Heterotopic ossification in patients previously hospitalized in an intensive care unit.

BACKGROUND: Heterotopic ossification (HO) is a potential complication in patients hospitalized in an intensive care unit (ICU). In this study we examined the association of HO diagnosed with three-phase bone scan (3pBS) in association with various parameters in patients previously hospitalized in ICU. MATERIAL AND METHODS: We retrieved patient records of the last 12 years subjected to 3pBS and diagnosed with HO from the Department of Nuclear Medicine (2004 up to 2016) and searched for a name match from ICU records. RESULTS: We found 61 patients that had a positive 3pBS for HO of whom 17 patients were hospitalized in the ICU. Among the 17 patients, twelve fulfilled the study criteria and were included in the study. The mean age was 38 years and 92% were males. HO was unilateral in 7 and bilateral in 5 patients. Patients with unilateral HO had up to 2 joints with HO, while those with bilateral had up to 4 joints. HO was most frequently observed in lower limbs, with hip being the most common joint affected. In the upper limbs, HO occurred predominantly in bilateral joints with elbow being the most frequently involved joint. Patients with longer duration of ICU stay had more joints affected. CONCLUSION: HO is a potential complication in patients with ICU hospitalization. Since 3pBS is an imaging method for early detection of HO, patients hospitalized in ICU should be screened with 3pBS for appropriate management.

Lung and 'end organ' injury due to mechanical ventilation in animals: comparison between the prone and supine positions.

INTRODUCTION: Use of the prone position in patients with acute lung injury improves their oxygenation. Most of these patients die from multisystem organ failure and not from hypoxia, however. Moreover, there is some evidence that the organ failure is caused by increased cell apoptosis. In the present study we therefore examined whether the position of the patients affects histological changes and apoptosis in the lung and 'end organs', including the brain, heart, diaphragm, liver, kidneys and small intestine. METHODS: Ten mechanically ventilated sheep with a tidal volume of 15 ml/kg body weight were studied for 90 minutes. Five sheep were placed in the supine position and five sheep were placed in the prone position during the experiment. Lung changes were analyzed histologically using a semiquantitative scoring system and the extent of apoptosis was investigated with the TUNEL method. RESULTS: In the supine position intra-alveolar hemorrhage appeared predominantly in the dorsal areas, while the other histopathologic lesions were homogeneously distributed throughout the lungs. In the prone position, all histological changes were homogeneously distributed. A significantly higher score of lung injury was found in the supine position than in the prone position (4.63 +/- 0.58 and 2.17 +/- 0.19, respectively) (P < 0.0001). The histopathologic changes were accompanied by increased apoptosis (TUNEL method). In the supine position, the apoptotic index in the lung and in most of the 'end organs' was significantly higher compared with the prone position (all P < 0.005). Interestingly, the apoptotic index was higher in dorsal areas compared with ventral areas in both the prone and supine positions (P < 0.003 and P < 0.02, respectively). CONCLUSION: Our results suggest that the prone position appears to reduce the severity and the extent of lung injury, and is associated with decreased apoptosis in the lung and 'end organs'.