ABSTRACT
Abstract Background and objectives: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. Material and methods: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. Results: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. Limitation of study: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. Conclusion: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.
Subject(s)
Humans , Male , Female , Disability Evaluation , Leprosy/physiopathology , Leprosy/pathology , Peripheral Nerves/physiopathology , Time Factors , Severity of Illness Index , Foot Deformities, Acquired/physiopathology , Foot Deformities, Acquired/pathology , Hand Deformities, Acquired/physiopathology , Hand Deformities, Acquired/pathology , Medical Records , Cross-Sectional Studies , Retrospective Studies , Follow-Up Studies , Disease Progression , Face/abnormalities , IndiaABSTRACT
Se presenta el caso de un paciente varón de 56 años quien es evaluado por presentar a nivel del dorso de ambas manos cicatrices hiperpigmentadas e hipopigmentadas, asociadas a quistes de milia. Se le realizó estudios del metabolismo de las porfirinas y biopsia cutánea de las lesiones los cuales resultaron compatibles con porfiria cutánea tarda. En el laboratorio inicial se encontró elevación de los valores de transaminasas, identificándose posteriormente infección crónica por virus de hepatitis C. Con la finalidad de tratar la infección viral y resolver el compromiso dérmico, considerado como manifestación extrahepática del virus hepatitis C, se inició tratamiento con interferón pegilado y ribavirina evolucionando favorablemente con respuesta viral rápida, carga viral no detectable hasta la actualidad (36 semanas de tratamiento), disminución del nivel de transaminasas séricas y mejoría de las lesiones dérmicas.
The present case is a 56 year old male who present hyperpigmented and hypopigmented scars in both hands, associated with the presence of milia cysts. It was studied the metabolism of porphyrins and skin biopsy of the lesions which were compatible with porphyria cutanea tarda. In the initial laboratory, elevated transaminases values were found and subsequently identified chronic infection of hepatitis C virus. In order to treat viral infection and resolve the dermal commitment; considered extrahepatic manifestation of hepatitis C virus, treatment was started with pegylated interferon and ribavirin, with favorably development and rapid viral response, with undetectable viral load until now (24 weeks of treatment), decreased level of serum transaminases and improvement of skin lesions.
Subject(s)
Humans , Male , Middle Aged , Porphyria Cutanea Tarda/etiology , Hepatitis C, Chronic/complications , Antiviral Agents/therapeutic use , Ribavirin/therapeutic use , Biopsy , Hand Deformities, Acquired/etiology , Hand Deformities, Acquired/pathology , Interferons/therapeutic use , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/drug therapy , Drug Therapy, CombinationABSTRACT
INTRODUÇÃO: A macrodactilia é uma anomalia rara e de etiologia desconhecida. Os primeiros casos foram descritos, em 1821, por Klein. Representa aproximadamente 1% de todas as anomalias congênitas. Surge no nascimento e caracteriza-se pelo crescimento dos dedos das mãos, dos pés ou de todo o membro; entretanto, pode se apresentar mais tardiamente, com os sintomas de compressão de nervo, podendo associar-se à síndrome do túnel do carpo. MÉTODOS: Estudo retrospectivo de quatro casos de macrodactilia atendidos no Hospital da Santa Casa Misericórdia de Campo Grande, MS, nos últimos 10 anos. RESULTADOS: Descrevemos quatro casos de macrodactilia, sendo três em quirodáctilos e um acometendo primeiro pododáctilo. Todos os pacientes tratados com procedimentos cirúrgicos, um dos casos com amputação de falanges e metacarpo. CONCLUSÕES: É recomendada a amputação como opção cirúrgica em alguns casos e o tratamento precoce da síndrome do túnel do carpo quando presente.
INTRODUCTION: Macrodactyly is a rare anomaly of unknown etiology. The first cases were described in 1821 by Klein. It represents approximately 1% of all congenital anomalies. It appears at birth and is characterized by excessive growth of the fingers, toes, or of the entire limb; however, its appearance may be delayed, with symptoms of nerve compression, and may present with carpal tunnel syndrome. METHODS: Retrospective study of four cases of macrodactyly treated at the Hospital da Santa Casa Misericórdia in Campo Grande, MS, in the last 10 years RESULTS: We describe four cases of macrodactyly: three in the fingers and one affecting the first toe. All patients were treated with surgical procedures, one with amputation of phalanges and metacarpals. CONCLUSIONS: Amputation is a surgical option recommended in some cases, as is the early treatment of carpal tunnel syndrome.
Subject(s)
Humans , Female , Child, Preschool , Child , History, 21st Century , Surgical Procedures, Operative , Congenital Abnormalities , Hand Deformities, Congenital , Foot Deformities, Acquired , Toes , Retrospective Studies , Limb Deformities, Congenital , Rare Diseases , Fingers , Amputation, Surgical , Surgical Procedures, Operative/methods , Congenital Abnormalities/surgery , Congenital Abnormalities/pathology , Hand Deformities, Congenital/surgery , Foot Deformities, Acquired/surgery , Foot Deformities, Acquired/pathology , Hand Deformities, Acquired/pathology , Toes/abnormalities , Toes/surgery , Limb Deformities, Congenital/surgery , Limb Deformities, Congenital/pathology , Rare Diseases/congenital , Rare Diseases/pathology , Fingers/abnormalities , Fingers/surgery , Amputation, Surgical/adverse effects , Amputation, Surgical/methodsABSTRACT
Se presentan tres pacientes con almohadillas articulares (knuckle pads): un caso primario de manos; otro también primario, de manos y pies, y uno secundario asociado a fibromatosis plantar (enfermedad de Lederhose) y campodactilia. Esta es una patología infrecuente de predominio masculino, que en raras ocasiones se asocia con otras fibromatosis superficiales
Subject(s)
Humans , Male , Adolescent , Adult , Fibroma/diagnosis , Foot Deformities, Acquired/etiology , Hand Deformities, Acquired , Fibroma/classification , Fibroma/pathology , Foot Deformities, Acquired/pathology , Hand Deformities, Acquired/pathologyABSTRACT
No es realista esperar un resultado exitoso uniforme en pacientes con mano espástica secuela de parálisis cerebral. La evaluación preoperatoria del paciente espástico en lo referente al nivel de inteligencia, sensibilidad, fuerza y control múscular, edad, extensión de la lesión y la motivación del paciente y sus familiares es de suma importancia para la planificación quirúrgica redunda en los resultados finales. Entre enero de 1981 y diciembre de 1991 fueron intervenidos 122 pacientes con parálisis cerebral y evaluados globalmente, con un seguimiento promedio de 17 meses. Los resultados postoperatorios fueron evaluados con el test de Green y Banks modificado con 41,8 por ciento de casos buenos, 37.7 por ciento regulares y un 20.49 por ciento de resultados pobres. Los resultados posteriores a la rehabilitación mejoraron estos datos de una manera notable. Se incluyen recomendaciones