Osificación heterotópica mesentérica como causa de obstrucción intestinal en un paciente con abdomen séptico / Mesenteric Heterotopic Ossification as a Cause of Intestinal Obstruction in a Patient with a Septic Abdomen

Presentación del caso. Se trata de un masculino de 49 años, con historia de un trauma abdominal cerrado con un objeto contuso sin alteraciones hemodinámicas. La ecografía focalizada de traumatismos resultó positiva a líquido libre en la cavidad abdominal en tres ventanas. Intervención terapéutica. Fue sometido a múltiples laparotomías exploratorias con lavados de cavidad abdominal posterior a presentar un cuadro de abdomen séptico Björk 4, quien después de 38 días de estancia intrahospitalaria presentó una fístula enteroatmosférica que causaba un déficit nutricional. En una intervención quirúrgica se realizó el cierre de la fístula enteroatmosférica, con el hallazgo de tejido óseo trabecular en cavidad abdominal, correspondiente a osificación heterotópica intraabdominal de formación reciente. Evolución clínica. Luego de la anastomosis del intestino delgado presentó signos de obstrucción intestinal, a causa de esto, se realizó una nueva laparotomía exploratoria, en la que se encontró tejido óseo adherido al mesenterio del intestino delgado que generó una obstrucción completa, se extirpó el material óseo y se logra restablecer el flujo intestinal liberando la obstrucción en el intestino delgado

Case presentation. A 49-year-old male, with a history of blunt abdominal trauma with a blunt object without hemodynamic alterations. The focused trauma ultrasound was positive for free fluid in the abdominal cavity in three windows. Treatment.The patient underwent multiple exploratory laparotomies with peritoneal lavage after presenting a septic abdomen (Björk 4), who after 38 days of intrahospital stay presented an enteroatmospheric fistula that caused a large nutritional deficit. In a surgical intervention, the enteroatmospheric fistula was closed, with the finding of trabecular bone tissue in the abdominal cavity, corresponding to intra-abdominal heterotopic ossification of recent formation. Outcome. After the small intestine anastomosis, he presented signs of intestinal obstruction, because of this, a new exploratory laparotomy was performed, in which bone tissue was found adhered to the mesentery of the small intestine that generated a complete obstruction. The bone material was removed and the intestinal flow was reestablished, freeing the obstruction in the small intestine

Tercer molar heterotópico, etiología y manejo quirúrgico / Heterotopic third molar, etiology and surgical management

Los terceros molares heterotópicos son dientes que se encuentran incluidos en los maxilares y la mandíbula distantes a su sitio de erupción habitual. Su etiología no está bien definida y existen diversas teorías. Estos dientes pueden aparecer en diferentes zonas de las estructuras óseas, teniendo predilección por la mandíbula. Suelen aparecer entre la segunda y la séptima década de la vida, la mayoría de los casos son hallazgos imagenológicos en la consulta odontológica. El tercer molar mandibular es el diente que presenta heterotopía con mayor frecuencia, siendo su localización habitual en rama mandibular y en la región subcondílea. El quiste dentígero es la patología asociada más común. Presentamos un caso de tercer molar heterotópico en rama mandibular derecha de larga evolución, relacionado a un quiste dentígero, el cual se manejó bajo anestesia regional. Se describe la etiología, técnica quirúrgica y consideraciones especiales relacionados con los dientes heterotópicos (AU)

Heterotopic third molars are teeth that are embedded in the maxilla and mandible, remote from their usual eruption site. Its etiology is not well defined and there are various theories at the moment. These teeth can appear in different areas of the bone's structures, having a predilection for the jaw. They usually appear between the second and seventh decade of life, and in most cases are imaging findings. The mandibular third molar is the tooth with the most frequent heterotopia, being its usual location in the mandibular branch and in the subcondylar region. The dentigerous cyst is the most common associated pathology. We present a case of a long evolution heterotopic third molar in the right mandibular branch, related to a dentigerous cyst which was managed under local anesthesia. The etiology, surgical technique and special considerations related to heterotopic teeth are described (AU)

Efficacy of Ibuprofen after Total Hip Arthroplasty to Prevent Heterotopic Ossification: Systematic Review and Meta-Analysis / Eficácia do ibuprofeno após artroplastia total de quadril para prevenção de ossificação heterotópica: Revisão sistemática e metanálise

Abstract The objective of this study was to conduct a systematic review and meta-analysis of relevant randomized control trials (RCTs) to determine the role of ibuprofen, as well as the optimum dose and duration of therapy, in preventing the incidence of heterotopic ossification (HO) after primary total hip arthroplasty (THA). A literature search was performed using the PubMed/MEDLINE and Cochrane Library databases for RCTs that compared the use of ibuprofen versus placebo as prophylaxis for HO in patients after THA. The main outcomes for this study were overall occurrence of HO, occurrence according to the Brooker classification, and gastrointestinal complications. A total of 27 potential articles were identified from the database. Eventually, four trials with 1,153 patients were included in the final analysis. When compared with placebo, the use of ibuprofen is associated with a reduction in the incidence of HO at the 3- and 12-month follow-up appointments, as well as the incidence of Brooker II and III HO (p < 0.05). However, there was no significant difference between the ibuprofen and placebo groups in terms of treatment discontinuation due to gastrointestinal complications or the incidence of Brooker I and IV HO (p > 0.05). The existing data indicates that ibuprofen is safe and efficacious in reducing the total incidence of HO along with Brooker II and III HO at follow-up. However, due to the small number of studies, the conclusions are limited; therefore, more high-quality clinical trials are required to develop guidelines for optimal dose and duration of therapy.

Resumo O objetivo deste estudo foi realizar uma revisão sistemática e metanálise de estudos clínicos randomizados (ECRs) relevantes para determinar o papel do ibuprofeno, sua dose ideal, e a duração do tratamento na prevenção de ossificação heterotópica (OH) após a artroplastia total primária do quadril (ATQ). Uma pesquisa bibliográfica foi feita nos bancos de dados PubMed/MEDLINE e Cochrane Library para a obtenção de ECRs quecomparassem ouso de ibuprofeno edeplacebo como profilaxiaparaOHem pacientes submetidos à ATQ. Os principais desfechos deste estudo foram ocorrência geral de OH, classificação de Brooker da OH, e complicações gastrintestinais. No total, 27 artigos foram identificados nos bancos de dados e 4 estudos, com 1.153 pacientes, foram incluídos na análise final. Em comparação ao placebo, o uso de ibuprofeno reduziu a incidência de OH aos 3 e 12 meses de acompanhamento e a incidência de OH Brooker II e III (p < 0,05). No entanto, não houve diferença significativa entre os grupos que receberam ibuprofeno e placebo em termos de interrupção do tratamento devido a complicações gastrintestinais ou da incidência de OH Brooker I e IV (p > 0,05). Os dados existentes indicam que o ibuprofeno é seguro e eficaz na redução da incidência total de OH e de OH Brooker II e III durante o acompanhamento. No entanto, as conclusões são limitadas devido ao pequeno número de estudos; logo, mais estudos clínicos de alta qualidade são necessários para o desenvolvimento de diretrizes em relação à dose e duração ideal da terapia.

Heterotopic ossification after spinal cord injury: prevention and treatment - a sistematic review / Ossificação heterotópica no lesado medular: prevenção e tratamento - revisão sistemática

ABSTRACT Trauma configures the main cause of spinal cord injuries. Patients with traumatic spinal cord injury often develop severe and debilitating outcomes that require multidisciplinary care to adapt patients to their new reality. Heterotopic ossification (HO) is one of the frequent comorbidities in these patients but it still lacks well-established treatments or a gold standard one. Thus, this systematic review aimed to search the current literature for HO treatment and prevention. This study was conducted following PRISMA recommendations (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) and searches were conducted in three databases (PubMed, Embase, and Web of Science). A total of 193 articles were found in an initial search. After screening following the established criteria, eight articles were included in this review; of these, two reported prevention and the others, treatments. Based on data analysis, the use of non-steroidal anti-inflammatory drugs in the acute post-traumatic period proved to be the best method of prevention. In cases of mature HO or accompanied by ankylosis, surgical resection proved to be the most effective treatment despite the high rate of postoperative infections. Level of Evidence III, Systematic Review.

RESUMO A principal causa de lesão medular é o trauma. O paciente com trauma raquimedular frequentemente evolui com incapacidades graves e debilitantes, fazendo com que necessite de cuidado multiprofissional para se adaptar a uma nova realidade. A ossificação heterotópica (OH) é uma comorbidade comum nesses pacientes, mas que ainda não tem tratamentos bem estabelecidos ou considerados padrão-ouro. Esta revisão sistemática teve como objetivo buscar formas de tratamento e prevenção da OH na literatura atual. O estudo seguiu a recomendação Principais Itens para Relatar Revisões Sistemáticas e Meta-Análises (PRISMA) e realizou buscas em três bases de literatura (PubMed, Embase e Web of Science). Foram encontrados 193 artigos inicialmente, e, após triagem considerando os critérios estabelecidos, oito foram eleitos para o trabalho final. Dois trabalhos abordaram a prevenção; e os demais, tratamentos. Pela análise dos dados, o uso de anti-inflamatórios não esteroidais (AINEs) no período agudo pós-traumático se mostrou como o melhor método de prevenção. Já em relação ao tratamento, nos casos de OH maduras ou com anquilose, a ressecção cirúrgica revelou-se como o método mais efetivo, a despeito da grande taxa de infecção pós-operatória. Nível de Evidência III, Revisão Sistemática.

Osificación heterotópica en COVID-19, ¿la asociación aún no documentada? Reporte de dos casos / Heterotopic Ossification in COVID-19: An Association Not Yet Documented? Two-case report

RESUMEN Se define como osificación heterotópica a la formación de tejido óseo en zonas de tejido blando en donde habitualmente no hay hueso. Se trata de una patología rara/ subdiagnosticada habitualmente relacionada con parálisis e inmovilización durante el curso crítico de traumatismos, lesiones neurológicas, síndrome de dificultad respiratoria aguda, cirugías o grandes quemados. En el transcurso de la pandemia por SARS-CoV-2 (nuevo COVID-19), se reportaron casos de pacientes críticos con osificación heterotópica y se interpretó que la magnitud de la reacción inflamatoria, posible efecto propio del virus, y los largos períodos de inmovilización mientras transcurría la etapa crítica podrían ser los determinantes de esta entidad clínica. Durante el período de internación de los casos que describiremos a continuación, el porcentaje ocupacional fue del 166 % y del 200 % y la carga laboral del personal de enfermería, medida por TISS-28, fue de 72 puntos, lo que excedió casi al doble de las posibilidades laborales. Al mismo tiempo, la rehabilitación motora, por parte del equipo de kinesiología, se vio postergada ante la necesidad de atender circunstancias urgentes como la optimización del soporte ventilatorio y la participación en maniobras de cambios de decúbito. De este modo, interpretamos que la gran sobrecarga laboral acontecida durante la pandemia condicionó una inadecuada provisión de movilización temprana que dio como resultado una mayor prevalencia de osificación heterotópica en pacientes pos-COVID grave cuando se la compara con síndrome de dificultad res piratoria aguda por otras causas. Presentamos dos casos de osificación heterotópica en pacientes que cursaron síndrome de dificultad respiratoria aguda por SARS-CoV-2 en momentos de alta carga laboral. Caso 1: Paciente masculino de 48 años, que ingresó a la UCI por NAC grave por COVID-19. Antecedentes de obesidad. Requirió 31 días de AVM, 4 ciclos de posición prona (192 h total), TQT al día 18, 23 días de bloqueantes neuromusculares y 24 de sedación. Comienza la movilización activa-asistida al día 24 con MRC 38/60. Un total de 52 días de internación. A los 6 meses del alta, se diagnosticó osificación heterotópica bilateral de cadera. Caso 2: Paciente de 58 años, que ingresa a UCI por NAC grave por COVID-19. Ante cedentes de HTA y obesidad. Requirió 39 días de AVM, dos ciclos de posición prona (60 h total), TQT al día 7. Un total de 45 días de UCI y 111 de hospital. Al año del alta, se diagnostica osificación heterotópica bilateral de cadera.

ABSTRACT Heterotopic ossification (OH) is defined as the formation of bone tissue in areas of soft tissue where there is usually no bone. It is a rare/underdiagnosed pathology usually related to paralysis and immobilization during the critical course of trauma, neurological lesions, acute respiratory distress syndrome (ARDS), surgery, or major burns. In the course of the SARS-CoV2 (new COVID-19) pandemic, cases of critically ill patients with OH were reported, interpreting that the magnitude of the inflammatory reaction, possible effect of the virus itself, and long periods of immobilization while the critical stage was taking place could be the determinants of this clinical entity. During the hospitalization period of the cases that we will describe below, the occupa tional percentage was 166 % and 200 % and the workload of the nursing staff, mea sured by TISS-28, was 72 points, exceeding almost twice the possibilities labor. At the same time, motor rehabilitation by the Physiotherapy team was postponed due to the need to address urgent circumstances such as optimization of ventilatory support and participation in decubitus change maneuvers. In this way, we interpret that the great work overload that occurred during the pandemic conditioned an inadequate provision of early mobilization, resulting in a higher prevalence of OH in severe post-COVID patients when compared with ARDS due to other causes. We present two cases of HO in patients who underwent ARDS due to SARS-CoV2 at times of high workload. Case 1: A 48-year-old man, who was admitted to the ICU due to severe Pneumonia (NAC) due to COVID-19. History of obesity. He required 31 days of Mechanical Ven tilation Assistance (AVM), 4 cycles of prone position (192 total hours), tracheostomy (TQT) on day 18, 23 days of neuromuscular blockers and 24 of sedation. Active-assisted mobilization begins on day 24 with a Medical Research Council (MRC) score of 38/60. A total of 52 days of hospitalization. Six months after discharge, bilateral HO of the hip was diagnosed. Case 2: 58-year-old patient, admitted to the ICU with severe NAC due to COVID-19. History of Hypertension and Obesity. She required 39 days of AVM, two cycles of prone position (60 total hours), TQT on day 7. A total of 45 days in the ICU and 111 in the hospital. A year after discharge, bilateral OH of the hip was diagnosed.

Forensic Analysis of Eighteen Tubal Pregnancy-Related Medical Damage / 法医学杂志

OBJECTIVES@#To analyze the cases of medical damage after misdiagnosis of tubal pregnancy, to explore the causes of medical damage, the causal relationship between medical malpractice and the damage consequences, as well as the causative potency, in order to provide evaluation ideas for forensic identification of such cases.@*METHODS@#Eighteen cases of forensic identification of tubal pregnancy related medical damage were collected and retrospectively analyzed from the aspects of age, maternity history, fertility requirements, risk factors, diagnosis and treatment, medical malpractice, damage consequences, and causative potency.@*RESULTS@#All 18 cases were tubal pregnancy, of which 17 cases had medical malpractice, resulting in 14 cases of affected tubal resection, 2 cases of hemorrhagic shock death, 1 case of intrauterine fetal death and affected tubal resection. The other case had the consequence of affected tubal resection, but there was no malpractice in the treatment.@*CONCLUSIONS@#Correct diagnosis is helpful to make appropriate treatment plan, prevent disease progression and reduce serious adverse consequences and the occurrence of medical disputes. Scientific and reasonable analysis of the causal relationship between medical malpractice and damage consequences and the causative potency is of great significance to the successful settlement of medical disputes.

Association between cervical curve and the cranio-cervical curve and ossification of ligaments in patients with cervical degenerative diseases / 中华骨科杂志

Objective:To explore the correlation between cervical curve and ossification of ligaments in cranio-cervical junction and cervical spine in patients with cervical degenerative diseases.Methods:A retrospective study was conducted among 458 patients with cervical degenerative disease who underwent cervical spine X-ray and CT examinations at the Orthopedics Department of Beijing Tiantan Hospital, Capital Medical University between January 2016 and July 2020. There were 265 males and 193 females, with an average age of 57.02±10.41 years (range, 22-87 years). Patients were divided into 5 types (lordosis, straight, S-type degenerative kyphosis, R-type degenerative kyphosis and C-type degenerative kyphosis). Cervical lordosis was defined as C 2-C 7 curve <-4°, cervical kyphosis was defined as >4°, cervical straight was defined as -4° to 4°. C 2-C 7 curve, C 0-C 2 curve were measured respectively, and correlations among these imaging parameters were analyzed. CT images were used to assess the presence of ossification of ligaments in cranio-cervical and cervical spine, including ossification of the posterior longitudinal ligament, nuchal ligament, ligamentum flavum, transverse ligament, apical ligament, diffuse idiopathic skeletal hyperostosis (DISH), as well as capped dens sign (CDS), and correlations between these cervical curve and presence of ossification of ligaments were analyzed. The different grades were based on the length of the ossification of interest with respect to the distance from the posterosuperior rim of the anterior arch of the atlas to the inferior margin of the foramen magnum on mid-sagittal cervical spine CT images, Grade 3 CDS was determined when the length was more than two-thirds. Results:There were 245 patients with cervical lordosis, 114 patients with straight, 53 patients with S-type degenerative cervical kyphosis, 36 patients with R-type degenerative cervical kyphosis and 10 patients with C-type degenerative cervical kyphosis. C 0-C 2 curve showed a negative correlation with C 2-C 7 curve in all enrolled patients ( r=-0.45, P<0.001) and R-type degenerative kyphosis group ( r=-0.58, P<0.001); C 0-C 2 curve showed no correlation with C 2-C 7 curve in lordosis ( r=-0.10, P=0.124), straight ( r=-0.11, P=0.233), S-type degenerative kyphosis ( r=-0.01, P=0.943) or C-type degenerative kyphosis groups ( r=0.03, P=0.946). CDS was detected in 38.4% (176/458) of patients, and Grade 3 was detected in 17.9% (82/458) of patients. The prevalence of CDS was correlated with R-type degenerative cervical kyphosis ( r=0.10, P=0.030). Cervical kyphosis, S-type degenerative kyphosis, C-type degenerative kyphosis, C 2-C 7 curve and C 0-C 2 curve showed no correlation with ossification of the posterior longitudinal ligament, nuchal ligament, ligamentum flavum, transverse ligament, apical ligament, diffuse idiopathic skeletal hyperostosis (DISH) or different grades CDS ( P>0.05). Conclusion:R-type degenerative cervical kyphosis are more likely to correlate with the cranio-cervical curve and CDS, which is an ossification of ligament in cranio-cervical junction.

Prevalence and distribution of ossification of ligamentum flavum at the adjacent segment of the apex in patients with degenerative kyphosis / 中华骨科杂志

Objective:To evaluate the prevalence and distribution of ossification of ligamentum flavum (OLF) at the segments adjacent to the apex in patients with degenerative kyphosis.Methods:All of 74 patients with degenerative kyphosis from January 2018 to December 2021 were retrospective reviewed. All patients were taken anteroposterior and lateral radiographs, CT scan and magnetic resonance imaging (MRI) of the entire spine. Global kyphosis, the morphology of kyphosis and the occurrence of OLF at three segments adjacent to the kyphosis apex were recorded.Results:Of the 74 patients, 54 patients (73%) developed OLF in three segments adjacent to the kyphotic apex. The mean age of the 54 patients was 61.4±6.8 years, and the mean global kyphosis was 49.5°±21.2°. Among other 20 patients without OLF, the mean age was 56.1±7.5 years, and the mean kyphosis angle was 52.1°±19.1°. There was a statistically significant difference in ages ( t=2.92, P=0.005), but no statistically significant difference was observed regarding global kyphosis ( t=0.48, P=0.634). In these 74 patients, 9 patients had angular kyphosis, of which 8 (89%) developed OLF; of the 65 patients without angular kyphosis, 46 patients (71%) developed OLF. There was no significant difference between them (χ 2=1.32, P=0.251). Among the 54 patients diagnosed with OLF, 5 patients (9%) suffered ossification of the posterior longitudinal ligament (OPLL) and 20 patients (37%) suffered dural ossification; 43 patients (80%) developed OLF at proximal segments of apex, 6 patient (11%) developed OLF at distal segments of apex, and 5 patients (9%) developed OLF both at proximal and distal segments of apex. Thirty-two patients (59%) developed OLF at the first segment adjacent to the kyphotic apex, 27 patients (50%) developed OLF at the second segment, and 15 patients (28%) developed OLF at the third segment. Conclusion:Among patients with degenerative kyphosis, about 73% may development OLF within three segments adjacent to the kyphotic apex, and it mostly occurred within two segments adjacent to the apex proximally.

Treating Neurogenic Heterotopic Ossification around a Femur Following Paraplegia after an Open Surgery for Thoracoabdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

A 59-year-old man who was diagnosed with hypertension and a large thoracoabdominal aortic aneurysm was referred to our hospital for surgical treatment. He underwent open surgery and thoracic endovascular aneurysm repair in three stages. He developed paraplegia after the third surgery. Despite acute postoperative treatment and rehabilitation, his lower extremity motor function and bladder and bowel dysfunction did not improve. He was transferred to a recovery hospital 67 days after the third surgery. However, he was readmitted to our hospital about four months later for management of a refractory decubitus ulcer and recurrent urinary tract infections. Computed tomography revealed hematoma and calcification around the femur. Based on the clinical course and imaging findings, we diagnosed neurogenic heterotopic ossification associated with postoperative paraplegia in this patient. He had flap reconstruction for the ulcer. Finally, he was discharged 79 days after readmission. To date, no study has reported neurogenic heterotopic ossification associated with postoperative aortic aneurysm paraplegia. The mechanism underlying this condition is similar to the widely accepted process associated with traumatic spinal cord injury, and conservative treatment comprising pressure ulcer treatment and antibiotics was continued. Although acute rehabilitation is important after highly invasive aortic aneurysm surgery, rehabilitation is limited by the risk of neurogenic heterotopic ossification in patients with postoperative paraplegia, and recovery and maintenance of activities of daily living are challenging. To our knowledge, early diagnosis and prompt treatment for these complications are important considering neurogenic heterotopic ossification.

Clinical Features, Diagnosis and Management of Fibrodysplasia Ossificans Progressiva / 罕见病研究

Fibrodysplasia ossificans progressiva(FOP) is a rare congenital disease characterized by progressive heterotopic ossification, causing severe immobility with multi-system involvement. The relatively low incidence rate and incomplete knowledge among clinicians of the disease often result in misuse of invasive procedures or surgical treatment, leading to the progression of heterotopic ossification. To promote the knowledge of FOP, this article presents a comprehensive review involving epidemiology, pathological mechanisms, clinical features, diagnosis, and management of the FOP.

Heterotopic pancreatic tissue in gall bladder incidentally detected in a case of acute cholecystitis: A case report and review of the literature

Heterotopic pancreatic tissue in the gall bladder is a very uncommon lesion. In most cases, it is an incidental finding. The placement of pancreatic tissue in an organ outside the pancreas is called pancreatic heterotopy. Heterotopic pancreas is commonly found in the stomach, small intestine, and Meckel’s diverticulum. It has rarely been seen in the gall bladder, bile duct, splenic hilum, or liver. We present a case of incidentally discovered heterotopic pancreatic tissue in a case of acute cholecystitis in a 63-years-old lady having a history of pain in the right hypochondriac region

Heterotopía de mucosa gástrica del esófago proximal como causa de distrés respiratorio en un neonato: reporte de caso / Gastric mucosa heterotopia of the proximal esophagus as a cause of respiratory distress in a newborn: case report

Introducción: la heterotopia de mucosa gástrica del esófago proximal (HMGEP) es una entidad clínica poco entendida y probablemente subdiagnosticada, que consiste en la presencia de islas de mucosa gástrica ectópica en el esófago proximal. Caso clínico: presentamos el caso de un neonato que presenta de manera temprana estridor y distrés respiratorio secundario a mucosa redundante en la región poscricoidea, que prolapsa sobre la supraglotis y ocluye la luz de la vía aérea. El estudio histopatológico reporta HMGEP. Se realiza una terapia ablativa con láser, con lo cual la paciente se recupera paulatinamente. Metodología: se llevó a cabo una amplia búsqueda de la literatura de HMGEP en las bases de datos PubMed, SciELO, Mendeley y Elsevier, en idioma inglés y español, desde 1980 a 2021 y se incluyeron 18 artículos en total. Discusión: la HMGEP suele ser una entidad asintomática que en ocasiones genera síntomas faringolaríngeos, y de manera infrecuente puede asociarse con complicaciones como estenosis, úlceras, perforación esofágica e incluso obstrucción de la vía aérea como en el presente caso. Conclusiones: además de las diversas alteraciones en la vía aérea que pueden generar estridor y dificultad respiratoria en niños, debemos descartar causas gastroesofágicas subyacentes asociadas con estas manifestaciones, como la HMGEP.logos y expertos en radioterapia permite obtener buenos resultados quirúrgicos y clínicos en la inmensa mayoría de casos.

Introduction: Gastric mucosal heterotopia of the proximal esophagus (HMGEP) is a poorly understood and probably underdiagnosed clinical entity that consists of the presence of islands of ectopic gastric mucosa in the proximal esophagus. Clinical Case: In this article, we present the case of a newborn who started with early stridor and respiratory distress secondary to redundant mucosa in the postcricoid region that prolapsed over the supraglottis, occluding the airway lumen. The histopathological study reports HMGEP. Ablative laser therapy is performed with which the patient gradually recovers. Methodology: An extensive search of the HMGEP literature was conducted in PubMed, SciELO, Mendeley, and Elsevier data base; in English and Spanish, from 1980 to 2021, including a total of 18 articles. Discussion: HMGEP is usually an asymptomatic entity that sometimes causes pharyngolaryngeal symptoms and, infrequently, can be associated with complications such as stenosis, ulcers, esophageal perforation, and even airway obstruction, as in the present case. Conclusions: In addition to the various alterations in the airway that can generate stridor and respiratory distress in children, we must rule out underlying gastroesophageal causes associated with these manifestations, such as HMGEP.

Gravidez heterotópica espontânea: implicações de um diagnóstico tardio / Spontaneous heterotopic pregnancy: implications of a late diagnosis

A gestação heterotópica é uma entidade rara, principalmente se resultante de concepção natural. O diagnóstico é ultrassonográfico, porém a gestação intrauterina concomitante contribui para a dificuldade propedêutica. Neste relato de caso, a detecção foi tardia, a ultrassonografia não identificou a gestação heterotópica e apenas durante a avaliação intraoperatória, por meio de uma cirurgia de emergência devido a choque hemorrágico, houve o reconhecimento. A suspeita de uma gestação heterotópica deve ser sempre aventada quando sinais clínicos típicos (sangramento, dor abdominal) estão presentes, mesmo na ausência de fatores de risco ou imagens anômalas na ecografia. Assim, uma intervenção precoce menos invasiva pode ser realizada, reduzindo a morbimortalidade materna e do feto intrauterino. Este relato de caso destaca uma situação incomum dentro dessa patologia rara: diagnóstico tardio, apenas no segundo trimestre de gestação, sem evidência prévia ultrassonográfica, certificada apenas durante o intraoperatório. O manejo cirúrgico preciso permitiu a manutenção da gravidez intrauterina.(AU)

Heterotopic pregnancy is a rare entity, especially if it is resulted from natural conception. The diagnosis is ultrasonographic, but the concomitant intrauterine pregnancy contributes to the propaedeutic difficulty. In this case report, the detection was late, the ultrasonography did not identify heterotopic pregnancy and, only during intraoperative evaluation through emergency surgery, exploratory laparotomy, there was recognition. The suspicion of a heterotopic pregnancy should always be raised when typical clinical signs (bleeding, abdominal pain) are present, even in absentia of risk factors or anomalous images on ultrasound. Thus, a less invasive early intervention can be performed, reducing maternal and intrauterine fetus morbimortality. This case report highlights an unusual situation within this rare pathology: late diagnosis, only in the second trimester of pregnancy, without previous ultrasound evidence, certified only during the intraoperative period. Precise surgical management allowed the maintenance of intrauterine pregnancy.(AU)

Term delivery of a heterotopic pregnancy coexisting with ruptured tubal ectopic pregnancy: A case report

Pregnancies that occur in two different implantation sites simultaneously is described as Heterotopic pregnancy (HP). In the current study, a case of term delivery of a heterotopic pregnancy coexisting with ruptured tubal ectopic pregnancy, diagnosed by ultrasound (US) and clinical examination findings, which was managed successfully. A 25 year old Nigerian female, gravida 4, para 2 (2 term gestation, 1 spontaneous abortion) presented at the Emergency room with acute abdominal pain associated with vomiting. She had 8 weeks amenorrhea and a positive pregnancy test three weeks prior to presentation. Transvaginal ultrasound scan revealed a sixweeks viable intrauterine gestation. A diagnosis of possible ectopic pregnancy was made. Further trans-abdominal ultrasonography imaging revealed viable intrauterine pregnancy with evidence of an echogenic mass measuring 6.5 x 7.5cm in the abdominal cavity with significant fluid collection, and both ovaries were visualized and separate from the mass. An emergency exploratory laparotomy with right salpingectomy was performed with minimal handling of the uterus and other pelvic structures. At 37 weeks and 5 days gestation, she had an elective C/S for a transverse lying fetus and delivered a live normal birth weight baby girl with a good Apgar score. (Afr J Reprod Health 2022; 26[4]: 110-113).

Animal models of acquired heterotopic ossification: a systematic review / 中国康复理论与实践

@#Objective To systematically summarize the animal models of acquired heterotopic ossification (AHO), and provide reliable modeling methods for the study of disease prevention and treatment programs.Methods Literatures about the animal models of AHO were researched from PubMed, Web of Science, CNKI and Wanfang Database till November, 2021. The important contents of the literatures were extracted, and the animal models of various types of AHO were evaluated and analyzed by literature induction.Results A total of 20 literatures related to animal experiments were included, which could be divided into two types: post-traumatic and neurogenic heterotopic ossification animal models, which were used to simulate the occurrence and development of AHO. Currently, seven different animal models were commonly used to study post-traumatic heterotopic ossification, such as muscle injury, achilles tenotomy, muscle injury combined with joint immobilization, hip injury, heterotopic implantation, blast injury and burn. The studies of neurogenic heterotopic ossification animal models mainly included spinal cord injury and traumatic brain injury. At present, the methods of achilles tenotomy and osteogenic factor implantation were commonly used in the laboratory, and with the advantages of reliability, feasibility and high success rate; however, they could not accurately explain the pathogenesis of heterotopic ossification under complicated clinical conditions. Therefore, the improvement of modeling methods based on explosion injury, burn, nerve injury and other conditions became the basis for clinical research of molecular biological mechanism, prevention and treatment of heterotopic ossification.Conclusion Current modeling methods have their own advantages and disadvantages, but none of them can completely replicate all the characteristics of human heterotopic ossification. Therefore, there is no unified standard in the selection of animal model in clinic. According to different etiology of the disease, the selection of appropriate animal models is crucial to study effective intervention for different types of AHO in the early stage.

Clinical, endoscopic and histological characteristics of heterotopic gastric mucosa in upper esophagus / 中华消化内镜杂志

Objective:To study the clinical, endoscopic and histological characteristics of heterotopic gastric mucosa in upper esophagus (HGMUE).Methods:A Total of 177 patients who underwent gastroscopy and were diagnosed as having HGMUE at the Endoscopy Center of Wuhan Union Hospital from January 2017 to December 2017 were included in the study. According to the gastroesophageal reflux disease symptom questionnaire (GERD-Q) scores, patients were divided into the HGMUE group (GERD-Q<8, n=101) and GERD+HGMUE group (GERD-Q≥8, n=76). The data of clinical, endoscopic and histological characteristics were analyzed. Results:Among the 177 HGMUE cases, there were 111 males (62.71%) and 66 females (37.29%), 76 (42.94%) with GERD, and 101 (57.06%) without GERD. The most common symptom was continuous clearing throat [54.24% (96/177)], followed by foreign body sensations of throat [48.59% (86/177)], and gastroesophageal reflux symptoms such as heartburn, chest pain, indigestion, acid reflux [48.59% (86/177)]. In the HGMUE group, the occurrence rate of clearing throat was the highest [42.57% (43/101)], then foreign body sensations of throat accounted for 33.66% (34/101), and gastroesophageal reflux symptoms was 27.72% (28/101). In the HGUME+GERD group, the most common symptom was gastroesophageal reflux symptoms [76.32% (58/76)], then clearing throat [69.74% (53/76)] and foreign body sensations of throat [68.42% (52/76)]. Under gastroscopy, 177 heterotopic gastric lesions were found under gastroscopy with orange-red round, oval or elongated island like ones, most of which were flat and a few slightly protruded from the peripheral plane. There were 132 (74.58%) single-lesion cases, 38 (21.47%) 2-lesion, and 7 (3.95%) 3- or more-lesion cases; there were 37 (20.90%) small lesions (maximum diameter <0.5 cm), and 74 (41.81%) median-size lesions (maximum diameter of 0.5-1.0 cm), and 66 (37.3%) larger lesions (maximum diameter >1.0 cm). Among the 30 [16.95% (30/177)] samples of mucosal tissue, 15 [50.00% (15/30)] were mainly cardia gland, 8 [26.67% (8/30)] were mainly pyloric gland, 6 [20.00% (6/30)] were mixed type, and 1 [3.33% (1/30)] was squamous epithelium. In the immunohistochemical test, 20 cases [66.67% (20/30)] showed positive of H +/K +-ATPase, and 10 cases [33.33% (10/30)] were negative. Conclusion:HGMUE is more common in male patients, and may be combined with GERD. Among them, patients with combined GERD are more likely to develop laryngopharyngeal reflux. The heterotopic gastric mucosas lesions are orange-red round, oval or elongated island-like under gastroscopy, and most of them are flat, single and median- or large-sized. Histological types are mostly fundic glands, and H +/K +-ATPase positive is more common. It is speculated that acid secretion may be an important factor leading to throat symptoms.

Locational distribution characteristics and risk factors of heterotopic ossification following traumatic elbow stiffness / 中华创伤骨科杂志

Objective:To study the locational distribution characteristics of the heterotopic ossification (HO) following traumatic elbow stiffness and the risk factors for HO development at different locations.Methods:Consecutively included according to our inclusion criteria in the present study were the patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from January 2018 to December 2018 for elbow release due to traumatic elbow stiffness but developed postoperative HO. Their baseline data and CT data were collected and processed using Mimics 20.0. The HO distribution for each patient was characterized at the anteromedial, anterolateral, posteromedial, posterolateral, posterior, medial, lateral, and proximal radioulnar locations. The patient's original injury was categorized into 5 types: distal humerus fracture, olecranon fracture, radial head fracture, coronoid fracture, and elbow dislocation. After the univariate analysis with the HO occurrence at a specific location as the dependent variable and the original injury and baseline data as the independent variables, the factors with P value less than 0.1 were included in the logistic regression analysis to determine the risk factors for HO at each location.Results:A total of 91 patients were included in this study. Of them, 88 had posteromedial HO (96.7%, 88/91), 62 posterior HO (68.1%, 62/91), 60 posterolateral HO (65.9%, 60/91), 41 anteromedial HO (45.1%, 41/91), 26 anterolateral HO (28.6%, 26/91), 13 proximal radioulnar HO (14.3%, 13/91), 8 lateral HO (8.8%, 8/91), and 7 medial HO (7.7%, 7/91). Logistic regression analysis showed that presence of ulnar nerve symptoms ( OR=4.354, P=0.017) and presence of original elbow dislocation ( OR=2.927, P=0.042) were the independent risk factors for the anteromedial HO development and that presence of original olecranon fracture ( OR=0.277, P=0.023) was the protective factor for the anteromedial HO development. Presence of original radial head fracture was the independent risk factor for the anterolateral HO development ( OR=2.891, P=0.033) and the posterolateral HO development ( OR=3.123, P=0.043). Conclusions:HO development in patients with post-traumatic elbow stiffness is closely related to their original injury. Posteromedial HO may develop in almost all the patients. Patients with ulnar nerve symptoms and original elbow dislocation are more prone to anteromedial HO development, but patients with original olecranon fracture are less likely to develop anteromedial HO. Patients with original radial head fracture are more likely to develop anterolateral and posterolateral HO.

Cartografia dos territórios da escola: mapeando espaços heterotópicos de lazer que possibilitam inflexões de aprendizagem / Cartography of school territories: mapping heterotopic spaces of leisure that enable learning inflections

Este artigo apresenta passos e reconhecimentos de uma pesquisa de doutorado, que buscou abordar e problematizar questões no entorno do sujeito social 'criança' no seu processo de conhecer e aprender no decorrer do 'brincar' nos momentos de 'lazer' da/na 'infância' nos territórios da Escola. Para tanto, se subsidia num movimento de uma pesquisa bibliográfica, ancorada nos caminhos metodológicos desenhados por meio de uma pesquisa qualitativa e pós-crítica, tendo como rota a abordagem de uma cartografia. Nesse sentido, teve como objetivo se movimentar com a escola e com seus atores e sujeitos sociais, para 'compreender como a cartografia pode mapear espaços dentro dos territórios da escola, e, desta forma, apontar os acontecimentos de inflexões de aprendizagem, por meio das práticas sociais presentes nos brincares dessas crianças em lugares identificados e denominados como sendo 'espaços heterotópicos de lazer'.

This article presents steps and acknowledgments of a doctoral research, which sought to address and problematize issues surrounding the social subject 'child' in their process of knowing and learning in the course of 'playing' in the 'leisure' moments of / in 'childhood 'in the School's territories. To this end, it is subsidized in a movement of a bibliographic research, anchored in the methodological paths designed through a qualitative and post-critical research, having as a route the approach of cartography. In this sense, it aimed to move with the school and with its actors and social subjects, in order to 'understand how cartography can map spaces within the school's territories, and, in this way, point out the events of learning inflections, through the social practices present in the play of these children in places identified and called as 'heterotopic leisure spaces'.

Tratamiento integral de la osificación heterotópica en politraumatismo con traumatismo encéfalo craneano reporte de un caso / Comprehensive treatment of heterotopic ossification in polytraumatism with traumatic brain injury case report

RESUMEN Introducción: La osificación heterotópica (OH) es una complicación descrita en los pacientes con daño neurológico. Reporte de caso: Paciente que sufrió un politraumatismo y traumatismo encéfalo craneano (TEC), con fracturas y déficit neurológico secundario al TEC, quien presentó varias osificaciones heterotópicas durante su evolución, que comprometieron el logro de los objetivos funcionales. Presentó como principal manifestación tumefacción y limitación del rango articular (RA) para la extensión de cadera y rodilla izquierda, lo que mantenía el miembro inferior izquierdo (MI) flexionado, impidiendo la bipedestación y marcha. Fue diagnosticado como osteoma secundario a trauma neurológico y recibió un manejo médico estructurado, que incluyó la intervención quirúrgica: "resección del osteoma y tenotomía en isquiotiobiales", obteniendo mejora del rango articular, logrando la bipedestación y marcha con apoyo biomecánico. Discusión: La fisiopatología se cree que está relacionada a la liberación sistémica de sustancias estimulantes de células madre pluripotenciales, que se diferencian como osteoblastos. Conclusión: Un manejo integral multidisciplinario provee mejores resultados funcionales, lo que contribuye a la meta de la independencia.

ABSTRACT Introduction: Heterotopic ossification (OH) is a complication described in patients with neurological damage. Case report: Patient who suffered a multiple trauma and traumatic brain injury (TBI), with fractures and neurological deficit secondary to TBI, who presented several heterotopic ossifications (OH) during his evolution that compromised the achievement of functional objectives. The main manifestation was swelling and limitation of the articular range (RA) for the extension of the left hip and knee, which kept the lower left limb (MI) flexed, preventing standing and walking. He was diagnosed as osteoma secondary to neurological trauma and received structured medical management, which included surgical intervention: "resection of the osteoma and tenotomy in hamstrings", obtaining improvement of the joint range, chieving standing and walking with biomechanical support. Discussion: The pathophysiology is believed to be related to the systemic release of stimulating substances from pluripotent stem cells, which differentiate as osteoblasts. Conclusion: A multidisciplinary comprehensive management provides better functional results, which contributes to the goal of the independence.

Heterotopic ossification in acetabular fractures: systematic review and meta-analysis of prophylaxis / Ossificação heterotópica nas fraturas do acetábulo: revisão sistemática e metanálise da profilaxia

ABSTRACT Objective: Heterotopic ossification is defined as the formation of trabecular bone in soft tissues. It is a common complication after surgical treatment of acetabular fractures. However, its prophylaxis and treatment are still controversial. The objective of this research is to evaluate the effectiveness of actions to prevent the development of heterotopic ossification after surgical correction of acetabular fractures. Methods: A systematic review was carried out with research in the databases PubMed/MEDLINE, Embase, LILACS and Cochrane until August 4, 2020, without restrictions on language and year of publication. Only randomized clinical studies carried out in humans without restrictions based on the dosage of treatments, use and duration of prophylaxis were included in this review. Results: Two studies compared the use of radiotherapy and indomethacin and three compared the use of indomethacin with a placebo or non-indomethacin group. The meta-analysis calculations did not indicate statistical differences between radiotherapy versus indomethacin (RR 1.45, IC 95% 0.97 to 2.17, p = 0,55) and indomethacin versus placebo or not indomethacin (RR 0.85, IC 95% 0.68 to 1.06, p = 0,59). Conclusion: There is insufficient evidence to affirm that the use of radiotherapy or indomethacin are effective to prevent the formation of heterotopic ossification after surgery for fractures of the acetabulum. In addition, the number of complications was higher in the indomethacin group when compared to placebo or no intervention. Level of Evidence I, Systematic Review.

RESUMO Objetivo: A profilaxia e o tratamento da ossificação heterotópica ainda são controversos. O objetivo desta pesquisa foi avaliar a efetividade das intervenções para prevenir o desenvolvimento da ossificação heterotópica após a fixação cirúrgica das fraturas do acetábulo. Métodos: Foi realizada uma revisão sistemática com pesquisa nas bases de dados PubMed/MEDLINE, Embase, LILACS e Cochrane até 4 de agosto de 2020, sem restrições quanto ao idioma e ano de publicação. Foram incluídos apenas ensaios clínicos randomizados realizados em humanos sem restrições com base na dosagem dos tratamentos, no uso e na duração da profilaxia. Cálculos de metanálise foram realizados utilizando o software Review Manager desenvolvido pela Cochrane. Resultados: Dois estudos compararam o uso de radioterapia e indometacina e três compararam o uso de indometacina com um grupo placebo ou não indometacina. Os cálculos de metanálise não indicaram diferenças estatísticas entre radioterapia versus indometacina (RR 1.45, IC de 95% 0.97 a 2.17, p = 0,55) e indometacina versus placebo ou não indometacina (RR 0.85, IC de 95% 0.68 a 1.06, p = 0,59). Conclusão: Não há evidências suficientes para afirmar que a utilização da radioterapia ou da indometacina é efetiva para prevenir a formação da ossificação heterotópica após cirurgias por fraturas do acetábulo. Além disso, o número de complicações foi maior no grupo indometacina quando comparado ao placebo ou à não intervenção. Nível de Evidência I, Revisão Sistemática.