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Interphalangeal Joint (interphalangeal + joint)
Kinds of Interphalangeal Joint Selected AbstractsCollateral desmitis of the distal interphalangeal joint in conjunction with concurrent ossification of the cartilages of the foot in nine horsesEQUINE VETERINARY EDUCATION, Issue 9 2008T. S. Mair Summary The purpose of this study was to describe the frequency of occurrence of severe ossification of the collateral cartilages (sidebone) coexistent with collateral desmitis of the distal interphalangeal joint (DIPJ) in lame horses. Sidebone was diagnosed and graded on standard radiographs and soft tissue injuries of the foot were diagnosed using standing low-field magnetic resonance imaging (MRI). Of 15 horses with forelimb lameness and severe sidebone, 9 had evidence of concurrent collateral desmitis of the DIPJ. All 15 horses had damage to other structures (including the deep digital flexor tendon, distal sesamoidean impar ligament, collateral sesamoidean ligament, navicular bone and distal phalanx) within the affected feet as identified on MRI. The clinical and pathophysiological significance of concurrent collateral desmitis of the DIPJ and sidebone is currently uncertain. However, this study shows that injuries to multiple structures within the foot are common and that collateral desmitis of the distal interphalangeal joint is frequently seen in lame horses in conjunction with severe ossification of the collateral cartilages. [source] Arthroscopic removal of an osteochondral fragment at the palmaroproximal aspect of the distal interphalangeal jointEQUINE VETERINARY EDUCATION, Issue 6 2001H. Brommer First page of article [source] Osseous abnormalities associated with collateral desmopathy of the distal interphalangeal joint: Part 1EQUINE VETERINARY JOURNAL, Issue 8 2009Miss S. G. Dakin Summary Reasons for performing study: Osseous abnormalities. associated with collateral ligament (CL) injury of the distal interphalangeal (DIP) joint have been documented using magnetic resonance imaging (MRI) but there is currently limited information about the frequency of osseous pathology associated with CL injury. Objectives: To determine the frequency of occurrence of osseous abnormality coexistent with CL injury of the DIP joint and describe the distribution and character of osseous lesions; and to establish if there was an association between osseous abnormality and increased radiopharmaceutical uptake (IRU). Hypotheses: There would be a higher incidence of osseous abnormality at the insertion of an injured CL than at the origin; and a relationship between the presence of osseous abnormality and duration of lameness. Materials and methods: Magnetic resonance images of 313 feet of 289 horses with foot pain and a definitive diagnosis of collateral desmopathy of the DIP joint were analysed retrospectively for presence and type of osseous abnormality in the middle and distal phalanges. Scintigraphic images were examined and the presence of IRU in the middle or distal phalanges recorded. Results: Osseous abnormalities were detected in 143 (45.7%) feet, 27 (18.8%) of which had osseous and CL injury alone, while the remaining 116 had CL related osseous injury and multiple injuries within the hoof capsule. Entheseous new bone and endosteal irregularity of the middle and distal phalanges were the most frequent types of osseous abnormality. There was a higher incidence of osseous abnormalities medially than laterally and at the ligament insertion than at the origin. There was a significant association between presence of IRU and osseous injury. Conclusions: A variety of osseous lesions of differing severity are associated with CL injury. Normal radiopharmaceutical uptake does not preclude significant osseous pathology associated with CL injury. Clinical relevance: Further studies are necessary in order to determine if osseous abnormalities associated with CL injury influence prognosis for return to performance. [source] Osseous abnormalities associated with collateral desmopathy of the distal interphalangeal joint.EQUINE VETERINARY JOURNAL, Issue 8 2009Part 2: Treatment, outcome Summary Reasons for performing study: There are currently few long-term follow-up data relating to recovery from injury of a collateral ligament (CL) of the distal interphalangeal (DIP) joint and limited information about the effect of associated osseous injury on prognosis. Objectives: To describe long-term follow-up results for horses with CL injury, with and without associated osseous injury; and to determine the effect of extracorporeal shock wave therapy (ECSWT) or radial pressure wave therapy (RPWT) on outcome. Hypotheses: Prognosis for return to performance for horses with CL-related osseous injury would be worse than for horses with CL injury alone. Methods: Magnetic resonance images from 313 feet of 289 horses with foot pain and a definitive diagnosis of collateral desmopathy of the DIP joint were analysed retrospectively for presence of osseous abnormality associated with the ligament origin or insertion and the middle and distal phalanges. Horses were assigned to groups according to the combination of their injuries. Type of treatment was recorded and follow-up information obtained. Thirty-two horses with additional sources of lameness were excluded from analysis of outcome. Results: Follow-up data were available for 182 horses, 55 of which had follow-up information for up to 2 years after presentation. Twenty-seven percent of horses with CL injury alone and 34% of horses with CL related osseous injury returned to their previous performance level. Prognosis for a combination of injuries to multiple soft tissue and osseous structures within the hoof capsule was substantially worse. There was no effect of ECSWT or RPWT on outcome. Conclusions: The presence of mild to moderate CL related osseous injury does not appear to influence prognosis compared with CL injury alone. Clinical relevance: Further studies of a larger number of horses are necessary in order to ascertain if specific types of osseous pathology influence return to performance levels. [source] Influence of the position of the foot on MRI signal in the deep digital flexor tendon and collateral ligaments of the distal interphalangeal joint in the standing horseEQUINE VETERINARY JOURNAL, Issue 5 2009M. SPRIET Summary Reasons for performing study: Hyperintense signal is sometimes observed in ligaments and tendons of the equine foot on standing magnetic resonance examination without associated changes in size and shape. In such cases, the presence of a true lesion or an artifact should be considered. A change in position of a ligament or tendon relative to the magnetic field can induce increased signal intensity due to the magic angle effect. Objectives: To assess if positional rotation of the foot in the solar plane could be responsible for artifactual changes in signal intensity in the collateral ligaments of the distal interphalangeal joint and in the deep digital flexor tendon. Methods: Six isolated equine feet were imaged with a standing equine magnetic resonance system in 9 different positions with different degrees of rotation in the solar plane. Results: Rotation of the limb induced a linear hyperintense signal on all feet at the palmar aspect of one of the lobes of the deep digital flexor tendon and at the dorsal aspect of the other lobe. Changes in signal intensity in the collateral ligaments of the distal interphalangeal joint occurred with rotation of the limb only in those feet where mediolateral hoof imbalance was present. Conclusions: The position and conformation of the foot influence the signal intensity in the deep digital flexor tendon and in the collateral ligaments of the distal interphalangeal joint. Potential relevance: The significance of increased signal intensity in the deep digital flexor tendon and in the collateral ligaments of the distal interphalangeal joint should be interpreted with regard to the position and the conformation of the foot. [source] Magnetic resonance imaging evaluation of 264 horses with foot pain: The podotrochlear apparatus, deep digital flexor tendon and collateral ligaments of the distal interphalangeal jointEQUINE VETERINARY JOURNAL, Issue 4 2007S. DYSON Summary Reasons for performing study: To improve understanding of the interrelationships between injuries of the podotrochlear apparatus and deep digital flexor tendon (DDFT). Hypotheses: There is a difference in frequency of different types of lesions at different anatomical sites of the DDFT. Lesions of the collateral sesamoidean ligament (CSL), distal sesamoidean impar ligament (DSIL), distal interphalangeal (DIP) joint and navicular bursa are seen in association with lesions of the navicular bone. Methods: The magnetic resonance (MR) images of 264 horses with unilateral or bilateral foot pain were analysed and graded. Descriptive statistics were performed to establish the frequency of occurrence of DDFT lesion types at different anatomical levels, and lesions of the CSL, DSIL, navicular bursa, DIP joint and collateral ligaments (CLs) of the DIP joint. A Chi-square test was used to test for a difference in the proportion of navicular bone grades between limbs with and without DDFT lesions at each level, and to compare navicular bone grades for limbs with and without each of DSIL, CSL, navicular bursa or DIP joint lesions. Results: Lesions of the DDFT occurred in 82.6% of limbs, occurring most commonly at the level of the CSL (59.4%) and the navicular bone (59.0%). Core lesions predominated at the level of the proximal phalanx (90.3%), whereas at the level of the CSL and navicular bone core lesions, sagittal splits and dorsal abrasions were most common. There was a positive association between DDFT lesions and navicular bone pathology involving all aspects of the bone. Lesions of the DSIL (38.2% limbs) were more common than those of the CSL (10.5%), but the presence of either was associated with abnormalities of the navicular bone, especially involving the proximal or distal borders and the medulla. Conclusions and clinical relevance: There are close interactions between injuries of the components of the podotrochlear apparatus, the DDFT, the navicular bursa and the DIP joint. Further knowledge about the biomechanical risk factors for injury may have importance for both disease prevention and management. [source] Developmental aspects of distal limb conformation in the horse: the potential consequences of uneven feet in foalsEQUINE VETERINARY JOURNAL, Issue 7 2006A. M. KROEKENSTOEL Summary Reasons for performing study: Distal limb conformation is generally accepted to be an important item with respect to performance and soundness in mature horses, but little is known about the developmental aspects. Objectives: To gain insight into the development of distal limb conformation and to assess the possible consequences of uneven feet in foals. Methods: Conformation of the distal front limbs of 23 Warmblood foals was scored visually and measured using radiographs, at ages 27 and 55 weeks. At the same ages, pressure measurements were made under both front feet. Results: At both ages the hoof-pastern axis was broken-backwards on radiographs, but only occasionally recognised as such, when scored by eye. Over time, the hoof angle decreased, while both the angles of the dorsal and solar surfaces of the distal phalanx (P3) increased and the parallelism between hoof wall and P3 improved. The foals with uneven feet at age 27 weeks showed a significant difference in distal limb loading that persisted until age 55 weeks. Conclusions: The alignment of the distal limb in the sagittal plane increased in a 6 month period. Visual assessment was not sensitive enough to appreciate this. The growth processes in the distal limb could not compensate for existing unevenness and ensuing asymmetrical limb loading. Potential relevance: Foals have a different conformation of the distal limb from mature horses, which should be taken into account when interpreting radiographs. Unevenness of the feet resulted in asymmetrical loading of the proximal and distal interphalangeal joint, which might lead to increased susceptibility to overload injuries and decreased performance at mature age. [source] Tuberculosis verrucosa cutis: antitubercular therapy, a well-conceived diagnostic criterionINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 3 2005Virendra N. Sehgal MD A 39-year-old housewife sustained inadvertent trauma to the right index finger about 6 years ago, whilst stitching clothes. A couple of weeks later, the site of trauma became hard and gritty. Ever since, it has progressed slowly, without any appreciable outward sign. It was not associated with any discomfort/pain. Consequent on an opinion from a surgeon, it was decided to operate on the right index finger. During the operation, under local anesthesia, a hard and gritty material was removed. The material was subjected to histopathologic study. Several stitches were applied to the wound. It failed to respond to antimicrobial therapy over a 4-week period, prompting the patient to seek another opinion. Examination of the skin surface revealed a plaque with an irregular configuration on and around the distal interphalangeal joint of the right index finger. It was erythematous and pigmented. The top of the plaque was irregular and had alternating elevations and depressions (Fig. 1). Diascopy was negative for apple jelly nodule. A bacillus Calmette,Guérin (BCG) vaccination scar was identified on the left deltoid. There was no regional lymphadenopathy or systemic abnormality. Mantoux test with intradermal injection of 0.1 mL SPAN's tuberculin (purified protein derivative/5 tuberculin units/0.1 mL) (Span Diagnostic Ltd., Murat, India) was negative after 72 h. Investigations, including total and differential leukocyte count, erythrocyte sedimentation rate, serum biochemistry, and renal and liver function tests, were within the normal range, as was a chest X-ray. Figure 1. Tuberculosis verrucosa cutis before (a) and after (b) antitubercular therapy (ATT) Hematoxylin and eosin-stained sections prepared from the biopsy taken from the lesion revealed noteworthy changes in the epidermis and the dermis. The former was marked by the presence of hyperkeratosis, acanthosis, and papillomatosis, whilst the latter contained tubercle granulomas. Each of the granulomas was well formed and consisted of large numbers of lymphocytes, histiocytes, and foreign body (Langerhans') giant cells (Fig. 2). Caseation necrosis and acid-fast bacilli could not be demonstrated. The preceding revelations were fairly conducive to the diagnosis. Accordingly, antitubercular therapy (ATT), comprising 450 mg of rifampicin, 300 mg of isonicotinic acid hydrazide, and 800 mg of ethambutol, was recommended for oral administration each day for 60 days. The outcome of the treatment was satisfactory, resulting in perceptible regression of the skin lesion (Fig. 1b). The patient was advised to continue the treatment for another 30 days, after which 450 mg of rifampicin and 300 mg of isonicotinic acid hydrazide were to be continued for another 6 months. Figure 2. Tuberculosis verrucosa cutis depicting well-formed tubercle(s) comprising lymphocytes, histiocytes, neutrophils, and a few giant cells (hematoxylin and eosin, × 100) [source] A robot-assisted study of intrinsic muscle regulation on proximal interphalangeal joint stiffness by varying metacarpophalangeal joint positionJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 3 2006Zong-Ming Li Abstract The tightness of intrinsic hand muscles is a common cause of finger joint stiffness. The purposes of this study were to develop a robot-assisted methodology to obtain torque,angle data of a finger joint, and to investigate the regulation of the intrinsic muscles on finger joint stiffness. Our robot system features the integration of a low payload robot arm, a controller, and a force/torque transducer. The system provided highly reproducible torque,angle curves. Torque,angle data of the proximal interphalangeal joint with the metacarpophalangeal joint at 0 and 60 degrees were obtained from eight asymptomatic hands. The torque,angle curve shifted with the position of the metacarpophalangeal joint. As the metacarpophalangeal joint flexion angle changed from 60 to 0 degrees, the equilibrium of the proximal interphalangeal joint increased more than 20 degrees, and joint stiffness increased more than 50%. The dependence of the stiffness of the proximal interphalangeal joint on metacarpophalangeal joint position supports the regulatory role of the intrinsic muscles on finger joint mechanics. This regulatory mechanics is likely amplified in hands with intrinsic muscle tightness, justifying the commonly used Bunnell Intrinsic Tightness Test. © 2005 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 24:407,415, 2006 [source] Long-term functional and subjective results of thumb replantationMICROSURGERY, Issue 8 2006Frank Unglaub M.D. The aim of this follow-up study was to evaluate the functional and subjective results after thumb replantation. Twenty-four patients with replantation of the thumb, performed during the period 1992,1997, were reexamined after 6.5 years (range, 4.2,9.1 years post-injury). In 10 cases the amputations were isolated, 14 amputations were combined with other injuries of the hand, 15 amputations resulted from crush/avulsion injuries, and 9 amputations were sharp. Range of motion, grip strength, cutaneous sensibility, and upper-extremity functioning using the DASH questionnaire were determined. A correlation analysis with important variables was performed. Average range-of-motion in the metacarpophalangeal joint was 44° (±24.2) and in the interphalangeal joint was 12° (±8.4). Grip-strength of the injured hand was 70% (±31.4) and pinch strength was 68% (±28.7) in comparison to the non-injured hand. DASH-scores correlated with grip-strength, pinch-strength, and cutaneous sensation but no correlation was found between DASH and the level of amputation. Functional results were independent of amputation levels and patient age. Although the results of cutaneous sensibility were only moderate, patients were able to use their thumb to perform work and daily living activities. The majority of patients had returned to their previous occupation. © 2006 Wiley-Liss, Inc. Microsurgery, 2006. [source] Design and assessment of a tissue-engineered model of human phalanges and a small jointORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 4 2005WJ Landis Structured Abstract Authors ,, Landis WJ, Jacquet R, Hillyer J, Lowder E, Yanke A, Siperko L, Asamura S, Kusuhara H, Enjo M, Chubinskaya S, Potter K, Isogai N. Objectives ,, To develop models of human phalanges and small joints by suturing different cell-polymer constructs that are then implanted in athymic (nude) mice. Design ,, Models consisted of bovine periosteum, cartilage, and/or tendon cells seeded onto biodegradable polymer scaffolds of either polyglycolic acid (PGA) or copolymers of PGA and poly-L-lactic acid (PLLA) or poly- , -caprolactone (PCL) and PLLA. Constructs were fabricated to produce a distal phalanx, middle phalanx, or distal interphalangeal joint. Setting and Sample Population ,, Studies of more than 250 harvested implants were conducted at the Northeastern Ohio Universities College of Medicine. Experimental Variable ,, Polymer scaffold, cell type, and implantation time were examined. Outcome Measure ,, Tissue-engineered specimens were characterized by histology, transmission electron microscopy, in situ hybridization, laser capture microdissection and qualitative and quantitative polymerase chain reaction analysis, magnetic resonance microscopy, and X-ray microtomography. Results ,, Over periods to 60 weeks of implantation, constructs developed through vascularity from host mice; formed new cartilage, bone, and/or tendon; expressed characteristic genes of bovine origin, including type I, II and X collagen, osteopontin, aggrecan, biglycan, and bone sialoprotein; secreted corresponding proteins; responded to applied mechanical stimuli; and maintained shapes of human phalanges with small joints. Conclusion ,, Results give insight into construct processes of tissue regeneration and development and suggest more complete tissue-engineered cartilage, bone, and tendon models. These should have significant future scientific and clinical applications in medicine, including their use in plastic surgery, orthopaedics, craniofacial reconstruction, and teratology. [source] Incidence and ossification of sesamoid bones in the hands and feet: A radiographic study in an Arab populationCLINICAL ANATOMY, Issue 4 2007A.S. Dharap Abstract The incidence and ossification of sesamoid bones in the hands and feet were studied in 922 radiographs (400 hands and 522 feet) in an Arab population from Bahrain, 5,83 years of age and consisting of 549 adults (393 men and 156 women) and 373 children (286 boys and 97 girls). All radiographs of the hand and foot in the adult population showed two sesamoid bones in the thumb metacarpophalangeal (MCP) joint and in the hallucal metatarsophalangeal (MTP) joint, respectively. Only 2.3% and 1.5% of hands showed sesamoids at the MCP joints of the middle and ring fingers respectively compared to a reported incidence of 7.1% for each digit in Caucasians. The incidence of sesamoids in the MTP joints of third and fourth toes (0.6% each) and inferior to the hallucal interphalangeal joint (3.1%) is probably the lowest reported so far in the literature. In the hands, ossification commenced first in the thumb sesamoids, at the age of 10 years in females and 11 years in males and was completed by the age of 13 and 14 years, respectively. In the feet, ossification began first in the hallucal sesamoids at the age of 8 years in females and 9 years in males and was completed by the age of 10 years in both sexes. The incidence and ossification of sesamoids in the hands and feet in the Arab population from Bahrain seem to differ considerably from reports in other populations. The clinical significance of our findings is discussed. Clin. Anat. 20:416,423, 2007. © 2006 Wiley-Liss, Inc. [source] Gross anatomy of the interphalangeal joint of the great toe: Implications for excision of plantar capsular accessory ossiclesCLINICAL ANATOMY, Issue 4 2005M.B. Davies Abstract Bony or cartilaginous ossicles occur at the plantar aspect of the interphalangeal joint of the great toe. The variation in pattern, prevalence, and anatomic relationships of these structures is not clearly established in the literature, especially in a Caucasian population. Without this knowledge, pathology at this joint may be underestimated and surgical approaches may be poorly planned particularly as radiographs underestimate the incidence of ossicles at this joint. The aims of this study were to determine the incidence and pattern of ossicles at this joint and to establish their anatomic relationships to aid planning the approach for their excision. The interphalangeal joint of the left hallux was dissected in 40 British Caucasian cadavers and the pattern of nodules and their anatomic relationships were established. In 27.5% of subjects, there was no identifiable ossicle and, in these specimens, the tendon of flexor hallucis longus was adherent to the joint capsule. In the remaining specimens (72.5%), a bursa separated the tendon of flexor hallucis longus from the plantar joint capsule and nodules were found embedded within the joint capsule. More than half (52.5%) of the specimens had a single nodule located centrally within the plantar capsule and the remaining 20% had two nodules lying within the capsule. This study shows that a large proportion of the population have either one or two bony or cartilaginous ossicles at this joint. It has also shown that, when present, these structures do not lie within the tendon of flexor hallucis longus and may be most safely excised from a medial approach. Clin. Anat. 18:239,244, 2005. © 2005 Wiley-Liss, Inc. [source] Effects of 6° elevation of the heels on 3D kinematics of the distal portion of the forelimb in the walking horseEQUINE VETERINARY JOURNAL, Issue 8 2004H. CHATEAU Summary Reasons for performing study: Understanding of the biomechanical effects of heel elevation remains incomplete because in vivo studies performed with skin markers do not measure the actual movements of the 3 digital joints. Objective: To quantify the effects of 6° heel wedge on the 3-dimensional movements of the 4 distal segments of the forelimb in the walking horse. Methods: Four healthy horses were used. Kinematics of the distal segments was measured invasively with a system based on ultrasonic triangulation. Three-dimensional rotations of the digital joints were calculated by use of a ,joint coordinate system' (JCS). Data obtained with heel wedges were compared to those obtained with standard shoes during the stance phase of the stride. Results: Heel wedges significantly increased maximal flexion of the proximal (PIPJ) and distal (DIPJ) interphalangeal joints and maximal extension (mean ± s.d. +0.8 ± 0.3°) of the metacarpophalangeal joint (MPJ). Extension of the PIPJ and DIPJ was decreased at heel-off. Few effects were observed in extrasagittal planes of movement. Conclusions: Heel wedges affect the sagittal plane kinematics of the 3 digital joints. Potential relevance: Controversial effects previously observed on the MPJ may be explained by the substantial involvement of the PIPJ, which was wrongly neglected in previous studies performed on the moving horse. [source] A case of progressive pseudorheumatoid arthropathy of ,childhood' with the diagnosis delayed to the fifth decadeINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2006A. CEFLE Summary Progressive pseudorheumatoid arthropathy of childhood (PPAC) is a rare single gene disorder which is frequently misdiagnosed as juvenile rheumatoid arthritis. It is characterised with arthralgia, joint contractures, bony swelling of metacarpophalangeal and interphalangeal joints and platyspondyly. Clinical and laboratory signs of joint inflammation such as synovitis, a high erythrocyte sedimentation rate and an elevated C-reactive protein level are usually absent. Although the disease begins early in life (usually between 3 and 8 years of age), the diagnosis may be delayed. In the present case report, we describe a male patient diagnosed with PPAC at the age of 46 years, although he had been exhibiting the typical radiological and clinical features of the disease since the age of 7 years. [source] Cutaneous sclerosing perineurioma of the digitINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2006Toshitsugu Nakamura MD An 11-year-old Japanese girl noticed a small nodule, with mild tenderness, on the right index finger 5 years before visiting our outpatient clinic. She had no familial history of neurofibromatosis or past history of traumatic injury at the site of the tumor. Physical examination revealed a slightly elevated, subcutaneous, nodular tumor in the volar aspect between the proximal and distal interphalangeal joints of the digit (Fig. 1A). By magnetic resonance imaging examination, the tumor showed low density on both T1- and T2-weighted images, and was located just adjacent to the tendon with no invasive signs. The tumor was extirpated; at operation, it was well circumscribed and mobile without adhesion to adjacent tendon or nerve, and was easily removed. Figure 1. (a) Slightly elevated subcutaneous tumor (arrow) on the volar aspect of the right index finger. (b) gross appearance of the extirpated tumor, showing a well-circumscribed, whitish solid nodule Grossly, the tumor was a well-circumscribed, firm nodule (10 mm × 8 mm × 5 mm in size) (Fig. 1B). The cut surface was whitish, homogeneous, and solid without cystic lesions. Histologically, it was an unencapsulated, paucicellular dense, fibrous nodule with a concentric circular arrangement of collagen bundles (Fig. 2A). Amongst the fibrous bundles, a small number of ovoid/epithelioid or plump spindle cells were arranged in a corded, trabecular, or whorled (onion bulb-like) pattern (Fig. 2B); a storiform pattern was not noted. These cells were relatively uniform and had a somewhat elongated, slightly hyperchromatic nucleus with fine granular chromatin. Neither nuclear pleomorphism nor multinucleated cells were evident, and necrosis and mitotic figures were not observed. Periodic acid,Schiff (PAS) stain after diastase digestion highlighted the corded or whorled pattern of the tumor cells by encasing them. For immunohistochemical examination, formalin-fixed, paraffin-embedded serial tissue sections were stained by a labeled streptavidin,biotin method. The tumor cells were positive for vimentin and epithelial membrane antigen (EMA) (Fig. 3A), and negative for pan-cytokeratin, carcinoembryonic antigen (CEA), CD34, ,-smooth muscle actin, desmin, and CD68. Type IV collagen and laminin (Fig. 3B) were detected along the cords or whorls of the tumor cells, similar to the staining pattern of the diastase-PAS reaction. Schwann cells and axonal components, immunoreactive for S100 protein and neurofilament, respectively, were focally detected just adjacent to the cords or whorls, although the tumor cells per se did not express these proteins. Consequently, the tumor was found to be perineurial in origin and was diagnosed as cutaneous sclerosing perineurioma. Figure 2. (a) Low-power view of the tumor, showing an unencapsulated, paucicellular, dense, fibrous nodule with a concentric circular arrangement of collagen bundles (hematoxylin and eosin stain: original magnification, ×15). (b) Higher magnification of the tumor, showing ovoid or epithelioid cells arranged in cords or whorls in the abundant collagen bundles (hematoxylin and eosin stain: original magnification, ×150) Figure 3. Immunohistochemical profiles of the tumor. The tumor cells are positive for epithelial membrane antigen (a) and are surrounded by laminin (b) (original magnification, ×150) [source] A case of erythema elevatum diutinum associated with breast carcinomaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 11 2005Fikriye Yilmaz MD A 53-year-old woman diagnosed with invasive ductal-type breast carcinoma was referred to our clinic with red,purple lesions on the hands and legs. She had neither pruritus nor pain. The first lesion developed on the dorsal hand. In the following days, new lesions appeared on the extensor surface of the legs. The patient had been treated with modified radical mastectomy and three courses of cyclophosphamide, adriamycin, and fluorouracil chemotherapy. Dermatologic examination revealed reddish-violaceous papules and plaques ranging from a few millimeters to 2 cm in diameter, bilaterally located on the dorsal hands, especially over the metacarpophalangeal and interphalangeal joints (Fig. 1). Multiple red,purple, circumscribed papules and plaques of various diameters were observed bilaterally over the shins (Fig. 2). The largest of these plaques showed an annular configuration. The nails showed distal subungual keratosis and yellow discoloration. The rest of the physical examination was normal. Figure 1. Violaceous papules and plaques on the dorsal hands Figure 2. Red,purple, circumscribed, papules and plaques over the shins A biopsy taken from the medial side of the shin revealed a predominantly neutrophilic infiltrate and nuclear dust around the dermal vessels and orthokeratotic stratum corneum (Fig. 3). Figure 3. Predominantly neutrophilic infiltrate and nuclear dust around the dermal vessels and orthokeratotic stratum corneum (hematoxylin and eosin stain, ×100) Complete blood count, routine biochemical tests and fasting lipids, serologic tests of bacterial and viral agents, serum electrophoresis, and serologic profiles for autoimmune connective tissue diseases revealed normal results. Mycologic examination of nail clippings did not show any evidence of fungal infection. In the light of our clinical and histopathologic findings, a diagnosis of erythema elevatum diutinum was made, and the patient was given topical clobetasol propionate therapy. Complete clearance was achieved in 3 weeks (Fig. 4). After six courses of cyclophosphamide, adriamycin, and fluorouracil chemotherapy, and radiotherapy, no recurrence of erythema elevatum diutinum lesions was observed. Figure 4. Healed lesion 3 weeks after high-potency topical glucocorticoids [source] Finger pebbles in a diabetic patient: Huntley's papulesINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2005Claudio Guarneri MD A 60-year-old obese man was referred to our department from the internal medicine unit. He had a 20-year history of poorly controlled diabetes (no other cases in the family), and was admitted to hospital because of respiratory and consequent heart failure. Skin examination showed diffuse xerosis and a rough, sandpaper-like appearance of the skin of the finger, of approximately 15 years' duration, consisting of multiple, minute, hyperkeratotic papules grouped in a miniature "cobblestone" pattern on the dorsum of the distal phalanges (Fig. 1), more dense over the knuckles and the interphalangeal joints. No pruritus was present. Figure 1. Pebbly pattern of the skin on the dorsum of the second digit He was a pensioner, who had been physically inactive for months previously, and this condition had occurred progressively in the absence of any known trauma. No other cutaneous manifestations were evident. Histologic examination was performed using hematoxylin and eosin staining of a biopsy specimen taken from the left second finger; it displayed a hyperorthokeratotic epidermis with enlarged dermal papillae, thickened and vertically oriented collagen bundles, few elastic fibers, and a mild perivascular inflammatory infiltrate (Fig. 2). Figure 2. Histologic view of a biopsy specimen of the skin of the finger: the epidermis is hyperkeratotic, the dermal papillae are enlarged and there are thickened vertical collagen bundles, elastic fibers, and a mild perivascular inflammatory infiltrate (hematoxylin and eosin stain; original magnification, ×100) [source] Hereditary palmoplantar keratoderma (four cases in three generations)INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2001Virendra N. Sehgal MD A 39-year-old man reported with progressive thickening of the skin of the hands and feet and an inability to flex his hand. It was largely asymptomatic; however, brisk walking caused excessive sweating, pain, and widening of the fissures on the soles of the feet. He was unable to walk barefooted. According to his mother, the first episode presented with blistering at 7 days of age. Ever since, the condition has steadily worsened to acquire the current status. He was married at the age of 18 years, and had a stillborn child 18 months afterwards. Presently, he has three children, two girls aged 14 and 12 years and a son aged 10 years. Both the daughters are similarly affected. While cataloguing the details of the pattern of inheritance, the mother of the index case was also found to be affected (Fig. 1). The natural history of the disease was identical. Figure 1. Palmoplantar keratoderma: pattern of inheritance; black indicates affected individuals Examination of the palms was marked by pronounced thickening of the skin resulting in the masking of palmar creases. The thickening was well demarcated and its margins were prominent and surrounded by an erythematous halo. The color of the skin was yellow and waxy (Fig. 2a). Contractures were present on all the fingers; nevertheless, the deformity of the middle and distal interphalangeal joints of the little finger was prominent. The soles of the feet had a similar morphology. In addition, marked fissuring was obvious (Fig. 2b). His daughters had an identical affliction of the palms and soles. The texture and morphology of the nails were normal. Light microscopy performed on scrapings from the fissures, mounted on 10% potassium hydroxide, revealed mycelia (hyphae) and spores. Figure 2. Well-demarcated hyperkeratosis depicting the yellow, waxy color of the palms, with masking of creases (a). Marked fissuring on the soles was prominent (b) Hematoxylin and eosin-stained microsections from the palms and soles showed exquisite changes in the epidermis characterized by considerable uniform orthohyperkeratosis. Hypergranulosis and acanthosis were other associated changes. In addition, perinuclear vacuolization and keratohyalin granules of varying sizes and shapes were located at the periphery of the cells. A sparse mononuclear infiltrate was located at the dermo-epidermal junction. Hyphae and spores of fungi were also identified in the stratum corneum (Fig. 3). Figure 3. Orthohyperkeratosis, hypergranulosis, and acanthosis. Perinuclear vacuolization and keratohyalin granules at the periphery of the cells; a sparse mononuclear infiltrate was also present (hematoxylin and eosin, ×,40 (a), ×,400 (b)) Itraconazole, 400 mg/day in two equally divided doses, was administered with major meals for 7 days. In addition, high doses of vitamin A (100,000 IU) were given daily for 2 weeks, supplemented by 12% salicylic acid (Salicylix SF12) ointment for daytime application and an ointment containing 6% coal tar and 3% salicylic acid (Salytar) for night-time application. This treatment is useful in recalcitrant cases. [source] Pachydermoperiostosis and psoriatic onychopathy: an unusual associationJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 1 2003P Fietta ABSTRACT A 33-year-old man, suffering from cutaneous psoriasis since the age of 16, in the last 6 years experienced slow and painless enlargement at his fingertips and later at his big toes, which resulted in digital clubbing. Since the age of 31, the patient also presented psoriatic nail changes involving all his fingernails, without joint pain or inflammation. The patient's family history was negative for psoriasis, however, his brother, a 29-year-old healthy man, also presented digital clubbing. The diagnosis of pachydermoperiostosis coexistent with ungual and cutaneous manifestations of psoriasis vulgaris was made. The differential diagnosis with psoriatic onycho-pachydermo-periostitis, as well as other clinical conditions that involve the distal interphalangeal joints is discussed. [source] Focal Acral Hyperkeratosis: A Rare Cutaneous Disorder within the Spectrum of Costa AcrokeratoelastoidosisPEDIATRIC DERMATOLOGY, Issue 2 2004Emel Erkek M.D. These disorders are distinguished solely on the basis of the absence of elastorrhexis in the latter. We present a case of focal acral hyperkeratosis in a 9-year-old girl. The lesions consisted of translucent polygonal papules clustered on the thenar regions of the palms and over the metacarpophalangeal and interphalangeal joints. Histopathologic examination revealed orthohyperkeratosis within focal clavus-like depressions of the epidermis and prominent hypergranulosis. There was no evidence of alterations in elastic tissue. The clinicopathologic distinction between focal acral hyperkeratosis and acrokeratoelastoidosis is blurred. There is enough evidence to consider the former as a histologic variant of Costa acrokeratoelastoidosis syndrome, and a better nomenclature for this disorder would be "acrokeratoelastoidosis without elastorrhexis." [source] Thyromental distance measurement , fingers don't ruleANAESTHESIA, Issue 8 2009P. A. Baker Summary Thyromental distance (TMD) measurement is commonly used to predict difficult intubation. We surveyed anaesthetists to determine how this test was being performed. Comparative accuracy of ruler measurement and other forms of measurement were also assessed in a meta-analysis of published literature. Of respondents, 72% used fingers for TMD measurement and also considered three finger widths the minimum acceptable TMD. In terms of distance, the minimum acceptable TMD was felt to be 6.5 cm by 55% of respondents. However, the actual width of three fingers was (range) 4.6,7.0 cm (mean 5.9 cm), with significant differences between genders and between proximal and distal interphalangeal joints. The meta-analysis showed ruler measurement increased test sensitivity (48% (95% CI 43,53) vs 16% (95% CI 14,19) without a ruler), when predicting difficult intubation. [source] Impaired activation-induced cell death promotes spontaneous arthritis in antigen (cartilage proteoglycan),specific T cell receptor,transgenic miceARTHRITIS & RHEUMATISM, Issue 10 2010Ferenc Boldizsar Objective To investigate whether genetic preponderance of a T cell receptor (TCR) recognizing an arthritogenic peptide of human cartilage proteoglycan (PG) is sufficient for development of arthritis. Methods We performed a longitudinal study using BALB/c mice expressing a TCR that recognizes the arthritogenic ATEGRVRVNSAYQDK peptide of human cartilage PG. PG-specific TCR,transgenic (PG-TCR,Tg) mice were inspected weekly for peripheral arthritis until 12 months of age. Peripheral joints were examined histologically, and T cell responses, T cell activation markers, serum cytokines, and autoantibodies were measured. Apoptosis and signaling studies were performed in vitro on T cells from aged PG-TCR,Tg mice. Results Spontaneous arthritis developed as early as 5,6 months of age, and the incidence increased to 40,50% by 12 months of age. Progressive inflammation began with cartilage and bone erosions in the interphalangeal joints, and later expanded to the proximal joints of the front and hind paws. Spontaneous arthritis was associated with a high proportion of activated CD4+ T cells, enhanced interferon-, and interleukin-17 (IL-17) production, and elevated levels of serum autoantibodies. PG-TCR,Tg mice lacking IL-4 developed arthritis earlier and at a higher incidence than IL-4,sufficient mice. Antigen-specific activation,induced cell death was diminished in vitro in CD4+ T cells of PG-TCR,Tg mice with spontaneous arthritis, especially in those lacking IL-4. Conclusion The presence of CD4+ T cells expressing a TCR specific for an arthritogenic PG epitope is sufficient to trigger spontaneous autoimmune inflammation in the joints of BALB/c mice. IL-4 appears to be a negative regulator of this disease, through attenuation of activation-induced cell death. [source] | ||||||||||||||||||||||||||||