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[External radiotherapy or non-steroidal anti-inflammatory drugs for prevention of heterotopic ossification following total hip replacement].

Heterotopic ossification (HO) is detained as the development of abnormal ossification in soft tissues. HO is a common disease after total hip replacement. Many therapeutic modalities have been proposed to prevent HO. The most commonly used modalities are non-steroidal anti-inflammatory drugs (NSAID) or ionizing radiation administered just before or immediately after total hip replacement. As far as external radiation therapy is concerned, there are several published randomized studies aimed at investigating its efficacy and timing related to surgery, and at comparing ionizing irradiation to NSAID. In this article we review the published data in order to define guidelines which could be used in daily practice for the choice of prophylactic treatment against HO.

Anti-Inflammatory Agents, Non-Steroidal↗

[Ossification of the posterior longitudinal spinal ligament--comparative studies with computerized tomography (author's transl)].

Ossification of the posterior longitudinal spinal ligament (OPLL) was characterized by calcified longitudinal band along the posterior margin of vertebrae, but it has not been possible to know how the cord is compressed within the narrowed spinal canal. Our neuroradiological studies based on CT-view of the 15 cases of OPLL suffering from various degree of myelopathy revealed: 1) Computed tomography precisely delineated shape of OPLL, which was quite polymorphic, like mushroom, irregular cubic and round. OPLL ranged more than two vertebrae was not uniform, but exhibited different configuration at each level. 2) OPLL at lower cervical and higher thoracic regions was difficult to diagnose by conventional lateral roentgenograms, but CT-scan demonstrated clearly whole extent of OPLL. 3) obliteration ratio of the affected spinal canal was calculated on CT-scan. Cases showing severe myelopathy, such as quadriparesis and neurogenic bladder, presented spinal canal stenosis of more than 30%. Spondylosis were concomittant roentgenographic findings on 13 cases of OPLL (87%). However, spondylotic changes responsible to the myelopathy were seen on only three cases. In these case, the obliteration ratio by ossificated ligament was lower than 26%. On conclusion, computed tomographic views of OPLL gave us more detailed information about the stenotic spinal canal and found to be essential examination when considering operative intervention.

Aged↗

[A case of intestinal Behçet's disease with abnormal ossification complicated by myelodysplastic syndrome, symptoms revealed after the perforation of ileum ulcer].

A 39-year-old man, who had been treated with Etretinate for common wart since he was 29 years old, was admitted to Taga General Hospital complaining of gradually deteriorating lumbago and bilateral hip joints pain in September, 1996. His lower vertebrae and bilateral hip joints showed abnormal ossification on X-ray. The bone scintigraphy indicated the existence of sacroiliitis. His platelet counts were fluctuating between 8 x 10(4) and 9 x 10(4)/mm3. During the follow-up in our out-patient clinic, he was suddenly suffered from severe abdominal pain in August, 1997 and admitted to our hospital. An emergency operation revealed multiple ulcers of his ileum with several perforations. Histological findings of the specimen of the ileum showed simple ulcer. After the operation, he had oral and genital ulcers. He did not have any signs or symptoms of ocular involvement. He was diagnosed as intestinal Behçet's disease. Because he showed gradually pancytopenia for several months after the operation, bone marrow aspiration was performed and a diagnosis of refractory anemia, a type of myelodysplastic syndrome (MDS), with trisomy of chromosome 8 was made. Abnormal ossification of his vertebrae and hip joints were considered to be related to Behçet's disease because an coexistence with sacroiliitis. On the other hand, there is no denying the effects of orally Etretinate administration. Several cases have been reported the association of MDS with Behçet's disease. In this case, the existence of MDS or various symptoms in Behçet's disease became apparent after the perforation of ileum ulcer. This paper discusses possible etiology of the relation between Behçet's disease and MDS, or the characteristic clinical course in this case.

Adult↗

[Ossification of the transverse ligament of the atlas. A report on three new cases (author's transl)].

Following the publication of the first two cases reported of ossification of the transverse ligament, the authors describe three recent observations of this lesion. In contrast to the first two cases, in which ossification was reported at the level of the cervico-occipital articulation, which was normal, these three new cases were noted to have associated acquired or congenital abnormalities of the craniovertebral junction.

Aged↗

Neurogenic heterotopic ossification : a diagnostic and therapeutic challenge in neurorehabilitation.

Heterotopic ossification (HO) is an important cause of restriction in range of movements and secondary motor disability following neurotrauma, orthopaedic interventions and burns. It has not received focussed attention in non-traumatic neurological disorders. In a prospective study of 377 patients, on medical problems in neurological rehabilitation setting, 15 subjects (3.97%) had neurogenic heterotopic ossification. Their clinical diagnosis was: transverse myelitis (7), neurotuberculosis (4), traumatic myelopathy (2) and stroke (2). Hip (10), knee (4) and elbow joints (1) were involved. The risk factors included urinary tract infection (15), spasticity (6), pressure sores (13) and deep venous thrombosis (DVT) (6). The initial diagnosis was often other than HO and included DVT (3), haematoma (2) and arthritis (2). ESR and serum alkaline phosphatase levels were elevated in all but one subject. The diagnosis of HO was established using X-rays, CT Scan and three-phase bone scan. Following treatment with non-steroidal anti-inflammatory drugs, the range of motion improved in only four patients. HO resulted in significant loss of therapy time during rehabilitation. High index of suspicion about this complication is necessary for early diagnosis and prompt intervention.

Disability Evaluation↗

[A case of idiopathic disseminated pulmonary ossification (author's transl)].

A patient aged 92 years was discovered to have disseminated pulmonary ossification of the interstitial tissues without any valvular cardiopathy. The authors underline the rarety of such ectopic ossifications and review their radiological, anatomical, and etiological characteristics as reported in the published literature.

Adult↗

[Endometrial ossification. 6 cases].

Endometrial ossification is a rare and benign pathology. The etiopathogenesis of this pathology is controversial. Findings suggestive of diagnosis are fairly well know, menstrual irregularities is the main clinical symptoms, expulsion of bony fragments is a rare but pathognomonic event. Pelvic ultrasonography suggested an intrauterine foreign body and hysteroscopy was necessary to make the correct diagnosis. Six cases of endometrial ossification diagnosis and treated at obstetrics and gynaecology department A of centre of La Rabta teaching hospital (Tunis) are reported.

Adult↗

Ossification of posterior longitudinal ligament causing cervical cord compression.

Ossification of the posterior longitudinal ligament (OPLL) is an uncommon cause of compressive myelopathy outside Japan. A case of cervical cord compression in a female whose MRI showed OPLL is reported. T2 weighted MRI images are the most effective to evaluate both spinal cord compression due to ossification and abnormal signal intensity of the cord. OPLL should be included in the differential diagnosis of cervical radiculomyelopathy.

Adult↗

Correlation between hyperplastic scars, hyperplastic callus and heterotopic ossifications.

Independently of the local and general physiopathological factors that influence the repair of skin and bone, there seems to be marked parallelism in the same subject between hyperplastic scars, exuberant callus formation, and heterotopic ossification. The writer describes his findings in a series of personal cases. Arising out of these observations, he discusses the probable pathogenesis of this parallelism of behaviour, and its practical implications. Subjects in whom hyperplastic scars are produced are constitutionally more predisposed to form rapid and exuberant callus, or heterotopic ossification, than normal subjects.

Adolescent↗

Ossification of the ligamentum flavum in a Caucasian. Case report.

There have been few reports of ossification of the yellow ligaments causing spinal cord compression in Caucasian population. This disease is described mainly in Japanese patients and is termed as "Japanese disease". We describe the case of a 58-year-old Caucasian male with progressive paraparesis. Radiographic features were suggestive of ossification of the yellow ligaments in the lower thoracic level causing spinal cord compression. Early decompressive laminectomy and removal of the ossified ligament resulted in a marked clinical improvement. The etiological hypothesis, epidemiological, histological, clinical and radiological features of this disease are reviewed.

Humans↗

Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up.

OBJECT: The authors report the long-term (more than 10-year) results of cervical laminoplasty for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine as well as the factors affecting long-term postoperative course. METHODS: The authors reviewed data obtained in 92 patients who underwent cervical laminoplasty between 1982 and 1990. Three patients were lost to follow up, 25 patients died within 10 years of surgery, and 64 patients were followed for more than 10 years. Results were assessed using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. The recovery rate was calculated using the Hirabayashi method. The mean neurological recovery rate during the first 10 years after surgery was 64%, which declined to 60% at the last follow-up examination (mean follow up 12.2 years). Late neurological deterioration occurred in eight patients (14%) from 5 to 15 years after surgery. The most frequent causes of late deterioration were degenerative lumbar disease (three patients), thoracic myelopathy secondary to ossification of the ligamentum flavum (two patients), or postoperative progression of OPLL at the operated level (two patients). Postoperative progression of the ossified lesion was noted in 70% of the patients, but only two patients (3%) were found to have related neurological deterioration. Additional cervical surgery was required in one patient (2%) because of neurological deterioration secondary to progression of the ossified ligament. The authors performed a multivariate stepwise analysis, and found that factors related to better clinical results were younger age at operation and less severe preexisting myelopathy. Younger age at operation, as well as mixed and continuous types of OPLL, was highly predictive of progression of OPLL. Postoperative progression of kyphotic deformity was observed in 8% of the patients, although it did not cause neurological deterioration. CONCLUSIONS: When the incidence of surgery-related complications and the strong possibility of postoperative growth of OPLL are taken into consideration, the authors recommend expansive and extensive laminoplasty for OPLL.

Adult↗

Heterotopic ossification presenting as acute arthritis.

We describe a patient with acute myeloblastic leukemia in remission who developed painful, swollen knees 6 weeks after being ventilated for acute respiratory distress syndrome. Synovial fluid analysis was nondiagnostic and initial radiographs of his knees were normal. Repeat radiographs 5 weeks later showed periarticular calcification and the diagnosis of heterotopic ossification was made. Heterotopic ossification should be part of the differential diagnosis of acute arthritis in critically ill patients.

Acute Disease↗

[Ossification of the posterior longitudinal ligament].

The authors described 21 patients aged 37 to 83 with ossification of the posterior longitudinal ligament (10 with ischemic myelopathy, 6 with aftermaths of a trauma of the cervical spine, and 5 with the radicular syndrome on the basis of vertebral osteochondrosis. X-ray signs of three types of ossification of the posterior longitudinal ligament were defined and specified: linear, curved and mixed. The linear type was more frequently observed in the cervical spine whereas the curved type was more frequent in the lumbar spine.

Adult↗

[Two cases of renal cell carcinoma accompanied with ossification].

We report two cases of renal cell carcinoma accompanied with ossification. Case 1: A 40-year-old male visited a physician with the complaint of epigastric pain. Examination of the stomach revealed compression of the greater curvature. Abdominal radiography and CT scan revealed a left renal mass with calcification, which was a hypovascular tumor on angiography. A transperitoneal left nephrectomy was performed. The resected kidney was 700g in weight and the tumor, which was 12 x 10 x 10 cm in size and located in the upper pole of the kidney, was enveloped with a hard capsule and was extensively necrotized. Histopathological diagnosis was renal cell carcinoma (papillary type, mixed subtype). Case 2: A 69-year-old female was occasionally pointed out to have a left renal mass in ultrasonic examination. It was accompanied with calcification in CT scan and a hypervascular tumor in angiography. A transperitoneal left nephrectomy was performed. The resected kidney was 320 g in weight and the tumor located in the lower pole of the kidney, was 6 x 6 x 6 cm in size and necrotized. Histopathological diagnosis was renal cell carcinoma (alveolar type, clear cell subtype). Microscopically in both cases, ossified tissue existed among the fibrous tissue in the necrotized lesion of the tumor, but not near the cancer cells and, it was accompanied by calcification. During the ossification process, the connective tissue proliferates after the necrosis of the tumor, and metaplasia occurred from its juvenile plastic cells to osteoblastic cells.

Adult↗

Prophylaxis for heterotopic ossification after primary total hip arthroplasty. A cohort study between indomethacin and meloxicam.

The authors have conducted a prospective cohort study of the efficacy of a 7 days administration of Indomethacin (n = 89) versus Meloxicam (n = 92), in the prophylaxis of heterotopic ossification (HO) in primary total hip arthroplasty. To assess the interobserver variability of the Brooker classification, all radiographs were evaluated by three investigators. In the Indomethacin group 25 patients developed HO (grade I: 22, grade III: 2 and grade IV: 1). In the Meloxicam group 34 developed HO (grade I: 30, grade II: 1 and grade III: 3). We were not able to show any difference between Indomethacin and Meloxicam in preventing heterotopic ossification after primary hip arthroplasty. We found a high interobserver variability in the grading system according to Brooker, in particular for the higher grades(grade II, III and IV).

Adult↗

Postoperative heterotopic ossification in the child with cerebral palsy: three case reports.

Three children with cerebral palsy and mental retardation showed irritability after surgical procedures. They were subsequently diagnosed as having heterotopic ossification. Heterotopic ossification developed around the hip in all cases--two after bilateral adductor releases at the operative site and the third after spinal fusion at a site unrelated to the surgery.

Adult↗