additional health risks from obesity, such as fatty accumulation in the liver, intestinal bacterial dysbiosis, and changes to renal architecture, are less well understood, but have been demonstrated to occur clinically in obese animals and may lead to deleterious long-term health effects. Keeping dogs and cats lean lowe…

Extracutaneous manifestations and complications of inherited epidermolysis bullosa: part II. Other organs.

It is well known, primarily via case reports and limited case series, that nonepithelial tissues may become injured in patients with epiderm … d management. Some epidermolysis bullosa subtypes are at risk for severe injury of the bone marrow, musculoskeletal system, heart, kidney, and teeth, and for the development of squamous cell carcinoma, basal cell carcinoma, or malignant melanoma. If untreated, significant morbidity or mortality may result.

Removal of ossified ligamentum flavum via a minimally invasive surgical approach.

Ossified ligamentum flavum (OLF) in the thoracic spine is a rare cause of myelopathy, often presenting with progressive symptomatology over an extended period of time. Surgical decompression via wide laminectomy has been the mainstay of treatment for this symptomatic disease phenomenon, but complications such as kyphotic deformity have developed due to extensive bone removal and release of the posterior tension band. The authors present a case of OLF excised via a minimally invasive microsurgical approach in which an expandable tubular retractor system was used. This approach enables complete

[Dermatological symptoms in rheumatology].

The connective tissue of the skin, joints and musculoskeletal system is often involved concomittantly in rheumatic diseases. Specific skin lesions can be the hallmark of certain collagen vascular diseases, but unspecific dermatoses like purpura, neutrophilic dermatoses or ulcers are also common. Recent investigations suggest that the different histopathologic reaction patterns are derived from cytokine- and chemokine-mediated processes. Thus neutrophilic dermatoses are observed in rheumatic, hematologic and gastric diseases, or in patients without apparent disease. The mediators causing interp…

Sinonasal hemangiopericytoma of the middle turbinate: a case report and brief review of the literature.

Hemangiopericytomas (HPCs) are rare vascular neoplasms that arise from the pericytes of Zimmerman. They account for 2-3% of all soft tissue sarcomas in humans and they occur mainly in the musculoskeletal system. 15 to 30% of all HPCs occur in the head and neck region. Only 5% are located in the sinonasal region, where they display a more benign behaviour than in other parts of the body. We will describe a case of a right-sided HPC, in the posterior third of the middle turbinate. We will also discuss the epidemiology, the macro- and microscopical characteristics, the clinical and pathological f…

Hydatid cyst presenting as a soft-tissue calf mass in a child.

Hydatid disease caused by Echinococcus granulosus often manifests as a slow growing cystic mass; it mainly affects the liver or lung and rarely other parts of the body such as the brain, heart, spleen, peritoneal cavity, or bone. Hydatid cysts of the musculoskeletal system are rare. Since the intramuscular hydatid cyst closely resembles a soft-tissue tumor on clinical examination, the preoperative radiological diagnosis is very important for the identification of the lesion prior to surgery. We describe a rare case of primary intramuscular hydatidosis in a child, together with its clinical pre…

[Type IX collagen diseases].

Type IX collagen is a structural protein which consists of the cartilage collagen II/IX/XI heteropolymer. Transgenic mice overexpressing a m … isc diseases. It is getting more important to understand the biological roles of collagen IX in the musculoskeletal system.

Scleromyxoedema: treatment of cutaneous and systemic manifestations with high-dose intravenous immunoglobulin.

Scleromyxoedema is a rare disease characterized by cutaneous sclerosis, mucin deposition and paraproteinaemia. Internal disease is common, particularly musculoskeletal, gastrointestinal and central nervous system involvement. We report a series of three consecutive patients with scleromyxoedema treated with high-dose intravenous immunoglobulin (hdIVIg). Each of the three patients had relatively low levels of a highly basic IgG-lambda paraprotein, and each has demonstrated a sustained response of both their cutaneous and extracutaneous disease to hdIVIg. As all patients had perioral skin involv

Marfan syndrome and fibrillin disorders.

Marfan syndrome is the second most common inherited connective tissue disorder after osteogenesis imperfecta. Musculoskeletal abnormalities are at the forefront of the clinical picture and count among the major diagnostic criteria for Marfan syndrome, together with cardiovascular and ocular system involvement. Early diagnosis is of the utmost importance since preventive measures significantly increase life expectancy and prevent the occurrence of impairments and disabilities. Marfan syndrome is due to mutations within the fibrillin-1 gene, which is the main protein of the microfibril network.

Cutaneous polyarteritis nodosa in a child with positive antiphospholipid and P-ANCA.

A case of juvenile cutaneous polyarteritis nodosa (cutaneous PAN) is presented. Since early infancy the child underwent attacks of fever and cutaneous rash that occasionally progressed to gangrene and amputations of distal portions of toes and fingers. Although occasional episodes of high blood pressure and persistence of moderate eosinophilia were present, the clinical pattern was mostly restricted to the musculoskeletal system and skin. The authors discuss the definition of the disease and its present therapeutic possibilities, calling attention to a feature not referred in previous reports:…

Uses of nonsteroidal anti-inflammatory drugs in pediatrics.

Nonsteroidal anti-inflammatory drugs have an expanding role in pediatrics. The indications include (1) treatment of childhood rheumatic disease and other chronic inflammatory conditions; (2) symptomatic treatment of clinical problems such as fever, musculoskeletal pain, or dysmenorrhea; and (3) induction of closure of patent ductus arteriosus. Nonsteroidal anti-inflammatory drugs are generally well tolerated with a low incidence of serious side effects. However, potentially serious gastrointestinal, hepatic, central nervous system, and renal adverse effects have occurred. The pediatrician shou

Clinical applications of contrast agents in body imaging.

Although parenteral contrast agents are now widely used in the central nervous system, progress in the development of applications in the remainder of the body has been slow. Both intravenous Gd-DTPA and magnetic iron oxide particles have many potential applications but the former will probably require faster imaging techniques and the latter will require reformulation to produce a less toxic preparation. In spite of these problems methods have been developed for the diagnosis of myocardial infarction, breast carcinoma, and musculoskeletal tumors. Interesting preliminary results are available

The role of myeloid derived suppressor cells in musculoskeletal disorders.

The immune system is closely linked to bone homeostasis and plays a pivotal role in several pathological and inflammatory conditions. Through various pathways it modulates various bone cells and subsequently sustains the physiological bone metabolism. Myeloid-derived suppressor cells (MDSCs) are a group of heterogeneous immature myeloid-derived cells that can exert an immunosuppressive function through a direct cell-to-cell contact, secretion of anti-inflammatory cytokines or specific exosomes. These cells mediate the innate immune response to chronic stress on the skeletal system. In chronic

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… MDSCs are a link between the immune and skeletal system MDSCs also regulate other immune cell types which directly affect the musculoskeletal system. They modulate macrophage polarization from M1 to M2. Anti-inflammatory M2 macrophages stimulate the osteogenic capacity of BMSCs ( 69 , 70 ). …