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PubMed1988

Cervical myelopathy due to ossification of the posterior longitudinal ligament. A clinical, radiological and evoked potentials study in six Chinese patients.

Six consecutive Chinese patients with cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL) who presented in a 4 yr period were studied. There were 5 males and 1 female whose mean age at presentation was 67 yrs. The common clinical features were spastic tetraparesis more marked in the lower limbs, spinothalamic and posterior column sensory deficits of varying degree and sphincter disturbance in advanced cases. OPLL was diagnosed on plain radiographs and cord compression ascertained by conventional and computer-assisted myelography. Somatosensory evoked potentials correlated with posterior column signs and appeared to reflect the clinical course following treatment. While the cord pathology in OPLL is similar to that of cervical spondylotic myelopathy (CSM), the pathogenetic mechanism probably differs in one aspect. Compression by OPLL is the determining factor in most cases whereas the combined presence of a congenitally narrow canal and spondylosis is essential for the development of CSM. Other contributory factors include coexisting spondylosis, a congenitally narrow canal, friction between cord and OPLL during neck movement and acute trauma. Cord damage is probably mediated by ischaemia which is due to disturbances of the microcirculation caused by the mechanical factors.

Aged↗
PubMed1980

Pathology of vascular sensorineural hearing impairment.

Circulatory disorders, which are well documented in most parts of the human body, are not well documented in the inner ear, although they are expected to occur. It has been previously shown that experimental occlusion of the labyrinthine artery in animals results in severe degenerative changes, fibrosis, and new bone formation in the cochlea. Accordingly, this paper presents presumptive evidence that depriving the human cochlea of its blood supply after surgical removal of an acoustic tumor results in severe degenerative changes that progress to total ossification of the cochlear spaces. This paper also discusses similar changes seen in temporal bones of two patients with sudden sensorineural hearing impairment. Based on these observations, the author concludes that occlusive arterial disease, whether thrombotic, embolic, or spastic, plays a role in some sudden sensorineural hearing losses. Cochlea ossification, detected by polytomography, suggests a vascular etiology of the hearing impairment. Treatment with vasodilator drugs and anticoagulants is justified in these cases until a better diagnostic protocol is developed to eliminate other causes.

Adult↗
PubMed1981

Anality: a theory of erotism and characterology.

The psychogenesis of anality is in the psychosexual events of the second year of life. An analysis of that phase of development centers on the biological determinants of psychological development, specifically on the erotization of the excretory functions. The social structures interfering with this process are examined. The interrelationship of feces, child, and penis are analyzed within the context of the total libidinal spectrum of development and object relations. Bipolarity is seen as an integral facet of the anal character, manifested in the retentive-eliminative continuum and in the aggressive-erotic divergences. These trends are examined in detail vis-à-vis the ultimate ossification of the anal adult. In this context, the percept of anal-sadism is introduced and alternate interpretations of the phenomenon are suggested. Various characteristics frequently associated with anal characterology are discussed and an attempt is made to demarcate the status (as integral or peripheral) of these traits. Sociocultural contingencies of anality are also considered, particularly with regard to Western institutions. The major pathological maladaptions related to anality are detailed. These include the obsessions and rigid superego development, paranoia, and homosexuality. The status of anality is then evaluated from the ego-psychological perspective, and interpersonal and societal factors are considered. What emerges is a unitary construct of anality which incorporates both erotism and characterology.

Defense Mechanisms↗
PubMed1997

A new computerised method for the assessment of skeletal maturity in the newborn infant.

Of the existing methods for assessment of skeletal maturity in children over 1 year of age none is particularly suited to the newborn infant. We describe a computerised method by which area, perimeter and progression in the shape of ossification centres of talus and calcaneus are evaluated separately. From single lateral radiographs of the left ankle of 302 normal term and preterm infants whose birth weights were appropriate for gestational age we constructed reference curves of areas and perimeters at different gestational ages, as well as frequency distributions of each morphological maturity stage. This method may be applicable in assessing skeletal maturity in pathological conditions, such as intrauterine growth retardation and congenital hypothyroidism.

Age Determination by Skeleton↗
PubMed2004

Complications in total hip replacement.

AIM: THE PURPOSE of the present study was to present the most common treatment failures and complications associated with total hip replacement. MATERIAL AND METHODS: Between 1986 and 2002, 486 total hip replacements (THR) in 403 patients were performed at the Clinics of Orthopedic and Trauma Surgery (St. George University Hospital, Plovdiv). 315 (61.8%) of the patients underwent THR for coxarthrosis, 171 (35.1%)--for traumatic or pathologic subcapital femoral neck fractures. 312 (64.2%) of the patients were women and 174 (35.8%) were men. Right and left arthroplasties were carried out. Patients' age was in the range of 28 to 53 years (median age 59.6). Complications were diagnosed in 97 (19.9%). Late postoperative complications (53.6%) as aseptic loosening of the prosthetic components, superficial and deep hematogenous infections, prosthetic dislocations and heterotopic ossifications were predominant. RESULTS: Complications were categorized as intraoperative, postoperative and late--a finding, consistent with the data in the literature. Among the intraoperative complications most common were malposition of the capsule (7 patients) and of the stem (4 patients) and longer stem (in 1 patient), but they caused no complaints. The postoperative complications consisted of hematomas and seromas wich were treated with early revision surgery. The main causes for late complications were postoperative ossification in 28 patients. Aseptic loosening of the prosthesis was seen in 11 patients. 8 of them complained of acetabular and 3 of thigh pain. Capsule dislocation was registered in 3 patients. CONCLUSIONS: Complications in THR are not infrequent. Their avoidance is largely dependent on the skill and qualification of the team and the quality of hospital care. Adequate risk assessment and prophylaxis are essential in disease outcome.

Adult↗
PubMed1993

Early prenatal sonographic diagnosis of neuropathic arthrogryposis multiplex congenita with osseous heterotopia.

A prenatal diagnosis of arthrogryposis multiplex congenita (AMC) has been carried out on a 19-week-old fetus by means of echography. The ultrasonographic characteristics were unnatural position of the four limbs associated with articular anomalies together with absence of active fetal movements. A therapeutic interruption of pregnancy was performed and the diagnosis was confirmed. At autopsy, architectural disorder of the motor neurons of the anterior medullary horn revealed a neuropathic pathogenesis of the arthrogryposis. Moreover, at the lumbar level the spinal cord was progressively replaced by heterotopic bony tissue which caused a more severe deformity of the lower limbs compared with the upper. The aspects of anatomo-pathological, genetic, and differential diagnosis are discussed showing the precocity of the prenatal diagnosis and the peculiarity of the aetiology of our case.

Abortion, Therapeutic↗
PubMed2006

Runx2 expression is associated with pathologic new bone formation around radicular cysts: an immunohistochemical demonstration.

BACKGROUND: Radicular cysts are the most common cysts in human jaw bones. These lesions induce bone remodeling of the surrounding alveolar bones, which was termed 'condensing osteitis', and was suggested to be related to cells of the osteoblastic lineage. The Runx2 (core-binding protein [cbfa]1/polyoma enhancer-binding protein [pebp]2alphaA) was shown to be a DNA-binding transcriptional molecule expressed in osteoprogenitor cells. METHODS: We confirmed the specificity of anti-Runx2 antiserum, using Western blotting analysis. We investigated the expression and localization of Runx2 in 32 radicular cyst cases with bone tissue fragments, immunohistochemically. RESULTS: Signals for Runx2 were seen in 18 cases (56.3%) of radicular cysts with bone formation. These signals were immunolocalized in the nuclei of the spindle-shaped osteoprogenitor cells in the cyst walls, whereas only a few signals were seen in the cuboidal osteoblastic cells near the fibrous bones. Signals for type I collagen were immunolocalized in the dense collagen fibers in the cyst walls and in the matrix of the fibrous bone around the radicular cysts, whereas no signals were seen on the inner portions with inflammatory cell infiltration of the cyst walls. Very weak signals for transforming growth factor (TGF)-beta1 were infrequently seen in the osteoblasts of the fibrous bone, whereas signals for TGF-beta2 were observed in young osteocytes in the fibrous bones, in B-cell lymphocytes infiltrating into the inner portions, and on the cellular membranes of the lining epithelium. CONCLUSIONS: The nuclear expression of Runx2 in spindle-shaped cells in the outer portions may play an essential role in the induction of fibrous bone tissue around radicular cysts. TGF-beta2 may play a role in the production of type I collagen, which acts as a template for pathologic new bone formation, in radicular cysts.

Activin Receptors, Type I↗
PubMed1982

Tracheopathia osteoplastica: report of four cases.

We describe 4 florid examples of tracheopathia osteoplastica (TPO) discovered incidentally at autopsy. The sparsity of previously reported cases of TPO from Australia possibly reflects a lack of awareness of this entity rather than its true incidence. The more recent literature concerning the etiopathogenesis, pathology and clinical complications of this uncommon condition is reviewed. In our view TPO is a distinct entity and does not represent a late stage of diffuse tracheal amyloidosis.

Aged↗
PubMed1980

Tracheopathia osteoplastica: clinical, radiologic, and pathological correlations.

The clinical, radiologic, and pathological features of tracheopathia osteoplastica are reviewed and three new cases are reported. Tracheopathia osteoplastica is usually not diagnosed until autopsy. However, it may be a surprise finding to the endoscopist and occasionally it may produce signs and symptoms of upper airway obstruction and enter into the differential diagnosis of a tumor of the trachea. The chest radiograph may permit the correct clinical diagnosis to be made. The pathological diagnosis is easy with adequate tissue. Because tracheopathia is a lesion predominantly of old age with little associated morbidity or mortality, the correct clinical diagnosis will prevent unnecessary operation.

Aged↗
PubMed1995

Bisphosphonates in the treatment of disorders of mineral metabolism.

Bisphosphonates are analogues of inorganic pyrophosphate, a naturally occurring chemical in bone. In vitro and animal experiments demonstrated that these agents were effective inhibitors of bone resorption. Subsequently they were applied to a variety of clinical problems in which increased bone resorption was an underlying feature of the pathology. In 1971 etidronate became the first bisphosphonate shown to inhibit bone resorption in humans when it was given to patients with Paget's disease. Subsequently this agent was also found to be useful in treating the hypercalcemia of malignancy. At the present time cyclic etidronate therapy is also used for the prevention of bone loss in patients with osteoporosis and for the prevention of heterotopic ossification in spinal cord-injured patients and in patients after hip replacement. Newer bisphosphonates are generally more potent than etidronate and do not produce a severe mineralization defect as do higher doses of etidronate. Pamidronate and clodronate are highly effective in the management of Paget's disease, hypercalcemia due to malignancy and immobilization, metastatic bone disease, and hematologic malignancies affecting bone. They are also promising agents for the prevention of osteoporosis. Alendronate, risedronate, and CGP 42446 are highly potent bisphosphonates that look very promising for the treatment of all disorders of bone resorption. It is fortunate that adverse reactions are not a prominent feature of bisphosphonate use. The main side effects are nausea and abdominal discomfort, mainly with oral use, a transient increase in bone pain in patients with Paget's disease, and an acute-phase reaction (fever, myalgia, mild leukopenia) in patients receiving aminobisphosphonates. The evolution of bisphosphonate therapy should be considered one of the major therapeutic events of the past 25 years. Future research should define the optimum use of these agents.

Diphosphonates↗
PubMed1995

[Electrophysiological and MRI study on poor outcome after surgery for cervical myelopathy].

Occasionally, the outcome from laminoplasty for cervical spondylosis is disappointing despite an adequate operation. Before surgery, it is difficult to diagnose the pathological extent of the involvement of the spinal cord. The purpose of this study is to determine the efficacy of magnetic resonance imaging (MRI) and of the motor evoked potentials (MEPs) for the indication of the surgery and prognosis. Retrospectively, we investigated the MEPs and the MRI image of 31 patients in surgery for cervical myelopathy, involving 21 cases with cervical spondylosis and 10 cases with ossification of the posterior longitudinal ligamentum, and compared the findings from those with a poor outcome (n = 31) with the findings from those with a good outcome (n = 32). The MEPs from the thenar muscle and the tibialis anterior were evoked by transcranial magnetic brain stimulation. In the poor-outcome patients, the spinal canal was narrow and lumbar spinal canal stenosis was seen in 5 cases which required lumbar laminectomy. Before operation, the MEPs from the thenar muscle could not be evoked in 5 cases while there was a remarkably prolonged central motor conduction time in the other 26 cases. MRI revealed the deformed spinal cord in the involved area, and the signal intensity of the involved spinal cord in the T2 weighted image was remarkable high. The signal intensity ratio was significantly higher in the poor-outcome patients than in the good-outcome patients. This study suggested that a high signal intensity in the T2 weighted image and a prolonged conduction time or absence of MEPs largely corresponded to the clinical and other investigative features of myelopathy responsible for a poor outcome.

Aged↗
PubMed1979

The Campomelic syndrome. Temporal bone histopathologic features and otolaryngologic manifestations.

The campomelic syndrome is characterized by dwarfism, craniofacial anomalies, bowing of the tibiae and femora, cutaneous dimpling overlying the tibial bend, respiratory distress, and early death. Otolaryngologic manifestations include flat facies with a broad nasal bridge, low-set ears, cleft palate, mandibular hypoplasia, and tracheobronchial malacia. The underlying pathologic feature appears to be disturbance in cartilage growth involving the affected bones and the respiratory tract cartilage. The cause is unknown. We report clinical and histopathologic features in two cases of this syndrome. The endochondral layer of the otic capsule contained no cartilage cells. The cochlea was short and flattened, presenting a scala communis. The vestibule and the canals were deformed by bone invasion. Defective endochondral ossification of the petrooccipital synchondroses possibly explains the shortened skull base seen in this syndrome. The tracheobronchial malacia significantly contributes to respiratory distress and neonatal death.

Abnormalities, Multiple↗
PubMed1985

Skeletal abnormality of sheep: clinical radiological and pathological account of occurrence of dwarf lambs.

Details are given of the clinical, radiological and pathological appearance of dwarf lambs. Twenty-seven of 110 lambs born were affected, occurring as singletons, twins or one of a pair of twins. All affected lambs were dead within a few minutes of birth. They were short and plump with a domed head and shortened nose, short paddle-like limbs, a narrow thorax and swollen abdomen. The defect involved chondrocyte dysplasia, producing defective endochondral ossification and the presence of abnormal cartilage in the respiratory tract. No specific genetic or environmental cause was identified.

Animals↗
PubMed1977

Long bone ossifying fibromas.

Ossifying fibromas involving the tibia were seen in two patients. In both patients, the radiographic appearance of the lesions suggested fibrous dysplasia, but histopathologic evaluation demonstrated findings similar to ossifying fibroma of the mandible and facial bones. Radiologic and pathologic recognition of this entity is necessary for proper treatment.

Adolescent↗
PubMed2005

Osseous metaplasia in the setting of nephrogenic fibrosing dermopathy.

BACKGROUND: Nephrogenic fibrosing dermopathy (NFD) is a new skin-fibrosing disorder associated with renal dysfunction. It is marked by the acute onset of induration involving the upper and lower limbs, and it is characterized by distinctive histopathologic findings. METHODS: We report the case of a patient on hemodialysis who presented initially with the characteristic clinical and pathological features of NFD. The patient progressively developed painful hyperkeratotic spicules on both thighs and bone metaplasia was confirmed. RESULTS: Histological studies were performed at different stages of the disease showing an evolution from the well-known initial phase of NFD, characterized by thickening of the dermis, increased number of fibroblast-like cells, and mucin deposits, to an end stage characterized by the presence of dermal ossification. CONCLUSIONS: We report the exceptional finding of bone metaplasia in the setting of a case of NFD.

Adult↗
PubMedDate not supplied

Cavovarus foot deformity with multiple tarsal coalitions: functional and three-dimensional preoperative assessment.

In rare instances, tarsal coalition leads to cavovarus foot deformity, although the pathologic mechanism leading to this deformity is not clear. This article reports a case of a 14-year-old boy presenting a severe cavovarus deformity of the right foot with talocalcaneal and calcaneonavicular coalitions, and a mild cavus deformity of the left foot with a single talocalcaneal coalition. Computed tomography and postoperative histologic analysis demonstrated a synostosis between talus and calcaneus and a fibrous calcaneonavicular coalition with partial ossification. Instrumented gait analysis revealed a limited range of ankle plantar flexion and increased external rotation of the ankle. Associated skeletal malformations including incomplete hemimelia of the forearm and scoliosis raised the possibility of a teratologic condition, but neurologic examination, spinal magnetic resonance imaging, and nerve conduction velocities were normal. The progressive ossification of combined coalitions during growth of the foot may have been one factor leading to this complex foot deformity. The fine-wire electromyogram showed normal tibialis anterior and posterior muscle activity. Small soft tissue tears in the sinus tarsi may have led to a mild reflexive increase of the muscle tone and tendon shortening, which pulled the forefoot into adduction and the heel into varus, and raised the medial arch. Mechanical alterations of the ankle appear secondary to the heel varus and to the progressive deformity of the talus. Three-dimensional computed tomography reconstruction and gait analysis appeared to be helpful additional parameters to understanding the pathomechanics of this complex foot deformity and for preoperative planning of triple arthrodesis.

Adolescent↗
PubMed2005

[The preliminary study on the characteristics of mandible and condyle in dentin matrix protein-1 gene knockout mice].

OBJECTIVE: To study the characteristics of mandible and condyle in Dmp1 gene knockout mice, and to investigate the role of Dmp1 in the osteogenesis and mineralization of bone and cartilage. METHODS: Dmp1-/-mice were executed at birth, 2 weeks, 2 months, 3 months and 5 months, and the mandible was taken out for physical, radiography, transmission electron microscopic, and histological examination. The difference between Dmp1 knockout mouse (ko) and wild type mouse (wt) in bone development, bone densitometry and histology were compared. RESULTS: There were obvious changes in the mandible and condyle of Dmp1-/-mouse, such as incomplete ossification, low density, decreased volume and condyle cartilage degeneration. CONCLUSIONS: Dmp1 is the key factor in the formation of growth plates and secondary ossification center, and plays an important role in the process of bone and cartilage formation and bone nodule remodeling. Dmp1 may be the candidate gene that controls the development of mandible and cartilage.

Animals↗