scholarly journals 983 Digital Angioleiomyoma: A Rare Tumour Of the Hand

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
F Motiwala ◽  
S Jivan
Keyword(s):  
Blood Vessels ◽  
Full Range ◽  
Specific Treatment ◽  
Middle Finger ◽  
Differential Diagnoses ◽  
Excision Biopsy ◽  
Digital Artery ◽  
Range Of Movement ◽  
Rare Tumour ◽  
Patient Reported

Abstract Introduction Angioleiomyoma is an unusual, benign tumour originating from the tunica media of blood vessels. They commonly occur in the face, neck and lower limb. It is rarely found in the hand and is not considered in the differential diagnoses of painful subcutaneous hand tumours. Case Report We present a case of a 40-year-old man with a several month history of a slow growing lump on his right middle finger. He complained of pain and difficulty flexing his finger. On examination, he had a solid tumour with normal overlying skin, on the volar ulnar border of middle phalanx with altered sensation and a positive Tinel’s along the ulnar digital nerve. Ultrasound and MRI reported a highly vascular subcutaneous tumour measuring 26x14x22mm with differential diagnoses of giant cell or peripheral nerve tumour. Intra-operatively the tumour was in continuity with the ulnar digital artery and solid in consistency. Tumour excision and microsurgical repair of the digital artery was required. Histology confirmed a well-defined nodule, composed of bundles of smooth muscle surrounding ectatic blood vessels, consistent with angioleiomyoma. On follow-up the patient reported return of full range of movement without hypersensitivity or evidence of recurrence. Conclusions Angioleiomyomas in the hand are rare. It should be considered in the differential diagnoses of painful subcutaneous tumours. Ultrasound and MRI are non-specific. Treatment is successful with excision biopsy and microsurgical repair of digital artery. Microvascular instruments should be available, and the patient consented for vein graft.

scholarly journals Congenital Syndactyly of the Fingers : A Report of Two Cases

2016 ◽  
Vol 06 (01) ◽  
pp. 082-084
Author(s):  
Sanath Kumar Shetty ◽  
Anoop Hegde ◽  
Lawrence John Mathias ◽  
H. Ravindranath Rai
Keyword(s):  
Full Range ◽  
Skin Grafting ◽  
Middle Finger ◽  
Interesting Case ◽  
Range Of Movement ◽  
Scar Contracture ◽  
Left Hand ◽  
Thickness Skin ◽  
Percutaneous Release ◽  
Contracture Release

AbstractSyndactyly is defined as the failure of separation of the digits during early gestation. It is one of the most common congenital anomalies. The incidence of syndactyly is uncertain, but estimates range from 1 in 2,500 live births. During development, the fingers are webbed. This remains so, until apoptosis and skin recession allow for formation of the digital interspaces. Full inter-digital spaces are usually present by the end of the 6th week of gestation.Here we present two patients and three hands who presented to us with syndactyly of the fingers. The first patient who was a 13 year old girl, had complete complex syndactyly between the ring and middle fingers of both hands. She underwent complete release with full thickness skin grafting in the first sitting. Six weeks later, she was reviewed and was noted to have developed scar contracture of the middle finger for which she underwent contracture release and z-plasty as a secondary procedure. In the final review at four months after the second surgery, the child was noted to have only terminal restriction of movements of the involved fingers of both hands with 'fair results' (as per the criteria of Cortez et al).The second patient was a two years old boy, who presented to us with incomplete simple syndactyly of the ring and index finger of the left hand. He was managed with percutaneous release of the syndactyly. He was reviewed after 4 months and there was full range of movement of the involved digits. He was also noted to have 'fair results' (as per the criteria of Cortez et al).As we had two different cases with a heterogenous presentation of two different types of syndactyly and who underwent different modalities of management, we are presenting it as an interesting case report in our article.

scholarly journals Validation of a menstrual pictogram and a daily bleeding diary for assessment of uterine fibroid treatment efficacy in clinical studies

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Claudia Haberland ◽  
Anna Filonenko ◽  
Christian Seitz ◽  
Matthias Börner ◽  
Christoph Gerlinger ◽  
...  
Keyword(s):  
Uterine Fibroid ◽  
Full Range ◽  
Intraclass Correlation ◽  
Phase Iii ◽  
Measurement Properties ◽  
Retest Reliability ◽  
Response Options ◽  
Patient Global Impression ◽  
Patient Reported ◽  
Test Retest Reliability

Abstract Background To evaluate the psychometric and measurement properties of two patient-reported outcome instruments, the menstrual pictogram superabsorbent polymer-containing version 3 (MP SAP-c v3) and Uterine Fibroid Daily Bleeding Diary (UF-DBD). Test-retest reliability, criterion, construct validity, responsiveness, missingness and comparability of the MP SAP-c v3 and UF-DBD versus the alkaline hematin (AH) method and a patient global impression of severity (PGI-S) were analyzed in post hoc trial analyses. Results Analyses were based on data from up to 756 patients. The full range of MP SAP-c v3 and UF-DBD response options were used, with score distributions reflecting the cyclic character of the disease. Test-retest reliability of MP SAP-c v3 and UF-DBD scores was supported by acceptable intraclass correlation coefficients when stability was defined by the AH method and Patient Global Impression of Severity (PGI-S) scores (0.80–0.96 and 0.42–0.94, respectively). MP SAP-c v3 and UF-DBD scores demonstrated strong and moderate-to-strong correlations with menstrual blood loss assessed by the AH method. Scores increased in monotonic fashion, with greater disease severities, defined by the AH method and PGI-S scores; differences between groups were mostly statistically significant (P < 0.05). MP SAP-c v3 and UF-DBD were sensitive to changes in disease severity, defined by the AH method and PGI-S. MP SAP-c v3 and UF-DBD showed a lower frequency of missing patient data versus the AH method, and good agreement with the AH method. Conclusions This evidence supports the use of the MP SAP-c v3 and UF-DBD to assess clinical efficacy endpoints in UF phase III studies replacing the AH method.

scholarly journals Clinical evaluation of pulmonary hypertension using patient-reported outcomes: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Miguel Ángel Amor-García ◽  
Sara Ibáñez-García ◽  
Xandra García-González ◽  
Teresa Mombiela ◽  
Cristina Villanueva-Bueno ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Hypertension ◽  
Clinical Evaluation ◽  
Patient Reported Outcomes ◽  
Specific Treatment ◽  
Tertiary Hospital ◽  
Functional Class ◽  
Cross Sectional ◽  
Patient Reported

Abstract Background Patients with pulmonary hypertension (PH) have progressive and disabling symptoms, as well as a burden of treatments and a difficult clinical evaluation that make health-related quality of life a particularly relevant endpoint in this disease. The objective of the study was to evaluate patient-reported outcomes of patients receiving specific treatment for PH in a tertiary hospital using a specific questionnaire (Cambridge Pulmonary Hypertension Outcome Review-CAMPHOR) in the pharmacy consultation. Methods A cross-sectional, observational, descriptive study was conducted. It included all patients receiving specific treatment for PH in a tertiary hospital in Madrid, Spain. The inclusion period comprised between August to December 2019. CAMPHOR questionnaires containing three domains: symptoms, activities and quality of life were completed by the patients at the pharmacy consultation. Demographic and clinical variables, including WHO Functional Class (WHO FC), PH-specific tests and hemodynamic parameters, were recorded. Non-parametric analyses to assess relations between variables and CAMPHOR domains were performed. Results Thirty-six patients consented to participate in the study and completed the questionnaire. Median scores for symptoms, activities, and quality of life domains were 5.5 (2.5–10), 8.0 (4.5–10.5) and 3.5 (1–7.5), respectively. Statistically significant differences were found in the three domains when comparing by WHO FC, in the activities domain for 6-m walking test and in the quality of life domain for patients who had emergency visits or hospitalizations in the last year. Conclusions The CAMPHOR questionnaire could be useful as a complementary test to achieve an integrated evaluation of PH patients, who could complete it easily during their routine pharmacy visits.

scholarly journals P158 Severity of hand vascular involvement as assessed by MRI Digital Artery Volume Index (DAVIX©) predicts worsening of clinical parameters and patient reported outcomes in scleroderma

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Fiammetta Danzo ◽  
Klodian Gjeloshi ◽  
Giovanni Lettieri ◽  
Giuseppina Abignano ◽  
Mark Hinton ◽  
...  
Keyword(s):  
Disease Activity ◽  
Health Assessment Questionnaire ◽  
Patient Reported Outcomes ◽  
Health Assessment ◽  
Volume Index ◽  
Vascular Involvement ◽  
Clinical Parameters ◽  
Digital Artery ◽  
Patient Reported ◽  
Assessment Questionnaire

Abstract Background Neointima proliferation is a key pathologic feature of systemic sclerosis (SSc), causing arterial vessel narrowing and being the recognised culprit pathological lesion in digital ulcers (DUs), pulmonary artery hypertension and renal crisis. Nevertheless, there are no validated imaging techniques to assess the severity of vascular involvement in SSc. We have previously shown digital artery volume index (DAVIX©) assessed with time of right MRI angiography, is a reliable measure of neointima proliferation in the hands. The purpose of our study was to identify the value of DAVIX© in predicting worsening of patient reported outcomes (PROs) and clinical parameters in SSc. Methods Cross-sectional data were available for 91 patients and complete 12 months follow-up data for 68 patients. Data collected included: modfied Rodnan skin score (mRSS), pulmonary function tests (PFTs), echocardiography, nailfold capillaroscopy, Health Assessment Questionnaire Disability Index (HAQ-DI), and Scleroderma Health Assessment Questionnaire (sHAQ). DAVIX© of the dominant hand was calculated as the % mean of the 4 fingers, employing MeVisLab software. Following analysis of distribution, Spearman or Pearson test were used to determine correlation coefficients, as appropriate (Prism 7). Results 56/68 were female and median of disease duration was 4 years (IQR 1.91-9). As previously reported DAVIX© correlated with the presence of DUs (p = 0.0093). Considering all patients, DAVIX© correlated with mRSS (r=-0.258, p = 0.017), DLCO% (r = 0.338, p = 0.008) and the pattern of capillaroscopy (r=-0.388, p = 0.001). In patients with DUs, DAVIX© showed a stronger correlation with DLCO% (r = 0.786, p = 0.048). Most importantly, DAVIX© predicted the worsening of HAQ-DI (r=-0.295, p = 0.029), sHAQ (r =-0.333, p = 0.029) and VAS pain (r=-0.269, p = 0.038) independently of the presence of DUs. Conclusion The quantitative assessment of neointima proliferation in the hand by DAVIX© is a useful imaging biomarker of vascular disease activity. The value of DAVIX© in predicting the worsening of PROs and clinical parameters in overall patients, may offer insights on the role of vascular disease activity in the global progression of SSc. The validation of our data in an independent cohort and the sensitivity to change over time of DAVIX© may aid to the implementation of hand MRI as imaging outcome measure of vascular severity in SSc. Disclosures F. Danzo None. K. Gjeloshi None. G. Lettieri None. G. Abignano None. M. Hinton None. A. Dean None. G. Cuomo None. O. Kubassova None. F. del Galdo None.

Shoulder examination: a systematic approach

2021 ◽  
pp. 1-15
Author(s):  
Akib M Khan ◽  
Angelos Assiotis ◽  
Mazin S Ibrahim ◽  
Andrew R Sankey
Keyword(s):  
Rotator Cuff ◽  
Systematic Approach ◽  
Healthcare Professionals ◽  
Full Range ◽  
Range Of Movement ◽  
Systematic Examination ◽  
Complex Joint ◽  
Different Levels ◽  
Shoulder Examination

The shoulder is a complex joint with static and dynamic stabilising structures working synchronously. These allow a full range of movement while preserving stability of the joint. Patients may present with pain, stiffness, weakness, deformity or instability. The authors suggest a systematic examination sequence to ensure that important pathology is not overlooked. Adopting this approach allows common pathologies, including tears of the rotator cuff, impingement and tendinopathy, to be easily identified. This shoulder examination sequence may be used by all healthcare professionals and can also act as a revision aid for those undergoing exams in this field, at different levels of training.

scholarly journals Bi-unicondylar arthroplasty

2021 ◽  
Vol 10 (11) ◽  
pp. 723-733
Author(s):  
Amy J. Garner ◽  
Oliver W. Dandridge ◽  
Andrew A. Amis ◽  
Justin P. Cobb ◽  
Richard J. van Arkel
Keyword(s):  
Repeated Measures ◽  
Cruciate Ligament ◽  
Full Range ◽  
Oxford Knee Score ◽  
Knee Extensor ◽  
Unicondylar Arthroplasty ◽  
Patient Reported ◽  
Fresh Frozen ◽  
Five Dimension

Aims Bi-unicondylar arthroplasty (Bi-UKA) is a bone and anterior cruciate ligament (ACL)-preserving alternative to total knee arthroplasty (TKA) when the patellofemoral joint is preserved. The aim of this study is to investigate the clinical outcomes and biomechanics of Bi-UKA. Methods Bi-UKA subjects (n = 22) were measured on an instrumented treadmill, using standard gait metrics, at top walking speeds. Age-, sex-, and BMI-matched healthy (n = 24) and primary TKA (n = 22) subjects formed control groups. TKA subjects with preoperative patellofemoral or tricompartmental arthritis or ACL dysfunction were excluded. The Oxford Knee Score (OKS) and EuroQol five-dimension questionnaire (EQ-5D) were compared. Bi-UKA, then TKA, were performed on eight fresh frozen cadaveric knees, to investigate knee extensor efficiency under controlled laboratory conditions, using a repeated measures study design. Results Bi-UKA walked 20% faster than TKA (Bi-UKA mean top walking speed 6.7 km/h (SD 0.9),TKA 5.6 km/h (SD 0.7), p < 0.001), exhibiting nearer-normal vertical ground reaction forces in maximum weight acceptance and mid-stance, with longer step and stride lengths compared to TKA (p < 0.048). Bi-UKA subjects reported higher OKS (p = 0.004) and EQ-5D (p < 0.001). In vitro, Bi-UKA generated the same extensor moment as native knees at low flexion angles, while reduced extensor moment was measured following TKA (p < 0.003). Conversely, at higher flexion angles, the extensor moment of TKA was normal. Over the full range, the extensor mechanism was more efficient following Bi-UKA than TKA (p < 0.028). Conclusion Bi-UKA had more normal gait characteristics and improved patient-reported outcomes, compared to matched TKA subjects. This can, in part, be explained by differences in extensor efficiency. Cite this article: Bone Joint Res 2021;10(11):723–733.

scholarly journals Dynamics of the IFT machinery at the ciliary tip

eLife ◽  
2017 ◽  
Vol 6 ◽  
Author(s):  
Alexander Chien ◽  
Sheng Min Shih ◽  
Raqual Bower ◽  
Douglas Tritschler ◽  
Mary E Porter ◽  
...  
Keyword(s):  
Basal Body ◽  
Full Range ◽  
Intraflagellar Transport ◽  
Feedback Mechanism ◽  
Conventional Imaging ◽  
Range Of Movement ◽  
Anterograde Transport ◽  
Traffic Jam ◽  
Negative Feedback Mechanism ◽  
Cilia And Flagella

Intraflagellar transport (IFT) is essential for the elongation and maintenance of eukaryotic cilia and flagella. Due to the traffic jam of multiple trains at the ciliary tip, how IFT trains are remodeled in these turnaround zones cannot be determined by conventional imaging. Using PhotoGate, we visualized the full range of movement of single IFT trains and motors in Chlamydomonas flagella. Anterograde trains split apart and IFT complexes mix with each other at the tip to assemble retrograde trains. Dynein-1b is carried to the tip by kinesin-II as inactive cargo on anterograde trains. Unlike dynein-1b, kinesin-II detaches from IFT trains at the tip and diffuses in flagella. As the flagellum grows longer, diffusion delays return of kinesin-II to the basal body, depleting kinesin-II available for anterograde transport. Our results suggest that dissociation of kinesin-II from IFT trains serves as a negative feedback mechanism that facilitates flagellar length control in Chlamydomonas.

scholarly journals Systematic collection of patient-reported outcomes in atrial fibrillation: feasibility and initial results of the Utah mEVAL AF programme

EP Europace ◽  
2019 ◽  
Vol 22 (3) ◽  
pp. 368-374 ◽  
Author(s):  
Benjamin A Steinberg ◽  
Jeffrey Turner ◽  
Ann Lyons ◽  
Joshua Biber ◽  
Mihail G Chelu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Symptom Score ◽  
Patient Reported Outcomes ◽  
Full Range ◽  
Heart Rhythm ◽  
Routine Care ◽  
Time Investment ◽  
Generic Hrqol ◽  
Patient Reported ◽  
Related Quality

Abstract Aims Incorporating patient-reported outcomes (PROs) into routine care of atrial fibrillation (AF) enables direct integration of symptoms, function, and health-related quality of life (HRQoL) into practice. We report our initial experience with a system-wide PRO initiative among AF patients. Methods and results All patients with AF in our practice undergo PRO assessment with the Toronto AF Severity Scale (AFSS), and generic PROs, prior to electrophysiology clinic visits. We describe the implementation, feasibility, and results of clinic-based, electronic AF PRO collection, and compare AF-specific and generic HRQoL assessments. From October 2016 to February 2019, 1586 unique AF patients initiated 2379 PRO assessments, 2145 of which had all PRO measures completed (90%). The median completion time for all PRO measures per visit was 7.3 min (1st, 3rd quartiles: 6, 10). Overall, 38% of patients were female (n = 589), mean age was 68 (SD 12) years, and mean CHA2DS2-VASc score was 3.8 (SD 2.0). The mean AFSS symptom score was 8.6 (SD 6.6, 1st, 3rd quartiles: 3, 13), and the full range of values was observed (0, 35). Generic PROs of physical function, general health, and depression were impacted at the most severe quartiles of AF symptom score (P &lt; 0.0001 for each vs. AFSS quartile). Conclusion Routine clinic-based, PRO collection for AF is feasible in clinical practice and patient time investment was acceptable. Disease-specific AF PROs add value to generic HRQoL instruments. Further research into the relationship between PROs, heart rhythm, and AF burden, as well as PRO-guided management, is necessary to optimize PRO utilization.

A SWOLLEN MIDDLE FINGER IN A MIDDLE-AGED FARMER

Hand Surgery ◽  
2012 ◽  
Vol 17 (01) ◽  
pp. 121-123 ◽  
Author(s):  
Somprakas Basu ◽  
Shilpi Bhadani ◽  
Vijay Kumar Shukla
Keyword(s):  
Proximal Phalanx ◽  
Middle Finger ◽  
Needle Aspiration ◽  
Excision Biopsy ◽  
Middle Aged ◽  
Cytological Examination ◽  
Diagnostic Dilemma ◽  
X Ray ◽  
The Right ◽  
Bony Erosion

Hand tumors are not common and a swollen finger poses considerable diagnostic dilemma. We present a case of a middle-aged farmer who had presented with a painless swelling of the middle finger of the right hand without any neurovascular deficit or evidence of metastasis. An X-ray of the finger showed cortical expansion and bony erosion of the proximal phalanx. A fine needle aspiration cytological examination was inconclusive. He underwent a digit amputation in view of subsequent morbidity and chances of recurrence following local excision. Biopsy proved it to be a giant cell tumor of the proximal phalanx. Following six months of treatment he is doing well. We herein highlight an unusual tumor of the finger and its diagnostic and treatment challenges.

scholarly journals Controversies In The Surgical Management Of Shoulder Instability: Associated Soft Tissue Procedures

2017 ◽  
Vol 11 (1) ◽  
pp. 989-1000 ◽  
Author(s):  
Santos Moros Marco ◽  
José Luis Ávila Lafuente ◽  
Miguel Angel Ruiz Ibán ◽  
Jorge Diaz Heredia
Keyword(s):  
Soft Tissue ◽  
Rotator Cuff ◽  
Shoulder Instability ◽  
Full Range ◽  
Rotator Interval ◽  
Range Of Movement ◽  
Slap Repair ◽  
Rotator Cuff Injuries ◽  
Complex Anatomy ◽  
Pubmed Database

Background:The glenohumeral joint is a ball-and-socket joint that is inherently unstable and thus, susceptible to dislocation. The traditional and most common anatomic finding is the Bankart lesion (anterior-inferior capsule labral complex avulsion), but there is a wide variety of anatomic alterations that can cause shoulder instability or may be present as a concomitant injury or in combination, including bone loss (glenoid or humeral head), complex capsule-labral tears, rotator cuff tears, Kim´s lesions (injuries to the posterior-inferior labrum) and rotator interval pathology.Methods:A review of articles related to shoulder anatomy and soft tissue procedures that are performed during shoulder instability arthroscopic management was conducted by querying the Pubmed database and conclusions and controversies regarding this injury were exposed.Results:Due to the complex anatomy of the shoulder and the large range of movement of this joint, a wide variety of anatomic injuries and conditions can lead to shoulder instability, specially present in young population. Recognizing and treating all of them including Bankart repair, capsule-labral plicatures, SLAP repair, circumferential approach to pan-labral lesions, rotator interval closure, rotator cuff injuries and HAGL lesion repair is crucial to achieve the goal of a stable, full range of movement and not painful joint.Conclusion:Physicians must be familiarized with all the lesions involved in shoulder instability, and should be able to recognize and subsequently treat them to achieve the goal of a stable non-painful shoulder. Unrecognized or not treated lesions may result in recurrence of instability episodes and pain while overuse of some of the techniques previously described can lead to stiffness, thus the importance of an accurate diagnosis and treatment when facing a shoulder instability.

Sign in / Sign up

Export Citation Format

Share Document