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Focal nodular hyperplasia with calcification and ossification.

We describe a 33-year-old woman with Crohn's disease, who presented with recurrent episodes of small bowel obstruction. A solitary liver lesion was discovered incidentally by abdominal ultrasound. Pathological examination of the resected specimen revealed features typical of focal nodular hyperplasia together with uncommon findings including calcification, ossification and fibrous obliteration of blood-filled "cysts", changes more commonly associated with regression in hepatic haemangiomas. This report strengthens the favoured hypothesis that a vascular malformation underlies the pathogenesis of focal nodular hyperplasia.

Adult↗

[Cleidocranial dysostosis. Presentation of a case].

INTRODUCTION: Cleidocranial dysostosis is a syndrome defined by three characteristic findings: clavicular aplasia, retarded cranial ossification, and autosomic dominant hereditary transmission, with completed penetrance and full expression. However, the diagnosis cannot only be made based on those finding, because the polymorphism and extension of the lesions of this disease is important. Therefore, in this disease we can see upset in the second teething, short stature or dwarf, persistence of the biconvex appearance of vertebral body, bone hypoplastic iliac, retarded pubis branch ossification, wedge shape distal phalanges or with brachymesophalangia of the forefinger and fifth finger. CLINICAL CASE: We describe a 20 years old man, with cleidocranial dysostosis, without familiar antecedent (probable mutation), that come to our center for treatment of denture pathology with disabled eating, because anomalous distribution and eruption. He had clavicle agenesis, cranial ossification upset with wormian bones, vertebral bodies biconvex, superior maxillary hypoplastic, and dental packed in the superior maxillary and jawbone. CONCLUSIONS: Cleidocranial dysostosis is a hereditary disease, which can be of spontaneous apparition (mutation), has a grand polymorphism, affect the osseous development, predominate in the middle line membranous bone and is an entity of radiologic diagnosis.

Adult↗

The 'Dejerines': an historical review and homage to two pioneers in the field of neurology and their contribution to the understanding of spinal cord pathology.

Our purpose, in this number of Spinal Cord devoted to the French speaking Society of Paraplegia (AFIGAP), is to render homage to two very distinguished doctors, who by their work at the end of the XIXth and the beginning of our century contributed greatly to our knowledge of the nervous system and in particular the spinal cord (SC). This was at the time a field of considerable interest in France and abroad. Professor Jules Dejerine was from 1911-1917 the holder of the Chair for Nervous System Diseases created for Charcot. Dejerine and his American born wife, Augusta Klumpke, and had very limited means for investigation compared to actual technological advances. They relied mainly on their superb clinical observations and neuropathological examinations. Dejerine was also a pioneer in the growing field of neuroanatomy. In 1895 he published a treatise on the anatomy of the nervous system, which is still considered worldwide to be a masterpiece. Augusta Dejerine-Klumpke, the first woman Intern in Paris Hospitals, was not only a fine clinician, neuroanatomist and pathologist, but also contributed greatly to her husband's work. Amongst other things she is known for the 'Klumpke palsy'. She was also a pioneer in France, during the First World War and subsequent following years, in the treatment and rehabilitation (medical and vocational) of the large number of soldiers afflicted by wounds of the nervous system and especially of the SC. During the same period, many authors contributed to SC pathology, but only a few to the treatment and rehabilitation of these patients. This was brought to our attention, in the sixties, by Professor Pierre Houssa, pioneer in Belgium in the field of comprehensive care of those who have SC lesions. Augusta Dejerine-Klumpke also contributed to our present knowledge of heterotopic ossification following a SC injury, including its pathogenesis. Most of their clinical and pathological findings and discussions are recorded in Dejerine's famous monograph which was published in 1914: La séméiologie des Affections du Système Nerveux (The Semiology of the Diseases of the Nervous System).

History, 20th Century↗

A case of abnormal findings in the course of the vertebral artery associated with an ossified hyoid apparatus. A contraindication for manipulation of the cervical spine?

OBJECTIVE: To describe a case of a simultaneous occurrence of an ossified stylohyoid ligament in a 56-year-old male cadaver and anomalies of the vertebral artery, and to consider the clinical implications for manipulative therapists. INTERVENTION AND OUTCOME: Dissection showed a simultaneous occurrence of complete developmental ossification of the left hyoid apparatus, variants of the vertebral artery, and a left superior vena cava in a 56-year-old male cadaver. DISCUSSION: Developmental variants, posttraumatic and degenerative changes of the hyoid apparatus may result in variable degrees of ossification or calcification. CONCLUSION: This unusual disorder should be considered in the differential diagnosis of facial and neck pain especially within the scope of manipulation of the upper cervical spine. Cervical spine manipulation may exacerbate existing pathological conditions of the stylohyoid apparatus, thereby irritating neurovascular structures, and induce a fracture. Developmental ossification of this apparatus might be associated with anomalies in the atlantic section of the vertebral artery which make the patient more susceptible to vertebrobasilar insufficiency. We conclude that extreme care should be taken in the presence of such an ossification to avoid trauma to the stylohyoid apparatus and maybe even because of increased vertebrobasilar risk.

Cadaver↗

Fracture of a bipartite medial cuneiform synchondrosis.

We report the occurrence of a bipartition and occult growth plate fracture in the medial cuneiform of a 5-year, 11-month-old traumatic amputee. Initial radiographs of the foot taken in an oblique projection revealed what appeared to be an osseous fracture of the medial cuneiform. Histologic examination of the pathologic specimen showed that the radiolucent cleft separating the two foci of ossification was actually a hyaline synchondrosis (growth plate) functioning in the normal endochondral transformation of the bone. Histology also detailed a previously undetected fracture traversing the synchondrosis that was sustained during the accident. This unusual case demonstrates that radiographic discontinuity often does not correspond to anatomic discontinuity and should not be misdiagnosed as an osseous fracture. Yet, as with all growth plates of the chondro-osseous skeleton, occult injury to the growth mechanism should be suspected in instances of obvious trauma. Discriminating between normal development of the skeleton and skeletal pathology can be a challenge to the treating physician. Therefore, an awareness of possible anatomic variations will enhance diagnostic evaluations.

Child, Preschool↗

[The collateral ligaments of the elbow joint: their functional anatomy with special reference to the pathology and treatment of post-traumatic stiff elbow].

Factors which cause stiff elbow were investigated both experimentally and clinically. Since a thickened and shortened medial collateral ligament is often seen in stiff elbow, then changes in the length of the medial collateral ligament (MCL) and in the length of the lateral collateral ligament (LCL) were investigated in cadaver elbow specimens, and correlated with the observed range of motion. The MCL was divided into five bundles, and the LCL into three bundles. The length changes during flexion and extension of the elbow joint were measured, and the length change pattern was found to be different from bundle to bundle. The lengths of the LCL and the anterior oblique ligament (AOL) of the MCL changed little during elbow flexion. On the other hand, the length of the posterior oblique ligament (POL) of the MCL considerably increased when the elbow joint was flexed. The more posterior the bundle was, the larger the change in length that was observed. Because the origin of the POL is far distant from the axis of motion, it was suspected that a shortening in the POL was one of the most important pathologic changes in stiff elbow. The results of the biomechanic study were applied to a subsequent clinical study. Scar formation or ectopic ossification on the medial and/or posterior parts of the elbow joint was observed in 38 of 43 cases at surgery. These pathologic regions were resected, including the scarred POL. The intra-operative findings revealed that the major restraints in stiff elbow were the medial and/or posterior parts of the elbow. The importance of the shortened POL in the clinical pathology of stiff elbow was clearly demonstrated.

Adolescent↗

Spondylosis in sand rats: a model of intervertebral disc degeneration and hyperostosis.

This study defines gross, histopathologic, and radiologic changes associated with intervertebral disc degeneration in a spontaneously occurring form of the disease in aging sand rats (Psammomys obesus). Sand rats (male/female) fed lab chow supplemented with desert salt bush were sacrificed at periods of 3-30 months. Lateral thoracolumbar spine films were obtained. At sacrifice, spines were surgically exposed and gross findings were recorded; after fixation/decalcification, histopathologic studies were carried out using hematoxylin and eosin, and Safranin-O with fast green counterstain. Metabolic studies included correlations of pathologic and radiologic findings with blood glucose and insulin levels. Disc-space narrowing and subchondral endplate sclerosis increased radiologically with age, with more severe lower lumbar disc lesions. Ligamentous calcifications ventral to involved discs and caudal vertebrae were common. Disc thinning and anterior vertebral bony/cartilaginous spurs were more marked with age. Microscopy revealed loss of nucleus pulposus physaliform cells, chondrocyte replication, disc necrosis, and ossification. Hyperglycemia with and without hyperinsulinemia was common. No statistically significant differences in pathologic findings were noted, neither in diabetic versus nondiabetic nor in hyperinsulinemic animals. The sand rat is a model of disc degeneration; similarities with possible overlap with diffuse idiopathic skeletal hyperostosis syndrome were noted.

Aging↗

Heterotopic ossification in unidentified skeletal remains.

Heterotopic ossification is a benign, ectopic bone growth that develops in muscle and other soft tissue. The exact cause is poorly understood, but it is a rarely serious complication of soft tissue trauma. Its most common form, myositis ossifications traumatica, occurs as a secondary complication of direct muscle injury. However, other forms are less common and can result from specific pathologic conditions, such as spinal cord trauma and metabolic disorders. In patients who have had spinal cord injury and subsequent paraplegia, heterotopic ossification often results in ankylosis of the hip and a loss in range of motion. Ectopic ossification occurs below the injury site, and, although the specific muscle groups can vary, it usually involves those for which the origin and insertion involve the anterior pelvis and proximal femur. In dried bone, heterotopic ossification can appear as a smooth, irregularly shaped benign tumor of mature bone, extending from the surface but not invading the cortical bone. These tumors range in size from a few millimeters to several centimeters. Because heterotopic ossification is often associated with specific types of injuries, it has a unique anthropological use in forensic cases.

Femur↗

Periodontal infection leading to periostitis ossificans ("Garrè's osteomyelitis") of the mandible. Report of a case.

Periostitis ossifications ("Garrè's osteomyelitis") of the mandible is a rather rare pathology that occurs as a hard swelling at the mandibular angle, persists for a long period, and is mostly painful on palpation. Clinical signs of infection are rarely noted. The etiological factor is generally a carious first permanent molar with a periapical infection or a fracture of the jaw. In this case, a 10 year-old girl showed a fixed painful swelling of the right mandibular angle. This revealed to be periostitis ossificans, although none of the classical causes were present. The symptoms were evoked by a periodontal infection: there was an osseous crater and a probing pocket depth of more than 10 mm disto-lingually of the first right permanent molar of the mandible. This was likely the etiological factor. Extraction of the first and second permanent right molar, curettage of the corresponding alveoli, and antibiotic treatment resulted in complete healing, clinically and radiologically, after 9 months.

Child↗

Extensive arachnoid ossification with associated syringomyelia presenting as thoracic myelopathy. Case report and review of the literature.

The authors present the case of progressive thoracic myelopathy caused by the extensive ossification of the arachnoid membrane and associated intramedullary syrinx. Based on their findings and results of the literature search, they describe a pathological basis for this rare condition, discuss its incidence and symptomatology, and suggest a simple classification for various types of the arachnoid ossification. They also discuss the magnetic resonance imaging features of arachnoid ossification and associated spinal cord changes. The particular value of plain computerized tomography, which is highly sensitive in revealing intraspinal calcifications and ossifications, in the diagnostic evaluation of patients with a clinical picture of progressive myelopathy is emphasized.

Arachnoid↗

[Ossification of the posterior longitudinal ligament].

Two asymptomatic, unusually young male patients aged 18 and 21 with ossification of the longitudinal posterior ligament of the cervical spine are presented. Geographical distribution, pathological and radiologic aspects of the disease are discussed together with those signs differentiating it from ankylosing spinal hyperostosis.

Adolescent↗

Skeletal growth in normal and pathological conditions.

The authors describe the morphological and functional differences between the various systems of enchondral ossification of the metaphysis and epiphysis of the long bones, the short bones and the zones of insertion of tendons and ligaments. They discuss the relationships between the various types of enchondral ossification, the rates of skeletal growth and a number of orthopaedic growth disorders. In deformity of the lower limb, skeletal growth produces spontaneous correction in the majority of cases. Spinal abnormalities, on the other hand, tend to deteriorate during the period of rapid growth of the trunk.

Adolescent↗

Cortical dysplasia with ossification.

We present the first case of cortical dysplasia with extensive intracerebral ossification. An eight-year-old epilepsy patient with a calcified lesion was successfully treated by surgical intervention. Pathological examination revealed a number of bizarre dysplastic cells in the whole lesion, which consisted of an epileptogenic cerebral cortex and a nonepileptogenic hamartomatous lesion with adipose tissue, vascular tissue, calcification, and ossification. The patient was diagnosed as having cortical dysplasia with ossification. Our findings support the notion that cortical dysplasia has a multipotentiality of cellular differentiation, including various hamartomatous tissues. We suggest that cortical dysplasia should be considered as a potential cause for epileptogenicity of a hamartomatous lesion even when magnetic resonance imaging (MRI) fails to disclose cortical dysplasia.

Brain Diseases↗

Cervical spine stenosis due to ossification of the posterior longitudinal ligament in Italian patients: surgical treatment and outcome.

Ossification of the posterior longitudinal ligament (OPLL) of the cervical spine is a frequent pathological entity in people of Japanese and Asian extraction and is reported with increasing frequency also in the USA; on the contrary, reports in the European and particularly in the Italian literature remain rare. This paper describes 8 Italian patients with cervical spine stenosis due to OPLL extending three to five vertebral segments (and above C3 in four cases). Magnetic resonance imaging shows the extent of the ossification well in terms of height and cord compression, while computed tomography is useful to measure the thickness of the bone mass and the residual spinal canal. Anterior cervical decompression by discectomy, corpectomy, and removal of the ossified ligament is the treatment of choice and results in clinical improvement in most cases. Decompressive laminectomy may be reserved for patients with ossification extending to four or five levels and above C3. The surgical technique and intraoperative findings are discussed.

Aged↗

Ovarian stone. A case report.

BACKGROUND: To our knowledge, ovarian calcification and ossification involving the whole ovary with images that mimic stone formations have not been reported before. CASE REPORT: A 42-year-old woman presented with severe abdominal pain. Plain abdominal radiography showed a well-defined, calcified mass, 4 x 5 cm, located in the pelvis. Physical examination showed a right adnexal mass accompanied by severe pain and tenderness while lifting. Transvaginal ultrasound showed an ill-defined mass with acoustic comet tail. Computed tomography demonstrated a well-defined mass on the right adnexa, 4 x 5 cm, with an extensively calcified shell. Surgical exploration revealed an enlarged, ovoid, pale brown ovary, which looked exactly like an ovary made of stone. The pathologic findings were compatible with a benign chocolate cyst with extensive calcification and ossification. The pelvic pain resolved completely after the surgery. CONCLUSION: Though the cause of this unique case remains unknown, torsion with subsequent infarction of an ovarian endometrioma was suggested. Complete excision was the treatment of choice.

Adult↗

Developmental abnormalities in chicken embryos after injection proteolysis inhibitors from Ascaris suum.

It has been found that trypsin and alpha-chymotrypsin inhibitors isolated from Ascaris suum act embryotoxically and teratogenically on White Leghorn chicken embryos. Mortality rate for the chicken embryos on day 15 of incubation was 45.0 +/- 3.5% after injection of trypsin inhibitor and 44.0 +/- 3.5% after adminstration alpha-chymotrypsin inhibitor. Gross examination of surviving embryos and their dissection revealed pathological changes (abdominal dropsy, umbilical hernia, subcutaneous oedema, hemoperitoneum, hemopericardium), symptoms indicating retardation in growth (lack of down, retarded ossification of long bones, decreased mean body weight) as well as malformations (schistocelia, micrognathia, cyclopia, crossed beak, cranial deformities) after injection of inhibitors from Ascaris. The highest incidence of embryos with pathological changes and malformations was found after administration of alpha-chymotrypsin inhibitor. The most commonly occurring abnormality was schistocelia (21.4 +/- 3.88%). Growth malformations were not found in the control groups. The trypsin and alpha-chymotrypsin inhibitors present in Ascaris homogenate have a significant disturbing effect on the development of the chicken embryo.

Animals↗

Paget's disease of bone: orthopedic complications.

Orthopedic complications of Paget's disease are among the most common indications for treatment of Paget's disease. These complications include severe bone pain, joint pain, skeletal deformity, pathological fracture, and rarely malignant degeneration. The use of effective pharmacological modalities has transformed the treatment of Paget's disease in the past four decades. Although few patients with Paget's disease ever require surgical therapy, successful surgical management of severe orthopedic complications has improved the quality of life for many sufferers. Selected modalities with promising results include total hip replacement for intractable pagetic arthritis of the hip, proximal tibial osteotomy for painful malalignment of the knees, total knee replacement for intractable arthritis of the knee, and internal fixation for pathological fracture. Common surgical complications of joint replacement include infection, hemorrhage, heterotopic ossification, and aseptic loosening. The medical, surgical, and rehabilitation modalities available in managing primary and secondary orthopedic complications of Paget's disease provide a wide array of options that must be carefully considered in each patient.

Arthroplasty↗

The influence of potentially limiting factors on paediatric outcomes following cochlear implantation.

OBJECTIVE: Children with isolated hearing impairment who have received cochlear implant at the optimal age mostly achieve remarkable results that are assessed by objective speech perception and production measurements. Different outcomes may be expected in case of conditions which may have a negative impact on postoperative performance. The aim of this study was to assess the influence of potentially limiting factors on postimplant outcomes. METHODS: Four groups of examinees (11 in total) were involved by the study: (A) four children with additional disabilities, (B) three children with cochlear malformation and/or ossification, (C) three reimplanted children, (D) a child with retrocochlear (cochlear nerve) pathology. Hearing, speech perception and production were examined by pure tone audiogram, speech audiogram, categories of auditory performance, speech intelligibility rating, listening progress profile, and monosyllabic trochee polysyllable test. Postoperative positive life changes were assessed by a questionnaire. RESULTS: Group A: perception skills better than expected, less satisfactory speech development. Group B: good sound perception, poor understanding. Group C: after reimplantation undisturbed conditions for continuation of optimal rehabilitation course. Group D: unsatisfactory results of pure tone hearing as well as speech perception and production. CONCLUSION: In spite of unfavourable conditions all examinees, except a child with retrocochlear pathology, were found to have a considerable benefit after cochlear implantation (with regard to obvious heterogeneity within each group). Evaluation of success, especially in children with multiple handicaps, also has to include subjective indicators of positive life changes, even those not directly associated with hearing.

Audiometry, Pure-Tone↗