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2.
Medicine (Baltimore) ; 100(2): e23611, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466121

RESUMO

RATIONALE: Neurofibromas can develop as part of neurofibromatosis or as a solitary tumor. Although solitary neurofibromas generally grow slowly, they rarely grow for more than 10 years, and such tumors have not been described in the hand. PATIENT CONCERNS: A 60-year-old woman presented with a mass on the dorsum of the proximal phalanx of the right thumb that had been enlarging since more than a decade. DIAGNOSES: Preoperative imaging revealed a moderately defined soft tissue mass, which measured 1.5 cm × 1.5 cm × 0.7 cm, with no bone and joint abnormalities on the right thumb. The final diagnosis of the tumor was solitary neurofibroma without evidence of neurofibromatosis. INTERVENTION: En bloc resection of the tumor was performed through a longitudinal skin incision. OUTCOMES: After surgery, the patient had no complaints of pain but had a temporary tingling sensation. After 14 months of follow-up, no signs of recurrence of the tumor were observed and she was highly satisfied with the results of the surgery. LESSONS: Solitary neurofibroma is quite rare, especially one in the hand. However, in dealing with soft tissue tumors of the hand, particularly those with neurologic symptoms, neurofibroma should be included in the differential diagnosis.


Assuntos
Neurofibroma/patologia , Polegar/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neurofibroma/cirurgia , Polegar/cirurgia
4.
J Cancer Res Ther ; 16(4): 926-929, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32930143

RESUMO

Benign and malignant bone tumors arise in small bones of the hands and feet. Nevertheless, secondary deposits at these sites are extremely rare. We report a peculiar case of an adult man who presented with thumb swelling, which was later discovered to be a metastasis from renal cell carcinoma. Such cases have a sinister prognosis with a survival rate of 6-12 months from the time of diagnosis. We intend to discuss the diagnostic dilemma and treatment of acrometastases.


Assuntos
Neoplasias Ósseas/secundário , Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/diagnóstico , Neoplasias Pulmonares/secundário , Polegar/patologia , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico
6.
Dev Neurorehabil ; 23(1): 50-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30668211

RESUMO

Aim: To determine the feasibility and acceptability of parent-delivered elastic taping to the thumb and wrist in infants with cerebral palsy (CP).Design: Randomized cross-over feasibility trial.Participants: 20 infants (11 male; mean age 22 months) with CP.Intervention: Groups A and B received taping for 4 and 2 weeks, respectively.Outcomes: Primary: Recruitment and retention rates; adherence to protocol; Parent Satisfaction Questionnaire. Secondary: House Thumb score; Zancolli classification; Assisting Hand Assessment (AHA)/mini AHA. Exploratory: Duration of hand regard, thumb in palm, and open hand contact with toys during AHA/mini AHA.Results: Recruitment was feasible (95.2% uptake). Completion rates were 80% and 60% in Groups A and B. Questionnaire feedback was generally positive. Some parents reported increased awareness of the taped hand. Objective improvements were rare though one participant showed consistent improvement in thumb position.Conclusion: Taping proved feasible and acceptable; individual case benefit suggests further research is required.Trial registration: ISRCTN41918400.


Assuntos
Paralisia Cerebral/reabilitação , Reabilitação Neurológica/métodos , Polegar/patologia , Atividades Cotidianas , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Pais
8.
BMC Cancer ; 19(1): 1002, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653251

RESUMO

BACKGROUND: Amputation is the standard of care even for early-stage subungual melanomas (SUMs), known as nail apparatus melanoma, because the nail bed and nail matrix are close to the distal phalanx. However, a recent study demonstrated that not all patients with SUMs had histologic invasion of the underlying distal phalanx. As most SUMs occur in the thumb or big toe, amputation of either the thumb or big toe substantially interferes with activities of daily living, including poor cosmesis, loss of function, and phantom pain. Non-amputative digit preservation surgery can thus be applied in such cases without compromising patient prognosis. METHODS: We are conducting a multi-institutional single-arm trial to confirm the safety and efficacy of non-amputative digit preservation surgery. We will compare our results with those reported in the Japanese Melanoma Study, in which patients underwent amputation for SUMs as a traditional standard of care. Patients aged between 20 and 80 years with stage I, II, or III without evidence of tumor invasion to the underlying distal phalanx on preoperative radiograph are included in the study. The primary endpoint is major relapse-free survival (major RFS), which does not include local recurrence as an event; secondary endpoints include overall survival, digit-preservation survival, relapse-free survival, local relapse-free survival, partial relapse-free survival, and incidence of adverse events. A total of 85 patients from 21 Japanese institutions will be recruited within 5.5 years, and the follow-up period will last at least 5 years. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in August 2017, and patient enrollment began in November 2017. Ethical approval was obtained from each institution's Institutional Review Board prior to patient enrollment. DISCUSSION: This is the first prospective trial to confirm the safety and efficacy of non-amputative digit preservation surgery for SUM without distant metastasis or bony invasion. The results of this trial could provide evidence to support this less-invasive surgery as a new standard of care to preserve adequately functioning digits. TRIAL REGISTRATION: Registry number: UMIN000029997 . Date of Registration: 16/Nov/2017. Date of First Participant Enrollment: 12/Dec/2017.


Assuntos
Melanoma/epidemiologia , Melanoma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doenças da Unha/epidemiologia , Doenças da Unha/cirurgia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Amputação/métodos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Estudos Prospectivos , Polegar/patologia , Polegar/cirurgia , Dedos do Pé/patologia , Dedos do Pé/cirurgia , Adulto Jovem
9.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 36(9): 890-892, 2019 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-31515783

RESUMO

OBJECTIVE: To detect potential mutation in a Chinese pedigree affected with congenital limb malformations. METHODS: Clinical data was collected. Genomic DNA was extracted from peripheral blood samples of family members. The zone of polarizing activity regulatory sequence (ZRS) were amplified by PCR and subjected to direct sequencing. RESULTS: Among the 13 individuals in this pedigree, there were 4 PPD patients, who were characterized by varying degrees of deformity. The female patients suffered triphalangeal thumb and preaxial polydactyly, while the male patients only had preaxial polydactyly. Only one patient had foot involvement. TA heterogeneous mutations was discovered in the ZRS (105C>G) in all patients, the same mutation was not detected in 2 healthy family members. CONCLUSION: The inheritance pattern of PPD was autosomal dominant inheritance. There was a significant variability of symptoms among family patients. The heterozygous mutation of the ZRS (105C>G) probably underlie the disease.


Assuntos
Deformidades Congênitas da Mão/genética , Deformidades Congênitas dos Membros/genética , Proteínas de Membrana/genética , Polidactilia/genética , Feminino , Testes Genéticos , Humanos , Masculino , Linhagem , Polegar/patologia
12.
Osteoarthritis Cartilage ; 27(9): 1315-1323, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31136802

RESUMO

OBJECTIVE: Osteophyte formation is a critical part of the degeneration of a joint with osteoarthritis (OA). While often qualitatively described, few studies have succeeded in quantifying osteophyte growth over time. Using computed tomography (CT) image data from a longitudinal, observational study of thumb carpometacarpal (CMC) OA, our aim was to quantify osteophyte growth volume and location over a three-year period in men and women. METHOD: Ninety patients with early thumb OA were recruited and assessed at baseline, 1.5 years, and 3 years with CT imaging. Osteophyte volume and location on the trapezium and first metacarpal were determined using a library of 46 healthy subjects as a nonarthritic reference database. RESULTS: There was a significant increase in osteophyte volume for women and men over the three-year follow-up in the trapezium (86.8 mm3-120.5 mm3 and 165.1 mm3-235.3 mm3, means respectively) and in the proximal metacarpal (63 mm3-80.4 mm3, and 115.8 mm3-161.7 mm3, respectively). The location of osteophyte initiation and growth was consistent across subjects and was located in non-opposing regions on the trapezium and first metacarpal. Osteophyte growth occurred about the radial and ulnar margins of the trapezial facet, while on the proximal metacarpal, growth occurred principally about the volar and dorsal margins of the facet. CONCLUSION: Osteophyte growth occurred in early thumb osteoarthritis over three years. Growth was localized in specific, non-opposing regions on the trapezium and metacarpal, raising intriguing questions about the triggers for their formation, whether the mechanisms are mechanical, biological or a combination of both.


Assuntos
Articulações Carpometacarpais/patologia , Osteoartrite/patologia , Osteófito/patologia , Polegar , Adulto , Articulações Carpometacarpais/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Polegar/diagnóstico por imagem , Polegar/patologia , Tomografia Computadorizada por Raios X
15.
Bull Hosp Jt Dis (2013) ; 77(1): 57-63, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30865866

RESUMO

The basal joint is a collection of articulations at the base of thumb that serve an important function in the overall dexterity of the hand. The unique anatomy of the basal joint provided many evolutionary advantages to the human hand, but also made this joint susceptible to arthrosis and degenerative changes. Surgical treatment of basal joint arthritis has continued to evolve since it was first described in 1949, including excisional arthroplasty, tendon interposition, ligament reconstruction, implant arthroplasty, and arthroscopy. A review of the pathoanatomy, history, and surgical treatments are assessed including a critical review of the literature.


Assuntos
Artrite/cirurgia , Articulações Carpometacarpais/cirurgia , Procedimentos Ortopédicos/métodos , Polegar/cirurgia , Artrite/diagnóstico por imagem , Artrite/história , Artrite/fisiopatologia , Fenômenos Biomecânicos , Articulações Carpometacarpais/diagnóstico por imagem , Articulações Carpometacarpais/patologia , Articulações Carpometacarpais/fisiopatologia , História do Século XX , História do Século XXI , Humanos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/história , Recuperação de Função Fisiológica , Polegar/diagnóstico por imagem , Polegar/patologia , Polegar/fisiopatologia , Resultado do Tratamento
16.
J Hand Surg Am ; 44(11): 994.e1-994.e6, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30910238

RESUMO

Osteoblastoma is a benign aggressive primary bone tumor that occasionally presents in the hand. Because surgical treatment remains the mainstay of treatment, there are no established nonsurgical pharmacological options for patients in whom resection is not feasible. Novel therapies, such as denosumab, are currently being investigated in primary bone tumors. We report a case of osteoblastoma of the first metacarpal that was successfully treated with denosumab. The patient showed a rapid and dramatic response to treatment that led to the transformation of a locally destructive tumor into an ossified painless mass, restoring function while avoiding surgery.


Assuntos
Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/patologia , Denosumab/administração & dosagem , Música , Osteoblastoma/tratamento farmacológico , Osteoblastoma/patologia , Adolescente , Biópsia por Agulha , Neoplasias Ósseas/diagnóstico por imagem , Seguimentos , Humanos , Imuno-Histoquímica , Injeções Subcutâneas , Imageamento por Ressonância Magnética/métodos , Masculino , Ossos Metacarpais/efeitos dos fármacos , Ossos Metacarpais/patologia , Osteoblastoma/diagnóstico por imagem , Medição de Risco , Polegar/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
17.
J. bras. nefrol ; 41(1): 65-73, Jan.-Mar. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1002423

RESUMO

Abstract Introduction: Evaluate the association between the thumb adductor muscle thickness and the patient's nutritional status, and propose cutoff points for muscle mass depletion in elderly patients with chronic kidney disease (CKD) under conservative treatment. Epidemiological and cross-sectional study, including patients with CKD stages 3 to 5, older than 60 years. Socioeconomic, clinical, physical activity and anthropometric data was obtained. TAMT was described and compared according to CKD stage, socioeconomic data, physical activity, nutritional status and correlated with age, glomerular filtration rate and anthropometric variables. Receiver Operating Characteristic (ROC) curves were produced, considering the lean tissue index classification as reference. The cut-off point was defined by the Youden index. Results: We evaluated 137 individuals. The TAMT was lower in malnourished and/or depleted muscle mass individuals; among males it was higher among those who practiced physical activities (p <0.05). This measure was moderately correlated with BMI, calf and brachial circumferences, lean body tissue, lean tissue index and body cell mass (r <0.7); negatively with age (r = -0.34). The ROC curve analysis determined cut points of 15.33 mm for females and 20.33 mm for males, with 72.22% and 62.50% accuracy, respectively. Conclusion: TAMT is used to estimate muscle mass and we suggest the cutoff point is useful to rule out the likelihood of muscle mass depletion. It is recommended that it be used in a complementary way in nutritional assessment.


Resumo Introdução: Avaliar a associação da espessura do músculo adutor do polegar (EMAP) com o estado nutricional e propor pontos de corte para depleção de massa muscular em idosos portadores da doença renal crônica (DRC) em tratamento conservador. Metodologia: Estudo epidemiológico, delineamento transversal, incluindo portadores de DRC estágios 3 a 5, acima de 60 anos. Obteve-se dados socioeconômicos, clínicos, prática de atividade física e antropométricos. A EMAP foi descrita e comparada de acordo com o estágio da DRC, dados socioeconômicos, atividade física e estado nutricional e correlacionada com idade, taxa de filtração glomerular e variáveis antropométricas. Foram produzidas curvas Receiver Operating Characteristic (ROC), considerando como padrão de referência a classificação do índice de tecido magro. O ponto de corte foi definido pelo índice Youden. Resultados: Avaliou-se 137 indivíduos. A EMAP foi inferior nos desnutridos e/ou com depleção de massa muscular; no sexo masculino foi superior nos praticantes de atividade física (p<0,05). A medida se correlacionou moderadamente com IMC, circunferência da panturrilha e braquial, tecido de massa magra, índice de tecido magro e massa celular corporal (r<0,7), e negativamente com a idade (r=-0,34). A análise da curva ROC determinou pontos de corte de 15,33 mm para o sexo feminino e 20,33 mm para o masculino, com acurácia de 72,22% e 62,50%, respectivamente. Conclusão: A EMAP serve para estimar a massa muscular, e o ponto de corte sugerido é útil para afastar a probabilidade de depleção de massa muscular. Recomenda-se que seja utilizada de forma complementar na avaliação nutricional.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Polegar/patologia , Envelhecimento/fisiologia , Avaliação Nutricional , Músculo Esquelético/patologia , Insuficiência Renal Crônica/terapia , Insuficiência Renal Crônica/epidemiologia , Tratamento Conservador , Composição Corporal , Atrofia Muscular/diagnóstico , Exercício Físico , Índice de Massa Corporal , Estado Nutricional/fisiologia , Estudos Transversais , Curva ROC , Fatores Etários , Taxa de Filtração Glomerular
18.
J Hand Surg Am ; 44(11): 995.e1-995.e4, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30704783

RESUMO

Osteoid osteomas are typically benign osteoblastic bone tumors. Patients often present in their twenties with progressively increasing pain that is worse at night and relieved with nonsteroidal anti-inflammatory drugs. These lesions rarely occur in the hand or wrist; however, when those are involved, the proximal phalanx is the most common location and the index finger is the most commonly affected digit. Lesions affecting the distal phalanges are least likely to occur and the thumb is least likely to be affected. Osteoid osteomas of the distal phalanges can cause great diagnostic challenges. They often present with atypical radiographic and physical examination findings. Although rare, osteoid osteomas of the distal phalanx can be a major cause of digit enlargement and pain. In a patient with a painful and/or swollen digit, the diagnosis should be considered.


Assuntos
Neoplasias Ósseas/cirurgia , Falanges dos Dedos da Mão/patologia , Osteoma Osteoide/patologia , Osteoma Osteoide/cirurgia , Adolescente , Biópsia por Agulha , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Falanges dos Dedos da Mão/diagnóstico por imagem , Seguimentos , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética/métodos , Masculino , Osteoma Osteoide/diagnóstico por imagem , Polegar/patologia , Polegar/cirurgia , Resultado do Tratamento
19.
J Hand Surg Am ; 44(2): 154.e1-154.e5, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29891266

RESUMO

PURPOSE: This study examined a palmar beak fracture model to determine which thumb carpometacarpal (CMC) joint ligament is the primary ligament relevant to the pattern of injury. METHODS: Six fresh-frozen cadaveric wrists were used. The radius, ulna, and first metacarpal were secured and tested with a materials testing system, holding the wrist in 20° extension, 20° ulnar deviation, and 30° palmar abduction of the first metacarpal. Testing consisted of preconditioning cycles followed by compressive loading at 100 mm/s. We confirmed fractures with fluoroscopy and dissected the specimens to examine the CMC joint ligaments. The metacarpal was stressed through a range of motion to determine which maneuvers reduced or displaced the fractures. RESULTS: Our model successfully created palmar beak fractures in all cadaveric specimens. All fractures were displaced and intra-articular. The anterior oblique ligament (AOL) was thin and partially attached to the palmar beak fracture fragment. The ulnar collateral ligament was attached in its entirety to the fracture fragment and represented a thicker, more robust ligament compared with the AOL. Radial abduction and pronation of the metacarpal reduced fracture displacement. Extension of the CMC joint or tensioning the AOL did not decrease fracture displacement. CONCLUSIONS: This model successfully created a reproducible and clinically relevant palmar beak fracture in a biomechanical setting. The primary ligament attached to the palmar beak fracture fragment was the ulnar collateral ligament, and not the AOL as previously described. These findings suggest that the AOL may not be a substantial contributor to palmar beak fracture morphology. CLINICAL RELEVANCE: A refined description of the ligamentous anatomy of the palmar break fracture enhances opportunities for improved reduction and treatment of this common hand injury.


Assuntos
Fratura-Luxação , Fraturas Intra-Articulares , Ossos Metacarpais/lesões , Polegar/lesões , Cadáver , Fratura-Luxação/diagnóstico por imagem , Fratura-Luxação/patologia , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/patologia , Ligamentos Articulares/anatomia & histologia , Masculino , Ossos Metacarpais/diagnóstico por imagem , Ossos Metacarpais/patologia , Pessoa de Meia-Idade , Modelos Biológicos , Polegar/diagnóstico por imagem , Polegar/patologia
20.
J Bras Nefrol ; 41(1): 65-73, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30281064

RESUMO

INTRODUCTION: Evaluate the association between the thumb adductor muscle thickness and the patient's nutritional status, and propose cutoff points for muscle mass depletion in elderly patients with chronic kidney disease (CKD) under conservative treatment. Epidemiological and cross-sectional study, including patients with CKD stages 3 to 5, older than 60 years. Socioeconomic, clinical, physical activity and anthropometric data was obtained. TAMT was described and compared according to CKD stage, socioeconomic data, physical activity, nutritional status and correlated with age, glomerular filtration rate and anthropometric variables. Receiver Operating Characteristic (ROC) curves were produced, considering the lean tissue index classification as reference. The cut-off point was defined by the Youden index. RESULTS: We evaluated 137 individuals. The TAMT was lower in malnourished and/or depleted muscle mass individuals; among males it was higher among those who practiced physical activities (p <0.05). This measure was moderately correlated with BMI, calf and brachial circumferences, lean body tissue, lean tissue index and body cell mass (r <0.7); negatively with age (r = -0.34). The ROC curve analysis determined cut points of 15.33 mm for females and 20.33 mm for males, with 72.22% and 62.50% accuracy, respectively. CONCLUSION: TAMT is used to estimate muscle mass and we suggest the cutoff point is useful to rule out the likelihood of muscle mass depletion. It is recommended that it be used in a complementary way in nutritional assessment.


Assuntos
Envelhecimento/fisiologia , Tratamento Conservador , Músculo Esquelético/patologia , Avaliação Nutricional , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Polegar/patologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Índice de Massa Corporal , Estudos Transversais , Exercício Físico , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia Muscular/diagnóstico , Estado Nutricional/fisiologia , Curva ROC
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