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The use of cobalt therapy to prevent heterotopic ossification after total hip arthroplasty.

The occurrence of heterotopic ossification after total hip arthroplasty may be prevented by radiation or medical therapy. The authors report the results obtained in 96 cases treated by cobalt therapy: the occurrence of high grade ossification (Brooker III and IV) is equal to 1% in cases treated, as compared to 9% in cases not treated. Male patients of advanced age and who are characterized by primary arthrosis are more at risk for ossification.

Adult↗

[Diffuse pulmonary ossification and diabetes mellitus. An association not previously described].

Diffuse pulmonary ossification is a relatively rare, well recognized condition, of which a number of reports exist in the literature. While the histologic picture of diffuse pulmonary ossification, with its nodular and dendritic forms, is well know, the pathogenesis is not yet fully clarified; a number of diseases have been claimed to be responsible for, or associated to diffuse pulmonary ossification, but the association with diabetes mellitus is so far undescribed. That's why we report this case, along with the discussion of some pathogenetic hypotheses and differential diagnosis.

Aged↗

[Value of ultrasound in diagnosis of post-traumatic heterotopic ossifications].

Heterotopic ossification is a non-neoplastic deposit of bone within soft tissue (myositis ossificans). The most common localized form is post-traumatic myositis ossificans. The ultrasonographic appearance of heterotopic ossification is characterized by highly echogenic areas with attenuation or complete disappearance of the acoustic signal distal to these areas. The size and extent of para-articular ossifications can also be evaluated, and the choice of the surgical approach is facilitated and damage to soft tissue minimized by the ultrasonographic examination.

Achilles Tendon↗

[Heterotopic periarticular ossification after total hip replacement].

Due to increased number of revisions in total hip replacements, prolonged surgery time and extensive surgical approaches heterotopic periarticular ossification is observed more frequently. A series of 790 hips operated between 1987 and 1996 has been reviewed. Type of the surgery, bone graft use, surgical approach, radiological appearance and pain around the operated hip during first 6 month after surgery were taken into consideration. In the increased risk group heterotopic ossification occurred in 52.2%, in others in 6.4% if NSAID were not prescribed. Prophylactics decreased heterotopic ossification three-fold (16.7%) in the high risk group.

Hip Joint↗

[Dysphagia caused by ossification of the anterior longitudinal ligament associated with diffuse idiopathic skeletal hyperostosis: report of 2 cases].

Two cases of ossification of the anterior longitudinal ligament (OALL) associated with diffuse idiopathic skeletal hyperostosis (DISH) presenting as dysphagia are reported. DISH has long been regarded as a radiological entity manifesting flowing ossification adjacent to the anterior and lateral borders of at least four contiguous vertebral bodies, maintenance of disc spaces, and a dearth of bony ankylosis and erosion of the apophyseal and sacroiliac joints. In the majority of cases, this entity shows an innocuous clinical course, but the dysphagia shown in our cases has also been documented in previous literature. Case 1 was a 63-year-old male developing progressive dysphagia and rhinolalia. Cervical X-rays and CT showed flowing OALL in the entire cervical spine. MRI demonstrated displacement of the trachea and esophagus by this mass. There was OALL in the thoracic and lumbar spine. Case 2 was a 62-year-old male who had undergone removal of ossification of the posterior longitudinal ligament (OPLL) from C2 to C5. He developed dysphagia and myelopathy. Cervical X-rays and CT demonstrated projection of OALL as well as posterior osteophytes at C5/6. MRI suggested that OALL had caused dysphagia, and osteophytes deteriorated myelopathy. Removal of OALL was carried out in these two cases. In case 2, removal of the osteophytes and herniated disc was carried out at the same time. Postoperative course was unremarkable with improvement of symptoms. Treatment of dysphagia due to OALL is considered to be conservative. However, surgical decompression should be considered in cases of marked projection of OALL obstructing the esophagus as shown in our cases.

Deglutition Disorders↗

Role of the ossification groove of Ranvier in normal and pathologic bone growth: a review.

According to Ranvier (1889), cells in the ossification groove originate in cartilage and differentiate to osteoblasts. He was supported by others until some authors stated after 1950 that the growth plate grows in width by apposition of cells from the groove. The apposition theory is still accepted in several textbooks. Our experiments with roentgen ray injury showed (1950) migration of cells toward the ossification groove in the germinal layer of the growth plate, a phenomenon not described by others. It was verified in normal bones with 35S (1967) and with vital staining (1993). In situ hybridization of bones in rabbits showed (1993) that cells in the groove and adjacent periosteum contain type II collagen messenger RNA (mRNA) characteristic of cartilage, a finding in accordance with Ranvier's views. The behavior of cells in the ossification groove plays a decisive role in the pathogenesis of several diseases of the growing skeleton.

Animals↗

Active role of chondrocyte apoptosis in endochondral ossification.

Endochondral ossification involves an ordered progression from cell division through hypertrophic differentiation to cell death. The apoptotic nature of chondrocyte death was first suggested by characteristic changes in morphology; and more recently by the pattern of DNA fragmentation and other characteristic features of apoptosis. In situ detection, although controversial, suggests that DNA fragmentation probably does not occur until late in hypertrophic differentiation. From observations of key features of apoptosis, including activation of the caspase cascade, changes in mitochondrial function, and expression of apoptosis inhibitors, the commitment of chondrocytes to apoptosis, appears to occur very early in hypertrophic differentiation. It is proposed that these changes produce effects that go far beyond the process of cell death and exert a focal influence on the endochondral ossification processes occurring in the microenvironment of the growth cartilage vascular interface. Endochondral ossification processes mediated by chondrocyte apoptosis may include intracellular calcium accumulation and release; matrix calcification; matrix resorption; maintenance of growth plate homeostasis; attraction of blood vessels and osteoblast precursors; and stimulation of bone formation.

Animals↗

Delayed membranous cranial ossification in a mother and child.

We report on a girl and her mother with delayed intramembranous ossification of the cranial vault. The 11-month-old girl had a large ossification defect involving parietal bones, squamous portion of temporal bones, and interparietal region of occipital bone, while the mother showed a complete ossified cranial vault with flat posterior parietal region and prominent occiput. Both had a similar face characterized by frontal bossing, hypertelorism, downward slant of palpebral fissures, flat nasal bridge, and short midface. On reviewing the literature, we concluded that these cases may be a dominant transmitted ossification defect with characteristic face, different from the cranium bifidum-parietal foramina entity.

Abnormalities, Multiple↗

Diaphanospondylodysostosis (DSD): confirmation of a recessive disorder with abnormal vertebral ossification and nephroblastomatosis.

We report on four patients from three families, with similar radiological findings: absent (or severely delayed) ossification of vertebral bodies and associated anomalies. The babies were stillborn or died soon after birth of respiratory insufficiency. Two patients are sibs (female and male) born to first cousin Malian parents. The two others were non-consanguineous. This perinatally lethal entity comprises short neck, short wide thorax, and normally shaped limbs. Associated, inconstant anomalies are myelomeningocele, cystic kidneys with nephrogenic rests (in the sibs), and cleft palate. Radiologically, the hallmarks are absence of ossification of the vertebral bodies and sacrum, abnormal position of the vertebral pedicles, which are lamellar and angulated, ribbon-like ribs reduced in number, narrow pelvis, upward widening of the iliac wings, and unusual tilt of the ischiopubic rami, contrasting with the normal appendicular skeleton. Maroteaux briefly described one of the patients in the 2002 edition of "Maladies osseuses de l'enfant" and three sibs with similar renal and radiological findings were reported in 2003 in this Journal. Combined with the latter cases, these four new patients allow delineation of a specific lethal AR syndrome with ossification defect of the axial skeleton and renal dysplasia. We propose to name this entity diaphanospondylodysostosis.

Abnormalities, Multiple↗

Sequence of ossification in human vertebral neural arch centers.

The purpose of the present study is to determine whether ossification of the human vertebral neural arches follows a craniocaudal sequences of development or develops in separate groups from the lower cervical/upper thoracic, upper cervical, and lower thoracic/upper lumbar regions as described by Bagnall et al. (1977b) in a radiographic study. Seven formalin-fixed, two fresh frozen, and six serial-sectioned human embryos and fetuses, ranging in crown-rump length (C-R) from 27 mm to 76 mm, were examined. A procedure adapted by Watson (1977a,b) for in toto staining of whole specimens with alcian blue and alizarin red S for cartilage and bone was used, whereas serial sections were stained with hematoxylin and eosin, or Koneff's stain (1960). The intact specimens demonstrated a vivid deep blue cartilaginous skeleton with differentiated red areas of bone development seen through soft tissues rendered transparent by potassium hydroxide or enzyme clearing. The ossification sequence of the neural arches differed from the conventional craniocaudal descriptions given in anatomical textbooks. Neural arch ossification was found to commence in the lower cervical/upper thoracic regions, quickly followed by a second group in the lower cervical region, and subsequently a third group in the lower thoracic/upper lumbar region.

Female↗

Developmental differences in the ossification process of the human corpus and ramus mandibulae.

A correlation was sought between the organization of the dental crest and the ossification of the corpus mandibulae in 14 human embryos and 13 human fetuses. The different types of ossification between the corpus and the ramus mandibulae suggest that the cartilago mandibularis (meckeliensis) guides the formation of the mandibula, while the dental crest acts as a coorganizer. In the area of the foramen mentale, the lamina dentalis begins to invaginate (to give rise to the dental crest), and at this level intramembranous ossification of the corpus mandibulae commences. These findings, together with the presence of the cartilago mandibularis before the appearance of the dental crest, and the fact that the former is seen along the entire length of the mandibula (from the symphysis mandibulae to the capsula otica), support the hypothesis that the dental crest, rather than the cartilago mandibularis, acts as the coorganizer in the corpus mandibulae.

Cartilage↗

Endochondral ossification of the mouse nasal septum.

Endochondral ossification at the caudal junctions of the cartilaginous nasal septum, in combination with interstitial expansion of the septum, is thought to displace the facial skeleton away from the neurocranium. However, the rate of endochondral ossification has not been measured or related to rates of septal enlargement. This study examined endochondral ossification at these junctions in mice from postnatal days 0-15, in the context of known cranial growth sites, the synchondroses. BrdU labeling was used to compare cell division at the septoethmoidal and septopresphenoidal junctions with cell division at the synchondroses, and double-fluorochrome labeling was used to measure mineralization rate. The results showed that the septoethmoidal and septopresphenoidal junctions develop the characteristic morphology of growth plates postnatally, and that the pattern of cell division is similar to that of synchondroses. Mineralization at these junctions occurred at rates that were not statistically different from those of the synchondroses. However, the cartilaginous septum increased in length much more rapidly than could be explained by caudal growth, implying that interstitial expansion is the more important contributor to septal growth.

Animals↗

Expression of NG2 proteoglycan during endochondral and intramembranous ossification.

We have used immunohistochemistry to study the distribution of the NG2 proteoglycan during bone development in the mouse. At embryonic day 15.5, NG2 was strongly detected in the immature cartilage of developing limbs. After transient down-regulation in mature chondrocytes, NG2 was up-regulated during primary ossification, colocalizing with alkaline phosphatase and tenascin C. In the epiphyseal growth plates of newborn mouse tibia, NG2 and alkaline phosphatase exhibited overlapping patterns of expression by hypertrophic chondrocytes and by osteoblasts surrounding newly formed bone trabeculae. NG2 was down-regulated after puberty, being only faintly detectable in the tibial growth plates of 3-month-old mice. In cranial sutures, NG2 was strongly labeled in osteogenic bone fronts and in the suture matrix. Our results indicate that NG2 expression is up-regulated during both endochondral and intramembranous ossification, but is down-regulated as ossification is completed.

Alkaline Phosphatase↗

Enzymes active in the areas undergoing cartilage resorption during the development of the secondary ossification center in the tibiae of rats ages 0-21 days: I. Two groups of proteinases cleave the core protein of aggrecan.

The formation of a secondary ossification center in the cartilaginous epiphysis of long bones requires the excavation of canals and marrow space and, therefore, the resorption of cartilage. On the assumption that its resorption requires the lysis of the major cartilage component aggrecan, it was noted that the core protein may be cleaved in vitro by proteinases from two subfamilies: matrix metalloproteinases (MMPs) and aggrecanases. Such cleavage results in aggrecan being replaced by a fragment of itself referred to as a "G1-fragment." To find out if this cleavage occurs in the developing epiphysis of the rat tibia, the approach has been to localize the G1 fragments. For this purpose two neoepitope antisera were applied, one capable of recognizing the MMP-generated G1-fragment that bears the C-terminus ...FVDIPEN341 and the other capable of recognizing the aggrecanase-generated G1-fragment that carries the C-terminus ...NITEGE373. With the aid of these antisera, we report here that aggrecan cleavage is localized to newly developed sites of erosion. Thus, at 6 days of age, canals allowing the entry of capillaries are dug out from the surface of the epiphysis in a radial direction (stage I), whereas immunostaining indicative of aggrecan cleavage by MMPs appears at the blind end of each canal. The next day, the canal blind ends fuse to create a marrow space in the epiphysis (stage II), whereas immunostaining produced by MMPs occurs along the walls of this space. By 9 days, clusters of hypertrophic chondrocytes are scattered along the marrow space wall to initiate the formation of the secondary ossification center (stage III), where the resorption sites are unreactive to either antiserum. From the 9th to the 21st day, the center keeps on enlarging and, as the distal wall of the marrow space recedes, it is intensely immunostained with both antisera indicating that both MMPs and aggrecanases are involved in this resorption. We conclude, that both enzyme subfamilies contribute to the lysis of aggrecan. However, the results suggest that the respective subfamilies target different sites and even stages of development in the tissue, suggesting some diversity in the mode of aggrecan lysis during the excavation of a secondary ossification center.

Aggrecans↗

Increased bone formation and osteoblastic cell phenotype in premature cranial suture ossification (craniosynostosis).

Craniosynostosis is a heterogeneous disorder characterized by premature fusion of the skull bone sutures. To evaluate the pathogenesis of premature cranial suture ossification in craniosynostosis, we have evaluated the histologic indices of bone formation and the characteristics of osteoblastic cells derived from normal and affected cranial sutures in 47 infants and children, aged 3-18 months, with nonsyndromic craniosynostosis. The histomorphometric analysis of normal and fused sutures showed an age-related decline in the extent of endosteal bone surface covered with osteoid and osteoblasts during postnatal suture ossification. Bone formation was 20-50% higher at 3-6 months of age in fused sutures compared with normal sutures in the same patients. Cells derived from normal and fused sutures displayed characteristics of the osteoblast phenotype in culture. Analysis of [3H]thymidine incorporation into DNA from 1-14 days of culture showed an age-related decrease in osteoblastic cell growth in both normal and affected sutures. The proliferation of osteoblastic cells isolated from fused sutures was similar at all ages to that of cells isolated from normal sutures in the same patients. In contrast, alkaline phosphatase activity and osteocalcin production by osteoblastic cells cultured in basal conditions and after stimulation with 1,25-dihydroxyvitamin D (1,25[OH]2D3), were 53-74% higher in fused sutures compared with cells isolated from normal sutures in the same patients. The results indicate that bone formation activity at the suture site is locally increased in craniosynostosis, and this disorder is associated with increased in vitro parameters of osteoblastic cell differentiation, suggesting that an increased maturation of osteoblastic cells at the site of the suture leads to the premature ossification in nonsyndromic craniosynostosis.

Aging↗

Delayed carpal ossification in Notophthalmus viridescens Efts: Relation to the progress of mesopodial completion in newt forelimb regenerates.

The persistence of cartilage in the adult newt (Notophthalmus viridescens) forelimb skeletal regenerate has recently been reported by Libbon et al. It is particularly evident in the carpal group, which remains cartilaginous for at least 9 months while all other regrown skeletal parts are either ossified or ossifying. The present investigation was undertaken to determine whether delayed ossification in the adult regenerate recapitulates a pattern evident during the development of the forelimb of the red eft (N. viridenscens' immature terrestrial phase). Right upper limbs of 20 efts were examined at low magnification to establish carpal composition and organization. Among five efts of the smallest size (26.54 plus or minus 2.20 mm snout-to-vent length), and displaying bright orange dorsal skin coloration, all carpal rudiments were cartilaginous. Eleven efts, intermediate in length (33.88 plus or minus 0.81 mm), displaying orange-green coloration, all carpals had ossified. These observations demonstrate that during adult newt forelimb regeneration, the failure of the carpal elements to begin ossification in synchrony with other regrown skeletal parts duplicates a similar schedule of delayed mesopodial ossification which is evident during the development of the red eft's forelimb.

Animals↗

Indomethacin inhibition of ossification induced by direct current stimulation.

In this study, we sought to clarify the mechanism of ossification induced by direct current stimulation by analyzing changes in local blood flow and vascular permeability and by examining the involvement of chemical mediators. Changes in blood flow were studied with laser Doppler flowmetry, and vascular permeability was determined by microquantification. To examine the involvement of chemical mediators, we determined the effect on vascular permeability of histamine H1 and H2-receptor blockers and indomethacin. In addition, direct current stimulation was performed during administration of indomethacin to determine whether indomethacin inhibits electrically induced callus formation. Local blood flow remained unchanged in the control group and in the group receiving 5 microA of stimulation, but it increased in the groups receiving 10 and 50 microA. Vascular permeability increased in the 5 and 10 microA stimulation groups. This increase was not suppressed by histamine-receptor blockers, but it was suppressed by indomethacin. Two weeks of electrical stimulation without concomitant indomethacin treatment resulted in active callus formation around the needle electrode and in the vicinity of the endosteum; however, direct current stimulation during administration of indomethacin inhibited callus formation. The results suggest that these changes serve as microenvironmental factors that play an important role in the promotion of ossification and that a prostaglandin-mediated mechanism is involved in the promotion of ossification by direct current stimulation.

Animals↗

Acceleration of experimental endochondral ossification by biophysical stimulation of the progenitor cell pool.

Endochondral ossification can be modulated by a number of biochemical and biophysical stimuli. This study uses the experimental model of decalcified bone matrix-induced endochondral ossification to examine the effect of one biophysical stimulus, an electromagnetic field, on chondrogenesis, calcification, and osteogenesis. A temporal acceleration and quantitative increase in sulfate incorporation, glycosaminoglycan content, and calcification suggests that the stimulation of endochondral ossification is due to an increase in extracellular matrix synthesis. The locus of that stimulation is identified in the mesenchymal stage of endochondral bone development, and stimulation at this stage is essential for accelerated bone formation. The data suggest that enhanced differentiation of mesenchymal stem cells present at this stage is most likely responsible for the increase in extracellular matrix synthesis and bone maturation.

Animals↗