Osificación heterotópica mesentérica precoz posabdomen abierto y su manejo quirúrgico: presentación de un caso / Mesenteric heterotopic ossification after open abdomen and its surgical management: presentation of a case

OBJETIVO: Reportar el caso de un paciente con antecedente de múltiples cirugías por peritonitis y abdomen abierto, con hallazgo intraoperatorio de osificación heterotópica en el mesenterio. CASO CLÍNICO: Paciente masculino de 59 años, con antecedente de apendicectomía complicada hace 12 meses, que en esa oportunidad requirió manejo de abdomen abierto, colectomía derecha e ileostomía terminal. Un año posapendicectomía reingresa para reconstitución de tránsito con hallazgo intraoperatorio de masa calcificada en mesenterio, de 15 x 10 x 6 cm, cuyo estudio histológico informa osificación heterotópica mesentérica. Esta entidad es de baja frecuencia, asociada al antecedente de trauma y cirugía abdominal, y se ha descrito como causa de morbimortalidad. El manejo quirúrgico resectivo es factible por equipos con experiencia. CONCLUSIÓN: Se describe un caso con antecedente de abdomen abierto, con posterior hallazgo de osificación heterotópica mesentérica. Este caso clínico es representativo por sus factores de riesgos clásicos y manejo empleado para su resolución.

OBJECTIVE: Report the case of a patient with a history of multiple surgeries due to peritonitis and open abdomen, with intraoperative finding of mesenetrioc heterotopic ossification. CLINICAL CASE: A 59-year-old male patient with a history of complicated appendectomy 12 months ago, which requires the management of an open abdomen, right colectomy and terminal ileostomy. One year after appendectomy, is readmitted for transit reconstitution. Intraoperative finding were calcified mass in mesentery, of 15 x 10 x 6 cm, whose histological study reports mesenteric heterotopic ossification. This entity has low frequency, and is associated with a history of trauma and abdominal surgery, is described as a cause of morbidity and mortality. Resective surgical management is feasible for experienced teams. CONCLUSION: A case with antecedent of open abdomen is described, with later finding of mesenteric heterotopic ossification. This clinical case is representative for its classic risk factors and management used for its resolution.

Osificación heterotópica de cadera asociada a pancreatitis aguda severa: reporte de un caso / Hip heterotopic ossification associated with severe acute pancreatitis: a case report

La osificación heterotópica (OH), es la formación anormal de hueso maduro dentro de tejidos blandos extra esqueléticos donde normalmente no existe tejido óseo. Varias formas de OH han sido descritas de acuerdo a su presentación clínica, localización y ocurrencia progresiva o aislada. Su presentación en pacientes sometidos a inmovilización prolongada en el contexto de coma farmacológicamente inducido, en ausencia de lesiones del sistema nervioso central, es poco habitual. Presentamos el caso de una paciente de 40 años, sexo femenino, sin antecedentes mórbidos, que presenta episodio de pancreatitis aguda grave, manejada en UCI. Producto de lo anterior, requiere coma farmacológicamente inducido por 3 meses y hospitalizaciones reiteradas y prolongadas durante los 10 meses siguientes. Durante 3 años desde la resolución de su cuadro inicial evoluciona con alteración progresiva de la marcha y rigidez de la extremidad inferior derecha, sin eventos traumáticos durante ese período. Se objetiva mediante radiografía y TAC foco de OH coxofemoral derecha. Se resuelve de forma quirúrgica y biopsia de pieza operatoria confirma el diagnóstico. La paciente logra buena recuperación posterior. NIVEL DE EVIDENCIA: IV

Heterotopic ossification (HO) is the abnormal formation of mature bone within extraskeletal soft tissues where bone does not exist. Various presentation of HO have been described according to the clinical settings and location of the lesions, and progressive or isolated occurrence. A rare form of presentation occurs in induced coma patients with long-term immobilization and without central nervous system injuries. We present the case of a 40 years old female patient, without previous morbidity, who develop a severe acute pancreatitis. The patient requires an intensive care unit management (ICU) and a 3-month pharmacology induced coma and reiterative and prolonged hospitalizations during the next 8 months. During 3 years after resolution of her base disease, patient develops a progressive step claudication and a hip rigidity in adduction and external rotation. A coxofemoral HO focus is confirmed by radiology and CT. A surgical treatment of HO was performed, and the initial diagnose confirmed by anatomic pathology after biopsy of the injury. Patient had a favorable outcome.

Hemosiderosis pulmonar idiopática con osificación pulmonar / Idiopathic pulmonary hemosiderosis with dendriform pulmonary ossification

La osificación pulmonar es un hallazgo poco usual, generalmente asintomático, que se reporta como incidental en biopsias de pulmón. Asimismo, la hemosiderosis pulmonar idiopática es una causa poco frecuente de infiltración pulmonar. Se presenta el caso de un hombre de 64 años con síntomas respiratorios crónicos, en quien se detectaron estas dos condiciones en el estudio histopatológico.

Pulmonary ossification is a rare and usually asymptomatic finding reported as incidental in lung biopsies. Similarly, idiopathic pulmonary hemosiderosis is a rare cause of pulmonary infiltrates. We report the case of a 64-year old man with chronic respiratory symptoms in whom these two histopathological findings converged

Eagle syndrome: a narrative review / Síndrome de Eagle: una revisión narrativa

Abstract: painful disorders in the maxillofacial region are common in dental practice. Most of these conditions are not properly diagnosed because of inadequate knowledge of craniofacial and cervico-pharyngeal syndromes such as Eagle Syndrome. The aim of this review is to describe the general aspects, diagnosis and treatment of Eagle syndrome. Eagle syndrome or stylohyoid syndrome was first described by Watt W. Eagle in 1937. It was defined as orofacial pain related to the elongation of the styloid process and ligament stylohyoid calcification. The condition is accompanied by symptoms such as dysphonia, dysphagia, sore throat, glossitis, earache, tonsillitis, facial pain, headache, pain in the temporomandibular joint and inability to perform lateral movements of the neck. Diagnosis and treatment of Eagle syndrome based on symptoms and radiographic examination of the patient will determine the need for surgical or nonsurgical treatment. Eagle syndrome is a complex disorder demanding a thorough knowledge of its signs and symptoms to make a correct diagnosis and provide an appropriate subsequent treatment. Disseminating information about this syndrome among medical-dental professionals is essential to provide adequate dental care to patients.

Resumen: en la práctica odontológica, es frecuente encontrar alteraciones con sintomatología dolorosa en la región maxilofacial, las cuales no son apropiadamente diagnosticadas, a causa del desconocimiento de síndromes craneofaciales y cervicofaríngeos, como el Síndrome de Eagle. El objetivo de esta revisión es describir los aspectos generales, diagnóstico y tratamiento del Síndrome de Eagle. El Síndrome de Eagle o estilalgia es la entidad nosológica, descrita por Watt W. Eagle en 1937, definida como aquel dolor orofacial relacionado con la elongación de la apófisis estiloides y calcificación del ligamento estilohioideo; el cual está acompañado de síntomas como: disfonía, disfagia, dolor faríngeo, glositis, otalgia, tonsilitis, dolor facial, cefalea, odinofagia, dolor en la articulación temporomandibular e imposibilidad de realizar movimientos laterales del cuello. El diagnóstico y tratamiento del Síndrome de Eagle está basado en la sintomatología y el examen radiográfico del paciente, lo cual determinará el tratamiento quirúrgico o no quirúrgico. El Síndrome de Eagle es una patología compleja que requiere un conocimiento amplio de sus signos y síntomas, para establecer un correcto diagnóstico y posteriormente un adecuado tratamiento. Para ello, es necesario difundir la información sobre este síndrome entre los profesionales médico-odontológico y así brindar una atención adecuada a cada uno de los pacientes.

Tuberculosis osteoarticular y osificaciones heterotópicas: reporte de un caso / Heterotopic ossification and osteoarticular tuberculosis: case report

La osificación heterotópica es una condición patológica que conduce al desarrollo de hueso en el tejido blando. En la piel se denomina osteoma cutis. Estas lesiones se clasifican en primarias o secundarias. Las causas secundarias constituyen el 85% y son consecuencia de enfermedades inflamatorias, infecciones, tumores, traumatismos, lesiones de médula espinal y cirugías. Si bien la osificación heterotópica es benigna e infrecuente, puede ser una enfermedad debilitante que, asociada a dolor y rigidez, provoque mayor comorbilidad en relación con la enfermedad que la desencadenó. Comunicamos el caso de un paciente que padeció osteoma cutis asociado a tuberculosis osteoarticular

Heterotopic ossification is a patologic condition that leads bone formation in soft tissue. In particular, osteoma curtis, which can be primary or secundary, occurs when ossification if found in the skin. Secondary lessions account 85% of the cases described and they are by inflammatory diseases, infections, tumors, traumas, spinal cord lesions and surgeries. Whereas heterotopic ossification is benign and rare, it may result in wasting sickness that in combination with pain and stiffness, adding comorbidity to the disease that triggers. We report here a patient suffering osteomas cutis and osteoarticular tuberculosis. (AU)

Influence of transcutaneous electrical stimulation on heterotopic ossification: an experimental study in Wistar rats

Heterotopic ossification (HO) is a metaplastic biological process in which there is newly formed bone in soft tissues, resulting in joint mobility deficit and pain. Different treatment modalities have been tried to prevent HO development, but there is no consensus on a therapeutic approach. Since electrical stimulation is a widely used resource in physiotherapy practice to stimulate joint mobility, with analgesic and anti-inflammatory effects, its usefulness for HO treatment was investigated. We aimed to identify the influence of electrical stimulation on induced HO in Wistar rats. Thirty-six male rats (350-390 g) were used, and all animals were anesthetized for blood sampling before HO induction, to quantify the serum alkaline phosphatase. HO induction was performed by bone marrow implantation in both quadriceps of the animals, which were then divided into 3 groups: control (CG), transcutaneous electrical nerve stimulation (TENS) group (TG), and functional electrical stimulation (FES) group (FG) with 12 rats each. All animals were anesthetized and electrically stimulated twice per week, for 35 days from induction day. After this period, another blood sample was collected and quadriceps muscles were bilaterally removed for histological and calcium analysis and the rats were killed. Calcium levels in muscles showed significantly lower results when comparing TG and FG (P<0.001) and between TG and CG (P<0.001). Qualitative histological analyses confirmed 100% HO in FG and CG, while in TG the HO was detected in 54.5% of the animals. The effects of the muscle contractions caused by FES increased HO, while anti-inflammatory effects of TENS reduced HO.

Growing Heterotopic Calcification in the Prevertebral Space of a Cervical Spine as a Late Complication of Irradiation: Case Report

Heterotopic calcification following head and neck irradiation has rarely been reported. It usually develops as a late complication of radiotherapy in patients with malignancies, including breast cancer, lymphoma, and genitourinary malignancies. The occurrence of heterotopic calcification in the prevertebral space of the cervical spine has not been described as a late complication of irradiation. Here, we report a case of prevertebral heterotopic calcification in a patient with history of chemotherapy and radiotherapy for tonsil cancer 21 years ago.

Oropharyngeal styloids: An unusual presentation.

The close proximity of the styloid process to many of the vital neurovascular structures in the neck makes it clinically significant. The styloid process is said to be elongated if it is longer than 3.0 cm in length. Anatomical variations are very common and clinical symptoms arising from such variations have to be recognized. Elongated styloid processes may cause chronic throat pain along with foreign body sensation, dysphagia, vague facial pain, and otalgia. Surgical excision of an elongated styloid is considered as a satisfactory treatment for such cases. Here, we present a unique case of bilaterally elongated styloids that could be visualized just by depressing the tongue, when they appeared like the tusks of an elephant in the oropharyngeal region.

Experimental model of heterotopic ossification in Wistar rats

Heterotopic ossification (HO) is a metaplastic biological process in which there is newly formed bone in soft tissues adjacent to large joints, resulting in joint mobility deficit. In order to determine which treatment techniques are more appropriate for such condition, experimental models of induced heterotopic bone formation have been proposed using heterologous demineralized bone matrix implants and bone morphogenetic protein and other tissues. The objective of the present experimental study was to identify a reliable protocol to induce HO in Wistar rats, based on autologous bone marrow (BM) implantation, comparing 3 different BM volumes and based on literature evidence of this HO induction model in larger laboratory animals. Twelve male Wistar albino rats weighing 350/390 g were used. The animals were anesthetized for blood sampling before HO induction in order to quantify serum alkaline phosphatase (ALP). HO was induced by BM implantation in both quadriceps muscles of these animals, experimental group (EG). Thirty-five days after the induction, another blood sample was collected for ALP determination. The results showed a weight gain in the EG and no significant difference in ALP levels when comparing the periods before and after induction. Qualitative histological analysis confirmed the occurrence of heterotopic ossification in all 12 EG rats. In conclusion, the HO induction model was effective when 0.35 mL autologous BM was applied to the quadriceps of Wistar rats.

Lipogranuloma with Osseous Metaplasia in the Breast That Developed after "Bu-Hwang" Oriental Medicine Treatment

A lipogranuloma is an inflammatory reactive process associated with exogenous or endogenous lipids, and it's occurrence in the breast has rarely been reported. Osseous metaplasia, which is used to describe bone formation in abnormal locations, can develop from several conditions such as trauma or a tumor. However, few studies have reported benign breast lesions that have been seen as osseous metaplasia. We present a case of a benign calcified breast lesion that developed after a traumatic treatment process called "Bu-Hwang", and it was confirmed as a lipogranuloma with osseous metaplasia. To the best of our knowledge, this is the first reported case of a lipogranuloma with osseous metaplasia in the breast.

Lesões múltiplas de osteoma cutis na face: terapêutica minimamente invasiva em pacientes com sequela de acne - relato de casos / Multiple injuries of osteoma skin in the face: therapeutical least invasive in patients with acne sequela - case report

Osteoma cutis é a formação óssea no interior da pele, podendo ser primária ou secundária. Única ou múltipla, de tamanhos variados e acometendo ambos os sexos, é uma lesão cutânea rara, de etiopatogenia e classificação ainda discutidas. Nosso objetivo foi relatar o diagnóstico e a terapêutica minimamente invasiva de lesões múltiplas de osteoma cutis na face em pacientes com sequelas de acne. Fizemos a retirada dos osteomas com agulhas BD 0,70 x 25 22G1, sem anestésicos tópicos ou injetáveis no local. As pequenas incisões foram deixadas expostas, com pomada cicatrizante. Obteve-se um excelente resultado estético em 15 dias.

Osteoma cutis is a bone formation in the dermis can to be primary or secondary forms. Only, multiples, many forms, occurring on either sex, they are a rare cutaneous disease. The pathogenesis and classification remains unclear. Our objective was the diagnostic and small invasive surgery treatment of the osteoma cutis multiple of the face, in patients as a sequel of acne. To remove the osteoma we used needle BD 0,70x25 22G1, without anesthetic topic or inject able site. The small wounds were exposed with scarring balsam. We got an excellent esthetic result after 15 days.

Risk factors of heterotopic ossification in traumatic spinal cord injury / Fatores de risco da ossificação heterotópica na lesão medular traumática

OBJECTIVE: Heterotopic ossification (HO) is a complication of the spinal cord injury (SCI). It can result in anchylosis, harming the rehabilitation and quality of life. Previous publications had not elucidated the relation between possible independent variables, the aim of this study. METHOD: From 230 patients with SCI, admitted in 1998 at Hospital SARAH Brasilia, 33 with HO (14.3 percent; CI95 percent 10.1-19.6) were compared with 33 controls. The risk factors had been tested in bivariate analysis and in a model of logistic regression. RESULTS: Spasticity (odds ratio=3.8; CI95 percent 1.15-12.30), number of pressure ulcers (2.1; CI95 percent 1.08-3.89) and time lapsed since the injury (1.1; CI95 percent 1.02-1.24) were independently associated with HO. There was a confounder effect among these variables, without interaction. CONCLUSION: Spasticity, pressure ulcer and time of injury are associated with HO in spinal cord injury. The first two factors can be prevented and treatable.

OBJETIVO: A ossificação heterotópica (OH) é uma complicação da lesão medular traumática (LMT). Pode resultar em anquilose, prejudicando a reabilitação e a qualidade de vida. Estudos prévios não elucidaram a relação entre as potenciais variáveis independentes, propósito desse estudo. MÉTODO: De 230 pacientes com LMT, admitidos em 1998 no Hospital SARAH Brasília, 33 tiveram o diagnóstico de OH (14,4 por cento; IC95 por cento 10,1-19,6), que foram comparados a 33 controles. Os fatores de risco foram testados de forma bivariada e num modelo de regressão logística. RESULTADOS: Espasticidade (razão de chances 3,8; IC95 por cento 1,15-12,30), número de escaras (2,1; 1,08-3,89) e tempo de lesão (1,1; 1,02-1,24) encontraram-se associadas, de forma independente, à presença de OH. Havia um efeito confundidor entre essas variáveis, porém sem interação. CONCLUSÃO: Espasticidade, escaras e tempo de lesão estão associados à OH na lesão medular traumática. Os dois primeiros são passíveis de prevenção e tratamento.

Uso da radioterapia na ossificação heterotópica imatura em pacientes com lesão medular / Use of radiotherapy in immature heterotopic ossification in patients with spinal cord injury

A incidência de ossificação heterotópica (OH) nos pacientes adultos com lesão raquimedular é de aproximadamente 20 por cento. A OH costumater evolução benigna, mas pode causar redução da amplitude do movimento articular e dificultar o processo de reabilitação. Existem poucos estudos que mostram o uso da radioterapia no tratamento da OH em pacientes com lesão medular. O objetivo deste estudo éavaliar se há progressão da ossificação imatura em pacientes com lesão medular submetidos à radioterapia como tratamento primário. Foram selecionados os prontuários de pacientes da clínica de lesão medular da Associação de Assistência à Criança Deficiente (AACD)que apresentaram OH imatura e que receberam tratamento com radioterapia, sendo este o único tratamento em todos os casos. É um estudo tipo corte histórico. Para análise da evolução da ossificação foram utilizados como parâmetros a comparação da amplitude demovimento da articulação afetada, medida com goniômetro, e a imagem radiográfica, graduando a ossificação de acordo com a classificação proposta por Brooker et al. O tempo de seguimento do estudo foi de 23,3 meses. Quatorze das 15 articulações estudadas não apresentaram piora clínica ou progressão da ossificação heterotópica. Não foram observados efeitos colaterais à radioterapia. Concluímos que os pacientes tratados precocemente com radioterapia não apresentaram progressão significativa da OH e que a radioterapia é um método seguro e de fácil aplicação.

Fibrodisplasia ossificante progressiva: relato de caso / Fibrodysplasia ossificans progressiva: a case report

Os autores descrevem um caso de fibrodisplasia ossificante progressiva, doença hereditária caracterizada por calcificações heterotópicas do tecido conectivo, geralmente induzida por trauma, gerando imobilidade permanente das articulações. Hálux valgo, clinodactilia e polegares curtos são as principais malformações congênitas associadas. Manifesta-se na infância, sendo o diagnóstico clínico-radiológico importante, pois procedimentos invasivos exacerbam a doença. Tratamentos disponíveis são apenas paliativos, tendo a prevenção relevância nesse contexto.

The authors describe a case of fibrodysplasia ossificans progressiva, a hereditary disease characterized by heterotopic ossification of the connective tissues, usually triggered by trauma, resulting in permanent immobility of the joints. Hallux valgus, clinodactyly and short thumbs are the main associated congenital anomalies. Fibrodysplasia ossificans progressiva usually develops during early childhood. Clinical and radiological diagnosis is essential, since invasive procedures exacerbate the disease. Only palliative treatments are available and prevention plays an important role in patients with fibrodysplasia ossificans progressiva.

Ossificação heterotópica em pacientes com lesão medular traumática: associação com antígenos do sistema HLA / heterotopic ossification in patients with traumatic medullar injury: association with HLA- system antigens

O objetivo deste trabalho foi identificar a prevalência dos antígenos leucocitários humanos (HLA) de classe l e ll nos pacientes com lesão medular traumática e sua relação com a ossificação heterotópica (OH). Foram estudados 54 pacientes (47 homens e 7 mulheres), idade de 33,5 + 12,5 anos (18 a 59 anos), com lesão medular traumática. Quarenta e quatro pacientes (81,5 por cento) apresentavam lesão medular completa e 10 pacientes tinham lesão incompleta; 23 pacientes (42,6 por cento) eram tetraplégicos e 31 (57,4 por cento) eram paraplégicos, sendo 28 com lesão torácica e 3 com lesão lombar. Para o diagnóstico de OH, os pacientes realizaram exames de imagem: cintilografia óssea, radiografias simples dos quadris e joelhos nos paraplégicos e tambem dos ombros nos tetraplégicos e tomografia computadorizada, quando os outros exames foram inconclusivos. Os pacientes foram divididos em dois grupos: 28 pacientes com OH (52 por cento) e 26 sem OH (48 por cento). Foi feita a tipificação dos antígenos HLA das classes l e ll de todos os pacientes. Os resultados da distribuição da freqüencia dos antígenos HLA nos dois grupos foram avaliados e não mostraram diferença com significância estatística. Concluiu-se que não existe associação entre os antígenos HLA classes l e ll e o desenvolvimento da ossificação heterotópica.

Intraocular osseous metaplasia. A clinico-pathological study.

PURPOSE: To evaluate the clinico-pathologic features of intraocular osseous metaplasia. METHODS: Pathology specimens of enucleated eyes submitted to the ophthalmic pathology service at a tertiary eye-care referral center between January 1995 and June 1999 were studied for intraocular osseous metaplasia. Specific histopathologic features noted in specimens with osseous metaplasia were the presence of retinal detachment, gliosis, retinal pigment epithelial hyperplasia, drusen, epiretinal membrane, fibrovascular proliferation and inflammation. Immunohistochemistry using monoclonal antibody against glial fibrillary acidic protein was performed to assess the glial component within the membranes and the proliferative vitreoretinal mass. Clinical records were reviewed and correlated with histopathologic findings. RESULTS: Osseous metaplasiaS was noted in 8 of 151 (5.2%) eyes examined. Clinical diagnosis in these was phthisis bulbi, staphyloma, absolute glaucoma and microphthalmos. Enucleation was performed for relief of symptoms (in painful blind eyes) or for cosmesis, and in an eye inciting sympathetic ophthalmia. Retinal detachment, gliosis and retinal pigment epithelial hyperplasia were noted in all the cases. Drusen with calcification or ossification (5 of 8), fibrovascular proliferation in the vitreous (5 of 8) and active inflammation (4 of 8) were the other associated histologic features. Location of ossification was subretinal in 3 cases, preretinal (ora serrata) in 1 case and in both locations in 4 cases. The eyes with subretinal osseous metaplasia had associated calcified drusen, while preretinal ossification was seen within the fibrovascular membranes. CONCLUSION: Chronic retinal detachment, hyperplasia and transdifferentiation of retinal pigment epithelium appear to be a few of the prerequisites for intraocular osseous metaplasia. Ossification can occur at isolated subretinal and preretinal locations or can involve both. Though a larger study is required to postulate the chronology of events, in this small series, isolated subretinal ossification appears to be initiated by calcification and ossification of drusen, while in the pre-retinal region it is associated with vitreoretinal proliferation.

Spinal cord and cauda equina compression in 'DISH'.

Diffuse idiopathic skeletal hyperostosis (DISH) has long been regarded as a benign asymptomatic clinical entity with an innocuous clinical course. Precise information is lacking in the world literature. Authors report the results of a retrospective analysis of 74 cases of DISH. Eleven patients presented with progressive spinal cord or cauda equina compression. In nine cases ossified posterior longitudinal ligament (OPLL) and in two cases ossified ligamentum flavum (OLF) were primarily responsible. Surgically treated patients (eight) had far better outcome as compared to the patients managed conservatively, as they had refused surgery. 'DISH' is neither a benign condition, nor it always runs a innocuous clinical course. In fact, in about 15% of the cases, serious neurological manifestations occur, which may require a major neurosurgical intervention.

Ossificacao endometrial: relato de caso / Endometrial ossification: case report

Os autores relatam o caso de uma paciente feminina, 37 anos, que durante a investigacao para infertilidade apresentou o diagnostico de ossificacao endometrial. A etiologia, patogenese e diagnosticos diferenciais de ossificacao endometrial sao...