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1.
Rev. Méd. Inst. Mex. Seguro Soc ; 60(1): 96-103, 2022. ilus
Article in Spanish | LILACS | ID: biblio-1361701

ABSTRACT

Introducción: la miositis osificante progresiva (MOP) es una enfermedad hereditaria del tejido conectivo de baja prevalencia (1:2,000,000 habitantes). Se caracteriza por osificación heterotópica con un comportamiento incierto que excepcionalmente se ha relacionado con neoplasias. Se buscó conocer la coexistencia de la MOP con neoplasias de origen mesodérmico, para que sean consideradas en el diagnóstico de otros pacientes, así como formular hipótesis para esclarecer su asociación. Caso clínico: mujer de 27 años con dolor de músculo isquitiobial y glúteo derecho que incrementaba con el ejercicio, sin remisión con analgésicos hasta limitar la movilidad de ambas extremidades. Se solicitó una serie ósea donde se evidenciaron zonas de radiolucidez heterogénea en la región de ambos muslos y pelvis de manera irregular, semejante a densidad ósea, que fue compatible con los hallazgos ecográficos y tomográficos; se concluyó que eran imágenes relacionadas con miositis osificante de cadera. La paciente refirió sintomatología gástrica y se solicitó una endoscopía que histopatológicamente reportó carcinoma gástrico difuso con células en anillo de sello; las imágenes de gabinete mostraron tumoración ovárica. Conclusión: la MOP es una patología de baja prevalencia, por lo que su conocimiento y sospecha son fundamentales para el diagnóstico. Hay poca literatura que involucre a las tres entidades; por ende, su fisiopatología y comprensión es limitada. En cuanto a la MOP, aún no hay un tratamiento curativo; sin embargo, el diagnóstico certero permite iniciar rehabilitación de manera oportuna con mejoría de la calidad de vida.


Background: Myositis ossificans progressiva (MOP) is a low prevalence hereditary connective tissue disease (1:2,000,000 habitants). It is characterized by heterotopic ossification with an uncertain behavior that has been exceptionally related to neoplasms. The objective was to know the coexistence of MOP with neoplasms of mesodermal origin, so that they can be considered in the diagnosis of other patients, as well as formulate hypotheses to clarify their association. Clinical case: 27-year-old female with right gluteal and ischitiobial muscle pain that increased with exercise, without remission with analgesics until limiting the mobility of both extremities. A bone series was requested where areas of heterogeneous radiolucency were evidenced in the region of, both, thighs and pelvis in an irregular manner, similar to bone density, which was compatible with the ultrasound and tomographic findings; we concluded that they were images of myositis ossificans of the hip. The patient reported gastric symptoms and an endoscopy was requested, which histopathologically reported diffuse gastric carcinoma with signet ring cells; cabinet images showed an ovarian tumor. Conclusion: MOP is a low prevalence disease, which is why its knowledge and suspicion are essential for the diagnosis. We found little literature that involves the three entities; therefore, their pathophysiology and understanding is limited. Regarding MOP, at this moment there is no curative treatment; however, an accurate diagnosis allows to start rehabilitation in a timely manner with an improvement in the quality of life.


Subject(s)
Humans , Female , Adult , Bone Neoplasms , Ossification, Heterotopic , Myositis Ossificans , Diagnostic Imaging , Bone Density , Risk Factors
2.
Rev. Hosp. Ital. B. Aires (2004) ; 41(3): 119-122, sept. 2021. ilus
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1363019

ABSTRACT

El síndrome de Eagle está caracterizado por una elongación o una curvatura medial excesiva de la apófisis estiloides o por una calcificación del ligamento estilohioideo que puede provocar dolor cervicofacial o síntomas neurológicos por la compresión de los vasos o nervios del cuello. El tratamiento más eficaz es el quirúrgico y consiste en la resección de la apófisis estiloides; puede ser realizado por vía externa o mediante un abordaje transoral. Se describe el caso clínico de un paciente con síndrome de Eagle que fue tratado con éxito mediante un abordaje transoral, sin amigdalectomía y con asistencia de endoscopios. (AU)


Eagle syndrome is characterized by an elongation or excessive medial curvature of the styloid process or calcification of the stylohyoid ligament that can cause cervicofacial pain or neurological symptoms due to compression of the vessels or nerves of the neck. The most effective treatment is surgical and consists of resection of the styloid process, it can be performed by externally or through a transoral approach.The clinical case of a patient with Eagle syndrome who was successfully treated by a transoral approach, without tonsillectomy and with the assistance of endoscopes, is described. (AU)


Subject(s)
Humans , Male , Middle Aged , Temporal Bone/abnormalities , Temporal Bone/surgery , Ossification, Heterotopic/surgery , Ossification, Heterotopic/diagnostic imaging , Mandible/surgery
3.
Autops. Case Rep ; 11: e2021331, 2021. graf
Article in English | LILACS | ID: biblio-1339245

ABSTRACT

Metaplastic breast carcinoma is a rare subtype of invasive breast carcinoma. Metaplastic carcinoma with osseous differentiation is exceptionally uncommon. Because of the heterogenous microscopy of the lesion, various clinical and radiological features are observed, leading to diagnostic difficulty. Herein, we present a case of a 43-year-old female with a recurrent breast lump, who was clinically diagnosed as a phyllodes tumor. However, histopathological examination revealed metaplastic carcinoma with extensive osseous differentiation.


Subject(s)
Humans , Female , Adult , Breast Neoplasms , Carcinoma, Ductal, Breast/pathology , Phyllodes Tumor/pathology , Ossification, Heterotopic/pathology
4.
Rev. bras. ortop ; 55(6): 722-727, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156204

ABSTRACT

Abstract Objective To evaluate the clinical and radiographic results as well as complications related to patients undergoing arthroscopic treatment of subspine hip impingement. Methods We retrospectively evaluated 25 patients (28 hips) who underwent arthroscopic treatment of subspine impingement between January 2012 and June 2018. The mean follow-up was 29.5 months, and the patients were evaluated clinically by using the Harris hip score modified by Byrd (MHHS), the non-arthritic hip score (NAHS), and in terms of internal rotation and hip flexion. In addition, the following items were evaluated by imaging exams: the center-edge (CE) acetabular angle, the Alpha angle, the presence of a sign of the posterior wall, the degree of arthrosis, the presence of heterotopic hip ossification, and the Hetsroni classification for subspine impingement. Results There was an average postoperative increase of 26.9 points for the MHHS, 25.4 for the NAHS (p < 0.0001), 10.5° in internal rotation (p < 0.0024), and 7.9° for hip flexion (p < 0.0001). As for the radiographic evaluation, an average reduction of 3.3° in the CE angle and of 31.6° for the Alpha angle (p < 0.0001). Eighteen cases (64.3%) were classified as grade 0 osteoarthritis of Tönnis, and 10 (35.7%) were classified as Tönnis grade 1. Two cases (7.1%) presented grade 1 ossification of Brooker. Most hips (n = 15, 53.6%) were classified as type II of Hetsroni et al. Conclusion In the present study, patients undergoing arthroscopic treatment with subspine impingement showed improvement in clinical aspects and radiographic patterns measured postoperatively, with an average follow-up of 29.5 months.


Resumo Objetivo Avaliar os resultados clínicos e radiográficos assim como as complicações relacionadas a pacientes submetidos ao tratamento artroscópico do impacto subespinhal do quadril. Métodos Foram avaliados retrospectivamente 25 pacientes (28 quadris) submetidos ao tratamento artroscópico de impacto subespinhal entre janeiro de 2012 e junho de 2018. O seguimento médio foi de 29,5 meses, e os pacientes foram avaliados clinicamente pelo Harris hip score modificado por Byrd (MHHS), o non-arthritic hip score (NAHS), e quanto à rotação interna e flexão do quadril. Além disso, foram avaliados por exames de imagem: o ângulo center-edge (CE) acetabular, o ângulo alfa, a presença de sinal da parede posterior, o grau de artrose, a presença de ossificação heterotópica do quadril e a classificação de Hetsroni para Impacto Subespinhal. Resultados Observou-se aumento médio pós-operatório de 26,9 pontos para o MHHS, 25,4 para o NAHS (p < 0,0001), 10,5° na rotação interna (p < 0,0024) e 7,9° para flexão do quadril (p < 0,0001). Quanto à avaliação radiográfica, observou-se redução média de 3,3° no ângulo CE e de 31,6° para o ângulo alfa (p < 0,0001). Foram classificados 18 casos (64,3%) como artrose grau 0 de Tönnis e 10 (35,7%) como Tönnis 1. Dois casos (7,1%) apresentaram ossificação grau 1 de Brooker. A maioria dos quadris (n = 15; 53,6%) foi classificada como tipo II de Hetsroni et al. Conclusão No presente estudo, os pacientes submetidos a tratamento artroscópico de impacto subespinhal apresentaram melhora nos aspectos clínicos e nos padrões radiográficos aferidos pós-operatoriamente, com seguimento médio de 29,5 meses.


Subject(s)
Humans , Male , Female , Adult , Osteoarthritis , Osteogenesis , Arthroscopy , Rotation , Ossification, Heterotopic , Femoracetabular Impingement , Hip Joint
5.
An. bras. dermatol ; 95(3): 351-354, May-June 2020. graf
Article in English | LILACS, ColecionaSUS | ID: biblio-1130885

ABSTRACT

Abstract Secondary osteoma cutis is a phenomenon that may occur in several conditions. When it occurs in a melanocytic nevus it is named osteonevus of Nanta, an event considered uncommon and characterized by the presence of bone formation adjacent or interposed with melanocytic cells. There are reports of its occurrence in various melanocytic lesions, being more frequently associated with intradermal nevus. We report a case of osteonevus of Nanta in combined nevus, possibly the first description of this association.


Subject(s)
Humans , Female , Adult , Scalp Dermatoses/pathology , Skin Diseases, Genetic/pathology , Skin Neoplasms/pathology , Bone Diseases, Metabolic/pathology , Ossification, Heterotopic/pathology , Nevus, Intradermal/pathology , Nevus, Pigmented/pathology , Scalp Dermatoses/surgery , Skin Diseases, Genetic/surgery , Skin Neoplasms/surgery , Bone Diseases, Metabolic/surgery , Immunohistochemistry , Ossification, Heterotopic/surgery , Nevus, Intradermal/surgery , Melanocytes/pathology , Nevus, Pigmented/surgery
6.
Rev. bras. ortop ; 55(2): 185-190, Mar.-Apr. 2020. tab
Article in English | LILACS | ID: biblio-1137997

ABSTRACT

Abstract Objective In the present study, we present the results with at least 10 years of follow-up of the cervical disc prosthesis implanted in a single level. Methods Retrospective study of patients undergoing single-level total cervical disc replacement (TCDR). Clinical results included the neck disability index (NDI) and the visual analogue scale (VAS) in the preoperative period, one year postoperatively, and a minimum of 10 years of follow-up. The radiographic parameters included cervical mobility, segmental lordosis, C2-C7 angle, heterotopic ossification (HO), facet and joint degeneration (FJD) and adjacent segment disease (ASD). Results We identified 22 patients, 16 women and 6 men with mean age of 39.7 years old (26-51 years old), of which fifteen completed a minimum follow-up of 10 years. There was a statistically significant improvement of NDI and VAS (p < 0.001) between the preoperative and the postoperative periods (1 year or > 10 years). At the end of 10 years, HO was observed in 59% of the cases. The mobility of the implant was preserved in 80% of the patients. Radiological evidence of ASD was recorded in 6 patients (40%). There was no correlation between the clinical parameters evaluated and the presence of ASD or the different classes of HO. Conclusion Clinical improvement in all evaluated parameters, which persists over time. Most implants maintained mobility, as has already been demonstrated in other studies with shorter follow-ups. In a significant percentage of cases, ASD was observed, questioning the concept of motion preserving technology. However, we did not have any surgical intervention for this reason, since there was no correlation with worse clinical results.


Resumo Objetivo No presente estudo, apresentamos os resultados com um acompanhamento mínimo de 10 anos da artroplastia total do disco cervical (ATDC) em um nível. Métodos Estudo retrospectivo de pacientes submetidos a ATDC em um nível. Os resultados clínicos incluíram o índice de incapacidade relacionada ao pescoço (IIRP) e a escala visual analógica (EVA) no período pré-operatório, um ano pós-operatório e um mínimo de 10 anos de acompanhamento. Os parâmetros radiográficos incluíram a mobilidade cervical, lordose segmentar, ângulo C2-C7, ossificação heterotópica (OH), degeneração facetária e articular (DFA) e doença do segmento adjacente (DSA). Resultados Identificados 22 pacientes, 16 mulheres e 6 homens com média de idade de 39,7 anos (26-51 anos), dos quais 15 tiveram um acompanhamento mínimo de 10 anos. Foi verificada melhoria estatisticamente significativa do IIRP e EVA (p < 0,001) entre pré-operatório e pós-operatório. (1 ano ou > 10 anos). Ao final de 10 anos, OH foi observada em 59% dos casos. A mobilidade do implante foi preservada em 80% dos pacientes. Houve evidência radiológica de DSA em 6 pacientes (40%). Não houve correlação entre os parâmetros clínicos avaliados e a presença de DSA ou as diferentes classes de OH. Conclusão Melhoria clínica em todos os parâmetros avaliados, que persiste ao longo do tempo. A maioria dos implantes manteve a mobilidade, como já demonstrado em estudos anteriores com acompanhamentos mais curtos. Numa percentagem significativa, a DSA estava presente, questionando o conceito da tecnologia de preservação de movimento. No entanto, sem nenhuma intervenção cirúrgica por esse motivo, uma vez que não houve correlação com piores resultados clínicos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Arthroplasty , Prostheses and Implants , Surgical Procedures, Operative , Cervical Vertebrae , Retrospective Studies , Ossification, Heterotopic , Total Disc Replacement , Joints
7.
Rev. chil. reumatol ; 36(4): 125-133, 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1282557

ABSTRACT

Introducción: La Fibrodisplasia osificante progresiva es una enfermedad congénita autosómica dominante poco frecuente, caracterizada por malformaciones esqueléticas y osificación heterotópica progresiva e invalidante. Caso clínico: Niño de 11 años consulta por múltiples lesiones osificadas en tronco y región cervical con importante limitación en su movilidad. En el examen físico destaca un ortejo mayor corto. Estudio genético muestra mutación del gen ACVR1. Recibe tratamiento con periodos cortos de corticosteroides posterior a traumas y previo a procedimientos, asociado a un manejo multidisciplinario. Revisión de la literatura: A la fecha el principal tratamiento es la prevención de los brotes de osificación y el uso de corticosteroides o antiinflamatorios cuando los brotes ya se iniciaron. Están en curso ensayos clínicos con bifosfonatos y anticuerpos anti-activina A. Conclusión: En la actualidad no existe un tratamiento específico, sin embargo, un diagnóstico precoz, la prevención de brotes y nuevas terapias podrían mejorar el pronóstico de los pacientes.


ntroduction: Fibrodysplasia ossificans progressiva is a rare autosomal dominant congenital disease characterized by skeletal malformations and progressive disabling heterotopic ossification. Clinical case: An 11-year-old boy consulted with multiple ossified lesions in the trunk and cervical regions associated with significant limitation in mobility. On physical examination, the big toe is short. Genetic study shows ACVR1 gene mutation. He received treatment with short corticosteroid periods after traumas and prior to clinical procedures, as well as a multidisciplinary management.Literature review: To date the main treatment is the prevention of ossification flare-ups and the use of corticosteroids or anti-inflammatories when they have already started. Clinical trials are ongoing with bisphosphonates and anti-activin A antibodies.Conclusion: There is currently no specific treatment, however, early diagnosis, prevention of flare-ups and new therapies could improve the prognosis of patients.


Subject(s)
Humans , Male , Child , Ossification, Heterotopic/drug therapy , Myositis Ossificans/diagnosis , Myositis Ossificans/therapy , Ossification, Heterotopic/diagnosis , Adrenal Cortex Hormones/therapeutic use
8.
Rev. otorrinolaringol. cir. cabeza cuello ; 79(3): 336-340, set. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058705

ABSTRACT

RESUMEN Un síndrome caracterizado por dolor cervical y un apófisis estiloides alargado fue descrito por primera vez por Watt Eagle en 1937. Aunque el síndrome de Eagle en su variante vascular es raro y no es reconocido como causa clara de disección carotídea, en los últimos años ha sido reportado un incremento del número de casos de disección carotídea causada por una apófisis estiloides alargada. Paciente de 56 años que acudió al servicio de urgencias por paresia facial izquierda aguda y habla confusa. Presentaba dolor cervical de dos días de evolución, relacionado con un ataque de tos. Se activó el código ictus y la tomografía computarizada (TC) mostró isquemia del lóbulo temporal derecho y disección bilateral de la arteria carótida interna. La angio-TC de los troncos supraaórticos con reconstrucción tridimensional, identificó una apófisis estiloides alargado en ambos lados. El paciente fue sometido a una angioplastía con colocación de dos stents. Debido al alto riesgo de padecer nuevo ictus, se decidió realizar tratamiento quirúrgico. Para el lado derecho se realizó un abordaje transoral y en el izquierdo un abordaje abierto. La apófisis estiloides alargado es una causa importante de disección carotídea y de las complicaciones cerebrovasculares relacionadas.


ABSTRACT A syndrome characterized by cervical pain and an abnormally elongated styloid process was first described by Watt Eagle in 1937. Even though vascular Eagle syndrome is uncommon and is not well recognized as a cause for carotid artery dissection, in the last few years there have been an increasing number of case reports of carotid artery dissection caused by an elongated styloid process. A 56 years old man presented to the emergency department with acute left facial weakness and slurred speech. He complained of two days neck pain, related to a coughing fit. The code stroke protocol was activated and imaging showed a right temporal bone stroke and a bilateral internal carotid artery dissection. A scan angiography of the supra-aortic vessels with 3D reconstruction was performed showing a bilateral abnormally elongated styloid process. The patient underwent angioplasty with two stent placements. Due to the high risk of recurrent strokes, the patient was evaluated in the otolaryngology department for styloid process resection. Finally a transoral approach for the right side and an open approach for the left side were performed. We have to consider an elongated styloid process as an important cause of carotid artery dissection and subsequent cerebrovascular complications


Subject(s)
Humans , Male , Middle Aged , Ossification, Heterotopic/complications , Carotid Artery, Internal, Dissection/etiology , Carotid Artery, Internal, Dissection/therapy , Stroke/etiology , Temporal Bone/abnormalities , Tomography, X-Ray Computed , Angioplasty , Neck Pain/etiology , Carotid Artery, Internal, Dissection/diagnostic imaging
9.
Autops. Case Rep ; 9(2): e2018083, Abr.-Jun. 2019. ilus
Article in English | LILACS | ID: biblio-994679

ABSTRACT

Heterotopic ossification has been described in papillary thyroid carcinoma in association with high incidence of extrathyroidal invasion, multifocality, lymph node metastasis, and older age. Nevertheless, it has not been described as a specific subtype of papillary thyroid carcinoma, because of its rarity. We described the case of an 80-year-old female patient, with familial history of papillary thyroid carcinoma. In the annual screening examination, she was diagnosed with thyroid nodules. The patient was submitted to a thyroidectomy because the fine needle aspiration cytology was positive for malignancy according to the Bethesda classification. The surgical specimen analyses showed a multifocal papillary carcinoma with one major lesion in the left lobe measuring 0.9 cm, and two small lesions (0.4 cm and 0.2 cm) in the right lobe. Only the biggest lesion in the right lobe had the osteoid matrix with rare osteoclasts and fat metaplasia with progenitor cells. There was perineural invasion, but vascular invasion was not identified. The margins were free and there was no extrathyroidal extension. In the left lobe there was an oncocytic nodule and a lipomatous follicular nodule. In recent years there has been a significant increase in the diagnosis of thyroid cancer, mainly because of the finding of microcarcinomas as a result of many requests for cervical image exams. Future studies may define (i) whether papillary thyroid carcinoma with heterotopic ossification is a true histological variant; (ii) the causes of that alteration; and (iii) eventual follow-up implications.


Subject(s)
Humans , Female , Aged, 80 and over , Thyroid Neoplasms/complications , Ossification, Heterotopic/pathology , Carcinoma, Papillary/complications , Thyroid Nodule/complications
10.
Rev. cir. (Impr.) ; 71(2): 168-172, abr. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1058251

ABSTRACT

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.


Subject(s)
Humans , Male , Middle Aged , Appendectomy/adverse effects , Peritoneal Diseases/etiology , Ossification, Heterotopic/etiology , Mesentery/pathology , Peritoneal Diseases/surgery , Ossification, Heterotopic/surgery
11.
Rev. méd. Chile ; 147(3): 384-389, mar. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1004361

ABSTRACT

Fibrodysplasia ossificans progressiva (FOP) or myositis ossificans, is a genetic disease, with a prevalence of 1 in 2.000.000. It is caused by pathogenic variants in ACVR1 gene and characterized by soft tissue heterotopic ossification, starting in the second decade of life. It is associated to early mortality caused by respiratory complications. It evolves in flare-ups, triggered by soft tissue injuries; therapy is symptomatic, using analgesia, steroids and diphosphonates. We report a 12-year-old female with left renal agenesis, hallux valgus and intellectual disability, presenting with a six months history of thoracic kyphosis, tender nodules in the thorax, and rigidity of right elbow and left knee. Clinical examination revealed dysmorphic facial features. A magnetic resonance showed heterotopic ossification nodules, which was confirmed with spinal radiography. These findings prompted the diagnosis of FOP. Pain treatment was started, and prednisone was used during flare-ups. The ACVR1 gene was analyzed and a pathogenic variant, p. Arg206His, was found, confirming the diagnosis of FOP.


Subject(s)
Humans , Female , Child , Myositis Ossificans/diagnostic imaging , Prednisone/therapeutic use , Magnetic Resonance Imaging , Chile , Ossification, Heterotopic/genetics , Ossification, Heterotopic/drug therapy , Ossification, Heterotopic/diagnostic imaging , Anti-Inflammatory Agents/therapeutic use , Myositis Ossificans/genetics , Myositis Ossificans/drug therapy
12.
Rev. chil. ortop. traumatol ; 60(1): 27-31, mar. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1146579

ABSTRACT

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.


Subject(s)
Humans , Female , Adult , Pancreatitis/complications , Ossification, Heterotopic/surgery , Ossification, Heterotopic/etiology , Hip , Acute Disease , Ossification, Heterotopic/diagnostic imaging
13.
Article in English | WPRIM | ID: wpr-763627

ABSTRACT

The incidence of heterotopic ossification in adolescents appears to be lower than in adults. There exist very few reports of heterotopic ossification with total bony ankylosis in child or adolescent populations. We describe a case of total bony ankylosis of the elbow secondary to heterotopic ossification, in a 14-year-old female. Total ankylosis of the elbow at 45 degrees of flexion was noted 6 months post-surgery, and complete surgical excision of the heterotopic mass was performed. After an additional one-time dose of radiation therapy and nonsteroidal anti-inflammatory drug medication, full range of motion was obtained without any recurrence or other complications, up to the last follow-up of 30 months.


Subject(s)
Adolescent , Adult , Ankylosis , Child , Joint Dislocations , Elbow , Female , Follow-Up Studies , Fractures, Bone , Humans , Incidence , Ossification, Heterotopic , Range of Motion, Articular , Recurrence
14.
Article in English | WPRIM | ID: wpr-763030

ABSTRACT

Ossification of the posterior longitudinal ligament (OPLL) can be defined as an ectopic ossification in the tissues of spinal ligament showing a hyperostotic condition. OPLL is developed mostly in the cervical spine and clinical presentations of OPLL are majorly myelopathy and/or radiculopathy, with serious neurological pathology resulting in paralysis of extremities and disturbances of motility lowering the quality of life. OPLL is known to be an idiopathic and multifactorial disease, which genetic factors and non-genetic factors including diet, obesity, physical strain on the posterior longitudinal ligament, age, and diabetes mellitus, are involved into the pathogenesis. Up to now, surgical management by decompressing the spinal cord is regarded as standard treatment for OPLL, although there might be the risk of development of reprogression of ossification. The molecular pathogenesis and efficient therapeutic strategy, especially pharmacotherapy and/or preventive intervention, of OPLL has not been clearly elucidated and suggested. Therefore, in this review, we tried to give an overview to the present research results on OPLL, in order to shed light on the potential pharmacotherapy based on molecular pathophysiologic aspect of OPLL, especially on the genetic/genomic factors involved into the etiology of OPLL.


Subject(s)
Diabetes Mellitus , Diet , Drug Therapy , Extremities , Ligaments , Longitudinal Ligaments , Obesity , Ossification, Heterotopic , Paralysis , Pathology , Quality of Life , Radiculopathy , Spinal Cord , Spinal Cord Diseases , Spine
15.
Asian Spine Journal ; : 544-555, 2019.
Article in English | WPRIM | ID: wpr-762975

ABSTRACT

STUDY DESIGN: Prospective observational cohort study. PURPOSE: This study aims to evaluate the safety and efficacy of bone morphogenetic protein-2 (BMP-2) in transforaminal lumbar interbody fusion (TLIF) with regard to postoperative radiculitis. OVERVIEW OF LITERATURE: Bone morphogenetic protein (BMP) is being used increasingly as an alternative to iliac crest autograft in spinal arthrodesis. Recently, the use of BMP in TLIF has been examined, but concerns exist that the placement of BMP close to the nerve roots may cause postoperative radiculitis. Furthermore, prospective studies regarding the use of BMP in TLIF are lacking. METHODS: This prospective study included 77 patients. The use of BMP-2 was determined individually, and demographic and operative characteristics were recorded. Leg pain was assessed using the Visual Analog Scale (VAS) for pain and the Sciatica Bothersome Index (SBI) with several secondary outcome measures. The outcome data were collected at each follow-up visit. RESULTS: Among the 77 patients, 29 were administered with BMP. Postoperative leg pain significantly improved according to VAS leg and SBI scores for the entire cohort, and no clinically significant differences were observed between the BMP and control groups. The VAS back, Oswestry Disability Index, and Short-Form 36 scores also significantly improved. A significantly increased 6-month fusion rate was noted in the BMP group (82.8% vs. 55.3%), but no significant differences in fusion rate were observed at the 12- and 24-month follow-up. Heterotopic ossification was observed in seven patients: six patients and one patient in the BMP and control groups, respectively (20.7% vs. 2.1%). However, no clinical effect was observed. CONCLUSIONS: In this prospective observational trial, the use of BMP in TLIF did not lead to significant postoperative radiculitis, as measured by VAS leg and SBI scores. Back pain and other functional outcome scores also improved, and no differences existed between the BMP and control groups. The careful use of BMP in TLIF appears to be both safe and effective.


Subject(s)
Arthrodesis , Autografts , Back Pain , Bone Morphogenetic Proteins , Cohort Studies , Follow-Up Studies , Humans , Leg , Lumbosacral Region , Ossification, Heterotopic , Outcome Assessment, Health Care , Prospective Studies , Radiculopathy , Sciatica , Spinal Fusion , Spine , Visual Analog Scale
16.
Article in Korean | WPRIM | ID: wpr-764837

ABSTRACT

PURPOSE: This retrospective study reports the intermediate-term clinical outcomes including the practical function in daily and sports activities after total ankle arthroplasty for end-stage rheumatoid arthritis, as well as the effects of modification of perioperative anti-rheumatic medications. MATERIALS AND METHODS: Twelve patients were followed for a minimum of 2 years after total ankle replacement for end-stage rheumatoid arthritis. Perioperative anti-rheumatic medications in all patients were modified based on a specific guideline. Clinical evaluations consisted of American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores. Periodic radiographic evaluation was conducted to detect changes in ankle alignment and postoperative complications. RESULTS: Mean AOFAS, FAOS, and FAAM scores improved significantly from 37.5 to 81.2, 39.1 to 72.4, and 33.8 to 64.0 points at final follow-up, respectively (p<0.001). Functional outcomes in daily and sports activities at final follow-up were found to be 76.5 and 55.8 points for the FAOS and 70.5 and 57.5 points for the FAAM, respectively. As early postoperative complications, there was one case of local wound necrosis, one case of medial malleolar fracture, and one case of deep peroneal nerve injury. Radiological evaluation revealed two cases of asymptomatic heterotopic ossification and one case of progressive arthritis in the talonavicular joint. Reoperation was performed in only one patient (8.3%) with a medial soft tissue impingement at a mean of 35.6 months follow-up. CONCLUSION: Total ankle arthroplasty appears to be an effective surgical option for end-stage rheumatoid arthritis. Practical functions in daily and sports activities were significantly improved at intermediate-term follow-up. Modification of perioperative anti-rheumatic medications can be one of the solutions to reduce the postoperative complication rate.


Subject(s)
Ankle , Arthritis , Arthritis, Rheumatoid , Arthroplasty , Arthroplasty, Replacement, Ankle , Follow-Up Studies , Foot , Humans , Joints , Necrosis , Ossification, Heterotopic , Peroneal Nerve , Postoperative Complications , Reoperation , Retrospective Studies , Sports , Wounds and Injuries
17.
Chinese Medical Journal ; (24): 827-833, 2019.
Article in English | WPRIM | ID: wpr-772205

ABSTRACT

BACKGROUND@#Heterotopic ossification (HO) is a known complication of hip arthroscopy. We investigated incidence of HO after hip arthroscopy and determined whether revision for HO improved outcome.@*METHODS@#A retrospective study was conducted on 242 patients (140 men and 102 women, mean age: 36.2 ± 9.5 years) who underwent hip arthroscopy for femoroacetabular impingement (FAI) between January 2016 and January 2018. The average follow-up period was 22.88 ± 11.74 months (range: 11-34 months). Thirteen (5.37%) cases of HO (six men and seven women, five left hips and eight right hips; mean age: 37.5 ± 4.7 years) were observed. Among them, four cases with HO with obvious pain symptoms and persistent non-remission underwent revision surgery to remove HO. Monthly follow-up was conducted. Visual analog scale (VAS), modified Harris Hip Score (mHHS), and non-Arthritis Hip Score (NAHS) were evaluated and compared between HO and non-HO patients. Independent sample t test, Mann-Whitney U test and the Chi-square test were used for inter-group comparisons. HO degree was evaluated using Brooker classification. Symptoms and function were evaluated before and after revision.@*RESULTS@#A total of 242 patients were involved in this study. Thirteen cases (5.4%) had imaging evidence of HO. Nine (9/13) were classified as Brooker stage I, three (3/13) Brooker stage II, and one (1/13) Brooker stage III. HO was detected by ultrasonography as early as 3 weeks after operation. After primary surgery, the mHHS of the HO group and non-HO group increased by 13.00 (8.50, 25.50) and 24.00 (14.00, 34.50) points (Z = -1.80, P = 0.08), NAHS increased by 18.00 (9.50, 31.50) and 26.00 (13.50, 36.00) points (Z = -1.34, P = 0.18), and VAS decreased by 3.00 (2.00, 4.00) and 4.00 (3.00, 4.50) points (Z = -1.55, P = 0.12). Average follow-up time after revision was 9.00 ± 2.94 months; mHHS increased by 34.75 points (t = -55.23, P < 0.01) and NAHS by 28.75 points (t = -6.03, P < 0.01), and VAS decreased by 4 points (t = 9.80, P < 0.01). HO and non-HO patients were similar for demographic and surgical data, and clinical and functional scores.@*CONCLUSION@#HO incidence after arthroscopic treatment of FAI is similar to that found in previous studies. Most HO have no effect on clinical symptoms. Patients who undergo revision HO resection show improvement in pain and joint function.


Subject(s)
Adult , Arthroscopy , Female , Femoracetabular Impingement , General Surgery , Hip Joint , Pathology , General Surgery , Humans , Male , Middle Aged , Ossification, Heterotopic , Diagnosis , Retrospective Studies , Treatment Outcome
18.
Article in Chinese | WPRIM | ID: wpr-781315

ABSTRACT

OBJECTIVE@#To explore the genetic basis for a child with scoliosis, congenital dislocation of the hip joint and growth retardation by using next generation sequencing (NGS).@*METHODS@#Peripheral blood samples were obtained from the proband and his parents. Whole genomic DNA was extracted and subjected to NGS. Suspected variant was predicted by bioinformatic tools and validated by Sanger sequencing.@*RESULTS@#The proband was found to carry compound heterozygous variants c.494T>C (p.Met165Thr) and c.848A>G (p.His283Arg) of the CANT1 gene, among which c.494T>C (p.Met165Thr) was inherited from her father and reported to be pathogenic by HGMD. c.848A>G (p.His283Arg) was inherited from her mother and was predicted to be likely pathogenic according to the ACMG 2015 guidelines.@*CONCLUSION@#The compound heterozygous variants of c.494T>C (p.Met165Thr) and c.848A>G (p.His283Arg) of the CANT1 gene probably underlie the disease in the proband.


Subject(s)
Child , Craniofacial Abnormalities , Genetics , Dwarfism , Genetics , Female , High-Throughput Nucleotide Sequencing , Humans , Joint Instability , Genetics , Mutation , Nucleotidases , Genetics , Ossification, Heterotopic , Genetics , Polydactyly , Genetics
19.
Article in Korean | WPRIM | ID: wpr-738448

ABSTRACT

Distal humerus fractures require stable fixation and early joint motion, similar to other intra-articular fractures, but are difficult to treat adequately because of the anatomical complexity, severe comminution, and accompanying osteoporosis. In most cases, surgical treatment is performed using two supporting plates. Plate fixation can be divided into right angle plate fixation and parallel plate fixation. In addition, depending on the type of fracture, surgical procedures can be performed differently, and autologous bone grafting can be required in the case of severe bone loss. The elbow joint is vulnerable to stiffness, so it is important to start joint movement early after surgery. Postoperative complications, such as nonunion, ulnar nerve compression, and heterotopic ossification, can occur. Therefore, accurate and rigid fixation and meticulous manipulation of soft tissues are required during surgery.


Subject(s)
Bone Transplantation , Elbow Joint , Humerus , Intra-Articular Fractures , Joints , Ossification, Heterotopic , Osteoporosis , Postoperative Complications , Rehabilitation , Ulnar Nerve , Ulnar Nerve Compression Syndromes
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