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1.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509861

RESUMO

We describe the case of a 21-year-old man with a background of sickle cell disease (SCD) who was on acute presentation in a sickle cell crisis required immediate intensive care admission with red blood cell exchange and ventilatory support. He had right frontal lobe infarcts and extensive bilateral deep white matter lesions most likely secondary to fat embolism. Inpatient investigations demonstrated a patent foramen ovale, explaining the route of spread of the fat embolus. He then had a transcatheter closure of the atrial defect. The patient needed prolonged inpatient rehabilitation. He was discharged from hospital in a wheelchair secondary to severe lower limb neurology and bilateral knee heterotopic ossification. He lives with the possibility of early onset dementia and cognitive decline, requiring constant care. The case highlights the multiple manifestations of SCD and their diverse and debilitating consequences.


Assuntos
Anemia Falciforme/fisiopatologia , Infarto Encefálico/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Embolia Gordurosa/fisiopatologia , Leucoencefalopatias/fisiopatologia , Neuralgia/fisiopatologia , Polineuropatias/fisiopatologia , Quadriplegia/fisiopatologia , Anemia Falciforme/complicações , Anemia Falciforme/terapia , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Disfunção Cognitiva/etiologia , Contratura/etiologia , Contratura/fisiopatologia , Ecocardiografia , Embolia Gordurosa/etiologia , Transfusão de Eritrócitos , Forame Oval Patente/complicações , Lobo Frontal/diagnóstico por imagem , Humanos , Unidades de Terapia Intensiva , Articulação do Joelho/diagnóstico por imagem , Leucoencefalopatias/diagnóstico por imagem , Leucoencefalopatias/etiologia , Imagem por Ressonância Magnética , Masculino , Neuralgia/etiologia , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/fisiopatologia , Plasma , Transfusão de Plaquetas , Polineuropatias/etiologia , Quadriplegia/etiologia , Adulto Jovem
2.
Ned Tijdschr Geneeskd ; 1642020 09 24.
Artigo em Holandês | MEDLINE | ID: mdl-33331722

RESUMO

COVID-19 patients admitted to the Intensive Care Unit may develop painful range of motion restrictions of the large joints due to heterotopic ossifications. Here we describe two patients who developed restricted and painful passive and active mobility of the hips, shoulders and elbows after mechanical ventilation because of respiratory failure due to COVID-19 pneumonia. Conventional radiography showed extensive heterotopic ossifications. Retrospectively, alkaline phosphatase levels were elevated. It is likely that local and systemic factors contribute to the development of heterotopic ossifications. Early diagnosis is important to provide complementary non-pharmacological interventions (gentle passive mobilization) and medication (non-steroidal anti-inflammatory drugs, such as indomethacin). If pain and limited joint mobility remain present, surgical removal of ectopic bone could be considered. Future trials are needed to systematically map the prevalence of heterotopic ossifications in COVID-19 patients who were admitted to the Intensive Care Unit, andto evaluate whether prophylactic treatment with non-steroidal anti-inflammatory drug is of relevance.


Assuntos
Articulações , Ossificação Heterotópica , Pneumonia Viral , Respiração Artificial/efeitos adversos , Insuficiência Respiratória , Anti-Inflamatórios não Esteroides/uso terapêutico , /terapia , Feminino , Humanos , Articulações/diagnóstico por imagem , Articulações/patologia , Articulações/fisiopatologia , Masculino , Pessoa de Meia-Idade , Terapia Passiva Contínua de Movimento/métodos , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/fisiopatologia , Ossificação Heterotópica/terapia , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Radiografia/métodos , Amplitude de Movimento Articular , Respiração Artificial/métodos , Insuficiência Respiratória/terapia , Insuficiência Respiratória/virologia , /isolamento & purificação
3.
Jt Dis Relat Surg ; 31(2): 386-389, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584742

RESUMO

Heterotopic ossification (HO) is a complication of injury to the central nervous system in which production of lamellar bone within the soft tissues occurs resulting in pain, reduced range of motion (ROM) and loss of functional capacity. Heterotopic ossification is rarely seen in stroke patients and mostly affects the paretic side. In this article, we present a case of established bilateral HO of the hips soon after stroke onset. A 77-year-old female patient with a five-month history of stroke presented to our rehabilitation clinic. Physical examination revealed sensorimotor aphasia, right-sided hemiplegia, bilateral painful limited ROM of the hips and left knee contracture. An anteroposterior X-ray of the pelvis revealed previously undiagnosed bilateral HO of the hips. The patient and her relatives declined operative interventions. The patient was discussed in the departmental meeting and it was agreed that she would not be able to partake in an active inpatient rehabilitation program. She was discharged with a home exercise plan. This case highlights the importance of HO, of both the paretic and non-paretic side, being included in the differential diagnosis of post-stroke patients presenting with joint pain and reduced ROM, both acutely and in the long-term. This may aid the timely diagnosis and management of HO, a pathology which has detrimental effects on functionality.


Assuntos
Quadril , Ossificação Heterotópica , Dor , Acidente Vascular Cerebral/complicações , Idoso , Diagnóstico Diferencial , Diagnóstico Precoce , Terapia por Exercício/métodos , Feminino , Hemiplegia/diagnóstico , Hemiplegia/etiologia , Quadril/diagnóstico por imagem , Quadril/patologia , Serviços de Assistência Domiciliar , Humanos , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/fisiopatologia , Ossificação Heterotópica/reabilitação , Dor/diagnóstico , Dor/etiologia , Desempenho Físico Funcional , Radiografia/métodos
4.
Clin Orthop Relat Res ; 478(5): 1101-1108, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31913154

RESUMO

BACKGROUND: Tendon loading might play a role in the development of heterotopic ossification after Achilles tendon ruptures. Early heavy loading on a healing tendon in animals has been shown to prolong the proinflammatory response, and inflammatory cells are thought to drive heterotopic ossification formation. Taken together, this suggests that early rehabilitation might influence heterotopic ossification development. QUESTIONS/PURPOSES: The purposes of this study were to investigate (1) whether the presence of heterotopic ossification after Achilles tendon ruptures influences clinical outcome and (2) whether early mobilization or weightbearing prevents the development of heterotopic ossification. METHODS: This was a retrospective analysis of 69 patients from a previous clinical trial. All patients were treated surgically, but with three different early rehabilitation protocols after surgery: late weightbearing and ankle immobilization, late weightbearing and ankle mobilization, and early weightbearing and ankle mobilization. Plain radiographs taken 2, 6, 12, 26, and 52 weeks postoperatively were analyzed for heterotopic ossification, which was detected in 19% of patients (13 of 69) at 52 weeks. Heterotopic ossification was measured, scored, and correlated to clinical outcomes; heel-raise index (HRI), ankle joint ROM, tendon strain, Achilles tendon rupture score (ATRS), and Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire scores at 26 and 52 weeks postoperatively. RESULTS: Heterotopic ossification had no adverse effects on patient-reported outcomes (ATRS or VISA-A), tendon strain, or ROM. In fact, patients with heterotopic ossification tended to have a better HRI at 52 weeks compared with patients without (mean difference 14% [95% CI -0.2 to 27]; p = 0.053). Neither the occurrence (heterotopic ossification/no heterotopic ossification) nor the heterotopic ossification severity (ossification score) differed between the three rehabilitation groups. Seventeen percent of the patients (four of 24) with early functional rehabilitation (early weightbearing and ankle joint mobilization exercise) had heterotopic ossification (score, 2-3) while late weightbearing and immobilization resulted in heterotopic ossification in 13% of the patients (score, 3-4). CONCLUSIONS: Heterotopic ossification occurs relatively frequently after Achilles tendon ruptures but appears to have no adverse effects on functional outcomes. Furthermore, heterotopic ossification develops during the first 6 weeks after rupture, and weightbearing or ankle-joint mobilization does not prevent this from occurring. LEVEL OF EVIDENCE: Level III, prognostic study.


Assuntos
Tendão do Calcâneo/lesões , Ossificação Heterotópica/etiologia , Ruptura/complicações , Traumatismos dos Tendões/complicações , Tendão do Calcâneo/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/fisiopatologia , Ossificação Heterotópica/prevenção & controle , Modalidades de Fisioterapia , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Ruptura/reabilitação , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/reabilitação , Resultado do Tratamento , Suporte de Carga/fisiologia
5.
World Neurosurg ; 136: e407-e418, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931240

RESUMO

BACKGROUND: Heterotopic ossification (HO) and anterior bone loss (ABL) are 2 complications in cervical disc replacement (CDR), which have impacts on the clinical outcomes. Physiologically, bone formation (HO) and bone loss are 2 sides of bone remodeling. However, clinically, some patients experienced anterior HO (AHO) after CDR, whereas other patients experienced ABL. Is there any factor in determining the fate of the vertebral bone in the anterior region? Is ABL the opposite of AHO? This study aims to answer these questions. METHODS: Seventy patients with 1-level Prestige-LP CDR were retrospectively reviewed and were divided into an AHO group or ABL group. Radiologic outcomes, including cervical lordosis, sagittal vertical axis, functional spine unit angle, disc angle, range of motion, implant migration, subsidence, and adjacent segment degeneration were evaluated. Patient-reported clinical outcomes were also evaluated. RESULTS: AHO group showed significantly lower disc angle after surgery (0.9° ± 4.2°), compared with ABL group (6.7° ± 4.7°) (P < 0.001). The preoperative segmental range of motion was significantly higher in the AHO group (10.2° ± 3.3°) than in the ABL group (8.2° ± 3.7°) (P = 0.042). No correlation was observed between clinical outcomes and the presence of anterior bone remodeling. Both groups maintained cervical alignment and functional spine unit angle during long-term follow-up. No significant difference was found in the end plate preparation, implant subsidence, migration, or adjacent segment degeneration rate between the 2 groups. CONCLUSIONS: The differences in the disc angle showed the role of mechanical load in the anterior bone remodeling. Combined the results with the basic concepts of bone remodeling, ABL may be the opposite of AHO.


Assuntos
Reabsorção Óssea/etiologia , Vértebras Cervicais/cirurgia , Ossificação Heterotópica/etiologia , Substituição Total de Disco/efeitos adversos , Adolescente , Adulto , Idoso , Reabsorção Óssea/fisiopatologia , Feminino , Humanos , Lordose/etiologia , Lordose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/etiologia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Adulto Jovem
6.
Eur J Med Genet ; 63(1): 103613, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30677517

RESUMO

Congenital insensitivity to pain with anhidrosis (CIPA), also known as hereditary sensory and autonomic neuropathy type IV (HSAN-IV), is a rare and severe autosomal recessive disorder. We report on an adult female patient whose clinical findings during childhood were not recognized as CIPA. There was neither complete anhidrosis nor a recognizable sensitivity to heat. Tumorlike swellings of many joints and skeletal signs of Charcot neuropathy developed in adolescence which, together with a history of self-mutilation, led to a clinical suspicion of CIPA confirmed by identification of a novel homozygous variant c.1795G > T in the NTRK1 gene in blood lymphocytes. Both parents were heterozygous for the mutation. The variant predicts a premature stop codon (p.Gly599Ter) and thus represents a pathogenic variant; the first reported in the Southeastern European population.


Assuntos
Artropatia Neurogênica/genética , Predisposição Genética para Doença , Ossificação Heterotópica/genética , Receptor trkA/genética , Adulto , Artropatia Neurogênica/fisiopatologia , Feminino , Humanos , Hipo-Hidrose/genética , Hipo-Hidrose/fisiopatologia , Ossificação Heterotópica/fisiopatologia , Dor/genética , Dor/fisiopatologia , Adulto Jovem
7.
Otolaryngol Pol ; 73(5): 18-24, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-31701903

RESUMO

INTRODUCTION: The aim of the study was to assess the effectiveness of surgical treatment of patients with Eagle's syndrome, taking into account both early and late results. MATERIAL AND METHODS: The study group consisted of 15 patients who underwent resection of the styloid process due to Eagle syndrome in the period of 2005-2017. During the follow-up visit, the patients were asked to fill in a post-operative questionnaire that compared the pre-operative symptoms and their severity with the patients' current health condition. The VAS pain scale was used to assess each symptom, and the Laitinen scale was used to assess the quality of life. Data from patients' medical records were also included. The results of the surveys were subjected to statistical analysis. RESULTS: The study showed that in 11 out of 15 cases there was a significant improvement in the level of pain (70.5% on average) and an improvement in quality of life (on average 65%) comparing to the pre-operative condition. The Wilcoxon test for binding pairs, the Mann-Whitney test, the Kruskal-Wallis test and the Spearman correlation coefficient were used in the statistical analysis. There were statistically significant correlations between the recorded improvement rate and the length of the resected styloid process and its setting. DISCUSSION: The study proved that resection of prolonged styloid process from extraoral approach in most cases is an effective method of treatment of Eagle syndrome, that carries low risk of complications.


Assuntos
Ossificação Heterotópica/psicologia , Ossificação Heterotópica/cirurgia , Qualidade de Vida/psicologia , Índice de Gravidade de Doença , Osso Temporal/anormalidades , Adulto , Dor Facial/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Bucais/métodos , Ossificação Heterotópica/fisiopatologia , Medição da Dor , Osso Temporal/fisiopatologia , Osso Temporal/cirurgia
8.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570345

RESUMO

Anterior elbow dislocation without periarticular fracture (simple dislocation) is an extremely rare injury and is usually caused by distraction or torsional forces. It is important to look for associated ligamentous and musculotendinous injuries in this pattern. We report an elderly patient who sustained simple anterior dislocation of the elbow and in whom successful closed reduction could be achieved. Reduction by closed method is possible if we know the exact mechanism of elbow injury. Despite the presence of medial collateral ligament injury, he was managed non-operatively and had full functional recovery. Checking for joint stability and collateral ligaments after reduction and getting additional radiological investigations help in better treatment planning. Early protected active mobilisation should be initiated to achieve better functional results.


Assuntos
Ligamentos Colaterais/lesões , Articulação do Cotovelo/lesões , Luxações Articulares/fisiopatologia , Ossificação Heterotópica/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Idoso , Ligamentos Colaterais/diagnóstico por imagem , Ligamentos Colaterais/fisiopatologia , Tratamento Conservador , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/terapia , Masculino , Radiografia , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(42): e17505, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626106

RESUMO

The purpose of the study was to identify risk factors of cage subsidence and evaluate surgical outcome by at least 12 months postoperative follow-up.We retrospectively investigated 113 consecutive patients who underwent anterior surgery to relieve spine cord compression resulted from localized heterotopic ossification, from July, 2011 to February, 2016. We divided the patients into 2 groups: cage subsidence <2 mm group and ≥2 mm group. According to magnetic resonance imaging (MRI), the severity of increased signal intensity (ISI) was classified into grade 0, 1, and 2. Clinical outcome was assessed by the Japanese Orthopedic Association (JOA) scoring system. Logistic regression analysis and receiver-operating characteristic (ROC) curve were utilized for predicting risk factors of cage subsidence, and the recovery rate was evaluated by Kruskal-Wallis test or Mann-Whitney U test.Logistic regression with cage subsidence as the dependent variable showed independent risks associated with a cervical sagittal malalignment (odds ratio [OR] 11.23, 95% confidence interval [CI] 3.595-35.064, P < .001), thoracic 1 (T1) slope angle (OR 1.59, 95% CI 1.259-1.945, P < .001), and excisional thickness (OR 2.38, 95% CI 1.163-4.888.0, P = .018). The cut-off values of T1 slope and excisional thickness were 19.65 angle and 3.7 mm, respectively. Patients with high occupying ratio (P = .001) and high ISI grade (P = .012) are more likely to occur lower recovery rate.Patients with high T1 slope angle or preoperative kyphotic deformity should avoid excessive removal of endplate and vertebral body so as to reduce the occurrence of cage subsidence. Poor outcome was closely related to cervical sagittal malalignment and higher ISI grade.


Assuntos
Discotomia/efeitos adversos , Ossificação Heterotópica/cirurgia , Complicações Pós-Operatórias/etiologia , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/efeitos adversos , Vértebras Cervicais/cirurgia , Discotomia/métodos , Feminino , Seguimentos , Humanos , Cifose/fisiopatologia , Cifose/cirurgia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ossificação Heterotópica/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Equilíbrio Postural , Estudos Retrospectivos , Caixa Torácica/cirurgia , Fatores de Risco , Compressão da Medula Espinal/fisiopatologia , Fusão Vertebral/métodos , Resultado do Tratamento
10.
Bull Hosp Jt Dis (2013) ; 77(3): 217-220, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487489

RESUMO

Olecranon fractures are common trauma presentations, and generally good or excellent functional outcomes are expected after surgical treatment. The development of heterotopic ossification (HO) is a well-known complication, leading to restricted motion, subsequent joint contractures, and marked functional limitation of the upper extremity. Whereas most olecranon fractures complicated by HO have less extensive ossification and limited clinical implications, we report a rare case of HO that required revision surgery for elbow contracture after tension band wiring for an isolated olecranon fracture. Our findings indicate that even patients with isolated olecranon fractures should be notified about the potential risk of HO development, which could result in restricted motion and subsequent joint contractures. The risk factors associated with the development of HO after elbow trauma should be recognized during surgical treatment for olecranon fracture. Fractures of the olecranon are common trauma presentations. 1 Most olecranon fractures are treated surgically, and good or excellent functional outcomes are expected after surgical treatment.1 The development of heterotopic ossification (HO) is a well-known complication after elbow trauma that causes restricted motion, subsequent joint contractures, and marked functional limitation of the affected upper extremity.2 The severity of HO is related to the nature of the injury. Most olecranon fractures complicated by HO have less extensive ossification, and the clinical implications of this type of injury are limited.3 We report a rare case of HO in which revision surgery for the treatment of elbow contracture was required after an isolated olecranon fracture.


Assuntos
Contratura/cirurgia , Fixação Interna de Fraturas , Olécrano , Ossificação Heterotópica , Reoperação/métodos , Fraturas da Ulna , Idoso , Contratura/diagnóstico , Contratura/etiologia , Contratura/fisiopatologia , Articulação do Cotovelo/lesões , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Humanos , Olécrano/lesões , Olécrano/cirurgia , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/fisiopatologia , Ossificação Heterotópica/cirurgia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Fraturas da Ulna/diagnóstico , Fraturas da Ulna/cirurgia
11.
World Neurosurg ; 131: e408-e414, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376560

RESUMO

OBJECTIVE: To investigate the occurrence and progression of heterotopic ossification (HO) in patients treated by anterior cervical discectomy with arthroplasty. It was evaluated if HO affects clinical outcome and range of motion (ROM). Risk factors of HO was studied as well. METHODS: Patients who underwent anterior cervical discectomy with arthroplasty for a cervical radiculopathy because of a herniated disc from the NECK and PROCON trial were analyzed for HO at 12 and 24 months postoperatively. HO was scored according to the McAfee-Mehren classification. The index ROM was defined by a custom developed image analysis tool, and global cervical ROM was measured by Cobb's angle. Clinical outcome was evaluated by means of the Neck Disability Index and the 36-Item Short Form Health Survey. RESULTS: The occurrence of HO was 60% at 1 year, and it increased to 76% at 2-year follow-up. A total of 31% of patients were scored as high-grade HO at 1-year follow-up, and this percentage increased to 50% at 2-year follow-up. Clinical outcome does not correlate to HO grade, and no risk factor for high-grade HO could be identified. The ROM at the index level was significantly higher in low-grade HO group than those patients with high-grade HO, but in 15%-38% HO grade does not correspond to ROM. CONCLUSIONS: HO occurs in three fourths of the patients at 2 years after surgery, but does not necessarily correspond to clinical outcome, nor loss or preservation of ROM. The McAfee-Mehren classification should be combined with ROM evaluation to properly study HO.


Assuntos
Artroplastia , Vértebras Cervicais/cirurgia , Discotomia , Deslocamento do Disco Intervertebral/cirurgia , Ossificação Heterotópica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Radiculopatia/cirurgia , Amplitude de Movimento Articular , Adulto , Idoso , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Radiculopatia/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
12.
Oper Neurosurg (Hagerstown) ; 17(6): 554-561, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31329946

RESUMO

BACKGROUND: Styloidogenic jugular venous compression syndrome (SJVCS) is a rare cause of idiopathic intracranial hypertension (IIH). OBJECTIVE: To elucidate the pathophysiology and the hemodynamics of SJVCS. METHODS: We conducted a retrospective review of medical records, clinical images, dynamic venography, and manometry for consecutive patients with SJVCS undergoing microsurgical decompression from April 2009 to October 2017. Patients with IIH with normal venography and manometry findings served as controls. RESULTS: Data were analyzed for 10 patients with SJVCS who presented with headaches. Neck flexion exacerbated headaches in 7 patients. Eleven patients with IIH provided control data for normal intracranial venous pressure and styloid process anatomy. Patients with SJVCS had bilateral osseous compression of venous outflow. The styloid processes were significantly longer in patients with SJVCS than in those with IIH (mean [standard deviation (SD)] distance, 31.0 [10.6] vs 19.0 [14.1] mm; P < .01). The styloid process-C1 lateral tubercle distance was shorter in patients with SJVCS than in those with IIH (mean [SD] distance, 2.9 [1.0] vs 9.9 [2.8] mm; P < .01). Patients with SJVCS had significantly higher global venous pressure and a higher pressure gradient across the stenosis site than controls (mean [SD] pressure, 2.86 [2.61] vs 0.13 [1.09] cm H2O; P = .09). All 10 patients with SJVCS experienced venous pressure elevation during contralateral neck turning (mean [SD] pressure, 4.29 [2.50] cm H2O). All 10 patients with SJVCS underwent transcervical microsurgical decompression, and 9 experienced postoperative improvement or resolution of symptoms. One patient had transient postoperative dysphagia and facial drooping, and another patient reported jaw numbness. CONCLUSION: SJVCS is a novel clinical entity causing IIH. Patients should be evaluated with dynamic venography with manometry. Surgical decompression with removal of osseous overgrowth is an effective treatment in select patients.


Assuntos
Descompressão Cirúrgica , Hipertensão Intracraniana/fisiopatologia , Veias Jugulares/diagnóstico por imagem , Microcirurgia , Ossificação Heterotópica/fisiopatologia , Osso Temporal/anormalidades , Osso Temporal/cirurgia , Adulto , Atlas Cervical/diagnóstico por imagem , Feminino , Cefaleia/etiologia , Cefaleia/fisiopatologia , Humanos , Hipertensão Intracraniana/diagnóstico por imagem , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/cirurgia , Angiografia por Ressonância Magnética , Masculino , Manometria , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Ossificação Heterotópica/complicações , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/cirurgia , Flebografia , Postura , Osso Temporal/diagnóstico por imagem , Osso Temporal/fisiopatologia , Transtornos da Visão/etiologia , Transtornos da Visão/fisiopatologia , Adulto Jovem
13.
Artif Cells Nanomed Biotechnol ; 47(1): 2569-2574, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31219353

RESUMO

Background: Interactions between the heterotopic ossification (HO) and the neurological injuries have got lots of interest but still poorly understood. The present study aims to determine the effect of neuroinflammation related calcitonin gene-related protein (CGRP) on HO following spinal cord injury (SCI). Method: C57Bl6 mice were anesthetized to make an SCI model, together with the ectopic injection of snake venom cardiotoxin (SVC) or CGRP protein into tibialis anterior (TA) muscles. The TA muscles were then harvested for radiologic, histologic, and immunohistology examinations to determine the formation of bone and the expression of CGRP. Fibro/adipogenic progenitors (FAPs) were isolated and cultured. CGRP protein was added into the medium and then detected for chondrogenic markers. Result: The callus formed following SVC injection and SCI successfully, with much more formed in the group with SCI, as well as an increased level of CGRP. Similarly, the injection of CGRP directly was able to induce the formation of bone-like tissues in vivo. And, the additional CGRP protein was able to induce chondrogenic differentiation as shown in RT-PCT and immunofluorescence, in a dose-dependent manner. Conclusion: CGRP was able to induce chondrogenic differentiation of FAPs, which may be an important part of Neurological heterotopic ossification developing.


Assuntos
Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/metabolismo , Traumatismos da Medula Espinal/complicações , Animais , Diferenciação Celular , Condrogênese , Camundongos , Ossificação Heterotópica/patologia , Ossificação Heterotópica/fisiopatologia
14.
Am J Med Genet A ; 179(9): 1764-1777, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31240838

RESUMO

Diffuse idiopathic skeletal hyperostosis (DISH) is a disorder principally characterized by calcification and ossification of spinal ligaments and entheses. Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disabling disorder characterized by progressive ossification of skeletal muscle, fascia, tendons, and ligaments. These conditions manifest phenotypic overlap in the ossification of tendons and ligaments. We describe herein a patient with DISH, exhibiting heterotopic ossification of the posterior longitudinal ligament where clinical whole exome sequencing identified a variant within ACVR1, a gene implicated in FOP. This variant, p.K400E, is a novel variant, not identified previously, and occurs in a highly conserved region across orthologs. We used sequence-based predicative algorithms, molecular modeling, and molecular dynamics simulations, to test the potential for p.K400E to alter the structure and dynamics of ACVR1. We applied the same modeling and simulation methods to established FOP variants, to identify the detailed effects that they have on the ACVR1 protein, as well as to act as positive controls against which the effects of p.K400E could be evaluated. Our in silico molecular analyses support p.K400E as altering the behavior of ACVR1. In addition, functional testing to measure the effect of this variant on BMP-pSMAD 1/5/8 target genes was carried out which revealed this variant to cause increased ID1 and Msx2 expression compared with the wild-type receptor. This analysis supports the potential for the variant of uncertain significance to contribute to the patient's phenotype.


Assuntos
Receptores de Ativinas Tipo I/genética , Músculo Esquelético/metabolismo , Miosite Ossificante/genética , Ossificação do Ligamento Longitudinal Posterior/genética , Ossificação Heterotópica/genética , Adolescente , Adulto , Algoritmos , Simulação por Computador , Feminino , Humanos , Ligamentos Longitudinais/fisiopatologia , Masculino , Simulação de Dinâmica Molecular , Músculo Esquelético/fisiopatologia , Mutação/genética , Miosite Ossificante/sangue , Miosite Ossificante/diagnóstico por imagem , Miosite Ossificante/fisiopatologia , Ossificação do Ligamento Longitudinal Posterior/fisiopatologia , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/fisiopatologia , Fenótipo , Transdução de Sinais/genética , Proteínas Smad/genética
15.
Biomed Res Int ; 2019: 3860142, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31119167

RESUMO

Background: This review is intended to summarize the risk factors, classification, diagnosis, and treatment of heterotopic ossification (HO) of previously published studies. Results: Heterotopic ossification is a common complication of total hip arthroplasty. Its prevalence is not the same in all of the patient groups. Frequency of HO varies from 15 to 90%. Hip ankylosis, male gender, and previous history of HO are said to be risk factors with a significant level. Diagnosis is based on a single AP radiograph: the Brooker classification that divides HO into four grades is the most commonly used. The confirmation test that can be used is a bone scan. A great amount of bone metabolic turnover markers have been tested, but none of them seems to be relevant in case of prevention or diagnosis of HO. The most effective prophylactic treatment is radiotherapy or administration of nonsteroidal anti-inflammatory drugs. Over the years a lot of different RT protocols have been tested. Nowadays the most often used regimen is 7 Gy given postoperatively in a single dose. The most commonly prescribed drug in prophylaxis of HO is indomethacin. Also, the efficacy of ibuprofen and diclofenac was proven. Recently researchers focused on selective COX-2 inhibitors. They appear to be as effective as nonselective NSAIDs having less side effects. The one and only treatment of HO is a revision arthroplasty.


Assuntos
Artroplastia de Quadril/efeitos adversos , Ossificação Heterotópica/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Feminino , Humanos , Masculino , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Período Pós-Operatório , Radiografia , Fatores de Risco , Caracteres Sexuais , Resultado do Tratamento
16.
Reumatol. clin., Supl. (Barc.) ; 15(supl.1): 2-6, abr. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184207

RESUMO

Una de las características patogénicas de las espondiloartritis (EspA) es la neoformación ósea. Distintos estudios han puesto de manifiesto que el origen de este proceso está en las entesis, donde algunos factores desen cadenantes, como el estrés biomecánico, en un individuo genéticamente predispuesto producirían una compleja cascada de señales que favorecería la vasodilatación local y la activación de células inmunocompetentes residentes. Estas, a su vez, provocarían una respuesta inflamatoria caracterizada por la secreción de factor de necrosis tumoral alfa e interleucina 17 (IL-17), entre otros, y reclutamiento de otras células inmunocompetentes. Además, se ha demostrado que la IL-17 y la IL-22 favorecen la proliferación de células madre mesenquimatosas del periostio perientesítico, lo que lleva a la formación de hueso nuevo en la entesis. En las EspA, la formación de hueso nuevo es principalmente ortotópica (en continuidad con el hueso existente) y se origina a partir de la entesis y del periostio. Al parecer, la mayoría de la neoformación ósea se produce mediante osificación endocondral. En la osificación endocondral, las células progenitoras mesenquimatosas se diferencian en condrocitos, que construyen un «molde» de cartílago, en el cual las células progresivamente maduran y evolucionan hacia condrocitos hipertróficos. Esta matriz es invadida por vasos y precursores osteoblásticos que reemplazan progresivamente el modelo por hueso maduro


One of the pathogenic characteristics of spondyloarthritis (SpA) is bone neoformation. Several studies have revealed that this process originates in the enthesis, in which triggering factors such as biomechanical stress in genetically predisposed individuals may produce a complex cascade of signals favouring local vasodilation and activation of resident immune cells. These in turn induce an inflammatory response characterised by secretion of TNF-alfa and IL-17 (among other substances) and recruitment of other immune cells. In addition, it has been demonstrated that IL-17 and IL-22 favour the proliferation of mesenchymal stem cells of the peri-enthesic periosteum, leading to the formation of new bone in the enthesis. In SpA, new bone formation is mainly orthotopic (in continuity with existing bone) and arises from the enthesis and periosteum. Most bone neoformation seems to occur through endochondral ossification. In this process, mesenchymal progenitor cells differentiate towards chondrocytes, which construct a cartilaginous "mould" in which the cells progressively mature and develop towards hypertrophic chondrocytes. This matrix is invaded by vessels and osteoblastic precursors that progressively replace the model with mature bone


Assuntos
Humanos , Espondilartrite/fisiopatologia , Osteocondrodisplasias/fisiopatologia , Ossificação Heterotópica/fisiopatologia , Periósteo/fisiopatologia , Osteogênese/fisiologia
17.
Clin Orthop Relat Res ; 477(4): 813-820, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30811353

RESUMO

BACKGROUND: High-energy open forearm fractures are unique injuries frequently complicated by neurovascular and soft tissue injuries. Few studies have evaluated the factors associated with nonunion and loss of motion after these injuries, particularly in the setting of blast injuries. QUESTIONS/PURPOSES: (1) In military service members with high-energy open forearm fractures, what proportion achieved primary or secondary union? (2) What is the pronation-supination arc of motion as stratified by the presence or absence of heterotopic ossification (HO) and synostosis? (3) What are the risks of heterotopic ossification and synostosis? (4) What factors may be associated with forearm fracture nonunion? METHODS: A retrospective study of all open forearm fractures treated at a tertiary military referral center from January 2004 to December 2014 was performed. In all, 76 patients were identified and three were excluded, leaving 73 patients for inclusion. All 73 patients had serial radiographs to assess for HO and union. Only 64 patients had rotational range of motion (ROM) data. All patients returned to the operating room at least once after initial irrigation and débridement to ensure the soft tissue envelope was stable before definitive fixation. The indication for repeat irrigation and débridement was determined by clinical appearance. Patient demographics, fracture and soft tissue injury patterns, surgical treatments, neurovascular status at the time of injury, incidence of infection, heterotopic ossification (defined as the presence of heterotopic bone visible on serial radiographs), radioulnar synostosis, bony status after initial definitive treatment (union, nonunion, or amputation), and forearm rotation at final followup were retrospectively obtained from chart review by someone other than the operating surgeon. Seventy-six open forearm fractures in 76 patients were reviewed; 73 patients were examined for osseous union as three went on to early amputation, and 64 patients had forearm ROM data available for analysis. Union was determined by earliest radiology or orthopaedic staff official dictation stating the fracture was healed. Nonunion was defined as the clinical determination by the orthopaedist for a repeat procedure to achieve bony union. Secondary union was defined as union after reoperation to achieve bony union, and final union was defined as overall percentage of patients who were healed at final followup. Of the patients analyzed for union, 20 had less than 1 year of followup, and of these, none had nonunion. Of the patients analyzed for ROM, eight patients had less than 6 months of followup (range, 84-176 days). Of these, one patient had decreased ROM, none had a synostosis, and the remaining had > 140° of motion. RESULTS: Initial treatment resulted in primary union in 62 of 73 patients (85%); secondary union was achieved in eight of 11 patients (73%); and final union was achieved in 70 of 73 patients (96%). Although pronation-supination arc in patients without HO was 140° ± 35°, a limited pronation-supination arc was primarily associated with synostosis (arc: 40° ± 40°; mean difference from patients without HO: 103° [95% confidence interval {CI}, 77°-129°], p < 0.001); patients with HO but without synostosis had fewer limitations to ROM than those with synostosis (arc: 110° ± 80°, mean difference: 77° [35°-119°], p < 0.001). Heterotopic ossification developed in 40 of 73 patients (55%), including a radioulnar synostosis in 14 patients (19%). Bone loss at the fracture site (relative risk (RR) 6.2; 95% CI, 1.8-21) and healing complicated by infection (RR, 9.9; 95% CI, 4.9-20) were associated with the development of nonunion after initial treatment. Other potential factors such as smoking status, vascular injury, both-bone involvement, need for free flap coverage and blast mechanism were not associated. CONCLUSIONS: Despite a high-energy mechanism of injury and high rate of soft tissue defects, the ultimate probability of fracture union in our series was high with a low infection risk. Nonunions were associated with bone loss and deep infection. Functional motion was achieved in most patients despite increased burden of HO and synostosis compared with civilian populations. However, if synostosis did not develop, HO itself did not appear to interfere with functional ROM. Future investigations may provide improved decision-making tools for timing of fixation and prophylactic means against HO synostosis. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Traumatismos por Explosões/cirurgia , Traumatismos do Antebraço/cirurgia , Consolidação da Fratura , Fraturas Expostas/cirurgia , Fraturas não Consolidadas/fisiopatologia , Medicina Militar , Adulto , Traumatismos por Explosões/diagnóstico por imagem , Traumatismos por Explosões/fisiopatologia , Feminino , Traumatismos do Antebraço/diagnóstico por imagem , Traumatismos do Antebraço/fisiopatologia , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/fisiopatologia , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Masculino , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/fisiopatologia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Sinostose/etiologia , Sinostose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Guerra , Adulto Jovem
18.
J Shoulder Elbow Surg ; 28(7): 1406-1410, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30685280

RESUMO

BACKGROUND: Heterotopic ossification (HO) is a well-recognized cause of limited flexion-extension, but it can also limit pronation-supination. There is a paucity of literature concerning restriction of pronation-supination due to HO. METHODS: We conducted a retrospective review of patients who had undergone elbow surgery for HO removal between January 1, 2003, and September 27, 2013. Computed tomography scans were reviewed to determine the presence of HO restricting forearm rotation and were rated independently by 4 observers. Each elbow was given 1 of 4 scores according to the likelihood that HO was restricting forearm rotation. Agreement was achieved when 3 or 4 observers thought that HO definitely or probably caused a loss of pronation-supination. RESULTS: Of 132 post-traumatic patients undergoing HO excision for restricted elbow motion, 61 (46%) also lacked a functional arc of pronation and supination (50° and 50°, respectively). Of these 61 patients, 32 (53%) were considered to have lost forearm rotation because of HO. The remaining 29 patients (47%) were thought to have restricted forearm rotation for reasons unrelated to HO. DISCUSSION: In this study, loss of pronation-supination affected almost half of the patients (61 of 132 [46%]) undergoing HO excision around the elbow. Of these 61 patients, 32 (52%) had HO extending into the proximal forearm and affecting rotation. From our data, one can expect that about one-quarter (24% of patients in this study, or 32 of 132) with post-traumatic HO of the elbow will have a significant functional loss of pronation-supination due to HO extending into the forearm.


Assuntos
Cotovelo/cirurgia , Antebraço/fisiopatologia , Ossificação Heterotópica/fisiopatologia , Ossificação Heterotópica/cirurgia , Adulto , Feminino , Humanos , Imageamento Tridimensional , Masculino , Ossificação Heterotópica/diagnóstico por imagem , Pronação , Estudos Retrospectivos , Rotação , Supinação , Tomografia Computadorizada por Raios X
19.
J Shoulder Elbow Surg ; 28(5): 931-938, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30595502

RESUMO

HYPOTHESIS: This study aimed to evaluate the safety and efficacy of the fixation of Dubberley type B capitellar and trochlear fractures using dorsolateral anatomic plates with support of the distal humerus (DAPSDHs). METHODS: Fifteen patients with Dubberley type B capitellar and trochlear fractures (two type 1B, five type 2B, and eight type 3B) were treated through the extended lateral approach, and fixation was achieved with DAPSDHs. Radiographic evaluation was performed, and range of motion of the elbow and forearm was recorded. Functional outcomes were assessed using the Mayo Elbow Performance Score and Disabilities of the Arm, Shoulder and Hand score. RESULTS: The mean follow-up period was 32.5 months (range, 24-54 months). Fracture union was achieved in all cases. At the final follow-up, range of motion was as follows: flexion, 123.7° ± 8.1° (range, 110°-135°); lack of extension, 11.0° ± 7.1° (range, 5°-30°); pronation, 81.7° ± 5.6° (range, 70°-90°); and supination, 78.7° ± 5.2° (range, 70°-85°). At the final follow-up, the mean Disabilities of the Arm, Shoulder and Hand score was 11.9 ± 4.0 (range, 4.2-20.8) and the mean Mayo Elbow Performance Score was 89.0 ± 7.1 (range, 70-95). The outcome was rated as excellent in 12 patients (80.0%), good in 2 (13.3%), and fair in 1 (6.7%). Avascular necrosis of the capitellum developed in 1 patient. One patient had implant irritation. Heterotopic ossification developed in 1 patient. Ten patients returned to their previous activity levels. CONCLUSION: Capitellar and trochlear fractures with posterior comminution are safely and effectively treated through the extended lateral approach using DAPSDHs, resulting in good radiographic and functional outcomes.


Assuntos
Fixação Interna de Fraturas , Fraturas Cominutivas/cirurgia , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/cirurgia , Adulto , Idoso , Placas Ósseas , Articulação do Cotovelo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/fisiopatologia , Pronação , Amplitude de Movimento Articular , Estudos Retrospectivos , Supinação , Resultado do Tratamento , Adulto Jovem
20.
J Shoulder Elbow Surg ; 28(3): 587-595, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30639172

RESUMO

BACKGROUND: Heterotopic ossification (HO) is a known complication that can arise after total elbow arthroplasty (TEA). In most cases, it is asymptomatic; however, in some patients, it can limit range of motion and lead to poor outcomes. The objective of this review was to assess and report the incidence, risk factors, prophylaxis, and management of HO after TEA. METHODS: A systematic search was conducted using MEDLINE, Embase, and PubMed to retrieve all relevant studies evaluating the occurrence of HO after TEA. The search was performed in duplicate, and a quality assessment of all included studies was performed. RESULTS: A total of 1907 studies were retrieved, of which 45 were included involving 2256 TEA patients. HO was radiographically present in 10% of patients and was symptomatic in 3%. Fewer than 1% of patients went on to undergo surgical excision of HO, with outcomes after surgery reported as good or excellent as assessed by range of motion and the Mayo Elbow Performance Score. HO appears more likely to develop in patients undergoing TEA because of ankylosis, primary osteoarthritis, and distal humeral fractures. Surgical intervention is more likely to be required in patients in whom HO develops after TEA performed for ankylosis and post-traumatic osteoarthritis. CONCLUSION: HO is an uncommon complication after TEA, with most patients in whom HO develops being asymptomatic and requiring no surgical management. Routine HO prophylaxis for TEA is not supported by the literature. The effectiveness of prophylaxis in high-risk patients is uncertain, and future studies are required to clarify its usefulness.


Assuntos
Artroplastia de Substituição do Cotovelo/efeitos adversos , Doenças Assintomáticas/epidemiologia , Ossificação Heterotópica/epidemiologia , Anquilose/cirurgia , Doenças Assintomáticas/terapia , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Humanos , Fraturas do Úmero/cirurgia , Incidência , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/fisiopatologia , Ossificação Heterotópica/terapia , Osteoartrite/cirurgia , Amplitude de Movimento Articular , Fatores de Risco
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