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PubMed2004

[Could hypoxia of connective tissue lead to heterotopic ossification?].

The pathogenesis and treatment of heterotopic ossification still remains controversial. According to clinical study 164 patients after total hip replacement and review the recent literature the new hypothesis was established. This study showed that probably, heterotopic ossification of muscles is triggered by ischemia/reperfusion injury at the time of surgery procedure. That assumption was established on the base of causalities between ectopic bone formation and disturbances of connective tissue oxygenation observed at clinical trial and mentioned in the study.

Arthroplasty, Replacement, Hip↗
PubMed2005

Ossification of the ligamentum flavum as a result of fluorosis causing myelopathy: report of two cases.

OBJECTIVE AND IMPORTANCE: Ossification of the ligamentum flavum (OLF) is increasingly being recognized as a cause of myeloradiculopathy. However, the cause of such OLF has been identified only occasionally. The purpose of this case report is to highlight one more cause of OLF causing myelopathy. CLINICAL PRESENTATION: Two middle-aged men residing in an area endemic for fluorosis presented with the insidious onset of myelopathy. Clinical examination revealed evidence of thoracic cord compression in both patients. Plain x-rays revealed markedly increased bone density characteristic of fluorosis. Magnetic resonance imaging revealed OLF in the lower thoracic region causing cord compression (at one level in the first patient and at three consecutive levels in the second patient). Plain x-rays of the forearm revealed ossification of the interosseous membrane, which is characteristic of fluorosis. INTERVENTION: Both patients underwent decompressive laminectomy with removal of the OLF. The laminae and ossified yellow ligaments formed one mass of bone, which was removed with rongeurs and drills. After surgery, the first patient demonstrated improvement in motor power, whereas the second patient did not demonstrate any change in neurological status. CONCLUSION: Fluorosis should be entertained in the differential diagnosis of OLF, especially in patients from endemic areas. The magnetic resonance imaging appearance of the spine in such cases is characteristic. In properly selected cases of fluorotic myelopathy, surgery is indicated. However, the prognosis is guarded, and long-term follow-up of these patients is necessary given the nature of the underlying disease.

Decompression, Surgical↗
PubMed1992

Heterotopic ossification in children after iliopsoas release.

Heterotopic calcification or ossification of the soft tissues adjacent to the lesser trochanter was observed in the radiographs of 4 patients during a retrospective review of the records of 68 patients with Perthes' disease. This abnormality has since been seen in one other patient with Perthes' disease and in five with spastic quadriplegia. All 10 patients are known to have undergone iliopsoas release as part of adductor tenotomy. The authors believe that the heterotopic ossification is related to the surgery.

Adolescent↗
PubMed2005

Heterotopic ossification of the ulnar collateral ligament: a description of a case in a top level weightlifting athlete.

The purpose of this paper is to describe a case of heterotopic ossification of the ulnar collateral ligament in a 29-year-old top level weightlifter. Plain radiography of the elbow determined the extent and location of heterotopic ossification. Ultrasound and MR imaging completed the instrumental set-up. This symptomatic case had the resolution of pain after 2 months of a supervised rehabilitation program. At one year follow-up the athlete is asymptomatic referring occasional minor pain only in the periods of vigorous training.

Adult↗
PubMed2006

[Heterotopic ossification after total knee arthroplasty].

OBJECTIVES: The purpose of this study was to determine the incidence, time to development and clinical presentation of heterotopic ossification (HO) after total knee arthroplasty (TKA). METHODS: We retrospectively reviewed consecutive radiographs of 226 knees that were obtained at the end of sixth week, third, sixth, and twelfth months following TKA. The radiographic diagnosis of HO was based on the comparison of pre- and postoperative serial radiographs. Grading of HO was made according to the classification of Figgie et al. The clinical and radiographic course of HO and possible predisposing factors were investigated. No pharmacological prophylaxis was used other than mechanical measures to prevent deep vein thrombosis. RESULTS: Heterotopic ossification was detected only in two knees (0.9%) at the sixth month evaluation of lateral radiographs. It was grade 1 in both knees and localized at the supracondylar area of the distal femur. Both patients had primary osteoarthritis. There were no complaints except for mild nonspecific pain around the knee while standing. In both cases, HO underwent spontaneous improvement and disappeared on the twelfth month radiographs. CONCLUSION: Compared with previous studies, the incidence of HO after TKA was quite low and this could be attributed to the lack of pharmacological thromboprophylaxis. Delayed appearance of HO in two patients suggests that TKA cases be monitored for a longer period for HO development.

Adult↗
PubMed2006

[Management of anesthesia in patients with the potential for difficult intubation due to ossification of anterior longitudinal ligament (OALL)].

Ossification of anterior longitudinal ligament (OALL) is a disease inducing ossification of the ligamentum longitudinale anterius of the backbone. The esophagus can be compressed by the disease, which also can induce hoarse voice and dysphagia. Furthermore, the trachea can also be compressed. Difficult intubation had been anticipated based on the preoperative evaluation in this case, but the intubation fortunately was not difficult. However, OALL can accompany difficult intubation, and we anesthesiologists must pay attention to the disease.

Aged, 80 and over↗
PubMed2005

Heterotopic ossification in skeletal muscle metastasis from colonic adenocarcinoma--a case report.

Colonic adenocarcinoma metastasising to the skeletal muscle is rare. A-56-yr-old Malay man was diagnosed to have adenocarcinoma of the right colon [Dukes B] for which a right hemicolectomy was performed, followed by radiotherapy and chemotherapy. Five years later the patient presented with a mass in the rectus abdominis muscle. The serum carcinoembryonic antigen was 71 ng/Ml. The mass was resected. Gross and microscopical examination showed multiple deposits of mucin-secreting adenocarcinoma with prominent heterotopic ossification in the stroma. The exact pathogenesis and significance of heterotopic ossification is not clear, but bone morphogenetic proteins may play an important role.

Adenocarcinoma↗
PubMed1991

Endometrial ossification.

A case of endometrial ossification in a 22-year-old woman is reported. Chronic endometritis following post-abortion evacuation was considered the basis for the osseous metaplasia in her endometrium. Besides being a reversible cause of infertility, endometrial ossification needs to be differentiated from mixed mesodermal tumours of the endometrium.

Abortion, Spontaneous↗
PubMed1991

Induced bone development in transplants of fresh human pseudomalignant heterotopic ossification tissue in athymic nude mice.

Biopsy specimens of mature trabecular bone from tumors of two typical cases of pseudomalignant heterotopic ossification (PHO; myositis ossificans circumscripta) were transplanted into athymic nude mice. Specimens of normal metaphyseal bone in adjacent areas were also transplanted in the contralateral hindquarter muscles for controls. By seven days, control bone transplants were necrotic and enveloped in granulation tissues whereas PHO transplants were surrounded by proliferating connective tissue derived from the host-bed muscle tissues. In the intervals from 14 and 21 days, the PHO transplants showed vascular and hypertrophied connective-tissue proliferation with appositional deposits of new bone. The microscopic features of the new bone suggested that it was of mouse host-bed origin because the new bone from Case 1, a female, showed nuclei without sex chromatin. The quantities of new bone were measured by correlated histomorphometric and computer image analysis of microradiographs. Little or no cartilage development was noted at any stage. The normal control trabecular bone tissue was slowly resorbed by macrophages and mononuclear phagocytes; multinucleated giant cells were few and relatively small. Except in one questionably small area of one transplant, nontumorous undemineralized normal human bone failed to induce bone formation within the 28-day period of observation. The quantity of new bone formed in athymic mice in response to implants of PHO, estimated from equivalent quantities of bone developed from implants of lyophilized matrix-free bone morphogenetic protein (BMP) was about 1 microgram/g of wet PHO tumor weight. Although circumstantial evidence implicates BMP in the pathogenesis of heterotopic ossification, more research should be directed toward regional and systemic factors inhibiting bone development in normal and abnormal conditions, including malignant bone tumors.

Adult↗
PubMed1991

Incidence of heterotopic ossification after total hip replacement: effect of the type of fixation of the femoral component.

The incidence and severity of heterotopic ossification after sixty-five consecutive primary uncemented total hip replacements were compared with those after seventy consecutive primary hybrid total hip replacements (consisting of an uncemented acetabular component and a cemented femoral component). All patients had had the arthroplasty because of osteoarthrosis. The sex distribution, prevalence of bilateral disease of the hip, and frequency of previous operations were similar in both groups. All of the operations were performed by one surgeon who used the same operative approach. Preoperative, immediate postoperative, and six-month follow-up radiographs were reviewed for all patients. For 90 per cent of the hips, radiographs that were made after a minimum follow-up of one year were also reviewed. In the group of patients who had an uncemented femoral component, there was a statistically significant increase in the frequency of heterotopic bone and in its severity. Either none or only class-I ectopic bone developed in 74 per cent of the hips in the hybrid group, compared with 40 per cent of the hips in the uncemented group (p less than 0.005). In contrast, class-III or IV heterotopic ossification was evident in 13 per cent of the hips in the uncemented group (p less than 0.005). None of the patients in the hybrid group needed reoperation for excision of ectopic bone, but four (6 per cent) of the patients in the uncemented group needed such a reoperation because of severe limitation of motion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Pigmented nevus and cutaneous ossifications. Apropos of 125 cases of osteonevi].

In a series of 86,400 pathological examinations 125 cases of pigmented naevus associated with one or several foci of cutaneous ossification were observed. This association, known as osteonaevus of Nanta, account for 1.4 p. 100 of all pigmented naevi. In our series of examinations, osteonaevus was the most frequent cause (62 p. 100) of the 201 skin ossifications observed, the other causes being keratinizing basal cell epithelioma (7 p. 100) and pilomatricoma (5.5 p. 100). The patients' mean age was 46 years (range: 21-80 years), and 81 p. 100 of them were women. In almost every case the lesions were located on the head. The clinical diagnosis was always pigmented naevus, but it coexisted with inflammatory changes in 8 cases, and an underlying induration could be perceived at palpation in 4 cases. In 123 or ou 125 cases the pigmented naevus was restricted to the dermis, junctional theques being present in only 2 cases. The number of ossified foci varied from 1 in 45 p. 100 of the cases to 2 to 4 in 91 p. 100, and in 1 patient up to 8 foci were visible on the same section plane. The lesions presented as compact balls (135 cases), or lamellated bone (126 cases), or spicules of unorganized bone formations. They varied in size from 0.5 mm for balls to 1.5 mm for elements with a central cavity. In the latter were rudiments of bone marrow with capillary vessels, osteoclasts, adipose cells and cells that could be regarded as having haemopoietic functions. All naevi contained hair follicles.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Multiple calcifications and ossifications of tendons].

Multiple calcifications and ossifications of tendons are, as a rule, associated with similar lesions of other articular and/or periarticular structures. The nature and multiplicity of these lesions gives them an unquestionable diagnostic and nosological value. Multiple calcifications are part of the apatite arthritis or of diffuse articular chondrocalcinosis. Multiple ossifications of tendons often suggest Forestier's disease and ankylosing spondylitis.

Calcinosis↗
PubMed1990

Atypical ossification in bronchial carcinoid.

A patient is described with bronchial carcinoid and ossification in the surrounding bronchial wall. The osseous metaplasia was the only histologic abnormality discovered in bronchial biopsy specimens taken pre-operatively. We propose that underlying bronchial carcinoid tumour should be considered in isolated bronchial or bronchopulmonary ossification.

Bronchial Neoplasms↗
PubMed1990

[Endometrial ossification. Apropos of 5 recent cases].

Five cases of ossification of the endometrium that have been seen in the course of five years are reported. Special attention is paid to a case that occurred in the post-partum period. Several different hypotheses as to the aetiology of the pathology of this condition are discussed yet again; the only one that seems likely to be possible is that these ossifications start as metaplasias. The clinical, paraclinical and therapeutic angles are also dealt with.

Adult↗
PubMed1990

Heterotopic ossification in central nervous system-injured patients following closed nailing of femoral fractures.

Heterotopic ossification at the site of insertion of an intramedullary nail was observed in five central nervous system-injured patients with femoral fractures. Three of these patients experienced a reduction in the range of motion of the ipsilateral hip joint, which in two improved with physical therapy. Patients with central nervous system injury who have closed interlocking intramedullary nail fixation may be at increased risk of heterotopic ossification at the surgical site.

Adolescent↗
PubMed1990

[Indomethacin in the prevention of para-articular ossification following total hip endoprosthesis].

Indomethacin for prophylaxis of para-articular ossifications (PAO) after Total-Hip-Replacement We studied in a retrospective clinical trial the effect of indomethacin on the prevention of formation of heterotopic bone after total hip replacement. Compared were the grade lesions of ossification (described by Arcq) in the group of 63 patients that had received with the group of patients without indomethacin. Significantly fewer patients (p less than or equal to 0.001) who had received indomethacin had formation of heterotopic bone compared with the control group.

Adult↗
PubMed1990

Ossification of the cervical posterior longitudinal ligament with severe myelopathy and fatal outcome.

Ossification of the posterior longitudinal ligament is rare among Caucasians. We describe a new case with lethal outcome and we discuss the radiographic and pathologic findings. Posterior longitudinal ligament ossification is a benign disease in most cases, but it may cause severe myelopathy due to spinal stenosis. Diagnosis may be suspected or made on lateral views of the cervical spine and ascertained by CT.

Aged↗
PubMed1990

[Ossification of the posterior longitudinal ligament in the cervical spine].

Ossification of the ligamentum longitudinale posterius is a rare disease found in particular in Japan and southeastern Asia. In the literature it is described as the so-called Japanese disease or OPLL syndrome. The disease takes a slow, frequently asymptomatic, course but may cause severe stenosis of the spinal canal with neurological disorders, OPLL occurs frequently concurrently with ankylosing spondylitis, hypertrophic spondylosis, diffuse idiopathic hyperostosis of the skeleton. Own observation: a 68-year-old man with a long history of cervicalgia, subsequently paraesthesias of the upper extremities, without a spastic atactic symptomatology of the lower extremities. An X-ray extremities, of the skeleton was made, tomograms and CT of the cervical spine. In the Cl-6 area major ossifications of the posterior longitudinal ligament were found which caused stenosis of the spinal canal of an extent of up to two thirds.

Aged↗