The Tenosynovitis of Fingers Associated with Transthyretin Amyloidosis

2020 ◽  
Vol 25 (03) ◽  
pp. 340-344
Author(s):  
Yukinori Hara ◽  
Yasuhito Tajiri ◽  
Kenichi Kawano ◽  
Shinya Hoshikawa ◽  
Yusuke Kita
Keyword(s):  
Early Stage ◽  
Patient Characteristics ◽  
Tendon Sheath ◽  
Clinical Findings ◽  
Amyloid Deposition ◽  
Wild Type ◽  
Transthyretin Amyloidosis ◽  
Flexor Tendon Sheath ◽  
Tunnel Syndrome ◽  
The Mean

Background: Amyloidosis treatment has advanced rapidly along with the discovery of drugs to prevent amyloid deposition. Therefore, it is vital to detect amyloidosis at an early stage. Wild-type transthyretin, which can cause carpal tunnel syndrome, may also cause finger tenosynovitis. However, the correlation between wild-type transthyretin amyloid and finger tenosynovitis is unclear. Here, we investigated pathological and clinical findings for 20 patients with finger tenosynovitis who underwent operation at our hospital to determine the frequency of transthyretin amyloid deposition in idiopathic finger tenosynovitis. Methods: To check for the presence of amyloid deposition, all specimens (tendon synovium tissue or flexor tendon sheath) resected during the operation were stained by the direct fast scarlet method. Amyloid-positive specimens were evaluated by immunohistochemical staining using an anti-transthyretin antibody. Patient characteristics were evaluated with respect to amyloid presence. Results: Thirteen (65%) of 20 finger tenosynovitis cases had amyloid deposition. Nine (69.2%) of the 13 amyloid-positive cases exhibited extensive transthyretin staining and were considered to have transthyretin amyloid. Amyloid deposition was more frequent in men. The mean number of fingers with tenosynovitis was significantly higher in amyloid-positive cases (3.8 fingers) than in amyloid-negative cases (2.0 fingers). Conclusions: Men with multiple finger tenosynovitis tended to have transthyretin amyloid deposition. Our results support that multiple finger tenosynovitis may serve as an initial indication of evaluation for transthyretin amyloidosis.

Pathology of the Flexor Tendon Sheath in the Spontaneous Carpal Tunnel Syndrome

1987 ◽  
Vol 12 (2) ◽  
pp. 229-232
Author(s):  
N. C. NEAL ◽  
J. McMANNERS ◽  
G. A. STIRLING
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Flexor Tendon ◽  
Tendon Sheath ◽  
Vascular Lesions ◽  
Foreign Body Giant Cell ◽  
Pathological Changes ◽  
Histological Features ◽  
Flexor Tendon Sheath ◽  
Tunnel Syndrome

The histological features of the flexor tendon sheath in the spontaneous carpal tunnel syndrome were studied. The main differences between our findings and previous studies were twofold. Firstly a striking absence of inflammation in our material and secondly the diversity of the pathological changes encountered — alterations in the connective tissue especially the collagen; proliferation with thickening of the tissues of the tendon sheath; fibrosis; amyloid deposition; oedema; vascular lesions including thickening of vessels walls, intimal hyperplasia, and thrombosis; and a foreign body giant cell reaction. Although the lesions described here may not be significant in every case in which they are encountered, they do appear to support the view that pressure in the carpal tunnel and ischaemia are the important factors in a majority of cases of the spontaneous carpal tunnel syndrome.

scholarly journals Treatment With Tafamidis Slows Disease Progression in Early-Stage Transthyretin Cardiomyopathy

2017 ◽  
Vol 11 ◽  
pp. 117954681773032 ◽  
Author(s):  
Marla B Sultan ◽  
Balarama Gundapaneni ◽  
Jennifer Schumacher ◽  
Jeffrey H Schwartz
Keyword(s):  
Disease Progression ◽  
Amyloid Fibrils ◽  
Early Stage ◽  
Heart Association ◽  
Analysis Data ◽  
Amyloid Formation ◽  
Functional Classification ◽  
Wild Type ◽  
Open Label ◽  
Transthyretin Amyloidosis

Background: Transthyretin cardiomyopathy (TTR-CM) is a progressive, fatal disease caused by the accumulation of misfolded transthyretin (TTR) amyloid fibrils in the heart. Tafamidis is a kinetic stabilizer of TTR that inhibits misfolding and amyloid formation. Methods: In this post hoc analysis, data from an observational study (Transthyretin Amyloidosis Cardiac Study; n = 29) were compared with an open-label study of tafamidis in patients with TTR-CM (Fx1B-201; n = 35). To ensure comparable baseline disease severity, patients with New York Heart Association (NYHA) functional classification ≥III were excluded in this time-to-mortality analysis. Results: Patients with either wild-type or Val122Ile genotypes treated with tafamidis have a significantly longer time to death compared with untreated patients ( P = .0004). Similar results were obtained when limiting the analysis to wild-type patients only, without restricting NYHA functional classification ( P = .0262). Conclusions: These results support earlier conclusions suggesting that tafamidis slows disease progression compared with no treatment outside of standard of care and warrant further investigation. Trial Registration: ClinicalTrials.gov, NCT00694161.

Pathology of the flexor tendon sheath in the spontaneous carpal tunnel syndrome

1989 ◽  
Vol 84 (5) ◽  
pp. 866
Author(s):  
John C. Kelleher ◽  
N. C. Neal ◽  
J. McManners ◽  
G. A. Stirling
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Flexor Tendon ◽  
Tendon Sheath ◽  
Flexor Tendon Sheath ◽  
Tunnel Syndrome

Localized Amyloid Deposition in Trigger Finger

2001 ◽  
Vol 26 (4) ◽  
pp. 380-383 ◽  
Author(s):  
S. CORDINER-LAWRIE ◽  
J. DIAZ ◽  
P. BURGE ◽  
N. A. ATHANASOU
Keyword(s):  
Flexor Tendon ◽  
Tendon Sheath ◽  
Amyloid Deposition ◽  
Trigger Finger ◽  
Elderly Adults ◽  
Amyloid Deposits ◽  
Flexor Tendon Sheath ◽  
Sulphated Glycosaminoglycans ◽  
A1 Pulley ◽  
Fibrinoid Degeneration

Trigger finger is due to degeneration and thickening of the proximal portion (A1 pulley) of the flexor tendon sheath, which causes constriction of the flexor tendon. This study reports the presence of localized amyloid deposition in the tendon sheath of 11 of 47 cases (23%) of idiopathic primary trigger finger. Amyloid deposits were only found in patients aged over 46 years old and were present around cells and at sites of mucinous and fibrinoid degeneration which contained highly sulphated glycosaminoglycans. The pathogenic significance of these deposits is uncertain but their small size and presence only in middle-aged and elderly adults suggests that they represent a form of age-associated amyloid deposition.

Unusual causes of carpal tunnel syndrome: space occupying lesions

2011 ◽  
Vol 37 (1) ◽  
pp. 14-19 ◽  
Author(s):  
C.-H. Chen ◽  
T. Wu ◽  
J.-S. Sun ◽  
W.-H. Lin ◽  
C.-Y. Chen
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Tendon Sheath ◽  
Tophaceous Gout ◽  
Palpable Mass ◽  
Ganglion Cysts ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri

Space occupying lesions found at surgery caused or contributed to carpal tunnel syndrome in 23 of 779 patients operated for carpal tunnel syndrome from January 1999 to December 2008. The mean age of these 23 patients was 52.9 years, and in patients who had a local swelling or palpable mass, ultrasonography or magnetic resonance imaging (MRI) was done. All had open release of the transverse carpal ligament and lesions were removed. Histopathology showed tophaceous gout in 10 men, tenosynovitis in seven patients and tumors in eight. The tumors included ganglion cysts in two, lipoma in three and fibroma of the tendon sheath in one. The neurological symptoms subsided after surgery in all. In patients with gout, one had an infected wound and another had recurrence of symptoms 1 year after later. Carpal tunnel syndrome caused by a space occupying lesion is rare and more complicated than idiopathic carpal tunnel syndrome.

TRIGGER DIGITS-ASSOCIATED CARPAL TUNNEL SYNDROME: RELATIONSHIP BETWEEN CARPAL TUNNEL RELEASE AND TRIGGER DIGITS

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 205-208 ◽  
Author(s):  
K. Harada ◽  
H. Nakashima ◽  
K. Teramoto ◽  
T. Nagai ◽  
S. Hoshino ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Flexor Tendon ◽  
Carpal Tunnel Release ◽  
Tendon Sheath ◽  
Flexor Tendon Sheath ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
The Difference ◽  
Performance Rate

Of 875 idiopathic carpal tunnel syndrome (CTS) cases, 101 (11.5%) required trigger digit release operations within three years before and/or after carpal tunnel release (CTR); these 101 cases were investigated, retrospectively. Trigger digit release (TDR) was performed most often after the CTR, especially within three months. Next most common was at the same time as the CTR. The TDR performance rate after CTR was 5.9%. The nerve conduction study (NCS) comparison between trigger digits-associated CTS and isolated CTS showed that pre-operative distal motor latency was significantly more delayed in trigger digits-associated CTS, while there was no evidence of any difference due to age or gender. The difference of operative method (open or endoscopic procedure) did not influence the incidence rate of trigger digits after the CTR. This study suggested that trigger digits-associated CTS has a previously developed wide-ranging narrowing of the flexor tendon sheath.

scholarly journals Systemic Wild-type Amyloid Transthyretin Amyloidosis in Carpal Tunnel Syndrome in Men

2020 ◽  
Vol 34 (2) ◽  
pp. 151-155
Author(s):  
Daiki Sato ◽  
Masahito Yuzurihara ◽  
Kento Takebayashi ◽  
Motoo Kubota ◽  
Shigekuni Tachibana ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Wild Type ◽  
Transthyretin Amyloidosis ◽  
Tunnel Syndrome

scholarly journals Multiple Origins of Plasmodium falciparum Dihydropteroate Synthetase Mutant Alleles Associated with Sulfadoxine Resistance in India

2011 ◽  
Vol 55 (6) ◽  
pp. 2813-2817 ◽  
Author(s):  
Vanshika Lumb ◽  
Manoj K. Das ◽  
Neeru Singh ◽  
Vas Dev ◽  
Wajihullah Khan ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Early Stage ◽  
Wild Type ◽  
Andaman And Nicobar Islands ◽  
Drug Pressure ◽  
Content Type ◽  
Genetic Lineages ◽  
Multiple Origins ◽  
Nicobar Islands ◽  
The Mean

ABSTRACTWith the spread of chloroquine (CQ)-resistant malaria in India, sulfadoxine-pyrimethamine (SP) alone or in combination with artesunate is used as an alternative antimalarial drug. Due to continuous drug pressure, thePlasmodium falciparumparasite is exhibiting resistance to antifolates because of mutations in candidate genes dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps). Our earlier study on flanking microsatellite markers ofdhfrmutant alleles from India had shown a single origin of the pyrimethamine resistance and some minor haplotypes which shared haplotypes with Southeast Asian (Thailand) strains. In the present study, we have analyzed 193 of these IndianP. falciparumisolates for 15 microsatellite loci arounddhpsto investigate the genetic lineages of the mutantdhpsalleles in different parts of the country. Eighty-one of these samples had mutantdhpsalleles, of which 62 were from Andaman and Nicobar Islands and the remaining 19 were from mainland India. Of 112 isolates with a wild-typedhpsallele, 109 were from mainland India and only 3 were from Andaman and Nicobar Islands. Consistent with the model of selection, the mean expected heterozygosity (He) around mutantdhpsalleles (He= 0.55;n= 81) associated with sulfadoxine resistance was lower (P≤ 0.05) than the meanHearound the wild-typedhpsallele (He= 0.80;n= 112). There was more genetic diversity in flanking microsatellites ofdhpsthandhframong these isolates, which confirms the assertion thatdhpsmutations are at a very early stage of fixation in the parasite population. Microsatellite haplotypes around various mutantdhpsalleles suggest that the resistantdhpsalleles have multiple independent origins in India, especially in Andaman and Nicobar Islands. Determining the genetic lineages of the resistantdhpsalleles on Andaman and Nicobar Islands and mainland India is significant, given the role of Asia in the intercontinental spread of chloroquine- and pyrimethamine-resistant parasites in the past.

scholarly journals Septic Tenosynovitis of the Digital Flexor Tendon Sheath in 83 Cattle

Animals ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 1303
Author(s):  
Alexandra Hund ◽  
Markus Senn ◽  
Johann Kofler
Keyword(s):  
Flexor Tendon ◽  
Surgical Techniques ◽  
Tendon Sheath ◽  
Clinical Findings ◽  
Average Life Expectancy ◽  
Anatomical Structures ◽  
Surgical Methods ◽  
Flexor Tendon Sheath ◽  
Distal Interphalangeal ◽  
Digital Amputation

Septic tenosynovitis of the digital flexor tendon sheath (DFTS) is the second most prevalent infection of deeper structures of the distal limb in cattle, after septic arthritis of the distal interphalangeal (DIP) joint. Depending on the type of infection and the involvement of adjacent anatomical structures, various surgical techniques may be used for therapy: Incising the DFTS to resect one or both digital flexor tendons (RDFT), additional resection of the DIP joint (RDIP) or additional digital amputation (RAMP). Our goal was to describe clinical findings and outcome in cattle patients (euthanasia vs. treatment) and the success of surgical methods including improvement of locomotion and postoperative survival time (POST). Data of eighty-three cattle with a mean age of 4.3 years were reviewed in this retrospective study. Overall, 57.7% of tenosynovitis cases were in the lateral DFTS of a hind limb. Fifty-five cattle were treated surgically; the remaining 28 cattle were euthanized following diagnosis. The median cumulative POST was 17.3, 83.1, and 11.9 months for RDFT, RDIP, and RAMP, respectively. Fatal postoperative complications occurred in three cattle. We conclude that the applied methods were successful and allowed the animals to almost reach the average life expectancy of an Austrian dairy cow.

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