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At least 1,315 records · Page 73Linked to original sources
PubMed1999

Multiple pulmonary leiomyomatous hamartoma with secondary ossification.

A 31-year-old woman presented with multiple pulmonary leiomyomatous hamartoma (MPLH) with secondary ossification. She had a past history of parosteal osteosarcoma. The pulmonary lesions were composed of spindle-shaped cells arranged in interlacing fascicles, among which glands or duct-like spaces were scattered. As some lesions contained bony tissues, it was unclear whether or not the pulmonary lesions were metastases of parosteal osteosarcoma. However, the majority of spindle-shaped cells were positive for alpha-smooth muscle actin, including cells proliferating around the bony tissues. Clonality analysis using a target of human androgen receptor (HUMARA) gene disclosed that the pulmonary nodules were polyclonal. These findings do not indicate that the lesions were metastatic. We would like to emphasize that MPLH can show osseous metaplasia.

Adult↗
PubMed2001

Heterotopic ossification following elbow arthroscopy.

With advances in technique and skills, the indications for elbow arthroscopy continue to expand. The authors report a case of heterotopic ossification following arthroscopic debridement of the elbow. Surgeons need to be aware of this potential complication of elbow arthroscopy.

Arthroscopy↗
PubMed2003

Activation of beta-catenin-LEF/TCF signal pathway in chondrocytes stimulates ectopic endochondral ossification.

OBJECTIVE: Members of the Wnt signaling protein family are expressed during cartilage development and skeletogenesis, but their roles and mechanisms of action in those processes remain unclear. Recently, we found that beta-catenin-LEF/TCF-dependent Wnt signaling stimulates chondrocyte maturation and hypertrophy and extracellular matrix calcification in vitro, events normally associated with cartilage-to-bone transition during skeletogenesis. Thus, we tested here whether activation of this pathway promotes endochondral ossification. DESIGN: Chick chondrocytes were infected with avian retroviral expression vectors encoding constitutive-active (CA) or dominant-negative (DN) forms of LEF, which activate or block beta-catenin-dependent Wnt signaling respectively. These cells and companion uninfected control cells were seeded into type I collagen gels and transplanted intramuscularly into nude mice. The resulting ectopic tissue masses forming over time in vivo were subjected to histological and molecular biological analyses. RESULTS: Transplantation of chick chondrocytes induced de novo endochondral bone formation. In situ hybridization and RT-PCR using species-specific probes and primers showed that the ectopic cartilaginous tissue was avian and thus donor-derived, whereas the bone tissue was mouse and thus host-derived. CA-LEF-expressing ectopic tissue masses contained abundant bone and marrow, while DN-LEF-expressing masses contained little bone and lacked marrow. CONCLUSIONS: Activation of beta-catenin-LEF/TCF-dependent Wnt signaling accelerates chondrocyte maturation and replacement of cartilage by bone.

Animals↗
PubMed2003

The predictive value of creatine phosphokinase and alkaline phosphatase in identification of heterotopic ossification in patients after spinal cord injury.

OBJECTIVE: To determine the predictive value of serum levels of creatine phosphokinase (CPK) and alkaline phosphatase (ALP) in identifying patients with spinal cord injury (SCI) who are at risk to develop heterotopic ossification (HO) at the hips. DESIGN: Prospective cohort study. SETTING: Tertiary-care level I trauma center. PARTICIPANTS: Consecutive sample of 18 adults with acute traumatic SCI. Patients were excluded if they had medical or surgical conditions that are known to cause elevated enzyme levels. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Conventional hip radiographs were taken approximately 3 weeks after injury and again from between 3 to 6 months after injury. Serum ALP and CPK were measured approximately 3 weeks after SCI. Patients were later separated into 2 groups: group 1 was comprised of those who developed HO and group 2 was comprised of those who did not. RESULTS: The initial radiographs showed no evidence of HO in either group. The radiographs taken at 3 to 6 months showed HO in 7 of 18 patients. The levels of CPK at the initial evaluation were significantly higher (R=.947, P<.0024) in group 1 than in group 2 and correlated with the severity of HO. There was no correlation between serum ALP levels and subsequent development of HO between the 2 groups (P=.07). CONCLUSION: Elevated serum levels of CPK have value in predicting the HO.

Adult↗
PubMed2001

Radiation prophylaxis for heterotopic ossification of the knee.

Heterotopic ossification (HO) occurs in 42% of patients who have undergone total knee arthroplasty. Bone formation usually is found in the quadriceps expansion and causes minimal to no symptoms. Specific therapy usually is unnecessary, but cases have been reported in which manipulation under anesthesia or revision arthroplasty has been required. We report a small series of 5 patients (6 knees) who have undergone surgical intervention for HO of the knee with radiotherapy given postoperatively for prophylaxis against future HO. Although this series is small, it appears that the use of prophylactic radiation may reduce recurrence after resection of symptomatic HO after total knee arthroplasty. Further investigation is required to confirm these preliminary findings.

Adult↗
PubMed2001

The effect of pulsed irrigation on the incidence of heterotopic ossification after total hip arthroplasty.

Heterotopic ossification (HO) is a common complication of total hip arthroplasty (THA). Pulsed lavage is being used with increasing frequency for THA. A prospective randomized, double-blind trial was initiated to determine if pulsed lavage affected the incidence of HO. A total of 94 THAs in 91 patients were analyzed. No significant difference in the incidence of HO was found between the 2 groups. Hypertrophic osteoarthritis was found to be a significant risk factor for HO. The findings suggest that the osteogenic precursor cells thought to be involved in the pathogenesis of HO possibly are derived from within the local soft tissues in the proximity of the hip joint.

Arthroplasty, Replacement, Hip↗
PubMed2001

Heterotopic ossification after uncemented hydroxyapatite-coated primary total hip arthroplasty.

A total of 134 patients who had a cementless hydroxyapatite-coated total hip arthroplasty (THA) and had no recognized risk factors for heterotopic ossification (HO) were reviewed retrospectively. The average follow-up period was 83 months. Pharmacologic or radiotherapeutic prophylaxis against HO was not used. HO was seen in 90 (67.2%) of the 134 patients reviewed. HO was rated as Brooker class I in 68 (50.7%) patients, class II in 17 (12.7%) patients, class III in 3 (2.2%) patients, and class IV in 2 (1.5%) patients. The average Merle d' Aubigne score in patients with mild forms of HO (Brooker classes I and II) was 16 compared with 13.2 in patients with severe HO (Brooker classes III and IV). A statistically significant negative correlation was found between the presence of HO and the postoperative hip score. Based on our study findings and on a comparison with data in the literature, hydroxyapatite-coated cementless THA alone does not seem to increase the likelihood of HO over other types of THA. The presence of a hydroxyapatite coating does not result in more class III or IV HO, which are the only classes of HO with real clinical significance. Fear of HO should not be a factor in the choice of fixation for THA.

Adult↗
PubMed2002

Heterotopic ossification after total hip arthroplasty: a critical analysis of the Brooker classification and proposal of a simplified rating system.

We evaluated the reproducibility of the Brooker classification for heterotopic ossification (HO) and, based on the results and weaknesses observed, proposed a simplified system with addition of objective criteria. Six observers classified radiographs of 169 total hip arthroplasties, using the Brooker classification and a modified system consisting of i) absence of HO or islands measuring <1 cm in length, ii) islands >1 cm or spurs leaving at least 1 cm between femur and pelvis, and iii) spurs leaving <1 cm between opposing surfaces or bony ankylosis. Reproducibility was calculated using kappa statistics. For the Brooker classification, interobserver kappa averaged 0.43 (range, 0.74-0.18) (poor). Intraobserver kappa averaged 0.74 (fair). For the modified classification, interobserver kappa averaged 0.59 (range, 0.51-0.76) (fair). Intraobserver kappa averaged 0.78 (good). Interobserver differences were significant (P=.0085). Interobserver consistency to detect severe HO (Brooker 3 and 4, or grade C) improved from 52% to 76% with the modified system. The new classification showed adequate interobserver reproducibility, less variability, and improved consistency for classification of significant HO.

Arthroplasty, Replacement, Hip↗
PubMed1978

[Disseminated branching pulmonary ossification combined with heterotopic bone formation in the muscles (author's transl)].

Idiopathic disseminated pulmonary ossification is a rarely recognised condition in which small pieces of marrow containing bone are found in the interstitial tissues of the lungs. The case reported here is unique in showing combination with myositis ossificans circumscripta. The extent of the lung changes was also unusual. The clinical, radiological and histological findings are compared.

Diagnosis, Differential↗
PubMed2001

Sagittal splitting laminoplasty for spinal canal enlargement for ossification of the spinal ligaments (OPLL and OLF).

Patients have been followed up radiologically after sagittal splitting laminoplasty (SSL) for ossification of the posterior longitudinal ligament (OPLL) and ligamentum flavum. The enlarged spinal canal was maintained satisfactorily in all the cases, and the posterior spinal elements were also almost completely restored. In most cases, the range of the vertebral motion was good with more than 50% of the preoperative status. Postoperative instability of the vertebral column was not identified in any case. Mild cervical kyphosis was noted in 6% of cervical OPLL patients. There were no patients with neurological deterioration. Using SSL, reconstruction and restoration of the posterior spinal elements and retention of the enlarged spinal canal were accomplished safely and adequately.

Female↗
PubMed2002

Cervical myelopathy associated with degenerative spine disease and ossification of the posterior longitudinal ligament.

Cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament are two of the leading etiologies of spinal cord damage in older patients. For most patients, the natural history is one of slow stepwise decline in function. With nonsurgical therapy only 30 to 50% of patients are expected to stabilize. Surgical options include anterior and posterior surgical decompression, spinal canal expansion, and spinal column stabilization. Prospective, randomized trials with standardized outcome measures are needed to clarify the benefit of surgery conclusively.

Cervical Vertebrae↗
PubMed2005

[The modified Brooker classification for evaluation of heterotopic ossifications in total hip replacement].

INTRODUCTION: To evaluate heterotopic ossifications (HTO) in total hip replacement several classifications have been developed. Most often the classifications according to Brooker or Arcq are used. These systems enable the description of HTO on x-rays in ap view, functional aspects like range of motion are not evaluated. In several studies we could observe that patients with HTO IV degrees according to Brooker ("ankylosis") had a free or excellent range of motion. We introduce a modified Brooker classification system which enables the evaluation of HTO in two X-ray planes and allows in addition a description of hip function. PATIENTS AND METHOD: On the a.-p. X-ray view the original Brooker classification is used, on the lateral view the Brooker classification ventrally and dorsally of the longitudinal axis of the stem of the total hip replacement is used. In addition functional deficits as a sequalae of HTO are documented (1: yes; 2: no). The new classification system is used in 10 cases with HTO IV degrees according to Brooker in the a.-p .view. RESULTS: 8 cases with "ankylosis" according to Brooker showed a good range of motion. In these cases HTO I-III degrees according to Brooker were found in the lateral view. In the ap view these HTO were evaluated as HTO IV degrees because of an overlapping effect. DISCUSSION: The new classification using X-rays in two planes allows to describe HTO sufficiently especially in respect to hip function. The most important advantage of this new classification is the fact that it modifies only a widly used and accepted system. This may lead to a high acceptance of the new classification.

Ankylosis↗
PubMed1998

[Idiopathic pulmonary ossification].

OBJECTIVE: Linear and round shadows are very often revealed on chest radiographs. A rare entity most commonly appearing as branching linear shadows of calcific density involving a limited area of the lung is the so-called disseminated pulmonary ossification (DPO). Only 141 cases have been reported worldwide up to now since the first description. MATERIAL AND METHODS: A study on 490 autopsies was performed to find out the frequency of DPO. In case of DPO we compared the structures with the chest radiographs and CT of the patients. Further, we evaluate clinical communities of patients with DPO. RESULTS: From a total of 490 lungs eight were identified with DPO (1.6%). The mean age of patients with DPO was 80.2 years, the male/female ratio seven to one (mean age of all patients: 64.6 years, male/female ratio one to one). All cases were associated with hypertension followed by extreme arteriosclerosis. In 5 cases there was a proven extrapulmonary carcinoma and a renal insufficiency. In 4 cases we found diabetes mellitus. At postmortem radiographs and CT, a collection of small rounded calcific nodules and further linear shadows arranged in a branching or net-like configuration was identified. This was compared with the chest radiographs of the patients. There were no dysfunctions of lungs due to DPO. CONCLUSIONS: In chest radiographs of elderly men the differential diagnosis "DPO" should be given more importance.

Aged↗
PubMed1994

Morphological and clinical aspects of heterotopic ossification in sports. A case study.

Heterotopic ossification (HO) caused through sport injuries is a rare, clearly defined lesion. In a considerable number of cases, however, no adequate trauma can be remembered or otherwise established in the "sporting history". Differential diagnosis of this non-traumatic HO variant often presents many problems which may lead to the wrong diagnosis of sarcoma. We looked at 28 cases, in which in more than 50% a sarcoma was discussed as primary diagnosis. These difficulties arise mainly in cases where clinical features suggest a tumor, radiological changes are unspecific, and the diagnosis is based on a small biopsy sample. We demonstrate and discuss the problems involved in differential diagnosis using the history of a matchgrade sportsman as a sample. Unlike in sarcoma, patients with HO usually suffer severe pain, and well over 50% of all patients develop the disease during the 2nd or 3rd decade. Over 90% of all patients with soft tissue sarcoma, however, are over the age of 30. From the morphological point of view, the different histological pattern of HO has to be taken into account, since early stages may mimick a sarcomatous lesion. If the clinical findings suggest the presence of HO, surgical intervention including the taking of biopsy sample should be postponed, so that instead of early highly mitotic active phases more mature bone structures, which are easier to classify, will be available for evaluation. Only a profound knowledge of the different phases of HO, together with clinical and radiological features, will clarify the differential diagnostic problems of the non-traumatic variant of this lesion in sportsmen.

Adult↗
PubMedDate not supplied

[Indomethacin--short-term therapy vs. single low dosage radiation for prevention of periarticular ossifications after total hip endoprosthesis].

INTRODUCTION: With a general incidence of about 40% periarticular ossifications (PAO) constitute one of the more frequent complications after total hip arthroplasty. A prospective, randomized therapy--study investigates the prophylactic values of Indomethacin-Short-Term-Therapy and Single-Dose-Radiatio, respectively. MATERIAL AND METHODS: Consecutive patients for elective, cementless THA were randomized; the Indomethacin-Group (A, n = 31 at the end of the study) was admitted 100 mg Indomethacin/supp. at the day of operation and 3 x 25 mg orally from postoperative day 1 to 10. Other NSAID were not given. The Radiatio-group (B; n = 19) was irradiated by a single dose of 6 Gy within postoperative days 1 to 4; no NSAID were admitted. Follow up was at dismissal and after 6 (NU 1) and 12 (NU 2) months. Incidence and severity of PAO and the clinical objective and subjective results were registered. RESULTS: Age- and side-distribution as well as the etiologies were comparable in both groups. All patients took part in NU 1 and 90% in NU 2. There were no major differences in the incidence of postoperative PAO in both groups. In 68% (A) and 53% (B), resp., there were no PAO at dismissal and after six months, PAO of Brooker Grade I and II were seen in 30 (A) and 47% (B), resp., PAO of Grade III and IV--those having generally clinical relevance--did not occur at all. These results were confirmed after 12 months. The clinical objective result ameliorated between admission and dismissal by an average of 3.5 points and by another 2 points between dismissal and NU 2. DISCUSSION: The results show that Indomethacin-Short-Term-Therapy as well as Single-Dose-Radiatio with 6 Gy can reliably prevent the occurrence of severe PAO. Both therapeutic concepts therefore can be employed as prophylaxis in primary endoprosthetic operations. The choice between the two procedures will then mainly be determined by given logistic conditions in the clinic, specific contraindications of the patient and financial considerations.

Adult↗
PubMedDate not supplied

[Surgical treatment of para-articular ossifications after craniocerebral trauma].

This article reports on 45 cases in which extra-articular ossifications were removed following cranial-cerebral traumata. Radiologically detectable relapses occurred in 6% of the patients only; however, in none of these cases did the relapses lead to reankylosis of the joint. In the sagittal plane, the average gain in mobility was an increase of 84 degrees in the hip joint and of 100 degrees in the elbow joint. Considerable complications were caused by four fractures in extremely osteoporotic bones. To reduce the fracture rate, surgery should be performed as soon as possible after bone maturation. In addition, treatment of patients with craniocerebral traumata and serious concomitant conditions requires an experienced rehabilitation team.

Adolescent↗
PubMedDate not supplied

[Radiation therapy in the prevention of periarticular, heterotopic ossification following implantation of a total hip endoprosthesis].

From June 1988 to January 1991 the efficacy of a low-dose (5 x 2 Gy) versus a high-dose (10 x 2 Gy, resp. 5 x 3,5 Gy) prophylactic postoperative radiotherapy was assessed in a prospective randomized trial. 60 patients at the highest risk for formation of heterotopic ossification (HO) were included in this study, i.e. patients that presented already HO in the ipsi- or contralateral hip at the time of surgery. After both irradiation regimen the incidence and severity of HO was significantly less than without prophylaxis; there was no significant difference (regarding the severity of HO, the hip score (16) and the hip mobility) between the two regimen.

Adult↗
PubMed1995

[Prevention of heterotopic ossification by radiotherapy following total hip prosthesis].

BACKGROUND: Clinically relevant heterotopic bone formation (HBF) following total hip arthroplasty (THA) occurs in about one third of all high risk patients. HBF can reduce the functional result of surgery by pain and limited range of motion. The experience with patients treated with postoperative radiation therapy after THA with or without removal of HBF is reported. PATIENTS AND METHOD: Between November 1986 und June 1993, postoperative irradiation was performed on 238 hips of 216 patients (117 men, 99 women, median age 66 years, range 38-86 years) with defined risk factors using 10 Gy in 5 fractions (n = 176) or 7 Gy in one fraction (n = 62) with a cobalt unit. In general, irradiation was performed during the first four postoperative days after primary THA alone in 182 hips or removal of HTB in 56 hips with (n = 28) or without (n = 28) revision surgery. Risk factors for HBF were preexisting ipsi- or contralateral HBF in 105 hips (group 1) or hypertrophic osteoarthritis, previous operative procedures of the hip and others in 134 hips (group 2). After a follow-up of at least 6 months patients were examined and radiographs of the hip were performed to classify HBF. RESULTS: New or progressive ossifications had developed in the interval in 15 of 104 hips of group 1 (14.4%), compared with 19 of 134 hips in group 2 (14.2%). Clinically significant new HBF (grade 3 or 4) occurred in none of group 2, and in 3 hips of group 1 (2.9%). After radiation with 10 Gy HBF of all grades occurred in 23 of 176 hips (13.1%), and in nine of 62 hips after 7 Gy (14.5%). The lowest number of treatment failures was found in patients irradiated during the first 4 postoperative days. CONCLUSION: These results demonstrate that immediate postoperative radiation is efficacious for prevention of clinically relevant HBF following THA and removal of HBF.

Adult↗