Choking, sore throat with referred otalgia and dysphagia in a patient with diffuse idiopathic skeletal hyperostosis (DISH).

A patient with a progressively increasing immobilisation of the cervical spine, severe impaired swallowing (choking), sore throat with referred right-sided otalgia, mild voice disorder and dysphagia due to extrinsic bone compression of the posterior hypopharyngeal wall and oesophagus is presented. Radiographic investigation demonstrated the underlying condition to be a diffuse idiopathic skeletal hyperostosis with prominent and bumpy alteration of the anterior longitudinal ligament impinging the hypopharynx. Via an anterolateral approach towards the cervical spine the anterior irregular part of the ossification was removed and the surface of the spine flattened.

Non-invasive diagnostic assessment of extensive vertebral artery tortuosity with enlargement of the intervertebral foramen.

Two cases with an incidental finding of a widened intervertebral foramen due to extensive tortuosity of the vertebral artery are presented. Computed tomography angiography and magnetic resonance imaging/magnetic resonance angiography (MRA) both proved to be useful as non-invasive techniques to provide the diagnosis. In-plane saturation is a disadvantage seen with the two-dimensional time-of-flight MRA technique.

[The muscular pump of the calf. Video-phlebography and simultaneous EMG].

Gastrocnemical insufficiency is a common syndrome (in modern society mainly affecting young females who have been taking the pill for several years). Often it is the starting point for superficial varicosis. The clinical diagnosis is easy, provided the doctor is informed of its symptoms.