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Tytuł:
Verojatnostnaja ocenka riska ostrogo profeccional'logo zabolevanija (otravlenija) rabotnikov sel'sko khozjajjstva pri obrashhenii s jadovitymi khimicheskimi beshhestvami
Probabilistic estimation of risk of acute professional disease (poisoning) of workers of agriculture at handling poisonous chemicals
Autorzy:
Gnatyuk, O.
Voynalovich, A.
Bilko, T.
Golod, V.
Powiązania:
https://bibliotekanauki.pl/articles/76491.pdf
Data publikacji:
2013
Wydawca:
Komisja Motoryzacji i Energetyki Rolnictwa
Tematy:
risk estimation
poisoning
professional disease
agricultural worker
acute disease
technological process
Opis:
Проведена вероятностная оценка риска острого профессионального заболевания (отравления) работников сельского хозяйства, использующих в технологическом процессе различные ядовитые химические вещества. Определены наиболее значимые производственные факторы, влияющие на возникновение опасной ситуации, связанной с возможностью отравления работников, применяющих данные вещества.
The probabilistic estimation of risk of the sharp professional disease (poisoning) of workers of agriculture, using different poisonous chemicals in a technological process, is conducted. The most meaningful productive factors, influencing on the origin of the nearaccident, related to possibility of poisoning of workers applying these substances, are certain.
Źródło:
Motrol. Motoryzacja i Energetyka Rolnictwa; 2013, 15, 3
1730-8658
Pojawia się w:
Motrol. Motoryzacja i Energetyka Rolnictwa
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
Acute intestinal amebiasis in a four-year-old girl - a case report
Autorzy:
Mrowka, K.
Kludkowska, M.
Stefaniak, J.
Powiązania:
https://bibliotekanauki.pl/articles/5799.pdf
Data publikacji:
2016
Wydawca:
Polskie Towarzystwo Parazytologiczne
Tematy:
acute intestinal disease
amoebiasis
4-year-old girl
girl
parasitic disease
gastrointestinal tract
human disease
Entamoeba histolytica
Źródło:
Annals of Parasitology; 2016, 62, Suppl.
0043-5163
Pojawia się w:
Annals of Parasitology
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
Development of system of automated protection of employees from COVID-19 and other infections at the enterprise
Autorzy:
Bochkovskyi, A. P.
Sapozhnikova, N. Yu.
Powiązania:
https://bibliotekanauki.pl/articles/2201030.pdf
Data publikacji:
2022
Wydawca:
Stowarzyszenie Komputerowej Nauki o Materiałach i Inżynierii Powierzchni w Gliwicach
Tematy:
safety and health management
COVID-19
acute occupational disease
quarantine regime
system of automated protection
zarządzanie bezpieczeństwem i higieną pracy
choroba zawodowa
kwarantanna
system ochrony
Opis:
Purpose: To develop a system of automated protection of employees from Covid-19 and other infections, it is implemented through minimizing the risks of contracting the SARS-CoV-2 virus and other respiratory viral infections within the enterprise. Design/methodology/approach: Analysis of legal normative documents and scientific and technical literature – to update the scientific problem and formulate the research tasks; methods of system analysis - to build the overall structure of the system and to establish relationships between its elements; simulation methods - to develop the algorithms of functioning and interaction of sensors and actuators of the corresponding subsystems; methods of decision theory and data mining - to develop the training programs and testing the knowledge of employees on epidemic safety. Findings: The system of automated protection of employees from Covid-19 and other infections was developed, which, due to the connection of functionally independent elements according to a certain scheme, allows minimizing the risk of contracting the SARS-CoV-2 virus and other respiratory viral infections of employees at the enterprise and increasing their protection from the occurrence of the corresponding infections by implementing a complex of anti-epidemic measures within the system and providing and constant support of the quarantine regime at the enterprise in accordance with WHO recommendations. The developed system was implemented and pilot tested at the industrial enterprise "Odessa Experimental Plant" (Odessa, Ukraine). Based on the results of the development of the system, an application was filed for obtaining a patent for invention No. a 202105894 dated 20.10.2021. Research limitations/implications: The number of system elements can change (increase/decrease) depending on the number of workplaces, as well as areas requiring control. Practical implications: The implementation of the proposed system allows increasing the level of economic sustainability of the enterprise in a complex epidemiological situation of the state or world level by minimizing the risks of enterprise shutdown as a result of the need to limit social and labour connections between employees due to implementation a full range of antiepidemic measures (in accordance with WHO recommendations) at the enterprise and constant compliance with the established quarantine regime by the employees at enterprise. Originality/value: For the first time, the system of automated protection of employees from Covid-19 and other infections was developed and proposed for use at enterprises, institutions and organizations, which, unlike others, allows the implementation of a full range of appropriate anti-epidemic measures at the enterprise (according to WHO recommendations) and ensure compliance with the established quarantine regime by the employees, due to the constant management of the sanitary-epidemic control modes of admission to the enterprise, disinfection of surfaces, ventilation and air decontamination of industrial premises etc.
Źródło:
Journal of Achievements in Materials and Manufacturing Engineering; 2022, 112, 2; 70--85
1734-8412
Pojawia się w:
Journal of Achievements in Materials and Manufacturing Engineering
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
Discovering diagnostic gene targets for early diagnosis of acute GVHD using methods of computational intelligence on gene expression data
Autorzy:
Fiasch'e, M.
Morabito, F. C.
Verma, A.
Kasabov, N.
Cuzzola, M.
Iacopino, P.
Powiązania:
https://bibliotekanauki.pl/articles/91634.pdf
Data publikacji:
2011
Wydawca:
Społeczna Akademia Nauk w Łodzi. Polskie Towarzystwo Sieci Neuronowych
Tematy:
acute graft-versus-host disease
aGVHD
haematopoietic stem cell transplantation
HSCT
immunologic attack
diagnosis
computational intelligence
gene expression data
Opis:
This is an application paper of applying standard methods of computational intelligence to identify diagnostic gene targets and to use them for a successful diagnosis of a medical problem - acute graft-versus-host disease (aGVHD). This is the major complication after allogeneic haematopoietic stem cell transplantation (HSCT) in which functional immune cells of donor, recognize the recipient as ”foreign” and mount an immunologic attack. In this paper we analyzed gene-expression profiles of 47 genes associated with allo-reactivity in 59 patients submitted to HSCT. We have applied different dimensionality reduction techniques of the variable space, combined with different classifiers to detect the aGVHD at onset of clinical signs. This is a preliminary study which utilises both computational and biological evidence for the involvement of a limited number of genes for the diagnosis of aGVHD. Directions for further studies are also outlined in this paper.
Źródło:
Journal of Artificial Intelligence and Soft Computing Research; 2011, 1, 1; 81-89
2083-2567
2449-6499
Pojawia się w:
Journal of Artificial Intelligence and Soft Computing Research
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
Evaluation of renal function in primary care
Autorzy:
Musiałowska, B.
Rudzińska, M.
Koc-Żórawska, E.
Żórawski, M.
Powiązania:
https://bibliotekanauki.pl/articles/1918735.pdf
Data publikacji:
2018
Wydawca:
Uniwersytet Medyczny w Białymstoku
Tematy:
chronic kidney disease
acute kidney injury
Primary Care
Opis:
Evaluation of renal function is one of the primary tools used in treatment and monitoring kidney injury such as acute kidney injury (AKI) or chronic kidney disease (CKD) in Primary Care patients. Accompanying chronic diseases also have an impact on the assessment of renal function, treatment monitoring and adjustment of drug doses.
Źródło:
Progress in Health Sciences; 2018, 8(2); 202-205
2083-1617
Pojawia się w:
Progress in Health Sciences
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
Mucormycosis in a patient with acute myeloblastic leukemia following liver transplantation for Wilson’s disease
Autorzy:
Łanocha, A.A.
Guzicka-Kazimierczak, R.
Zdziarska, B.
Wawrzynowicz-Syczewska, M.
Powiązania:
https://bibliotekanauki.pl/articles/2085182.pdf
Data publikacji:
2019
Wydawca:
Instytut Medycyny Wsi
Tematy:
Mucormycosis
acute myeloblastic leukemia
Willson’s disease
liver transplantation
Opis:
A case is presented of mucormycosis in a patient with acute myeloblastic leukemia following liver transplantation for Wilson’s disease. A 58-year-old female was admitted to the Department of Haematology with deterioration of her general condition, loss of appetite, tiredness and difficulty with mental contact for a few days. Blood and urine cultures for bacteria and fungus, galactomannan antigen were negative. Whole body computed tomography demonstrated bilateral hilar lymphadenopathy with necrotic lesions: splenomegaly with a hypodensive lesion 13 × 20 × 19 mm and lower pulmonary infiltrates suggested fungal etiology. Magnetic resonance imaging of the brain showed thickened meninges. Finally, mucormycosis was diagnosed. Treatment with amphotericin B lipid complex was started, resulting in an partial improvement of the general condition and decreased level of inflammatory markers. However, the patient’s condition continued to deteriorate, with sepsis etiology Escherichia coli, and despite the intensive managements she eventually died.
Źródło:
Annals of Agricultural and Environmental Medicine; 2019, 26, 4; 665-668
1232-1966
Pojawia się w:
Annals of Agricultural and Environmental Medicine
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
Uromodulin – biomarker of renal function with promising clinical application
Autorzy:
Chojęta, D.
Kozioł, M.M.
Smarz-Widelska, I.
Powiązania:
https://bibliotekanauki.pl/articles/2087806.pdf
Data publikacji:
2020
Wydawca:
Uniwersytet Opolski. Instytut Nauk o Zdrowiu
Tematy:
Tamm-Horsfall protein
chronic kidney disease
acute kidney failure
Umod
Opis:
Uromodulin (also known as Tamm-Horsfall protein) is a glycoprotein produced exclusively in the kidneys, mainly in the epithelial cells of the thick ascending limb of the loop of Henle. Under physiological conditions, it is the most abundant urinary protein. A small proportion is released into the renal interstitium and then into the blood, where it can be detected and used as a potential parameter of renal function. Uromodulin has numerous physiological roles and potential pathogenetic significance, including providing protection against urinary tract infections and the formation of urinary deposits, as well as being involved in the immunomodulatory functions and regulation of water and electrolyte balance by the kidneys. Unlike classic renal markers (such as creatinine), uromodulin levels decrease with progressive renal dysfunction. A significant advantage of this parameter is therefore the detectable changes in concentration at the early stages of development of chronic kidney disease. In addition, assessment in clinical materials, such as urine and blood, is relatively simple by immunoenzymatic methods. It is evident that the quantitative determination of uromodulin in blood serum is associated with a lower risk of laboratory error and has a better correlation with renal function. Based on previous studies, Tamm-Horsfall protein / uromodulin can be considered a valuable parameter for standard diagnostics of kidney function and renal diseases. It appears that no other marker is currently able to reflect the integrity and functional state of the renal tubules as sensitively as uromodulin. Due to the potential of this parameter, the article presents and overview of the current information available about uromodulin, as well as the available diagnostic tests and the frequency of their use in clinical practice.
Źródło:
Medical Science Pulse; 2020, 14, 3; 84-90
2544-1558
2544-1620
Pojawia się w:
Medical Science Pulse
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
A link between the COVID-19 pandemic and Kawasaki-like multi-system inflammatory syndrome in children
Autorzy:
Elshamaa, M.F.
Powiązania:
https://bibliotekanauki.pl/articles/2097986.pdf
Data publikacji:
2020
Wydawca:
Instytut Medycyny Wsi
Tematy:
COVID-19
severe acute respiratory syndrome
Kawasaki disease
pathogenesis
child
Opis:
Introduction. COVID-19 (coronavirus disease 2019) – the epidemic outbreak caused by coronavirus-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – is a global public health problem. Children are less affected and have a mild form of the illness. The association between SARS-CoV-2 disease, COVID-19 and late symptoms of vasculitis is often suspected, in particular in young asymptomatic patients, especially due to the post-viral immune response. Objective. The aim of the review is to describe the characteristics of children and adolescents affected by the development of Kawasaki-like mult-system inflammatory syndrome (KD) (MIS-C), and assesses its possible temporal association with SARS-CoV-2 infection. Brief description of the state of knowledge. A group of children who presented with KD-type MIS-C during the COVID-19 pandemic have been identified in the United Kingdom, the United States, and Italy. Some children were diagnosed with SARS- CoV-2 infection by real-time polymerase chain reaction and IgG antibodies. SARS-CoV-2 infection and hyperinflammation in COVID-19 can serve as an ‘initial trigger’ for KD. IVIG should be administered within seven days of onset of illness until KD symptoms disappear and COVID-19 test is negative. Large numbers of children in African countries with the SARS-CoV-2 epidemic are likely to be affected by KD, and in such cases, a shortage of IVIG supplies is expected. Conclusions. This article suggests a correlation between COVID-19 and Kawasaki-like MIS-C, which is important for the care of sick children. However, the definitive relationship between childhood KD and COVID-19 needs to be confirmed by a large cohort study on a large numbers of infant and children patients worldwide.
Źródło:
Journal of Pre-Clinical and Clinical Research; 2020, 14, 4; 151-155
1898-2395
Pojawia się w:
Journal of Pre-Clinical and Clinical Research
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
Effectiveness of novel iron regulators in the treatment of diabetic nephropathy
Autorzy:
Banerjee, Dekai
Kaur, Ginpreet
Chatterjee, Bappaditya
Joshi, Hemant
Ramniwas, Seema
Singh Tuli, Hardeep
Powiązania:
https://bibliotekanauki.pl/articles/29519511.pdf
Data publikacji:
2023-09-30
Wydawca:
Uniwersytet Rzeszowski. Wydawnictwo Uniwersytetu Rzeszowskiego
Tematy:
acute kidney injury
chronic kidney disease
end-stage renal disease
iron chelators
renal iron handling
Opis:
Introduction and aim. The novel advancements of upcoming iron regulators used to treat diabetic nephropathy have implicated a common manifestation of combination chelation therapy used to eliminate end-stage renal disease associated with inflammation and iron imbalance that is altered by renal iron absorption. However, iron accumulation in the clustered kidneys that filter blood may cause problems that affect diabetic blood sugar regulation. Material and methods. A well-designed method was employed to discover relevant research publications on iron chelators and their potential to treat diabetic nephropathy. “Iron chelators”, “diabetic nephropathy”, “end-stage renal disease”, and “chelation therapy” were searched in Google Scholar, Web of Science, PubMed, and EMBASE. Analysis of literature. Although the specific etiology and development have not been fully explored, emerging evidence on iron pathophysiology helps comprehend the pathogenesis of acute kidney damage and chronic kidney disease, which crucially provides novel iron chelation therapy techniques. Ferroptosis and hepcidin marker proteins increase oxidative/nitrifying stress and kidney injury. Iron chelator medicines including deferoxamine, deferasirox, and deferiprone were tested as prophylactic strategies. Conclusion. This article covers both preclinical and clinical aspects of iron chelators to avoid diabetic nephropathy, including novel iron therapies that must be reviewed when selecting dosing regimens.
Źródło:
European Journal of Clinical and Experimental Medicine; 2023, 3; 639-647
2544-2406
2544-1361
Pojawia się w:
European Journal of Clinical and Experimental Medicine
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
Ostre zespoły wieńcowe
Acute coronary syndromes
Autorzy:
Ochyńska, Olga
Pieniacka, Magdalena
Powiązania:
https://bibliotekanauki.pl/articles/470130.pdf
Data publikacji:
2012
Wydawca:
Europejskie Centrum Kształcenia Podyplomowego
Tematy:
ostry zespół wieńcowy
choroba
zdrowie
acute coronary syndrome
disease
health
Opis:
Ostry zespół wieńcowy jest coraz częściej występującą chorobą, dotykającą coraz młodsze osoby. Najczęściej choroba ta wywoływana jest przez samych chorych, którzy prowadzą nieodpowiedni tryb życia, ze zbyt dużą ilością stresu, nieprawidłową dietą oraz unikają kontaktu z lekarzem. Wraz z postępem medycyny można szybciej wdrożyć odpowiednie leczenie, a nawet zapobiegać chorobie. Celem naszej pracy było przedstawienie problemu, jakim są ostre zespoły wieńcowe, ich następstwa oraz wykazanie, że nasze zdrowie jest zależne od naszego trybu życia.
Acute coronary syndromes is more occurring disease, which is affecting younger people. Mostly this disease is caused by patients, who have wrong lifestyle with a lot of stress, wrong diet and they don’t go to the physician. With medicine progress we can earlier implement right treatment even we can prevent disease. The target of our work was showing the problem which is acute coronary syndromes, their aftermaths and show that our health is dependent from our lifestyle.
Źródło:
Współczesne Pielęgniarstwo i Ochrona Zdrowia; 2012, 2; 40-44
2084-4212
Pojawia się w:
Współczesne Pielęgniarstwo i Ochrona Zdrowia
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
Acute collective gas poisoning at work in a manure storage tank
Autorzy:
Zaba, Cz.
Marcinkowski, J.T.
Wojtyla, A.
Tezyk, A.
Tobolski, J.
Zaba, Z.
Powiązania:
https://bibliotekanauki.pl/articles/50197.pdf
Data publikacji:
2011
Wydawca:
Instytut Medycyny Wsi
Tematy:
acute poisoning
collective poisoning
manure
storage tank
occupational disease
environment protection
Źródło:
Annals of Agricultural and Environmental Medicine; 2011, 18, 2
1232-1966
Pojawia się w:
Annals of Agricultural and Environmental Medicine
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
Patient with metastatic breast cancer presenting as acute cholecystitis with one-year survival on hormonotherapy
Autorzy:
Zamkowski, Mateusz
Kąkol, Michał
Makarewicz, Wojciech
Ropel, Jerzy
Bobowicz, Maciej
Powiązania:
https://bibliotekanauki.pl/articles/1392993.pdf
Data publikacji:
2017
Wydawca:
Index Copernicus International
Tematy:
breast neoplasm
advanced cancer
metastatic disease
Acute cholecystitis
gallbladder
laparoscopic cholecystectomy
Opis:
Breast cancer has high metastatic potential with distant metastases involving mainly lungs, liver and bones. Less frequently it gives distant spread to other organs. Herein we would like to present a very rare case of an acute cholecystitis which turned out to be a metastatic breast cancer in previously healthy woman. A female patient, 64-years old, presented to the emergency department with symptoms of biliary colic and acute abdomen. During the emergency cholecystectomy, we diagnosed the gallbladder empyema with thickened wall. There were also multiple metastatic nodules in the peritoneal cavity and an excessive amount of free fluid. The emergency physicians diagnosing female patient with the acute abdominal symptoms and a breast cancer history might suspect malignant spread into abdominal organs including gallbladder. On the other hand, acute cholecystitis symptoms might be the first symptoms of metastatic process in the gallbladder from the unknown primary source, which may be breast.
Źródło:
Polish Journal of Surgery; 2017, 89, 4; 46-49
0032-373X
2299-2847
Pojawia się w:
Polish Journal of Surgery
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
Empirical first-line antibioticotherapy in adult rural patients with acute respiratory tract infections
Autorzy:
Panasiuk, L
Lukas, W.
Paprzycki, P.
Powiązania:
https://bibliotekanauki.pl/articles/49984.pdf
Data publikacji:
2007
Wydawca:
Instytut Medycyny Wsi
Tematy:
human disease
rural patient
acute respiratory tract infection
antibiotic
therapy
respiratory tract infection
rural population
Opis:
The objective of the study was the evaluation of the frequency of occurrence of acute respiratory infections among rural population from the Lublin Region, and verifi cation of the appropriateness of the use of antibiotics in empirical fi rst-line therapy of these diseases. The analysis covered medical records concerning 1,839 patients selected from 27 rural health centres within the period of one year (1 September 2005–31 August 2006). As many as 656 patient visits were recorded, the reasons for which were qualifi ed by physicians as infections of the upper and lower airways. These disorders were diagnosed in 450 patients, which constituted 24.46% of the population examined. The following diagnoses were most frequently made: acute pharyngitis and tonsillitis (31.25% of the total number of diagnoses), acute upper respiratory infections of multiple and unspecifi ed sites (22.25%), and common cold (21.64%). Antibiotics were used in empirical fi rst-line therapy in as many as 82% of the total number of patients. The analysis showed that in the great majority of cases the use of antibiotics was inappropriate. If this situation persists, in the near future it will lead to an increase in the phenomenon of antibioticoresistance in Poland. In order to prevent this situation, it is necessary to carry out an extensive educational action concerning the hazardous effect of excessive use of antibiotics, both among physicians and the whole society.
Źródło:
Annals of Agricultural and Environmental Medicine; 2007, 14, 2
1232-1966
Pojawia się w:
Annals of Agricultural and Environmental Medicine
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
Neurotropism of SARS-CoV-2 in idiopathic hearing disorders
Autorzy:
Krasowska, S.
Powiązania:
https://bibliotekanauki.pl/articles/2098497.pdf
Data publikacji:
2021
Wydawca:
Instytut Medycyny Wsi
Tematy:
severe acute respiratory syndrome-coronavirus-2
smell dysfunction
taste dusfunction
otolaryngological disease
nervous system
global crisis
Opis:
Introduction and objective. The article focuses mainly on SARS-CoV-2 neurotropism and its consequences for hearing and otolaryngological disorders. The leading hypotheses regarding the mechanisms of the virus internalisation as well as its influence on the nervous system in extenso are presented, as well as the latest available knowledge, after a selective choice of articles relating to the subject. Brief description of the state of knowledge. Dizziness, tinnitus and sudden hearing loss are the main symptoms in the organ of hearing and balance, but it is often not possibile to objectively investigate their etiology and make a proper diagnosis. Among the most common causes of hearing disorders, such as vestibular neuritis, sudden sensorineural hearing loss and tinnitus, there are infections, injuries, and diseases that predispose to the occurrence of symptoms of hearing disorders. Despite the numerous possible causes, a high percentage of clinical symptoms still remain without diagnosis. Conclusions. The global health crisis has provoked a change in the perspective of thinking about infections and the consequences of viral infections; it haalso given rise to a new perception and conceptualisation of the impact of infections on other human systems. The challenge faced by scientists due to this virus is multi-dimensional, and it requires explication and reinterpretation of the knowledge to-date. It even forces us to retrospect the existing explanations of the known disorders, as well as to conduct prospective correlative studies that will help in understand the mechanisms of SARS-CoV-2 pathogenesis, and consequentl, to be able to establish a management pattern in order to prevent the spread of the virus causing the pandemic.
Źródło:
Journal of Pre-Clinical and Clinical Research; 2021, 15, 2; 100-103
1898-2395
Pojawia się w:
Journal of Pre-Clinical and Clinical Research
Dostawca treści:
Biblioteka Nauki
Artykuł
Tytuł:
Acute dyspnea as a manifestation of Forestiers disease. A case report
Autorzy:
Kuryłowicz, Jagoda
Stodulski, Dominik
Garsta, Ewa
Mikaszewski, Bogusław
Powiązania:
https://bibliotekanauki.pl/articles/1398952.pdf
Data publikacji:
2021
Wydawca:
Index Copernicus International
Tematy:
acute laryngeal dyspnea
diffuse idiopathic skeletal hyperostosis
dysphagia
Forestier’s disease
laryngeal oedema
otolaryngological symptoms
stridor
tracheotomy
Opis:
Introduction: Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier’s disease, is a noninflammatory disease and is characterized by ossification of the anterolateral aspect of vertebral bodies, mostly in thoracic part of the spine. Although, usually, DISH is asymptomatic, in rare cases osteophytes located in the cervical part of the spine can cause otolaryngological manifestations, such as dysphagia (most common), hoarseness and stridor Case report: In differential diagnosis of upper respiratory tract symptoms, we should consider DISH. We present case of 82-years old male patient with acute dyspnea, who was diagnosed with osteophytes of C4–C7 vertebral bodies. In this case conservative therapy was not efficient, therefore successful surgical treatment was performed. BMI – Body Mass IndexCRP – C Reactive Protein CT – computed tomography DISH – diffuse idiopathic skeletal hyperostosis GERD – gastro-esophageal reflux disease MRI – magnetic resonance imaging NSAIDs – nonsteroidal anti-inflammatory drugs ORL PPI – proton pump inhibitors Diffuse idiopathic skeletal hypMRerostosis (DISH), also known as Forestier’s disease, was first described under the name “senile ankylosing hyperostisis of the spine” by Jacques Forestier in 1950 [1]. It is a noninflammatory disease, characterized by ossification of the anterolateral aspect of vertebral bodies, mostly in thoracic part of the spine. It may also involve enthesopathy of the extremities. Forestier’s disease is a rather common condition, which affects approximately 40% of older (>65 years old) male patients. Prevalence of DISH increases with age (56% for age >80 years old), BMI and blood pressure [2] and is associated with diabetes mellitus, elevated insulin-like growth factor and hyperuricemia [3].Although usually DISH is asymptomatic, in rare cases osteophytes located in the cervical part of the spine can cause otolaryngological manifestations, such as dysphagia (most common), hoarseness and stridor [4–10]. null null null null An 82-years old man was admitted to the Department of Otolaryngology due to acute dyspnea with stridor at rest. Respiratory disorder was progressing for 2 months. Moreover, patient complained of dysphagia and hoarseness, which were present for a year. The patient was diagnosed with GERD and treatment was administrated. Medical history was significant of duodenal ulcer with perforation and prostate cancer treated with hormonal therapy for 13 months. Flexible nasopharyngoscopy revealed large mass protruding from the posterior wall of hypopharynx and oedema, which concealed interarytenoid notch and partly rima glottis (Fig. 1.). No other abnormalities in ORL examination were present. Increased CRP level and impaired fasting glucose were found in laboratory tests during hospitalization. CT (Fig. 2.) and MRI (Fig. 3.) revealed massive osteophytes on the anterior part of vertebral bodies C4–C7 without intervertebral disc space narrowing, thickened vestibular folds and peri-arytenoid region. X-ray revealed no changes in sacro-iliac joints. Hypopharyngoscopy and microlaryngoscopy were performed in due to rule out neoplastic changes. Antibiotis, steroids and high doses of PPI (proton pump inhibitors) were administered, resulting in oedema decrease and resolution of the symptoms. After 7 months patient was hospitalized again, due to acute dyspnea and stridor. Increased CRP level was found in laboratory tests. Despite conservative therapy (corticosteroids, antibiotics and PPI) no significant respiratory improvement was achieved, therefore decision on surgical treatment was made. Patient was referred to the Department of Neurosurgery where, after elective tracheotomy, cervical osteophytes (C2–C5) were removed, using an anterolateral transcervical approach, without any complications (Fig. 4.). Because of postoperative laryngeal and hypopharyngeal oedema, steroid therapy was maintained. Decannulation was performed on 7th postoperative day, although patient complained of more severe dysphagia with aspiration while swallowing. Nasogastric feeding tube was inserted for 3 weeks. At the 6-month follow up dyspnea and dysphagia are absent, patient successfully swallows solid food and liquids. Endoscopic examination revealed only small protrusion and minor oedema on posterior wall of hypopharynx on the level of arytenoids (Fig. 5., 6.). null null Forestier’s disease otolaryngological manifestations are extremely rare. The most common symptom is dysphagia, aside from it aspiration [11], dyspnea (with or without stridor) and hoarseness [4].Our patient’s main complaint and reason of hospitalization was dyspnea, while dysphagia was secondary problem. Foregoing symptoms can occur not only due to osteophytes compression on larynx and esophagus, but also because of chronic inflammation and chronic or recurrent edema caused by mechanic irritation. Other symptoms, such as aspiration while swallowing, can be caused by impaired movability of epiglottis or vocal chords [8, 11].In presented case symptoms (especially dyspnoe) were increasing during upper respiratory tract infections and due to exacerbation of GERD.In literature authors described similar cases, where inflammation led to oedema, chronic or remitting during infection, which worsened patient’s condition [12, 13] and caused respiratory decompensation, necessitating even urgent tracheotomy [10].During diagnosis of DISH with otolaryngologic manifestations, mirror laryngoscopy and fiberoscopy should be performed. It can reveal fine, firm protrusion on the posterior wall of pharynx, accompanied by oedema and impaired movability of larynx [8].In differential diagnosis of protrusion on the posterior wall of pharynx we should consider retropharyngeal pathologies, such as malignant tumors (including lymphoma), benign tumors, metastases, congenital defects (e.g. vascular malformations), lymphadenopathy, retropharyngeal abscess or massive oedema. Imaging (CT, MRI) can rule out these diseases [14].Forestier’s disease should also be distinguished from other pathologies, which involve vertebral bodies, including ankylosing spondylitis, osteophytes in osteoarthritis or osteomas [3]. Differential diagnosis can be based on Resnick’s radiological classification criteria of DISH [15]: presence of flowing calcification and ossification along with the anterolateral aspects of at least four contiguous vertebral bodies, relative preservation of intervertebral disc height in the involved vertebral segments and absence of apophyseal joint bony ankylosis and sacro-iliac joint erosion, sclerosis or bony fusion.In cases with dysphagia being the main patient’s complaint, esophagogram with barium swallowing should be performed [5, 9, 11]. Elective panendoscopy with biopsy should always be considered to rule out neoplasm [5, 16].If DISH is diagnosed accidently in imaging, we can assume an expectant attitude. Conservative treatment with NSAIDs, steroids and dietary measures can be introduced in cases without weight loss and with minor respiratory symptoms. Gastroesophageal reflux can be symptom-worsening factor, therefore PPI treatment should be considered. If conservative treatment is not effective, osteophytes’ surgical removal is recommended, preferably using anterolateral approach [16].In our case, conservative therapy was not sufficient. Massive hypopharyngeal oedema and stridor were present in spite of high doses of corticosteroids. Due to the pre-operative oedema we decided to perform an elective tracheotomy before neurosurgical intervention, to avoid possible complications [13].It is remarkable, that after surgery dyspnea resolved after few days, whilst dysphagia and aspiration worsened in post-operative time and nasogastric tube insertion was necessary.Authors present this case in aim to draw attention to Forestier’s disease as possible reason for respiratory and gastrointestinal symptoms among elderly people.
Źródło:
Polski Przegląd Otorynolaryngologiczny; 2021, 10, 1; 49-52
2084-5308
2300-7338
Pojawia się w:
Polski Przegląd Otorynolaryngologiczny
Dostawca treści:
Biblioteka Nauki
Artykuł
Wyświetlanie 1-15 z 28

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