Thumb adductor muscle thickness used in the nutritional assessment of chronic kidney disease patients under conservative treatment / Espessura do músculo adutor do polegar para avaliação nutricional de portadores de doença renal crônica em tratamento conservador

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.

Adductor Pollicis Muscle Thickness for nutritional assessment: a systematic review / Espesura del Músculo Aductor del Pulgar para evaluación nutricional: una revisión sistemática / Espessura do Músculo Adutor do Polegar para avaliação nutricional: uma revisão sistemática

ABSTRACT Objective: The aim of this study is to systematically review the scientific findings about the efficacy of the measure of the Adductor Pollicis Muscle Thickness for nutritional assessment of individuals in various clinical conditions. Method: Systematic review study performed according to the methodology Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: 13 original articles published between 2004 and 2016 were included. The measure was associated/correlated to parameters of nutritional status (such as weight, body mass index and Global Subjective Assessment) and muscle mass markers (such as circumference brachial muscle circumference, brachial muscle area, calf circumference, and muscle mass). All these correlations were weak or moderate. Conclusion: The measurement can be used in different populations, being able to estimate nutritional status and muscle mass. However, it is suggested that it be used in a complementary way to the nutritional evaluation, not constituting a single diagnostic/monitoring parameter.

RESUMEN Objetivo: Revisar de forma sistemática las constataciones científicas acerca de la eficacia de la medida de la Espesura del Músculo Aductor del Pulgar para evaluación nutricional de los individuos bajo diversas condiciones clínicas. Método: Estudio de revisión sistemática, realizado conforme la metodología Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados: Se incluyeron 13 artículos originales publicados entre 2004 y 2016. La medida se presentó asociada/correlacionada a los parámetros de evaluación del estado nutricional (peso, índice de masa corporal y Evaluación Subjetiva Global) y a los marcadores de masa muscular (como circunferencia braquial, circunferencia muscular braquial, área muscular braquial, circunferencia de la pantorrilla y masa muscular). Todas estas correlaciones fueron débiles o moderadas. Conclusión: La medida puede ser utilizada en diferentes poblaciones, siendo capaz de estimar el estado nutricional y la masa muscular. Sin embargo, se sugiere que se emplee de forma complementaria la evaluación nutricional, no constituyendo un parámetro único de diagnóstico/monitoreo.

RESUMO Objetivo: Revisar de forma sistemática as constatações científicas acerca da eficácia da medida da Espessura do Músculo Adutor do Polegar para avaliação nutricional de indivíduos em diversas condições clínicas. Método: Estudo de revisão sistemática, realizado conforme a metodologia PreferredReportingItems for SystematicReviewsand Meta-Analyses (PRISMA). Resultados: Foram incluídos 13 artigos originais publicados entre 2004 e 2016. A medida apresentou-se associada/correlacionada aos parâmetros de avaliação do estado nutricional (como peso, índice de massa corporal e Avaliação Subjetiva Global) e aos marcadores da massa muscular (como circunferência braquial, circunferência muscular braquial, área muscular braquial, circunferência da panturrilha e massa muscular). Todas essas correlações foram fracas ou moderadas. Conclusão: A medida pode ser utilizada em diferentes populações, sendo capaz de estimar o estado nutricional e a massa muscular. No entanto, sugere-se que seja empregada de modo complementar à avaliação nutricional, não constituindo um parâmetro único de diagnóstico/monitoramento.

Nodular Fasciitis with Cortical Erosion of the Hand

Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present.

Nodular Fasciitis with Cortical Erosion of the Hand

Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present.

Primary non-Hodgkin lymphoma of bone: an unusual presentation.

Primary lymphoma of bone (PLB) is an extremely rare condition that is usually confused with other primary injuries of the bone. It is characterized by the involvement of one or more bone locations, with or without involvement of regional lymph nodes and viscera. PLB constitutes 3-7% of all malignant bone tumors and approximately 3% of all extranodal lymphomas. It is found at all ages, being most frequently seen in adult life. Any part of the skeleton can be involved, but a trend exists in favor of bones with persistent bone marrow. We report a case of PLB with an unusual presentation: involvement of the proximal phalanx of the thumb. Treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus etoposide established complete remission. Consolidation with radiotherapy of the femur and phalanx was performed. There was no evidence of recurrence at the 14 th month follow-up.

Estudo comparativo entre ressecção do trapézio e interposição tendinosa com e sem ligamentoplastia no tratamento da artrose carpometacarpiana do polegar / Comparative study between trapezium resection and tendon interposition with and without ligament plasty in the management of carpometacarpal arthrosis of the thumb

OBJETIVOS: O tratamento da artrose da base do polegar tem sido tema de grande controvérsia. Numerosas cirurgias têm sido descritas, como ressecção isolada do trapézio, ressecção com interposição com e sem reforço ligamentar, artrodese e artroplastias. O objetivo deste trabalho foi o de comparar os resultados das duas técnicas mais utilizadas nesse tratamento. MÉTODOS: Foi realizado estudo prospectivo a fim de comparar os resultados cirúrgicos de ressecção do trapézio com interposição tendinosa (tenoartroplastia) - 22 casos e tenoartroplastia associada a ligamentoplastia - 24 casos. A avaliação objetiva foi feita através das medidas de oponência, dos movimentos da articulação metacarpofalangiana, da força de pinça e de preensão, da medida radiográfica da distância entre a base do 1º metacarpiano e o escafóide e do ângulo entre o 1º e o 2º metacarpianos. A avaliação subjetiva foi realizada através do questionário DASH, uma escala analógico-digital para avaliar a dor e a satisfação do paciente. RESULTADOS E CONCLUSÃO: Após a aplicação dos critérios descritos e usada análise estatística pelo teste t de Student, os autores concluem não haver vantagens da reconstrução ligamentar sobre a simples interposição tendinosa na artrose carpometacarpiana do polegar.

OBJECTIVES: Treating arthrosis in the base of the thumb has been a highly controverted subject. Many surgeries have been described, such as the isolated trapezium resection; resection with interposition with and without ligament plasty, arthrodesis, and arthroplasties. The purpose of this paper is to compare the two techniques which are the most used in this treatment. METHODS: A prospective study has been made to compare the surgical results between the trapezium resection with tendon interposition (tendon arthroplasty) - 22 cases - and tendon arthroplasty associated to ligament plasty - 24 cases. Objective evaluation was done by measuring opponency, movements of the metacarpophalangeal joint, pinching and pressure strength, radiographic measurement of the distance between the first metacarpian and the scaphoid, and measurement of the angle between the first and the second metacarpian. Subjective evaluation was done with a DASH questionnaire, an analogical-digital scale to evaluate pain and patient satisfaction. RESULTS AND CONCLUSION: After application of the criteria described and using Student t test for statistical analysis, the authors concluded that the ligament reconstruction has no advantage over the simple tendon interposition in carpometacarpal arthrosis of the thumb.

Macrodystrophia lipomatosa: a case report.

Macrodystrophia lipomatosa is a rare congenital form of localized gigantism, characterized by an increase in all mesenchymal elements, particularly fibroadipose tissue. The areas of predilection are segments supplied by the median or plantar nerves. We report such a rare case in a thirty four year old male patient, who presented with a swelling of the right upper limb and a marked increase in the size of the right thumb, index finger and radial half of the right hand, present since birth, with progressive increase to the present size. Amputation of the right thumb and debulking of the palm was done. The specimen measured 26 x 18 x 12 cms. and the thumb alone measured 13 x 7 x 7 cm. histology revealed hypertrophy of adipose tissue in the subcutaneous compartment and infiltration into the nerve sheaths and muscles.

Asphyxiating thoracic dystrophy with facial dysmorphism.

Here it is reported a male newborn baby with features of asphyxiating thoracic dystrophy (ATD) with facial dysmorphism. The disproportionate rhizomelic short stature, narrow thorax, long fibulae, wide metaphysis and trident acetabule are consistent with diagnosis of ATD. In addition the baby had facial dysmorphism and broad thumbs and great toes similar to Oto-palato-digital syndrome type II (OPD II). The association of these features with ATD is not reported till date.

Músculo accesorio del abductor largo del pulgar o tercer abductor / Accessory long abductor muscle of the thumb or third abductor

En el estudio de los tendones del músculo accesorio del abductor largo del pulgar, basados en la disección anatómica de 250 cadáveres adultos de raza mestiza del altiplano y valle, registramos que las variaciones anatómicas son muy frecuentes. La presencia de tendones accesorios ocurrió en todas las piezas disecadas. Este músculo constante, en nuestro medio se origina en el tercio inferior de la cara dorsal del radio, ulna y de la membrana interósea; diferenciandose del abductor largo del pulgar y del extensor corto del pulgar. Se dirige hacia abajo al nivel de la muñeca, pasa por debajo del retináculo extensor en la primera corredera osteofibrosa de la epífisis distal del radio junto con el abductor largo y extensor corto del dedo pulgar. Su inserción distal se realiza en primer metacarpiano.

In the study of the tendons of the accessory muscle of the long abductor of the thumb, based on the anatomical dissection of 250 mature cadavers of mestizo race of the highland and valley, we register that the anatomical variations are very frequent. The presence of accessory tendons happened in all the dissected pieces.This constant muscle, in our means, originates in the inferior third of the dorsal face of the radius, ulna and of the membrane interosseous; differing of the long abductor of the thumb and of the extending one short of the thumb. He she goes down, at the doll's level, it passes below the extending retináculo in the first sliding osteofibrosa of the lower extremity of the radius together with the short long and extending abductor of the thumb. Their insert distal is carried out in first metacarpal.

Distrofia ungueal en el liquen estriado / Ungual dystrophia in the striatus lichen

Presentamos una niña de 7 años de edad, con un liquen estriado en el miembro superior derecho acompañado de onicodistrofia del pulgar. La alteración ungueal, previa al rash cutáneo, mejoró espontáneamente en el curso de tres años