Clinical Case Reports for the Evidence-Based Era

Currently, syphilis is a growing epidemiological problem, as evidenced by the growing number of new infections, also in Poland [1]. A negative phenomenon is the increasing incidence of late-stage Treponema pallidum infections, including syphilis of the central nervous system (CNS) [2]. In advanced stages of syphilis, and especially in neurosyphilis, the risk of permanent complications increases, including tenesmus dorsi, progressive paralysis, stroke, and others [3]. CNS syphilis poses a significant diagnostic challenge because the symptoms of infection can mimic other primary CNS diseases or systemic diseases with secondary CNS involvement. Therefore, it is often called "the great imitator" [4, 5, 6, 7].

Foreign body ingestion is more common in children than in adults, but serious complications are less common in pediatric patients [1, 2]. Among adults, elderly individuals, those with masticatory disorders, esophageal strictures, prisoners, and patients with mental disorders predominate [2-4]. 80-90% of swallowed foreign bodies pass through the upper gastrointestinal tract spontaneously, but 10-20% require endoscopic removal, and 1% cause complications [3,5]. Possible locations of foreign bodies in the midpharynx include the epiglottis, the base of the tongue, the palatine tonsils, and in the hypopharynx, the piriform recesses, the retrocricoid region, and the posterior pharyngeal wall [6, 7]. In the esophagus, foreign bodies are located in the cervical part in over 80% of cases [1, 2, 8]. It is rare for a swallowed foreign body to penetrate the gastrointestinal tract and migrate deep into the soft tissues. This may be facilitated by the foreign body's structure, e.g., sharp-edged pieces of bone or glass. This poses a risk of serious and potentially fatal complications, such as retropharyngeal abscess, mediastinitis, or damage to the large vessels of the neck [7]. In such cases, prompt intervention and removal of the foreign body are essential. We present the case of a patient with a foreign body that migrated from the hypopharynx into the soft tissues of the neck, directly adjacent to the common carotid artery.

Polymyalgia rheumatica (PMR) is one of the most common rheumatic diseases diagnosed in people over 50 years of age. Its incidence increases with age, reaching a peak at 72-73 years of age (PMR is rarely diagnosed in the 50-year-old population) [1]. Statistically, it affects women twice as often. A greater predisposition is also observed in the white race [2]. In Europe, the incidence is on average 1 in 133 people over 50 years of age [3]. There is also a clear geographical variation – the vast majority of diagnoses occur in Northern European countries, particularly Sweden, while in Southern Europe, for example, in Italy, it is much less frequently diagnosed. The etiology of the disease has not been fully elucidated. It is assumed that autoimmune processes underlie it. The role of solar radiation and viral infections has also been suggested [2]. Typical symptoms of polymyalgia include pain and stiffness in the neck, shoulder girdle, and hip muscles [1,2]. PMR belongs to a group of inflammatory diseases with an immune basis. Its etiology also includes a genetic predisposition, including the involvement of antigens: HLA-DR4, HLADRB1*04, and proinflammatory cytokines: TNFα and IL6. Some studies have also demonstrated reduced secretion of adrenal cortex hormones (cortisol, dehydroepiandrosterone) in individuals affected by this condition [4]. The variety of factors postulated to play a significant role in the development of PMR indicates the need for further research into the etiology of this disease.

It is my great pleasure to present a special edition of our Journal, printed for the occasion of the 7th Annual Congress of the European Society of Paediatric Endoscopic Surgeons (ESPES)! In this issue you can find regular case reports submitted to the Journal and all abstracts of ESPES 2017 Congress (September 27th — 29th Wroclaw, Poland). Professor Dariusz Patkowski, a member of our Scientific Council, is the Congress Chairman. All abstracts will be also available after Congress on the journal’s website — www.MDcase.net.