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Expósito Raspeño M, Sánchez Escudero V, Pérez de Nanclares Leal G, Ortiz Santamaría M, Sánchez-Dehesa Sáez R, García Cuartero B, González Vergaz A. Diagnosis and approach of pseudohypoparathyroidism type 1A and related disorders during long term follow-up: a case report. J Pediatr Endocrinol Metab 2024; 37:289-295. [PMID: 38353264 DOI: 10.1515/jpem-2023-0454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/03/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES Pseudohypoparathyroidism type 1A (PHP1A) encompasses the association of resistance to multiple hormones, features of Albright hereditary osteodystrophy and decreased Gsα activity. Little is known about the early signs of PHP1A, with a delay in diagnosis. We report two PHP1A cases and their clinical and biochemical findings during a 20-year follow-up. CASE PRESENTATION Clinical suspicion was based on obesity, TSH resistance and ectopic ossifications which appeared several months before PTH resistance, at almost 3 years of age. Treatment with levothyroxine, calcitriol and calcium was required in both patients. DNA sequencing of GNAS gene detected a heterozygous pathogenic variant within exon 7 (c.569_570delAT) in patient one and a deletion from XLAS to GNAS-exon 5 on the maternal allele in patient 2. In patient 1, ectopic ossifications that required surgical excision were found. Noticeably, patient 2 displayed adult short stature, intracranial calcifications and psychomotor delay. In terms of weight, despite early diagnosis of obesity, dietary measures were established successfully in both cases. CONCLUSIONS GNAS mutations should be considered in patients with obesity, ectopic ossifications and TSH resistance presented in early infancy. These cases emphasize the highly heterogeneous clinical picture PHP1A patients may present, especially in terms of final height and cognitive impairment.
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Qi L, Guo Y. Fibrodysplasia Ossificans Progressiva: A Case Report. Cureus 2024; 16:e55528. [PMID: 38576636 PMCID: PMC10993004 DOI: 10.7759/cureus.55528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant genetic disorder characterized by congenital great toe malformations and progressive ectopic ossification. We report a typical case of FOP in a 22-year-old female patient presenting with limited movement of the left knee joint, which began following trauma in 2019. Clinical examination revealed a large mass behind the left knee, bilateral great toe deformities, and no palpable superficial lymph nodes, without systemic pain or other discomfort. Imaging and genetic testing further supported the diagnosis of FOP, demonstrating high-density ossification within soft tissues and a mutation in the ACVR1 gene. Treatment involved a combination of methylprednisolone and alendronate sodium vitamin D3 tablets, which yielded some therapeutic efficacy. The discussion emphasizes clinical diagnosis, pathogenesis, and treatment strategies for FOP, including injury prevention, rehabilitation exercises, and pharmacological interventions. Despite the lack of definitive treatment options, timely diagnosis and comprehensive management can effectively alleviate symptoms and improve the quality of life for affected individuals.
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Affiliation(s)
- Linzeng Qi
- Orthopedics, Qilu Hospital of Shandong University, Jinan, CHN
| | - Yongyuan Guo
- Orthopedics, Qilu Hospital of Shandong University, Jinan, CHN
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Felix M, Denis R, Chen C, Picaza A, Casadesus D. Myositis Ossificans Traumatica of Bilateral Sternocleidomastoid Muscles After Chiropractor Adjustment: A Case Report. Cureus 2024; 16:e56931. [PMID: 38665716 PMCID: PMC11043790 DOI: 10.7759/cureus.56931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
A woman in her 20s with a past medical history of surgical debulking of a right neck mass presented to the hospital for persistent and worsening right shoulder pain. The shoulder pain was associated with trismus and back and neck pain. A CT scan of the neck with contrast revealed post-surgical changes with increased heterotopic ossification throughout the surgical site extending to the supraclavicular soft tissues and the left sternocleidomastoid muscle, suggesting muscle ossification. A biopsy was performed, and the patient was diagnosed with myositis ossificans (MO). Initial treatment began with the administration of steroids and analgesics. She was scheduled for a follow-up with orthopedics, rheumatology, and genetics, but she was lost for follow-up. MO is a very rare medical condition usually associated with trauma, and in our patient, the symptoms started after a chiropractic adjustment.
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Affiliation(s)
- Martin Felix
- Internal Medicine, St. George's University School of Medicine, St. George, GRD
| | - Ryan Denis
- Internal Medicine, St. George's University School of Medicine, St. George, GRD
| | - Charles Chen
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Ana Picaza
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
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Yamamoto K, Hasegawa K, Yasuhara T, Otsuka F. Ossification of the Posterior Longitudinal Ligament Caused by X-linked Hypophosphatemia. JMA J 2023; 6:346-347. [PMID: 37560368 PMCID: PMC10407398 DOI: 10.31662/jmaj.2023-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/02/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- Koichiro Yamamoto
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kosei Hasegawa
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Penolazzi L, Straudi S, Lamberti N, Lambertini E, Bianchini C, Manfredini F, Piva R. Clinically-driven design of novel methods of investigation on skeletal health status in neurological disorders. The case of the traumatic brain injuries. Front Neurol 2023; 14:1176420. [PMID: 37265470 PMCID: PMC10230040 DOI: 10.3389/fneur.2023.1176420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/24/2023] [Indexed: 06/03/2023] Open
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Kato H, Okawa R, Ogasawara T, Hoshino Y, Hidaka N, Koga M, Kinoshita Y, Kobayashi H, Taniguchi Y, Fukumoto S, Nangaku M, Makita N, Hoshi K, Nakano K, Ito N. Effect of conventional treatment on dental complications and ectopic ossifications among 30 adults with XLH. J Clin Endocrinol Metab 2022; 108:1405-1414. [PMID: 36524341 DOI: 10.1210/clinem/dgac732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
CONTEXT Conventional treatment of XLH was reported to prevent dental complications, but whether the preventive effect was different among different types of teeth, including anterior teeth and molar teeth, is uncertain. Evidence of the preventive effect of conventional treatment on ectopic ossifications is also limited. OBJECTIVE To compare dental complications and ectopic ossifications among XLH adults with early (< 5 years old) or late (≥5 years old) conventional treatment. METHODS This retrospective observational study included a total of 30 adults with XLH using orthopantomograms, spinal computed tomography scans and X-rays of hip/knee joints. Dental complications, including decayed, missing filled (DMF) index and devitalized tooth, apical periodontitis, and periodontitis, were evaluated. The index of ossification of the anterior/posterior longitudinal ligament and yellow ligament (OA/OP/OY index) and the sum of the OA/OP/OY index (OS index) were utilized to evaluate the severity of spinal ligament ossification. The severity of the hip/knee osteophytes was evaluated by the Kellgren-Lawrence (KL) classification. RESULTS The number of sound teeth was significantly lower, and the DMF index was significantly higher in patients with late treatment. The severity of dental complications in the anterior tooth and molar tooth, OA/OP/OY/OS index, and KL grade were not significantly different among patients with early treatment and those with late treatment. CONCLUSION Early treatment could prevent dental complications but did not prevent ectopic ossification in adult patients with XLH. The difference in the preventive effect was not observed among different types of teeth.
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Affiliation(s)
- Hajime Kato
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Rena Okawa
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Toru Ogasawara
- Department of Oral and Maxillofacial Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshitomo Hoshino
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoko Hidaka
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Minae Koga
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuka Kinoshita
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroshi Kobayashi
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Seiji Fukumoto
- Fujii Memorial Institute of Medical Sciences, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
| | - Noriko Makita
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazuto Hoshi
- Department of Oral and Maxillofacial Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazuhiko Nakano
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Nobuaki Ito
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
- Osteoporosis Center, The University of Tokyo Hospital, Tokyo, Japan
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Abstract
BACKGROUND Heterotopic ossification (HO) is defined as the formation of lamellar bone in extraskeletal soft tissues. HO can be a severe complication after hip arthroplasty but can possibly be prevented by postoperative treatment with non-steroidal anti-inflammatory drugs (NSAIDs) or radiotherapy. Diclofenac is 1 of the most used drugs in HO prophylaxis because it is effective and long established. However, there is still no uniform therapy regimen in terms of duration, dose and side effect profile regarding the application of diclofenac in HO prevention. We have, therefore, conducted the first systematic review investigating diclofenac for HO prophylaxis after hip arthroplasty. The aim of this study is to assess the efficacy, dose and duration of diclofenac therapy in preventing HO after total hip arthroplasty (THA). METHODS According to the PRISMA Guidelines we performed a systematic literature search in EMBASE via Ovid, in MEDLINE via PubMed and in the Cochrane Library addressing all studies in English and German regarding the prophylaxis of HO with diclofenac after THA. We identified 731 potential studies and included 6 randomised controlled trials with 957 patients. RESULTS The studies were heterogeneous with regard to duration of therapy, dose, comparative group and follow-up period. The therapy duration ranged from 9 to 42 days, the applied diclofenac doses ranged from 75 mg to 150 mg daily. Patients treated with diclofenac showed a significant reduction in the total incidence of HO regarding to the Brooker Classification compared to placebo and no clinically relevant ossifications occured (Brooker III and IV). CONCLUSIONS Diclofenac is efficacious in the prevention of HO and can be used routinely after THA. The existing data indicates that a minimum dose of 75 mg diclofenac per day started on the first postoperative day for a minimum of 9 days is needed to prevent HO with an acceptable incidence of side effects, such as gastrointestinal symptoms.
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Affiliation(s)
- Henryk Haffer
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Germany
| | - Michael Müller
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Germany
| | - Rudolf Ascherl
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Germany
| | - Tobias Winkler
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Germany.,BIH Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany.,Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Germany
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Kimura A, Hirayama A, Matsumoto T, Sato Y, Kobayashi T, Ikeda S, Maruyama M, Kaneko M, Shigeta M, Ito E, Soma T, Miyamoto K, Soga T, Tomita M, Oya A, Matsumoto M, Nakamura M, Kanaji A, Miyamoto T. Hao1 Is Not a Pathogenic Factor for Ectopic Ossifications but Functions to Regulate the TCA Cycle In Vivo. Metabolites 2022; 12:82. [PMID: 35050204 DOI: 10.3390/metabo12010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 02/01/2023] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL), a disease characterized by the ectopic ossification of a spinal ligament, promotes neurological disorders associated with spinal canal stenosis. While blocking ectopic ossification is mandatory to prevent OPLL development and progression, the mechanisms underlying the condition remain unknown. Here we show that expression of hydroxyacid oxidase 1 (Hao1), a gene identified in a previous genome-wide association study (GWAS) as an OPLL-associated candidate gene, specifically and significantly decreased in fibroblasts during osteoblast differentiation. We then newly established Hao1-deficient mice by generating Hao1-flox mice and crossing them with CAG-Cre mice to yield global Hao1-knockout (CAG-Cre/Hao1flox/flox; Hao1 KO) animals. Hao1 KO mice were born normally and exhibited no obvious phenotypes, including growth retardation. Moreover, Hao1 KO mice did not exhibit ectopic ossification or calcification. However, urinary levels of some metabolites of the tricarboxylic acid (TCA) cycle were significantly lower in Hao1 KO compared to control mice based on comprehensive metabolomic analysis. Our data indicate that Hao1 loss does not promote ectopic ossification, but rather that Hao1 functions to regulate the TCA cycle in vivo.
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Palhares DB, Nascimento DR, Palhares MG, Lopes S, de L, Cristhina P, Mauro J, Alves F, Vieira RO, Souza-Fagundes EM, Underwood A, Milsted A, Augusto R, Martins AS. Propranolol and ascorbic acid in control of fibrodysplasia ossificans progressiva flare-ups due to accidental falls. Intractable Rare Dis Res 2019; 8:24-28. [PMID: 30881854 PMCID: PMC6409115 DOI: 10.5582/irdr.2018.01095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare, intractable and devastating genetic connective tissue disorder characterized by progressive ectopic ossification in the soft tissues and skeleton. Three patients, one teenage girl (P1), one male adult (P2) and one male child (P3), were studied and treated with FOPCON (combined formulation of 14 mg of propranolol and 250 mg of ascorbic acid), given three times per day. P1 started treatment in March 2012, P2 in October 2012 and P3 in July 2015. The clinical follow-up of these three patients, before initiating treatment with FOPCON, showed that FOP flare-ups used to occur frequently and that under FOPCON therapy, none of these patients had flare-ups. The striking feature of this treatment with FOPCON, is that, all three cases suffered accidental falls with documented injures until complete healing and that where major flare-ups should occur, injures or sequels, there was none. The present clinical observation shows that ascorbic acid plus the nonspecific beta blocker propranolol can be effectively useful, when administered previously and continually, in the prophylaxis of FOP flare-ups, especially for accidental falls. In this regard, FOPCON could be a prophylactic aid in cases of surgery of patients with FOP, hoping that it may benefit patients from having the severe sequels, characteristic of heterotopic bone formation. All three patients reported, to date, they no longer had flare-ups nor heterotopic ossification and showed normal scar healing.
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Affiliation(s)
| | - Deborah Ribeiro Nascimento
- UFMS/ Faculty of Medicine, Campo Grande, MS, Brazil
- Medical Faculty of Barbacena, José Bonifácio Lafayette de Andrada Foundation, MG, Brazil
| | | | - Suzana Lopes
- UFMS/ Faculty of Medicine, Campo Grande, MS, Brazil
| | - Liane de
- UFMS/ Faculty of Medicine, Campo Grande, MS, Brazil
| | | | - José Mauro
- Procter & Gamble Health Care & Global Clinical Sciences, Mason, OH, USA
| | - Fabiana Alves
- UFMG/ Department of Physiology and Biophysics, Belo Horizonte, MG, Brazil
- Centro Universitário Metodista Izabela Hendrix- IMIH, Belo Horizonte, MG, Brazil
| | - rancisco Oliveira Vieira
- UFMG/ Department of Physiology and Biophysics, Belo Horizonte, MG, Brazil
- Centro Universitário Metodista Izabela Hendrix- IMIH, Belo Horizonte, MG, Brazil
| | | | - Adam Underwood
- The Walsh University, Division of Mathematics and Sciences, North Canton, OH, USA
| | - Amy Milsted
- The Walsh University, Division of Mathematics and Sciences, North Canton, OH, USA
| | - Robson Augusto
- UFMG/ Department of Physiology and Biophysics, Belo Horizonte, MG, Brazil
| | - Almir Sousa Martins
- UFMG/ Department of Physiology and Biophysics, Belo Horizonte, MG, Brazil
- Address correspondence to:Dr. Almir Sousa Martins, Departamento de Fisiologia e Biofísica-ICB/UFMG. Av Antonio Carlos, 6627, A4-256, Belo Horizonte, MG, Brazil - 31.270-900. E-mail:
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Şahin S, Hiort O, Thiele S, Evliyaoğlu O, Tüysüz B. Follow-up Findings in a Turkish Girl with Pseudohypoparathyroidism Type Ia Caused by a Novel Heterozygous Mutation in the GNAS Gene. J Clin Res Pediatr Endocrinol 2017; 9:74-79. [PMID: 27425121 PMCID: PMC5363169 DOI: 10.4274/jcrpe.3191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Pseudohypoparathyroidism type Ia (PHP-Ia) is characterized by multihormone resistance and an Albright hereditary osteodystrophy (AHO) phenotype. It is caused by heterozygous mutations in GNAS gene. Clinical and biochemical findings of a female PHP-Ia patient were evaluated from age of diagnosis (6.5 years) to 14.5 years of age. The patient had short stature, brachydactyly, and subcutaneous heterotopic ossifications. Serum calcium and phosphorus levels were normal, but parathyroid hormone levels were high. Based on the typical clinical findings of AHO phenotype and biochemical findings, she was diagnosed as having PHP-Ia. A novel heterozygous mutation (c.128T>C) was found in the GNAS gene. Follow-up examinations revealed resistance to thyroid-stimulating hormone and a bioinactive growth hormone. Clinicians should take into consideration PHP-Ia in patients referred with short stature, and patients with an AHO phenotype must be further evaluated for hormone resistance, GNAS gene mutation, Gsα activity. To our knowledge, this is the first case report describing bioinactive growth hormone in PHP-Ia.
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Affiliation(s)
- Sezgin Şahin
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Rheumatology, İstanbul, Turkey
| | - Olaf Hiort
- University of Lübeck, Department of Pediatrics, Lübeck, Germany
| | - Susanne Thiele
- University of Lübeck, Department of Pediatrics, Lübeck, Germany
| | - Olcay Evliyaoğlu
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Beyhan Tüysüz
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Genetics, İstanbul, Turkey Phone: +90 212 4143192 E-mail:
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Kozlowski K. Osteogenesis imperfecta type V, spot diagnosis. Pol J Radiol 2010; 75:84-7. [PMID: 22802766 PMCID: PMC3389858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 09/02/2009] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The first case of Osteogenesis Imperfecta Type V in the Polish literature is reported. CASE REPORT Skeletal survey of an 8 year old girl with a history of multiple fractures and bilateral dislocation of radial heads was received for consultation. CONCLUSIONS Generalised osteoporosis with multiple fractures, periosteal thickening and bilateral dislocation of the radial heads are characteristic signs of osteogenesis imperfecta Type V. The Nosology and Classification of Genetic Skeletal Disorders 2006 Revision classified Osteogenesis Imperfecta into 8 major types. Type V is recognizable on the basis of skeletal survey alone.
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Affiliation(s)
- Kazimierz Kozlowski
- Author’s address: K. Kozlowski, New Children’s Hospital at Westmead, NSW 2145, Australia, e-mail:
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Oyama Y, Kazama JJ, Fukagawa M, Arakawa Y, Ezuka I. Ectopic ossification in the cranial dura mater in dialysis patients with secondary hyperparathyroidism. NDT Plus 2009; 3:64-7. [PMID: 25949408 PMCID: PMC4421539 DOI: 10.1093/ndtplus/sfp115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 07/30/2009] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 69-year-old woman with secondary hyperparathyroidism who underwent maintenance haemodialysis therapy for 17 years and who presented with severe dural calcification and right subdural haematoma. Her dura mater displayed a rock barnacle-like appearance, and cerebral superficial arteries adhered to the sclerotic lesions. On the microscopic observation, calcified tissue with a clear lamellar structure and osteopontin immunoreactivity was observed. Tartrate-resistant acid phosphatase immunoreactive polynucleated giant cells infiltrated around the tissue. Such morphological properties are specific to the calcified tissue formed through a bone formation-like mechanism that is often observed in arterial media in patients with chronic kidney disease.
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Affiliation(s)
- Yuko Oyama
- Division of Nephrology , Joetsu General Hospital , Joetsu
| | - Junichiro J Kazama
- Division of Clinical Nephrology and Rheumatology , Niigata University Graduate School of Medical and Dental Sciences , Niigata
| | | | - Yasuaki Arakawa
- Division of Brain Surgery , Joetsu General Hospital , Joetsu , Japan
| | - Isamu Ezuka
- Division of Brain Surgery , Joetsu General Hospital , Joetsu , Japan
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