Forestier’s disease presenting with dysphagia and dysphonia

Forestier’s disease, also known as diffuse idiopathic skeletal hyperostosis (DISH), is a pathology of the vertebral bodies characterised by exuberant osteophyte formation. Symptoms range from negligible back discomfort to, less commonly, debilitating dysphagia and airway disturbances. Conservative management including analgesia, chiropractic and diet modification are common and effective treatments. However, when conservative management fails to alleviate symptoms, particularly compressive symptoms, surgical management is indicated. We report a 55-year-old man presenting with 6 months’ progressive dysphagia and dysphonia. He was managed successfully with an anterior cervical osteophytectomy without fusion. A literature review is included.     

Monozygotic Twins With Trisomy 21 and Partial Agenesis of the Corpus Callosum

Trisomy 21 is the most common viable trisomy. Although it is invariably associated with mild to severe developmental delay and intellectual disability, no gross central nervous system malformation has been consistently identified in individuals with trisomy 21. We present the case of a monozygotic twin pregnancy in which both fetuses were identified as having trisomy 21 and partial agenesis of the corpus callosum. We discuss this rare association in the context of an emerging understanding of the neurobiology of trisomy 21.     

Why are we waiting? The relationship between low admission weight and end of treatment weight outcomes

Inpatient eating disorder units are increasingly being asked to admit patients at lower BMI's, often delaying hospital treatment until medically unavoidable. This paper aims to explore the impact of this trend on treatment outcome. Eighty‐two adults with anorexia nervosa admitted to a national inpatient eating disorder ward were assessed for BMI at admission, length of hospitalisation, discharge BMI and re‐admission within 1‐year post‐treatment. In the current study, admission BMI was unrelated to amount of weight gain during treatment or to length of hospital stay. As such patients admitted at lower BMI's had significantly lower BMI's on discharge from treatment. Low admission BMI's were related to significantly higher likelihoods of re‐admission within 1 year. This study provides strong evidence for the benefit of early treatment episodes and with more successful treatment outcomes being related to higher weights at start of treatment. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Insertion sequence IS1016 and absence of Haemophilus capsulation genes in the Brazilian purpuric fever clone of Haemophilus influenzae biogroup aegyptius.

Brazilian purpuric fever (BPF) strains of Haemophilus influenzae biogroup aegyptius form a clone of organisms distinct from more innocuous, conjunctivitis-associated isolates. There has been controversy over whether the virulence of BPF strains might derive from the presence of a polysaccharide capsule analogous to that found in conventional invasive H. influenzae, a controversy fuelled by the observation (G. M. Carlone, L. Gorelkin, L. L. Gheesling, A. L. Erwin, S. K. Hoiseth, M. H. O. Mulks, S. P. Connor, R. S. Weyant, J. Myrick, L. Rubin, R. S. Mumford III, E. H. White, R. J. Arko, B. Swaminathan, L. M. Graves, L. W. Mayer, M. K. Robinson, S. P. Caudill, and the Brazilian Purpuric Fever Study Group, J. Clin, Microbiol. 27:609-614, 1989) that a capsulation DNA probe from H. influenzae type b hybridized uniquely to BPF strains. In this work, the basis for this hybridization has been established as the possession by BPF strains, but not by non-BPF strains, of the Haemophilus insertion element IS1016. Although IS1016 is associated with the capsulation locus in some Haemophilus spp., a Southern hybridization study suggests that in BPF strains there are no capsulation genes.