[Dystrophic Calcinosis Cutis: a rare fearsome issue of Chronic Kidney Disease].

Disorders of calcium-phosphate-parathormone balance, are very important issues in ESRD patients, that may lead to severe complications, as dystrophic calcinosis cutis, a rare disease, caused by calcium salt deposits in cutaneous or subcutaneous tissues and many organs. We present the case of a 47 years old woman, in ESRD due to membranous glomerulopathy, treated by peritoneal dialysis, who, after 7 months of dialysis, developed painful masses on second finger and fifth metacarpus of the right hand. Laboratory and instrumental data showed hyperparathyroidism with a parathyroid mass consistent with adenoma. Increasing of therapy with phosphate binders and cinacalcet only, was not effective to solve cutaneous masses, that were biopsied. Histological exam revealed deposition of amorphic material with calcific component, consistent with cutaneous dystrophic calcinosis. We further increased dialysis and therapy and we observed complete regression of masses in 2 months.

Stiff hands and feet, facial deformities.

The appearance of the skin on this woman's face, hands, and feet helped us to recognize an advanced case of an autoimmune disease.

Tropical diabetes hand syndrome with autoamputation of the digits: case report and review of literature.

The tropical diabetes hand syndrome is a complication affecting patients with diabetes mellitus in the tropics, and consists of localized cellulitis, swelling and ulceration of the hands which may progress to fulminant sepsis and gangrene of the whole limb. It is associated with a poor outcome. We report a 32 year old woman with tropical diabetes hand infection with autoamputation of the digits, review the relevant literature, and highlight the need for prevention and early hospital presentation in diabetics with hand infection, in order to prevent potentially crippling or fatal complications.

The use of kinesiology taping method in patients with rheumatoid hand--pilot study.

BACKGROUND: Rheumatoid arthritis (RA) most frequently affects smaller joints in the hands and feet. Among the most common deformations resulting from the progression of the disease are ulnar deviation, Boutonniere deformity, swan neck deformity, contractures and limited range of movement in the hand and wrist joints, muscular atrophy of long and short muscles. The topic of this article is the influence of using Kinesiology Taping method on the functioning of the hand of the patient suffering from rheumatoid arthritis. MATERIAL AND METHODS: The research involved 20 patients suffering from rheumatoid arthritis (16 women, 4 men), treated in the Hospital in Kup. Average age of patients was 62.2. Research subjects, apart from pharmacological treatment in the hospital ward, received standard physiotherapy. In case of 10 patients additional K-Active Tape applications were used to correct ulnar positioning of the hand and improve hand functioning. Prior to physiotherapy, all patients were given a hand functioning test and a dynamometer measurement was made. The tests were repeated after the 2-week rehabilitation process has been completed. The results were subjected to statistical analysis with the use of the Wilcoxon test and the U Mann-Whitney test. The assessment of the correlation between analysed parameters was made with the use of linear correlation test. RESULT: In the group where Kinesiology Tape applications were used, hand muscle strength increased significantly (p<0.05) in comparison with the group treated with standard physiotherapy. Hand muscle strength increase correlated with the tempo of carrying out the hand functioning test (r>0.8). CONCLUSION: Results suggest Kinesiology Taping method useful for physiotherapy of rheumatoid hand.

[Deformation of the fist due to Taekwondo training]. / Droht dieser Faust bald das Knock-out?

Over a period of 25 years a 40-year-old taekwondo world champion had conditioned his hand for so-called "breaking championships", by repeatedly striking progressively harder materials (sand, dried peas, a mixture of dried peas and small stones, and such like). An MRI investigation revealed an augmentation of tissue between the heads of the metacarpals. The biomechanical effect resulting from this "smoothing" of the striking area of the fist is to reduce the peak load acting on the prominent bony elements on impact, and thus reduce the risk of injury. The build-up of tissue represents a response of connective tissue to repetitive microtrauma.

Thalamic hand dystonia: an MRI anatomoclinical study.

Focal dystonia has been attributed to lesions involving the basal ganglia and/or thalamus. Hand dystonia was studied in a patient with a unilateral thalamic infarction documented by MRI. A 18-year-old girl presented with severe isolated dystonia of the right hand as a sequel of perinatal infarction. MRI scan revealed infarction affecting part of the dorsomedian, lateral posterior, ventral lateral, ventral posterior lateral nuclei, and centromedian-parafascicular nucleus of the contralateral thalamus. The unique MRI anatomoclinical presentation of this case, taken together with the literature data, could provide evidence that a lesion affecting one or several thalamic nuclei, including the centromedian nucleus, can induce hand dystonia.

Mixed sclerosing bone dystrophy presenting with upper extremity deformities. A case report and review of the literature.

We present a detailed study of a 59-year-old white woman with mixed sclerosing bone dystrophy: the rare occurrence of two or more sclerosing bone dysplasias in a single subject. She exhibited features of osteopoikilosis, osteopathia striata and melorheostosis. The symptoms were primarily the result of the melorheostosis lesions which were distributed within the C6 sclerotome. This is an unusual case of mixed sclerosing bone dystrophy in that the upper extremity was the main site of involvement, instead of the usual symmetrical involvement of all limbs. The patient developed a recalcitrant lateral epicondylitis in the un-involved contralateral elbow that required surgical treatment.

Psoriatic arthritis and acquired immunodeficiency syndrome.

We describe 2 patients who developed psoriatic arthritis during the course of acquired immunodeficiency syndrome. Both patients developed skin and articular involvement characteristic of psoriatic arthritis; these manifestations were refractory to conventional therapy. Our findings suggest that psoriatic arthritis should be added to the expanding spectrum of musculoskeletal manifestations of the acquired immunodeficiency syndrome.

Alumina ceramic prosthesis arthroplasty of the metacarpophalangeal joint in the rheumatoid hand. A 2-4-year follow-up study.

Swanson's finger implant is being widely used to improve deformity of the thumb and finger and to restore function in the rheumatoid hand. Breakage of the implant and implant synovitis have been the most troublesome complications. The authors developed an alumina ceramic finger prosthesis to lessen these complications. This prosthesis was used for the metacarpophalangeal joint in 5 cases of flexion deformity of the thumb and in 21 cases (82 digits) with ulnar drift deformity. These cases were followed for 24-62 months (average, 38 months). Postoperative extension of the thumb was limited to 18 degrees and flexion was 48 degrees, on average. Postoperative range of motion was 30 degrees. The average limitation of extension of all digits was 18 degrees, and the average flexion was 54.5 degrees. The average range of motion was 36.5 degrees. Flexion deformity of the metacarpophalangeal joint of the thumb disappeared after operation, and ulnar drift was reduced to less than 10 degrees deviation in 87.8%. No dislocation or fracture of the prosthesis has been found on roentgenologic examination during short-term follow-up study. This prosthesis is useful for reducing deformity of the thumb and the finger in the rheumatoid hand. Postoperative extension of the metacarpophalangeal joint, however, has been unsatisfactory. The design of the prosthesis should be improved so that the rotational center of the metacarpophalangeal joint is located palmarly.

Care of the hand in recessive epidermolysis bullosa.

Epidermolysis bullosa refers to a group of disorders whose common feature is blistering of the skin. This paper deals specifically with the loss of motion and digital function resulting from the recessive dystrophic type of epidermolysis bullosa in five young patients aged 3 to 11 years. Indications for surgery and preoperative planning are discussed. Special management considerations included skin care, the need for dietary supplements, and a preference for ketamine anesthesia. Epidermal degloving, full release of contractures, the use of split-thickness skin grafts, and immobilization and suspension of the hand by means of a traction bow without the use of other dressings constituted the important operative points. Postoperative treatment emphasizes wound care, splinting, and gradual mobilization of the joints. Long-term use of a splint to provide gentle digital separation helped prevent early recurrence of webbing. All the patients obtained increased joint motion and enhanced hand function as a result of their treatment.