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1.
Medicine (Baltimore) ; 100(5): e23828, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592839

RESUMO

ABSTRACT: Dermoscopy is a noninvasive diagnostic technique that is of great value for the differential diagnosis of palmoplantar psoriasis and palmoplantar eczema. Considering the particularity of palmoplantar anatomy, the dermoscopic features of psoriasis and eczema in palm region show fewer differences, compared with those in other parts of the body. Only a few studies have examined the palmoplantar region of psoriasis and eczema patients under a dermoscope.A total of 26 patients with palmoplantar psoriasis and 31 patients with palmoplantar eczema were enrolled in our study. Target palmoplantar areas were observed through general observation and under dermoscope.We found that the presence of white scales and a regular arrangement of dots and globular vessels were significantly indicative of palmoplantar psoriasis, while yellowish scales and an irregular arrangement of atypical vessels were significantly indicative of palmoplantar eczema.


Assuntos
Dermoscopia/métodos , Eczema/diagnóstico , Psoríase/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Mãos/patologia , Humanos , Masculino , Ilustração Médica , Sensibilidade e Especificidade
5.
Medicine (Baltimore) ; 99(31): e21519, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756192

RESUMO

RATIONALE: Pilar cyst mainly occurs on the scalp, but pilar cyst on the dorsum of hand has not been reported. Herein, we provide information to improve the clinical cognition of pilar cyst location. PATIENTS CONCERNS: A 76-year-old man presented with a round nodule on the opisthenar of his right hand for two months without any subjective symptoms. DIAGNOSES: Histological features of the lesion biopsy indicated the diagnosis of pilar cyst. INTERVENTIONS: Surgical resection was made under local anesthesia. OUTCOMES: Complete recovery was achieved after surgery. CONCLUSION: Pilar cyst rarely occurs on the dorsum of hand and its diagnosis depends on histopathological examinations. Surgical resection is the only way to treat it.


Assuntos
Cisto Epidérmico/patologia , Mãos/patologia , Idoso , Cisto Epidérmico/cirurgia , Mãos/cirurgia , Humanos , Masculino
6.
PLoS One ; 15(8): e0237606, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32797089

RESUMO

BACKGROUND: There are many types of hand tumors, and it is often difficult for imaging diagnosticians to make a correct diagnosis, which can easily lead to misdiagnosis and delay in treatment. Thus in this paper, we propose a deep neural network for diagnose on MR Images of tumors of the hand in order to better define preoperative diagnosis and standardize surgical treatment. METHODS: We collected MRI figures of 221 patients with hand tumors from one medical center from 2016 to 2019, invited medical experts to annotate the images to form the annotation data set. Then the original image is preprocessed to get the image data set. The data set is randomly divided into ten parts, nine for training and one for test. Next, the data set is input into the neural network system for testing. Finally, average the results of ten experiments as an estimate of the accuracy of the algorithm. RESULTS: This research uses 221 images as dataset and the system shows an average confidence level of 71.6% in segmentation of hand tumors. The segmented tumor regions are validated through ground truth analysis and manual analysis by a radiologist. CONCLUSIONS: With the recent advances in convolutional neural networks, vast improvements have been made for image segmentation, mainly based on the skip-connection-linked encoder decoder deep architectures. Therefore, in this paper, we propose an automatic segmentation method based on DeepLab v3+ and achieved a good diagnostic accuracy rate.


Assuntos
Mãos/patologia , Processamento de Imagem Assistida por Computador/métodos , Neoplasias/diagnóstico por imagem , Mãos/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Neoplasias/patologia , Redes Neurais de Computação , Sensibilidade e Especificidade , Software
7.
Dermatol Online J ; 26(6)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32815685

RESUMO

BACKGROUND: Squamous cell carcinoma (SCC) is the most common malignancy of the upper limb, and can pose a significant therapeutic challenge. Early treatment needs to be radical whilst maintaining function. METHODS: We describe two cases of upper limb squamous cell carcinoma treated with radiotherapy, review the literature on radiotherapy as a primary treatment modality, and discuss the specific difficulties treating SCC in the hand. RESULTS: Radiation therapy was inadequate in tumor clearance in both cases, with recurrence both extensive and distal to the initial focus. Moreover, both patients developed progressive functional loss related to pain, swelling, and stiffness. CONCLUSION: The evidence basis for radiation therapy as a primary modality is limited, although clearance rates are comparable to surgery. Both radiotherapy and surgery can be utilized to treat SCC. However, we make the case for the hand being especially susceptible to the unwanted side effects of radiotherapy.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias Cutâneas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia , Carcinoma de Células Escamosas/patologia , Feminino , Mãos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Lesões por Radiação/patologia , Radioterapia/efeitos adversos , Neoplasias Cutâneas/patologia
8.
Dermatol Online J ; 26(6)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32815692

RESUMO

Red puffy hand syndrome is an uncommon clinical manifestation of intravenous drug abuse, which presents with bilateral, painless and non-pitting erythema and edema of the dorsal hands. The pathophysiology is believed to primarily be the result of lymphatic blockage from either direct toxicity of the injected drug, drainage of impurities, or infection complications. A woman in her 40's with remote intravenous drug use presented with over a decade of fixed, painless erythema and swelling of bilateral dorsal hands. Owing to an elevated rheumatoid factor, which would later be attributed to patient's untreated hepatitis C, these findings were mistaken for rheumatoid arthritis and unnecessarily treated with methotrexate and prednisone. Upon proper recognition of her underlying Red puffy hand syndrome, systemic medications were discontinued and appropriate care was initiated with lymphedema decongestion and occupational therapy. Red puffy hand syndrome, albeit rare, is an important manifestation of intravenous drug abuse; its recognition will spare patients from unnecessary systemic treatments.


Assuntos
Artrite Reumatoide/diagnóstico , Erros de Diagnóstico , Edema/diagnóstico , Mãos/patologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Edema/etiologia , Feminino , Humanos
9.
J Am Acad Orthop Surg ; 28(16): e686-e695, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32769717

RESUMO

Scleroderma is derived from Latin meaning hard skin. It is an uncommon, noninflammatory connective tissue disorder characterized by increased fibrosis of the skin and in certain variants, multiple other organ systems. Scleroderma involves a spectrum of pathologic changes and anatomic involvement. It can be divided into localized and systemic scleroderma. Hand involvement is common and can include calcium deposits within the soft tissues, digital ischemia, and joint contracture. Nonsurgical management consists of lifestyle modifications, biofeedback, therapy for digital stiffness/contracture, and various pharmacologic medications. When nonsurgical measures are unsuccessful, certain surgical options may be indicated, each with their inherent advantages and pitfalls. Patients with scleroderma who are undergoing surgical intervention pose unique difficulties because of their poorly vascularized tissue and deficient soft-tissue envelopes, thus increasing their susceptibility to wound healing complications and infection. Some subgroups of patients are frequently systemically ill, and specific perioperative measures should be considered to reduce their surgical risk. The spectrum of hand manifestations seen in patients with scleroderma will be reviewed with the focus on evaluation and management.


Assuntos
Mãos , Procedimentos Ortopédicos/métodos , Esclerodermia Localizada/cirurgia , Escleroderma Sistêmico/cirurgia , Calcinose , Mãos/patologia , Mãos/cirurgia , Humanos , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente , Esclerodermia Localizada/diagnóstico , Esclerodermia Localizada/patologia , Esclerodermia Localizada/terapia , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/patologia , Escleroderma Sistêmico/terapia
11.
Medicine (Baltimore) ; 99(27): e20897, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629680

RESUMO

INTRODUCTION: Acrometastasis is infrequent and generally indicates a wider spread of metastasis with poor prognosis. The diagnosis is challenging, as it might mimic an infectious, inflammatory, or metabolic disease. Acrometastasis are most commonly found in patients with lung, gastrointestinal, kidney, and breast cancer. Only 3 cases of cervical cancer associated with hand metastasis have been reported in the literature. PATIENT CONCERNS: Herein, we report a 58-year-old patient with locally advanced cervical cancer and recurrence in the right thumb as presentation of widespread disseminated disease. She initially presented with adenocarcinoma of the uterine cervix and was treated with concurrent chemoradiation followed by high-dose rate brachytherapy. Six months later, she developed an insidious onset of pain and swelling in the right thumb, erythema, and edema, mimicking cellulitis. DIAGNOSIS: A biopsy of the soft tissues of the thumb was performed, and the histopathology indicated metastasis of adenocarcinoma to the bone and soft tissues. INTERVENTIONS AND OUTCOMES: The patient rejected further treatment and died of progressive disease 4 months after the diagnosis of the recurrence. CONCLUSION: Metastases in unusual sites are a diagnostic challenge, and there is no standardized treatment. Timely diagnosis and treatment can improve the prognosis of these patients and might preserve their quality of life.


Assuntos
Mãos/patologia , Neoplasias do Colo do Útero/patologia , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias do Colo do Útero/terapia
12.
Anticancer Res ; 40(6): 3411-3415, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487638

RESUMO

BACKGROUND/AIM: Acral lentiginous melanoma (ALM) is the least common subtype of cutaneous melanoma and typically occurs on the palms, soles, and nails. Tumor characteristics and disease severity in the US population are not well understood. Our aim was to analyze the characteristics of ALM of the extremities. PATIENTS AND METHODS: We queried the National Cancer Database to identify patients with the diagnosis of ALM and common malignant melanoma located in the extremities (CMME). We compared demographic, tumor, and treatment characteristics between patients with ALM and those with CMME. Statistical analysis was performed with chi-squared test and multivariate logistic regression models. RESULTS: We identified 5,203 patients with ALM and 118,485 with CMME. When compared with patients with CMME, those with ALM were more likely to be older than 80. years at diagnosis [odds ratio (OR)=2.85, 95% confidence intervaI (CI)=2.12-3.82; p<0.001], have stage III disease (OR=4.22, 95% CI=1.47-12.16; p=0.01), and have ulceration (OR=1.52, 95% CI=1.33-1.74; p<0.001). Moreover, patients with ALM were less likely to have a mitotic count of 1/mm2 or greater (OR=0.57, 95% CI=0.48-0.67; p<0.001). No statistical difference was found for sex, lymph node involvement, regression, and use of surgery, radiotherapy, and immunotherapy between groups. CONCLUSION: Age, disease stage, ulceration, and mitotic count are independent factors associated with ALM. Knowledge of the disease characteristics may allow for better diagnosis and understanding of disease pathophysiology.


Assuntos
Pé/patologia , Mãos/patologia , Melanoma/diagnóstico , Melanoma/epidemiologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Bases de Dados Factuais , Feminino , Humanos , Masculino , Melanoma/terapia , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Razão de Chances , Estudos Retrospectivos , Neoplasias Cutâneas/terapia , Resultado do Tratamento , Adulto Jovem
13.
Jt Dis Relat Surg ; 31(2): 341-345, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584735

RESUMO

OBJECTIVES: This study aims to evaluate the distribution and prevalence of pediatric hand tumors and tumor-like lesions according to age and gender. PATIENTS AND METHODS: We retrospectively examined the details of hospital records of 646 patients who were operated for hand mass between January 2009 and January 2019 and whose pathological diagnosis was established in the same hospital. A total of 54 patients (18 males, 36 females; mean age 12.07 years; range, 3 month to 17 years) under 18 years of age who had been operated for the wrist or hand mass were included in the study. RESULTS: Out of 54 tumors, 53 were benign (98%) and one was malignant (2%). There were 42 soft tissue tumors (78%) and 12 bone tumors (22%). The most common soft tissue mass was ganglion cyst (n=12). Six out of 12 ganglion cysts were on the dorsal side of hand or wrist and six were on the volar side. The distribution of the tumors according to gender was not statistically significant (p=0.73). We had two recurrences: one patient with giant cell tumor of the tendon sheath and one with palmar fibromatosis. CONCLUSION: Pediatric hand/wrist masses are mostly benign tumorous conditions. The location of the pathologies may be different from the adults. Diagnosis of the tumor should be established carefully clinically and radiologically while malignant tumors should be kept in mind by both pediatricians and orthopedic surgeons.


Assuntos
Cistos Glanglionares , Mãos , Procedimentos Ortopédicos , Neoplasias de Tecidos Moles , Punho , Fatores Etários , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Criança , Feminino , Cistos Glanglionares/patologia , Cistos Glanglionares/cirurgia , Mãos/diagnóstico por imagem , Mãos/patologia , Mãos/cirurgia , Humanos , Masculino , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Radiografia/métodos , Estudos Retrospectivos , Fatores Sexuais , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Punho/diagnóstico por imagem , Punho/patologia , Punho/cirurgia
17.
Trop Doct ; 50(3): 251-253, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32437296

RESUMO

We present a patient with severe Plasmodium falciparum malaria of seven days' duration who developed an altered sensorium of one day. During hospital admission, peripheral symmetrical gangrene of hands and feet followed, despite normal limb vasculature.


Assuntos
Gangrena/etiologia , Malária Falciparum/complicações , Idoso de 80 Anos ou mais , Feminino , Pé/patologia , Gangrena/parasitologia , Mãos/patologia , Humanos , Malária Falciparum/diagnóstico , Plasmodium falciparum/isolamento & purificação
18.
Reumatol. clín. (Barc.) ; 16(2,pt.2): 156-160, mar.-abr. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-194339

RESUMO

INTRODUCTION: Osteoarthritis (OA) is the most prevalent articular disease worldwide, and its prevalence is highly variable depending on the classification criteria, population studied, and/or affected joints considered. Reporting epidemiologic data about clinical and radiological OA prevalence in Mexico has not been done before. PATIENTS AND METHODS: A descriptive cross-sectional study was carried out with participants of Mexico City, and included both men and women above 40 years of age. All participants were evaluated with radiological and clinical criteria for OA. RESULTS: Two hundred and four individuals participated in the study: 80 men (39.2%) and 124 women (60.8%). The average age was 57.4±10.9 years. Using clinical criteria alone, 36 participants were found to have hand OA (17.6%; 95% CI, 13-23.4), 37 with hip OA (18.1%; 95% CI 13.4-24), and 40 with knee OA (19.6%; 95% CI 14.7-25.6). When radiological criteria were used, 51 individuals were reported as having hand OA (25%; 95% CI 19.5-31), 54 with hip OA (26.5%; 95% CI 20.8-32.9), and 52 with knee OA (25.5%; 95% CI 20-31.8). When clinical criteria were used and then corroborated with radiological criteria, the prevalence was 28 individuals with hand OA (13.7%; 95% CI 9.6-19), 31 with hip OA (15.1%; 95% CI 10.9-20.7), and 36 with knee OA 36 (17.6%; 95% CI 12.2-26.2). DISCUSSION: The prevalences found in this study are greater than those found in other studies in Mexico that only report clinical criteria


INTRODUCCIÓN: La osteoartritis (OA) es la enfermedad articular más prevalente a nivel mundial; la prevalencia reportada es muy variable ya que depende de los criterios de clasificación, la población estudiada y/o las articulaciones afectadas. Previamente no se habían reportado datos epidemiológicos sobre la prevalencia clínica y radiológica de la OA en México. PACIENTES Y MÉTODOS: Se realizó un estudio descriptivo y transversal, se incluyeron participantes de cualquier sexo mayores de 40 años de la Ciudad de México, todos ellos fueron evaluados con criterios radiológicos y clínicos para la OA. RESULTADOS: Se analizaron 204 individuos, 80 varones (39,2%) y 124 mujeres (60,8%). La edad promedio fue de 57,4±10,9 años. Usando solo criterios clínicos, 36 participantes tuvieron OA de mano (17,6%, IC 95%, 13-23,4), 37 con OA de cadera (18,1%, IC 95% 13,4-24) y 40 con OA de rodilla (19,6% IC 95% 14,7-25,6). Cuando se utilizaron los criterios radiológicos, se informó que 51 individuos tenían OA de mano (25%: IC 95% 19,5-31), 54 con OA de cadera (26,5% IC 95% 20,8-32,9) y 52 con OA de rodilla (25,5%; IC 95% 20-31,8). Al utilizar criterios clínicos y luego corroborados por criterios radiológicos, la prevalencia fue de 28 individuos con OA de mano (13,7% IC 95% 9,6-19), 31 con OA de cadera (15,1% IC 95% 10,9-20,7) y 36 con OA de rodilla 36 (17,6%; IC 95% 12,2-26,2). DISCUSIÓN: Las prevalencias encontradas en este estudio son mayores a las encontradas en otros estudios en México que solo reportan criterios clínicos


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Quadril/epidemiologia , México , Epidemiologia Descritiva , Estudos Transversais , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Quadril/diagnóstico por imagem , Mãos/diagnóstico por imagem , Mãos/patologia
20.
Am J Emerg Med ; 38(7): 1540.e5-1540.e8, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32197716

RESUMO

Capnocytophaga canimorsus, commonly transmitted by dog bites, can cause severe sepsis, and the mortality rate is very high. We experienced a case of hemophagocytic lymphohistiocytosis (HLH) complicated by severe sepsis caused by C. canimorsus. A 58-year-old man with no remarkable medical history was admitted to another hospital with fever and mild consciousness disorder developed 3 days after being bitten by his dog. The next day, the patient developed disseminated intravascular coagulation and shock and was transferred to our emergency medical center. Blood tests showed hyperferritinemia and cytopenia, and bone marrow aspiration was performed. As a result, we diagnosed severe sepsis and HLH. Once antibiotic and steroid therapy was started, the patient's infection and cytopenia improved. Unfortunately, the patient's fingers and toes required amputation, but his life was saved, and he was discharged from hospital. Because HLH may be hidden in such cases, it may be necessary to measure serum ferritin and perform bone marrow aspiration if hyperferritinemia is suspected.


Assuntos
Capnocytophaga , Infecções por Bactérias Gram-Negativas/complicações , Linfo-Histiocitose Hemofagocítica/microbiologia , Sepse/microbiologia , Amputação , Animais , Mordeduras e Picadas/complicações , Coagulação Intravascular Disseminada/etiologia , Cães , Ferritinas/sangue , Pé/patologia , Pé/cirurgia , Infecções por Bactérias Gram-Negativas/diagnóstico , Mãos/patologia , Mãos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/cirurgia
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