ABSTRACT
The principal objective of this investigation was to analyze the association between diffuse idiopathic skeletal hyperostosis (DISH) and the presence of aortic valve sclerosis (AVS). For this study we used results from 1000 consecutive outpatients (473 males), older than 50 years of age (average 67.6 years), that had been examined with Doppler echocardiogram and anterior and lateral chest radiographs. Overall, 195 patients (19.5%) were diagnosed with DISH and 283 (28.3%) with AVS. DISH was more prevalent than AVS in males (66.7% vs. 42.6%, p< 0.0001) and in older patients (73.6 ± 9 years vs. 66.1 ± 9 years, p < 0.0001). Furthermore, 55.4% of patients with dorsal DISH presented aortic sclerosis calcification vs. 21.7% of patients free of DISH (OR = 4.47; 95% CI = 3.22-6.21). The adjusted odds ratio (OR) was calculated by sex and age resulting in 3.04 (95% CI = 2.12-4.36; p < .0001). A statistically significant association was found between DISH and AVS in accordance to age and sex. The biological plausibility of this association is based on similar risk factors, pathogenic mechanisms and vascular complications.
Subject(s)
Aortic Valve Stenosis/etiology , Aortic Valve/pathology , Hyperostosis, Diffuse Idiopathic Skeletal/complications , Hyperostosis, Diffuse Idiopathic Skeletal/pathology , Vascular Calcification/complications , Age Factors , Aged , Aged, 80 and over , Echocardiography, Doppler , Female , Humans , Hyperostosis, Diffuse Idiopathic Skeletal/epidemiology , Logistic Models , Male , Middle Aged , Mitral Valve/pathology , Odds Ratio , Prevalence , Radiography, Thoracic , Risk Factors , Sclerosis , Sex FactorsABSTRACT
The principal objective of this investigation was to analyze the association between diffuse idiopathic skeletal hyperostosis (DISH) and the presence of aortic valve sclerosis (AVS). For this study we used results from 1000 consecutive outpatients (473 males), older than 50 years of age (average 67.6 years), that had been examined with Doppler echocardiogram and anterior and lateral chest radiographs. Overall, 195 patients (19.5%) were diagnosed with DISH and 283 (28.3%) with AVS. DISH was more prevalent than AVS in males (66.7% vs. 42.6%, p< 0.0001) and in older patients (73.6 ± 9 years vs. 66.1 ± 9 years, p < 0.0001). Furthermore, 55.4% of patients with dorsal DISH presented aortic sclerosis calcification vs. 21.7% of patients free of DISH (OR = 4.47; 95% CI = 3.22-6.21). The adjusted odds ratio (OR) was calculated by sex and age resulting in 3.04 (95% CI = 2.12-4.36; p < .0001). A statistically significant association was found between DISH and AVS in accordance to age and sex. The biological plausibility of this association is based on similar risk factors, pathogenic mechanisms and vascular complications.
El objetivo principal fue analizar la asociación entre la hiperostosis esquelética idiopática difusa (DISH) y la presencia de esclerosis valvular aórtica (AVS). Se evaluaron los resultados de 1000 pacientes ambulatorios consecutivos (473 varones), mayores de 50 años (promedio, 67.6 años), que habían sido examinados con un ecocardiograma Doppler y radiología torácica anterior y lateral. Globalmente, 195 pacientes (19.5%) tuvieron diagnóstico de DISH y 283 (28.3%) de AVS. DISH fue más prevalente que AVS en varones (66.7% vs. 42.6%, p < 0.0001) y en pacientes de mayor edad (73.6 ± 9 años vs. 66.1 ± 9 años, p < 0.0001). Además, 55.4% de los pacientes con DISH dorsal presentaron AVS vs. 21.7% de los pacientes sin DISH (OR = 4.47; 95% CI = 3.22-6.21). El odds ratio (OR) ajustado por sexo y edad fue 3.04 (95% CI = 2.12-4.36; p < 0.0001). Se encontró una asociación estadísticamente significativa entre DISH y AVS, que se mantuvo después de ajustar por sexo y edad. La plausibilidad biológica de esta asociación se basa en los factores de riesgo, mecanismos patogénicos y complicaciones vasculares compartidos.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Aortic Valve Stenosis/etiology , Aortic Valve/pathology , Hyperostosis, Diffuse Idiopathic Skeletal/complications , Hyperostosis, Diffuse Idiopathic Skeletal/pathology , Vascular Calcification/complications , Age Factors , Echocardiography, Doppler , Hyperostosis, Diffuse Idiopathic Skeletal/epidemiology , Logistic Models , Mitral Valve/pathology , Odds Ratio , Prevalence , Radiography, Thoracic , Risk Factors , Sclerosis , Sex FactorsABSTRACT
BACKGROUND: Forestier disease is a systemic disorder characterized by ossification of the anterior spinal longitudinal ligament (ALL) in at least three adjacent vertebrae, and diffuse spinal enthesopathy. Indication for surgical treatment is rare and limited to cases of related myelopathy, fracture or significant dysphagia. Few cases of surgical treatment are reported in the medical literature. Surgical treatment depends on the particular symptoms or complications, and usually involves osteophytectomy through the standard anterior approach. Surgery may bring about complications, such as pharyngeal paralysis, thrombosis, infections and respiratory obstruction. CLINICAL CASE: 79-year old male with dysphagia of 10 years of evolution, and hoarseness and respiratory distress since 8 years ago. Screening studies showed a diffuse calcification of anterior longitudinal ligament along with large cervical osteophytes. Forestier disease and secondary dysphagia were diagnosed. Surgical treatment consisted of resection of bone exostoses in C4 and C5 vertebral bodies. Six months after surgery, the patient reported improvement of esophageal and respiratory symptoms without evidence of recurrence on imaging studies. CONCLUSIONS: Data on Forestier disease's epidemiological nature and impact on life quality in Mexico is unknown. An increase in its occurrence is projected as the Mexican population ages. An observational study is required to identify the characteristics of this disease in Mexico.
Subject(s)
Cervical Vertebrae/surgery , Hyperostosis, Diffuse Idiopathic Skeletal/surgery , Aged , Deglutition Disorders/etiology , Diagnosis, Differential , Hoarseness/etiology , Humans , Hyperostosis, Diffuse Idiopathic Skeletal/complications , Hyperostosis, Diffuse Idiopathic Skeletal/diagnosis , Hyperostosis, Diffuse Idiopathic Skeletal/epidemiology , Male , Mexico/epidemiology , Population Dynamics , Respiration Disorders/etiology , Spondylitis, Ankylosing/diagnosisABSTRACT
Bioarchaeological research of ancient Amerindians was undertaken to test the hypothesis that seronegative spondyloarthropathies (SNS) and diffuse idiopathic skeletal hyperostosis (DISH) existed in prehistoric South Americans. An osteological-radiographic model was developed from clinical literature and systematically applied to 504 archaeological human remains housed at the Universidad de Tarapacá in Arica, Chile, to search for evidence of these arthritides. The results showed that SNS existed with an average frequency of 7% for the adult sample and DISH averaged 4% in individuals over 40 years old. It was found that the antiquity of SNS date back at least 5,000 years in both New World and Old World populations. In contrast, the antiquity of DISH in the Americas is not clear because no previous studies have dealt with this subject; however, this research finds mild DISH cases dating back 4,000 years in northern Chile. It was also found that SNS and DISH exhibit a trend of increasing incidence with the advent of agro-pastoral activities and village formation.