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1.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466974
2.
J Clin Neurophysiol ; 36(6): 468-470, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31274708

RESUMO

A 55-year-old woman presented with an 18-month history of intermittent left-hand paresthesias affecting her first, second, and third digits. A small, immobile, nontender midline mass on the volar aspect of the left wrist was also present. Evaluation included normal routine nerve conduction studies and needle electromyography. An ultrasound was performed in the electromyography laboratory, verifying median nerve involvement of the mass within the proximal carpal tunnel. This finding guided the electromyographer to perform the unconventional technique of sensory nerve short segmental stimulation across the carpal tunnel, which confirmed focal slowing across the lesion, achieving electrodiagnostic confirmation of median nerve impairment. This case of atypical carpal tunnel syndrome due to a median nerve schwannoma demonstrates both the utility and specificity of short segmental sensory stimulation in some cases of median neuropathy at the wrist and the value of sonography in the electromyography laboratory.


Assuntos
Síndrome do Túnel Carpal/diagnóstico , Eletromiografia/métodos , Nervo Mediano/patologia , Neurilemoma/diagnóstico , Síndrome do Túnel Carpal/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Neurilemoma/complicações , Ultrassonografia/métodos , Punho/inervação , Punho/patologia
3.
J Am Acad Orthop Surg ; 27(21): 785-793, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31305353

RESUMO

Since the advent of disease-modifying antirheumatic drugs for rheumatoid arthritis, orthopedic surgeons see fewer patients in the office who require hand surgery. However, a significant number of patients still seek surgical intervention to improve pain and function. These patients often present with isolated soft tissue pathologies, but even bone and joint pathology require meticulous soft tissue handling in this cohort. This review highlights the principles and techniques relevant to the management of soft tissue deformity in rheumatoid hand and wrist surgery, as exposure in training and practice continues to decrease.


Assuntos
Artrite Reumatoide/complicações , Deformidades Adquiridas da Mão/cirurgia , Procedimentos Ortopédicos , Punho/patologia , Punho/cirurgia , Artrite Reumatoide/cirurgia , Deformidades Adquiridas da Mão/etiologia , Humanos
4.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 37(2): 224-228, 2019 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-31168992

RESUMO

Bisphosphonates can directly inhibit osteoclasts, which may lead to increased bone density, reduced blood flow, and osteonecrosis of the jaw. Bisphosphonate-related osteonecrosis is usually observed in the jaw bone. In this article, we report a patient with bisphosphonate-related osteonecrosis of the jaw (BRONJ) complicated with wrist scaphoid osteomyelitis. Furthermore, we introduce the pathogenesis, treatment, and prevention of BRONJ.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Osteomielite , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/complicações , Difosfonatos , Humanos , Osteomielite/complicações , Punho/patologia
5.
Clin Exp Rheumatol ; 37(5): 826-833, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31025927

RESUMO

OBJECTIVES: To identify specific morphologic features of calcium pyrophosphate deposition disease (pseudogout, CPPD) manifestations of the wrist as detected using low-dose CT-scans. METHODS: In this retrospective study 46 patients with arthritis of the wrist were included. All patients underwent a low dose CT scan of both wrists on a 320-row detector in volume scan mode. Individual radiation exposure was recorded for all patients. Two blinded raters independently evaluated osteoarthritis, cysts, erosions, calcifications (cartilage and ligaments separately) and carpal misalignment in 33 specified locations. An expert rheumatologist classified the patients as CPPD positive or negative. Fisher's exact test was applied to identify differences between both groups. Receiver operating characteristics (ROC) analyses with calculations of area under the curve (AUC) were carried out for both in the literature established and newly identified imaging findings for each rater individually. RESULTS: Twenty-seven patients were classified as CPPD, 19 patients as other diagnoses. Ligamentous calcifications were significantly more prevalent in the CPPD group (p<0.05). All non-ligamentous findings revealed no difference in frequency. AUC analysis for established findings (0.675; 0.619 - rater 1; 2) vs. ligamentous calcifications (0.786 both raters) showed a markedly higher diagnostic accuracy for the latter. Effective radiation exposure was determined to be 0.019-0.095 mSv per patient. CONCLUSIONS: Calcifications of carpal ligaments are highly specific morphologic features of CPPD arthropathy. Low-dose CT is a useful tool to detect these calcifications at a radiation exposure similar to a standard radiograph.


Assuntos
Condrocalcinose , Artropatias/diagnóstico por imagem , Área Sob a Curva , Pirofosfato de Cálcio , Condrocalcinose/diagnóstico por imagem , Condrocalcinose/patologia , Humanos , Artropatias/patologia , Curva ROC , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Punho/diagnóstico por imagem , Punho/patologia
7.
Skeletal Radiol ; 48(10): 1525-1539, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30903260

RESUMO

There is a large variety of conditions that can result in 'bone marrow edema' or 'bone marrow lesions' (BML) in the wrist on magnetic resonance imaging (MRI). The combination of clinical history and the distribution of the BML can serve as a valuable clue to a specific diagnosis. This article illustrates the different patterns of BML in the wrist to serve as a useful guide when reviewing wrist MRI studies. Imaging artefacts will also be briefly covered.


Assuntos
Doenças da Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Punho/diagnóstico por imagem , Doenças da Medula Óssea/patologia , Diagnóstico Diferencial , Edema/patologia , Humanos , Punho/patologia
8.
Orthop Clin North Am ; 50(2): 211-221, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30850079

RESUMO

Distal radial fractures account for up to 18% of all fractures in patients over 65 years of age, and osteoporosis is a predominant factor in these fractures. Fracture treatment may include closed reduction and casting/splinting, external fixation, and open reduction and internal fixation.


Assuntos
Fixação de Fratura/instrumentação , Redução Aberta/métodos , Osteoporose/complicações , Fraturas do Rádio/etiologia , Traumatismos do Punho/patologia , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas/normas , Tratamento Conservador/métodos , Feminino , Humanos , Masculino , Osteoporose/epidemiologia , Prevalência , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/prevenção & controle , Fraturas do Rádio/cirurgia , Fatores de Risco , Resultado do Tratamento , Punho/patologia , Traumatismos do Punho/epidemiologia , Traumatismos do Punho/cirurgia
9.
Medicine (Baltimore) ; 98(7): e14431, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762750

RESUMO

Spondyloarthritis may be increasingly present in older patients as life expectancy increases. We investigated clinical differences between early-onset and late-onset spondyloarthritis in Japan.We retrospectively reviewed 114 patients consecutively diagnosed with spondyloarthritis. The clinical course of each patient was observed for ≥1 year. We defined early-onset and late-onset spondyloarthritis as <57 or ≥57 years at a median age of this study group, respectively. We compared clinical characteristics between these 2 groups.Disease duration was significantly shorter before diagnosis in the late-onset group (P < .01). Inflammatory back pain (IBP) was significantly more common in the early-onset group (P < .01), whereas dactylitis frequency was significantly higher in the late-onset group. Significantly more patients with early-onset spondyloarthritis were human leukocyte antigen (HLA) B27-positive (P < .01). Articular synovitis, particularly of the wrist, was significantly more common on power Doppler ultrasound (PDUS) in the late-onset group (P < .01). Tenosynovitis or peritendinitis, particularly in the finger and wrist flexors were also more frequent in the late-onset group (P < .001 and P < .05, respectively). Enthesitis of the finger collateral ligament and lateral collateral ligament were significantly more common in the late-onset group (both P < .05). Multiple logistic regression analysis revealed that, comparatively, IBP was significantly and independently much more likely to occur in the early-onset group.The patients with late-onset spondyloarthritis had a lower frequency of IBP and HLA B27 and a higher frequency of dactylitis and PDUS findings in peripheral involvement.


Assuntos
Dor nas Costas/etiologia , Espondilartrite/patologia , Sinovite/etiologia , Tendinopatia/etiologia , Idade de Início , Idoso , Dor nas Costas/patologia , Ligamentos Colaterais/diagnóstico por imagem , Ligamentos Colaterais/patologia , Feminino , Dedos/diagnóstico por imagem , Dedos/patologia , Antígeno HLA-B27/sangue , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espondilartrite/complicações , Espondilartrite/diagnóstico por imagem , Sinovite/diagnóstico por imagem , Sinovite/patologia , Tendinopatia/diagnóstico por imagem , Tendinopatia/patologia , Ultrassonografia Doppler , Punho/diagnóstico por imagem , Punho/patologia
10.
Indian Pediatr ; 56(1): 41-44, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30806360

RESUMO

OBJECTIVE: To describe a novel wrist deformity in b-thalassemia major patients, and their radiographic and magnetic resonance imaging findings. METHODS: 30 patients with b-thalassemia major who were noticed to have ulnar deviation at wrist joint were evaluated for previous history of medications, serum ferritin levels, presence of pain and swelling at the wrist joint, and the duration of iron chelation therapy. Radiographs of wrist and limited magnetic resonance imaging (MRI) sequences were obtained in 30 and 15 patients, respectively. RESULTS: Radiographs revealed varying severity of distal ulnar shortening, distal radial slanting and presence of soft tissue distal to the ulna. MRI showed similar deformities along with abnormal marrow signal at distal ulnar ends; in 8 patients, a soft tissue distal to the distal end of ulna was noted. CONCLUSIONS: Varying severity of radiological abnormalities, predominantly affecting the distal ulna, are present in children and adolescents with b-thalassemia receiving oral chelation therapy.


Assuntos
Terapia por Quelação/efeitos adversos , Quelantes de Ferro/efeitos adversos , Artropatias , Punho , Talassemia beta/tratamento farmacológico , Adolescente , Criança , Feminino , Humanos , Ferro , Quelantes de Ferro/uso terapêutico , Artropatias/induzido quimicamente , Artropatias/diagnóstico por imagem , Artropatias/patologia , Masculino , Ulna/diagnóstico por imagem , Ulna/efeitos dos fármacos , Ulna/patologia , Punho/diagnóstico por imagem , Punho/patologia
11.
Skeletal Radiol ; 48(6): 837-857, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30806723

RESUMO

Advanced imaging has become just as vital for diagnosing, staging, and monitoring disease in rheumatoid arthritis (RA) patients as it is for cancer patients. Part 1 of this review discussed synovitis, tenosynovitis, erosions, and osteitis-key imaging findings that occur in patients with RA. Part 2 will now show how these features, in combination with clinical and serologic data, can assist clinical decision-making at various stages of a patient's disease course. Specifically, assessing current disease activity and prognosticating future aggressiveness inform treatment decisions at initial presentation, during medical treatment, and at clinical remission. In addition to summarizing the current literature on advanced imaging in RA, clinical examples from different stages throughout the disease course will illustrate practical approaches for applying these research results. Last, this review will describe potential future roles of imaging in RA patients.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/terapia , Mãos/diagnóstico por imagem , Imagem por Ressonância Magnética , Artrite Reumatoide/patologia , Tomada de Decisões , Previsões , Mãos/patologia , Humanos , Osteíte/diagnóstico por imagem , Osteíte/patologia , Osteíte/terapia , Prognóstico , Tenossinovite/diagnóstico por imagem , Tenossinovite/patologia , Tenossinovite/terapia , Punho/diagnóstico por imagem , Punho/patologia
12.
Skeletal Radiol ; 48(5): 677-695, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30796506

RESUMO

The management of patients with rheumatoid arthritis (RA) has rapidly evolved with the development of newer disease-modifying drugs and the recognition that long-term damage can be mitigated by an earlier and more-informed use of these medications. Historically, radiographs were the mainstay of imaging in RA patients, but radiographic joint narrowing and erosions are late and insensitive findings in the disease. MRI (with intravenous contrast agent) and ultrasound (with power Doppler interrogation) of the hands and wrists are able to demonstrate erosions earlier and with greater sensitivity than radiographs. More importantly, these imaging studies also depict synovitis and active soft-tissue inflammation, which represents a precursor to structural damage. Additionally, MRI can show inflammation within the bones (osteitis), which is proving to be the most important prognosticator of an aggressive disease course. Part I of this review discusses the imaging techniques, pitfalls, definitions, and comparative studies of MRI and ultrasound for identifying and quantifying erosions, synovitis, and osteitis. Part II will demonstrate how these imaging findings influence the clinical management of RA patients throughout their disease course, from presentation through clinical remission.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Mãos/diagnóstico por imagem , Imagem por Ressonância Magnética , Ultrassonografia , Punho/diagnóstico por imagem , Artrite Reumatoide/patologia , Mãos/patologia , Humanos , Osteíte/diagnóstico por imagem , Osteíte/patologia , Tenossinovite/diagnóstico por imagem , Tenossinovite/patologia , Punho/patologia
13.
Neurol Sci ; 40(5): 1041-1047, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30796623

RESUMO

INTRODUCTION: No consensus exists about the upper limit of normal (ULN) of the cross-sectional area (CSA) of the median nerve in diagnosing carpal tunnel syndrome (CTS). Previously, we demonstrated a strong positive correlation between wrist circumference and CSA. ULN depending on wrist circumference turned out to have a low sensitivity, which was hypothesized to be caused by an age mismatch. The aim of this study was to re-evaluate the found invariance by augmentation of the healthy control group, adding older subjects, and to determine the diagnostic accuracy of the updated normal values. METHODS: CSA and wrist circumference were measured in an additional 42 healthy controls in the ages of 40-60. Univariable and multivariable linear regression analyses were applied to determine predicting factors for CSA. Diagnostic accuracy was assessed in a prospective cohort of 253 patients. RESULTS: A strong correlation was found between wrist circumference and CSA (r = 0.61). Wrist circumference is the most important independent predictor for ULN (r2 = 0.37). We managed to simplify our newly derived regression equations, which turned out to be unrelated to age. Sensitivity of our new equations is low, but higher than a general fixed cut-off value (53.4% and 47.4%, respectively). DISCUSSION: Wrist circumference is the most important independent predicting factor of CSA. By using our updated equations and taking wrist circumference into account, one can determine a more precise ULN for each individual, which will lead to the improvement of the diagnostic accuracy of ultrasonography (US). Sensitivity for US in diagnosing CTS remains low and it can therefore not replace EDX.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/patologia , Nervo Mediano/diagnóstico por imagem , Ultrassonografia , Punho/patologia , Adulto , Envelhecimento/patologia , Feminino , Humanos , Masculino , Nervo Mediano/anatomia & histologia , Nervo Mediano/patologia , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos , Punho/anatomia & histologia
15.
Acta Neurochir (Wien) ; 160(12): 2479-2484, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30377830

RESUMO

Superficial radial intraneural ganglion cysts are rare. Only nine previous cases have been described. We provide two examples with a wrist joint connection and review the literature to provide further support for the unifying articular (synovial) theory for the pathogenesis and treatment of intraneural ganglia.


Assuntos
Cistos Glanglionares/cirurgia , Punho/cirurgia , Adulto , Feminino , Cistos Glanglionares/diagnóstico por imagem , Cistos Glanglionares/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Punho/diagnóstico por imagem , Punho/patologia
16.
Proc Natl Acad Sci U S A ; 115(45): 11591-11596, 2018 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-30348771

RESUMO

Suspected fractures are among the most common reasons for patients to visit emergency departments (EDs), and X-ray imaging is the primary diagnostic tool used by clinicians to assess patients for fractures. Missing a fracture in a radiograph often has severe consequences for patients, resulting in delayed treatment and poor recovery of function. Nevertheless, radiographs in emergency settings are often read out of necessity by emergency medicine clinicians who lack subspecialized expertise in orthopedics, and misdiagnosed fractures account for upward of four of every five reported diagnostic errors in certain EDs. In this work, we developed a deep neural network to detect and localize fractures in radiographs. We trained it to accurately emulate the expertise of 18 senior subspecialized orthopedic surgeons by having them annotate 135,409 radiographs. We then ran a controlled experiment with emergency medicine clinicians to evaluate their ability to detect fractures in wrist radiographs with and without the assistance of the deep learning model. The average clinician's sensitivity was 80.8% (95% CI, 76.7-84.1%) unaided and 91.5% (95% CI, 89.3-92.9%) aided, and specificity was 87.5% (95 CI, 85.3-89.5%) unaided and 93.9% (95% CI, 92.9-94.9%) aided. The average clinician experienced a relative reduction in misinterpretation rate of 47.0% (95% CI, 37.4-53.9%). The significant improvements in diagnostic accuracy that we observed in this study show that deep learning methods are a mechanism by which senior medical specialists can deliver their expertise to generalists on the front lines of medicine, thereby providing substantial improvements to patient care.


Assuntos
Aprendizado Profundo/estatística & dados numéricos , Fraturas Ósseas/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/estatística & dados numéricos , Radiografia/métodos , Erros de Diagnóstico/prevenção & controle , Medicina de Emergência/métodos , Fraturas Ósseas/patologia , Equipe de Respostas Rápidas de Hospitais , Humanos , Sensibilidade e Especificidade , Punho/diagnóstico por imagem , Punho/patologia
17.
BMJ Case Rep ; 20182018 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-30209141

RESUMO

Diagnosis of a malignancy during pregnancy presents a dilemma regarding the work-up and treatment of the patient. This report presents a 42-year-old woman on her 23rd week of pregnancy with multiple enlarging fungating violaceous skin masses. Biopsy of the dominant mass revealed anaplastic large cell lymphoma. Due to the progressive enlargement and increase in number of the masses, the patient was given two cycles of chemotherapy (doxorubicin, vincristine, cyclophosphamide and prednisone) before delivering a live baby boy via spontaneous vaginal delivery, Apgar 9.9, at 37 4/7 weeks. After delivery, she completed four more cycles of treatment. A full-body positron emission tomography scan done 2 months after the last chemotherapy showed no evidence of disease. The patient is doing well with no evidence of disease 9 months after treatment. Her baby is thriving and has no gross deformities and no developmental delays.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma Anaplásico de Células Grandes/tratamento farmacológico , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Adulto , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Feminino , Humanos , Linfoma Anaplásico de Células Grandes/diagnóstico , Filipinas , Período Pós-Parto , Prednisona/uso terapêutico , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico , Vincristina/uso terapêutico , Punho/patologia
18.
ANZ J Surg ; 88(9): 913-916, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30117658

RESUMO

BACKGROUND: Anatomical variations in the first extensor compartment are associated with the pathogenesis of de Quervain's disease. Here, we report two novel anatomical variations of the first extensor compartment. METHODS: The wrists of two adult cadavers were dissected to reveal the anatomical variations in the first extensor compartment. RESULTS: In one of the cadavers, no septum was present in the first extensor compartment. However, the extensor pollicis brevis tendon and its proximal muscle belly were absent. The abductor pollicis longus (APL) tendon had multiple slips, and one of them inserted on the dorsal base of the proximal thumb phalanx. In another cadaver, a septum was present in the first extensor compartment. One of the multiple APL tendon slips ran into the septum alongside the extensor pollicis brevis tendon for 4 mm, which then exited the septum and inserted into the base of the first phalanx together with the APL tendon. CONCLUSION: Our findings may help to improve the awareness of the anatomical variations in the first extensor compartment.


Assuntos
Variação Anatômica/fisiologia , Doença de De Quervain/patologia , Antebraço/patologia , Tendões/patologia , Adulto , Conscientização , Cadáver , Doença de De Quervain/diagnóstico , Antebraço/anatomia & histologia , Humanos , Tendões/anatomia & histologia , Punho/anatomia & histologia , Punho/patologia
19.
Diagn Cytopathol ; 46(10): 853-858, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30144350

RESUMO

BACKGROUND: Swellings in the hand and wrist are frequently encountered in clinical practice and fine needle aspiration cytology (FNAC) is used as a primary diagnostic modality in most of them. A wide spectrum of lesions can be encountered at these sites. The aim of this study was to report the prevalence and spectrum of hand and wrist lesions and evaluate the diagnostic role of FNAC. METHODS: All the patients who presented with palpable lesions in the hand or wrist between January 2011 and July 2016 were reviewed, retrospectively. RESULTS: 1312 cases were subjected to FNAC of hand and wrist swellings, of which 1136 (86.6%) cases were satisfactory. Age ranged from 5 months to 90 years with M: F = 0.7:1. 138 (12.1%) were diagnosed as inflammatory lesions, 875 (77.0%) as benign, non-neoplastic (tumor-like) lesions and 123 (10.8%) were neoplastic lesions. The inflammatory lesions included 75 cases of synovitis, 30 cases of tuberculosis, 28 cases of abscess, one case of cysticercosis, two cases of gout, and fat necrosis each. In the benign, non-neoplastic (tumor-like) lesions, the most common lesion was ganglion (775 cases). The neoplastic lesions included 78 benign lesions with the most common being giant cell tumor of tendon sheath (61 cases). There were 40 cases of mesenchymal lesions, four cases of appendageal tumors and one case of malignancy (squamous cell carcinoma). Mesenchymal lesions accounted for 3.5% (40/1136) cases. CONCLUSION: FNAC is very useful and simple investigation for early diagnosis of lesions of hand and wrist. The lesions encountered at these sites most commonly are benign.


Assuntos
Citodiagnóstico/métodos , Mãos/patologia , Punho/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Criança , Pré-Escolar , Células Epiteliais/patologia , Feminino , Histiócitos/patologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Osteoblastos/patologia , Adulto Jovem
20.
JBJS Case Connect ; 8(2): e42, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29952776

RESUMO

CASES: Two patients with human immunodeficiency virus (HIV) developed wrist pain following the initiation of antiretroviral treatment, and were diagnosed with chronic atypical mycobacterial septic arthritis. Aggressive operative debridement led to clinical improvement, provided tissue samples for diagnosis, and allowed for a targeted long-term antibacterial regimen. CONCLUSION: Clinicians should consider atypical mycobacterial organisms as a cause of joint infection in patients with HIV. Symptoms may become apparent after patients experience immune system recovery following antiretroviral treatment.


Assuntos
Artrite Infecciosa , Infecções por HIV/complicações , Infecções por Micobactéria não Tuberculosa , Micobactérias não Tuberculosas , Punho , Humanos , Masculino , Pessoa de Meia-Idade , Punho/diagnóstico por imagem , Punho/microbiologia , Punho/patologia
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