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Arachnoiditis ossificans of the cauda equina. Case report and review of the literature.

The authors describe a case of arachnoiditis ossificans (AO) of the cauda equina. The lesion is a rare pathological entity usually confined to the thoracic and high lumbar regions that can cause progressive spinal cord and cauda equina compression, inducing severe neurological deterioration. The authors analyze the clinical symptoms, radiological features, histological data, and treatment options relating to this case and 13 others described in the literature; additionally, they consider the possible mechanisms responsible for ossification of the leptomeninges. Although clustered arachnoidal cells are usually implicated in its pathogenesis, an environment induced by arachnoiditis and disturbed cerebrospinal fluid flow appears to be a more important factor. A therapeutic strategy is proposed for AO for which no effective treatment currently exists.

Adult↗

[Malignant fibrous histiocytoma (MFH) of the maxilla--an analysis of 7 cases].

Malignant fibrous histiocytoma is a rare tumor of the soft tissue or bone, especially if located in the head and neck. Up to the present, only 7 cases have been reported (6 in the mandible and only one in the maxilla). From Mar. 1958 to Mar. 1985, 7 patients with maxillary MFH, proved by pathology, were treated in our hospital. The X-ray manifestations were studied and analysed. The main X-ray characteristics are as follows: A large soft tissue mass in the maxilla, extending into the infratemporal fossa, pterygopalatina fossa, orbit, ethmoid sinuses, nasal cavity and cheek. Marked and extensive destruction of the maxilla with some amorphous reactive ossification. The bone appears like melting ice or ground glass. The value of computerized tomography in differential diagnosis and clinical staging of the maxillary malignant fibrous histiocytoma are discussed.

Adult↗

Prenatal toxicity of xylene.

Prenatal inhalation toxicity of xylene (industrial mixture of isomers) was studied in experiments of white Wistar rats exposed daily (6 hours a day, 5 days in a week) to concentrations of 10, 50 (MAC for xylene in the air of work environment in Bulgaria) and 500 mg.m-3 throughout the period of gestation from the first to the 21st day. Both routine teratological indices and biochemical and physiological methods of observation were used to evaluate the integrity of the individual organs - liver, brain, lungs and myocardium of the generation in the postnatal period of development. In concentrations of 50 and 500 mg.m-3, xylene exhibits pronounced embryotoxic and teratogenic effects. Postimplantation embryonal mortality increases, the process of physical development of the fetus is delayed, the incidence of induced anomalies of internal organs (hydrocephalus, microphthalmia, intracerebral haematomas, haemorrhages in the liver) is enhanced, the processes of ossification of the sternum and the skull are impaired. In concentrations of 50 and 500 mg.m-3, xylene causes disturbances in postnatal development of F1 generation. The concentration of 50 mg.m-3 is the threshold of the embryotropic effect of the solvent. Measures for the protection of women at work are proposed to reduce industrial hazard of developing antenatal pathology in the newborn of workwomen in xylene works.

Abnormalities, Drug-Induced↗

Effects of a bisphosphonate on bone histomorphometry and dynamics in the canine cruciate deficiency model of osteoarthritis.

OBJECTIVE: To examine the effect of the bisphosphonate NE- 10035 on bone histomorphometry and bone dynamics in dogs after transection of the anterior cruciate ligament (ACL), and to determine, in a placebo controlled trial, whether treatment modified the severity of pathologic changes of osteoarthritis (OA) in the unstable joint. METHODS: Ten adult male mongrel dogs underwent ipsilateral ACL transection. Five dogs then received daily subcutaneous injections of NE-10035 on 5 days per week for 12 weeks beginning the day after surgery. The other 5 dogs served as concurrent OA controls and received subcutaneous injections of saline on the same schedule. At sacrifice, 12 weeks after ACL transection, the articular cartilage and synovium of both knees of each dog were evaluated grossly and histologically and the water content and uronic acid concentration of the articular cartilage was determined. Fifteen days before sacrifice, each dog was injected with the fluorochrome label calcein. The injection regimen was repeated 10 days after the initial date. At sacrifice, static and dynamic variables of bone formation were assessed and bone resorption was quantified. RESULTS: In the OA knee of the control group, bone formation and resorption were markedly increased. NE-10035 markedly reduced both formation and resorption of cancellous subchondral bone, but had no effect on osteophyte formation or pathologic changes of OA in the articular cartilage, which were mild in both treatment groups. Water content of the OA cartilage was increased by about 8% in both treatment groups. However, among the controls, the mean uronic acid concentration of the OA cartilage was increased by about 30% in comparison with values for the contralateral knee, while in the NE-10035 treatment group the mean uronic acid concentration of OA knee cartilage was about 15% lower in the active treatment group than in cartilage from the contralateral knee (p = 0.003 for the difference in OA knee uronic acid concentration between the 2 treatment groups, relative to that in the contralateral knee). CONCLUSION: The antiresorptive agent employed in this study effectively reduced turnover of subchondral bone in the OA joint, consistent with the coupling of bone formation to bone resorption at that site. Nonetheless, over the 12 week period of the study it had no effect on osteophyte formation, in which bone formation occurs via enchondral ossification and is not linked to bone resorption, and, despite the clear inhibition of bone turnover in the OA knee of the active treatment group, did not affect the severity of cartilage changes of OA. It should be noted, however, that although treatment with this antiresorptive agent did not affect the level of chondropathy, the cartilage changes in both treatment groups were relatively mild and the sample size relatively small. Additional studies with a larger number of animals and a longer period of observation (to increase the severity of pathology) are warranted to determine whether the inhibition of bone turnover and the decrease in proteoglycan concentration that resulted from therapy will affect articular cartilage degeneration in the OA joint.

Animals↗

Role of CTGF/HCS24/ecogenin in skeletal growth control.

Connective tissue growth factor/hypertrophic chondrocyte-specific gene product 24 (CTGF/Hcs24) is a multifunctional growth factor for chondrocytes, osteoblasts, and vascular endothelial cells. CTGF/Hcs24 promotes the proliferation and maturation of growth cartilage cells and articular cartilage cells in culture and hypertrophy of growth cartilage cells in culture. The factor also stimulates the proliferation and differentiation of cultured osteoblastic cells. Moreover, CTGF/Hcs24 promotes the adhesion, proliferation, and migration of vascular endothelial cells, as well as induces tube formation by the cells and strong angiogenesis in vivo. Because angiogenesis is critical for the replacement of cartilage with bone at the final stage of endochondral ossification and because gene expression of CTGF/Hcs24 predominates in hypertrophic chondrocytes in the physiological state, a major physiological role for this factor should be the promotion of the entire process of endochondral ossification, with the factor acting on the above three types of cells as a paracrine factor. Thus, CTGF/Hcs24 should be called "ecogenin: endochondral ossification genetic factor." In addition to hypertrophic chondrocytes, osteoblasts activated by various stimuli including wounding also express a significantly high level of CTGF/Hcs24. These findings in conjunction with in vitro findings about osteoblasts mentioned above suggest the involvement of CTGF/Hcs24 in intramembranous ossification and bone modeling/remodeling. Because angiogenesis is also critical for intramembranous ossification and bone remodeling, CTGF/Hcs24 expressed in endothelial cells activated by various stimuli including wounding may also play important roles in direct bone formation. In conclusion, although the most important physiological role of CTGF/Hcs24 is ecogenin action, the factors also play important roles in skeletal growth and modeling/remodeling via its direct action on osteoblasts under both physiological and pathological conditions.

Animals↗

[The contribution of computerized tomography to synovial pathology].

The authors have developed a technique of CT arthroscan which, by the use of a gas or opaque contrast medium, is able to demonstrate the synovial structures of the knee, the shoulder and the hip. Among the essential indications, they include the demonstration of neoplasia of the synovium and the evaluation of the pannus in rheumatoid arthritis. Their secondary indications include the demonstration of fluid effusions in the hip, the precise evaluation of hyperostotic lesions in the same joint, the detection of ossification phenomena in the capsule of the inter-apophyseal joints in ankylosing spondylitis and, in some cases, following negative or doubtful arthrography for the detection of synovial plica. They also recall the usefulness or the arthroscan in the diagnosis of lesions of the labrum glenoidale.

Adult↗

Heterotopic ossification of midline abdominal incisions: CT and MR imaging findings.

OBJECTIVE: Heterotopic ossification of a midline surgical incision in a form of myositis ossificans traumatica in which osseous, cartilaginous, and, occasionally, myelogenous elements develop within an abdominal wound. When large amounts of internal ossification are present, the scar may demonstrate a complex radiologic appearance and potentially may be misinterpreted as a retained foreign body or incisional neoplastic recurrence. This report describes the CT and MR imaging findings of this entity. SUBJECTS AND METHODS: The authors retrospectively reviewed the cross-sectional imaging findings of 11 patients with ossified midline abdominal wounds. All but one of the patients were men, and the median age at diagnosis was 40 years old (range, 20-76 years old). Initial imaging was performed 7 days to 36 months after surgery (mean, 6.7 months). CT and MR imaging scans were reviewed, and lesion size, location, distance from the xiphoid, shape, and stability were assessed. Pathologic proof was obtained in one patient. RESULTS: CT and MR imaging examination in all patients showed ossified surgical scars, with the attenuation or signal intensity of the ossified components equivalent to that of the spine. Intralesional, fat-density components suggestive of marrow were present in two patients. All scars were located in the upper abdomen between the anterior abdominal fascia and the peritoneal surface, at the level of or inferior to the xiphoid process. Scars ranged in length from 0.7 to 13.4 cm (mean, 6.9 cm). Distances from the inferior tip of the xiphoid to the superior aspect of the ossified scar ranged from 0 to 4.9 cm (mean, 2.2 cm). Time from surgery to the initial postoperative demonstration of scar ossification ranged from 11 days to 36 months (mean, 6.8 months). None of the five patients who underwent preoperative CT examinations had abnormalities in the location of subsequent scar ossification. Of the nine patients with multiple postoperative examinations, scar size and appearance remained stable in six. In the remaining three patients, scar size was stable but showed progressive internal ossification. CONCLUSION: Heterotopic ossification within midline abdominal scars can be diagnosed by both CT and MR imaging examination. Recognition of the imaging appearances of such ossification should help prevent diagnostic confusion when attending postoperative patients.

Abdominal Muscles↗

Pathogenesis of myelopathy in patients with ossification of the posterior longitudinal ligament.

OBJECT: The goal of this study was to clarify the pathogenesis of myelopathy in patients with ossification of the posterior longitudinal ligament (OPLL) based on the relationship between static compression factors and dynamic factors. METHODS: There was a total of 247 patients, including 167 patients who were conservatively followed for a mean of 11 years and 2 months and 80 patients who had myelopathy at initial consultation and underwent surgery. The changes in clinical symptoms associated with OPLL in the cervical spine were examined periodically. During the natural course of OPLL in the cervical spine, 37 (22%) of 167 patients developed or suffered aggravated spinal symptoms. All of the patients with a space available for the spinal cord (SAC) less than 6 mm suffered myelopathy, whereas the patients with an SAC diameter of 14 mm or greater did not. No correlation was found between the presence or absence of myelopathy in patients whose SAC diameter ranged from 6 mm to less than 14 mm. In patients with myelopathy whose minimal SAC diameter ranged from 6 mm to less than 14 mm, the range of motion of the cervical spine was significantly greater. CONCLUSIONS: These results indicate that pathological compression by the ossified ligament above a certain critical point may be the most significant factor in inducing myelopathy, whereas below that point dynamic factors may be largely involved in inducing myelopathy.

Aged↗

On the morphology of the terminal microvasculature during endochondral ossification in rats.

The investigation was carried out on the proximal tibia metaphysis by means of India ink-injection, reconstruction, corrosion casting combined with scanning electron microscopy, and transmission electron microscopy of thin sections. The terminal vasculature during endochondral ossification proved to be a labyrinth of interconnected sinusoidal complexes with bulbous buds invading the chondrocyte cavities of the growth plate. This system of vessels was canalized throughout. A special feature was the existence of endothelial pockets. The formation of the terminal microvasculature as a labyrinthine cavity during endochondral ossification, together with the still incompletely developed bone could be a weak point for compression injuries.

Animals↗

Physeal injuries of the cervical spine.

Four cases of cervical spine growth plate ("ring apophysis") injury are described. Two nonfatal injuries involved anterior displacement of a portion of the inferior physis and epiphyseal ossification center in the lower cervical spine. Neither injury was associated with neurological damage. Follow-up roentgenograms demonstrated healing, but with a spur-like prominence in one patient. A third patient sustained a fatal separation through the inferior end plate of C2. The fourth patient sustained a complete separation of C6 from C7. These injuries are correlated with pathologic specimens and normal developmental anatomy.

Adolescent↗

Anatomy of the pelvic joints--a review.

In adults, after the os ilium, os ischii and os pubis have joined together by ossification to form the os coxae, there is usually one joint between the hip bones ventrally (the pubic symphysis) and several more complex joints between the hip bones and os sacrum dorsally (sacroiliac, "axial sacroiliac" and accessory sacroiliac joints). These joints carry the weight of the upper part of the body, but they shall also enable pelvic distention during labour. Pathological conditions in these joints are common, and increased knowledge concerning their normal antomy is important for better understanding of these conditions.

Humans↗

Embryology and anatomy of the cranial base.

This article provides an overview of the complex embryologic development and anatomic relationships of the cranial base. The processes of neural cell migration, and chondrocranial base formation and ossification are discussed. In addition, the relative sectional anatomy is addressed with the goal of providing a functional review for clinicians dealing with cranial base disorders. The complex influences of the surrounding matrix and diffusible factors involved in skull base development are sources of continuing investigation. Through elucidation of the mechanisms of basal cranial development, the understanding of congenital and pathologic disorders of this area as well as cranial base influence on facial growth will be enhanced greatly.

Cartilage↗

[Diagnosis of an osseous form of hyperparathyroidism].

Under observation were 66 (50.3%) of 130 patients with an ossific form of hyperparathyroidism. Fourty five patients showed the classical picture of Recklinghausen disease, and 21-only diffuse osteoporosis. The correct diagnosis would be established 4-5 years following the onset of the disease. During the period of most distinct manifestations pains in bones were noted in 93 per cent of cases. Two thirds of patients showed marked atonia and fatigue. Pathological fractures were multiple and were observed in 45 of 66 patients (totally 125 fractures). Great importance in establishing the diagnosis of the form of hyperparathroidism is attached to roentgenological investigation of all bones and biochemical assay of blood and urine.

Acid Phosphatase↗

Osseous metaplasia in a preretinal membrane.

A highly myopic patient had surgery for retinal detachment in both eyes. After 3 procedures, the left eye developed phthisis bulbi. After multiple procedures, the right eye underwent a vitrectomy for proliferative vitreoretinopathy. A plaque of preretinal tissue was removed. We found bone on pathologic examination. The retina remains attached, and visual acuity is 20/200. Ultrasonography showed additional evidence of calcification of both eyes, presumably metaplastic bone.

Adult↗

Spinal stenosis due to ossified lumbar lesions.

OBJECT: Spinal stenosis due to lumbar ossified lesions is a rare pathological entity. The authors retrospectively evaluated the clinical features and surgical results associated with cases involving lumbar ossified lesion-induced stenosis. METHODS: Data obtained in 20 surgically treated patients with lumbar hyperostotic spinal stenosis were included. To evaluate the background of the disease, body mass index and general complications were assessed. Whole-spine radiological examination was conducted. The presence of ossification of the posterior longitudinal ligament or ossification of the ligamentum flavum was evaluated. Surgical results were classified according to the Japanese Orthopaedic Association (JOA) scale. In the patients in whom neurological deterioration was observed during follow up, the causes of deterioration were reviewed. Seven patients (35%) were obese and six patients (30%) suffered diabetes mellitus. Twelve patients harbored coexisting cervical and/or thoracic ossified lesions. The overall mean JOA score improved from 10.2 to a peak of 22.5; at last follow-up examination the mean JOA score was 20.9. In female and older patients with a long history of preoperative symptoms, a low preoperative JOA score, and other spinal lesions, recovery tended to be poorer. Recovery was poor in one patient, and neurological deterioration due to coexisting ossified spinal lesions occurred in another patient during the follow-up period. CONCLUSIONS: Because coexisting ossified lesions were frequently seen, whole-spine analysis is recommended. Early diagnosis and appropriate treatment are important to achieve a better surgical outcome.

Adult↗

[The middle period outcome of partial patellectomy for the treatment of comminuted patella fractures].

The fracture of the biggest sesamoid bone patella is encountered at a rate of 1% of all skeletal injuries. Partial patellectomy is advised in the treatment of comminuted fractures of patella. In this retrospective study, we evaluated 18 of 25 patients who had partial patellectomy in our clinic between 1986-1997. Five patients were female (%27.8) and 13 were male (%72.2). The mechanisms of injuries were as follows: 11 (%61) motor vehicle accidents; 4 (%22) falls from flat-roofed house; 2 (%11) gunshot; and 1 (%5) subsidence. The mean age of the patients was 34.3 (range, 13-65). Ten left (%55) and eight right (%45) partial patellectomy were performed. Ten (%55) patients had also additional pathologies. The median follow-up time was 5.2 years (range, 2-11 years). Patients were very well in the last follow-up. According to Cincinnati Knee Score, which was improved by Noyes, 5 patients (%30) had excellent, 8 (%42) good 3(%17) moderate and 2 (%11) bad results. In conclusion, in the following years, enlargement in patellar articular surface and ossification, which is developed compensationally in the extensor mechanism may be detected and misevaluated as osteoarthrosis. Hence, we determined that they had not restricted knee joint functions in our cases.

Adolescent↗