Dedo azul agudo idiopático no isquémico: síndrome de Achenbach. Presentación de un caso y revisión bibliográfica / Acute non-ischemic idiopathic blue finger. Achenbach's syndrome. Case report and literature review

El síndrome de Achenbach es un cuadro de baja incidencia y de etiología idiopática. Se caracteriza por la aparición aguda de coloración azul digital sin un episodio desencadenante, imitando a un cuadro isquémico, pero, al contrario, el síndrome de Achenbach se autolimita sin dejar secuelas. Se presenta una mujer de 75 años que consultó en la central de emergencias por dolor y cambio de coloración violácea del dedo índice de su mano derecha, de inicio súbito. Los estudios complementarios no aportaron información relevante. Se administró un tratamiento sintomático y se logró la resolución completa del cuadro. La anamnesis y el examen físico exhaustivo tienen un rol fundamental para sospechar este cuadro y los estudios complementarios se reservan para descartar otras enfermedades, si es necesario. Consideramos que conocer esta enfermedad y un abordaje correcto conducen a un diagnóstico apropiado. Nivel de Evidencia: IV

Achenbach's Syndrome (AS) is a pathology with low incidence and its etiology is unknown. It is characterized by the acute appearance of blue coloration in the finger without a triggering event and might be confused with an ischemic event. However, AS is a self-limited disease without sequelae. This case report is about a 75-year-old woman who presented sudden onset pain and purple coloration in the index finger of her right hand. Diagnostic tests were unhelpful and did not provide relevant information. She received symptomatic treatment, achieving complete resolution. The anamnesis and an exhaustive physical examination play a primary role in the suspicion; leaving diagnostic tests for the exclusion of other pathologies when they are required. We believe that knowing about this pathology allows a correct approach leading to an appropriate diagnosis. Level of Evidence: IV

Preliminary study on functional and aesthetic reconstruction by using a small artery-only free medial flap of the second toe for fingertip injuries

OBJECTIVES: This study was designed to introduce the feasibility of fingertip reconstruction by using a free medial flap of the second toe without vein anastomosis. METHODS: In total, 8 patients with fingertip injuries were treated successfully with this method. Patients who underwent reconstruction from September 2016 to October 2017 in our hospital with an artery-only free medial flap transfer of the second toe for fingertip injuries were included, and patients who underwent additional procedures that may impact the postoperative results and were followed up for less than 6 months were excluded. Clinical trial registration: ChiCTR19000021883. RESULTS: According to the Allen classification, five patients had Type 3 injuries, and three patients had Type 4 injuries. One arterial nerve and one digital nerve were repaired at the same time. No additional dissection was performed in either the donor or recipient site of the dorsal or volar vein. Postoperative venous congestion was monitored based on the color, temperature and the degree of tissue oxygen saturation. The flap size ranged from 1.20*1.0 cm2 to 1.80*1.0 cm2. The reconstruction time was 71.86 (SD 14.75) minutes. The two-point discrimination and the monofilament results were satisfying; cold intolerance did not appear in five patients, and the other three patients had cold intolerance with grades of 4, 12 and 26, which were considered satisfactory. Moreover, leech therapy, continuous bleeding and needle sutures were not utilized in any cases. CONCLUSIONS: Reconstruction with a small artery-only free medial flap transfer of the second toe led to satisfactory sensory and motor function in the selected patients with fingertip injuries.

Valor de la vena digital para el diagnóstico tradicional y pronóstico de las diarreas en una lactante / Value of the digital vein for the traditional diagnosis and prognosis of diarrheas in an infant

Se presenta el caso clínico de una lactante de 8 meses de edad, de procedencia rural, quien ingresa en el Hospital Docente Infantil Norte de Santiago de Cuba por presentar fiebre, vómitos y diarreas. Se le realizó examen físico y observación de la vena digital, cuyo resultado desde el punto de vista de la medicina tradicional fue diarrea por frío-humedad, para lo cual se orientó una estrategia terapéutica que favoreció la mejoría del cuadro diarreico y emético, sin el empleo de medicamentos

The case report of an 8 months infant is presented. She had rural origin and is admitted to the Northern Teaching Children Hospital in Santiago de Cuba due to fever, vomits and diarrheas. Physical examination and observation of the digital vein was carried out whose result from the traditional medicine point of view was diarrhea due to cold-humidity, for which a therapeutic strategy was guided that favored the improvement of the diarrheal and emetic pattern, without using medication

Pocket flashlight-elicited Quincke pulse for aortic dissection diagnosis

No abstract available.

Perspectivas en el estudio del fenómeno de Raynaud desde un punto de vista ecográfico / Perspectives of ultrasound in the assessment of Raynaud's phenomenon

Un correcto estudio de las alteraciones morfovasculares es un constante reto para el reumatólogo. Entre las manifestaciones clínicas más importantes para este fin, se encuentra el fenómeno de Raynaud en sus diferentes formas de presentación. La ecografía dinámica, mediante la modalidad del Doppler color y el Doppler de poder, encuentra cada vez mayores aplicaciones. El poder determinar la fase de actividad y severidad de la enfermedad vascular, contar con un dato predictivo de evolución del fenómeno de Raynaud y poder monitorear la respuesta al tratamiento son elementos en los cuales la ecografía ha generado últimamente una buena cantidad de datos que están despertando un gran interés por parte del reumatólogo. Esta revisión intenta abordar el concepto acerca de la utilidad de la ecografía en el estudio del fenómeno de Raynaud, haciendo un particular énfasis en sus potenciales y ventajas.

An adequate assessment of the microvascular changes is a continuous challenge for the rheumatologist. Raynaud’s phenomenon is the major clinical expression of this pathological condition. Dynamic ultrasound, using color Doppler or power Doppler systems, is generating a great interest by rheumatologist for its several potentialities. The possibility to determine the disease activity and severity, its potential in the predictive value and the capability of treatment monitoring are essential elements when the US is now firmly established. This paper was designed to give an up-to-date about the utility of US in the assessment of Raynaud’s phenomenon, with particular interest on its potentials and advantages.

Laser Doppler Imaging para quantificação do fluxo sanguíneo de polpa digital em condições basais e após estímulo frio em pacientes com esclerose sistêmica / Quantification of basal digital blood flow and after cold stimulus by laser doppler imaging in patients with systemic sclerosis

OBJETIVO: Determinar o comportamento dinâmico do fluxo sanguíneo da microcirculação digital, antes e após dois estímulos frios (EF) de diferentes intensidades, utilizando o método do Laser Doppler Imaging (LDI) em pacientes com esclerose sistêmica (ES) e controles saudáveis. MÉTODOS: Foram incluídos 14 pacientes com ES (51,2 ± 5,5 anos de idade) e 12 controles saudáveis (44,8 ± 9,9 anos). Foram realizados dois protocolos alternativos de EF (submersão das mãos em água a 10 ºC ou 15 ºC, durante 1 minuto). O fluxo médio das quatro polpas digitais da mão esquerda (FPD) foi mensurado com a utilização do LDI (Moor LDI-VR), em condições basais, nos períodos de 1, 4, 10, 25 e 40 minutos após EF. RESULTADOS: O fluxo basal foi significativamente menor em ambos os protocolos em pacientes com ES comparados a controles (312,9 ± 102,7 versus 465,4 ± 135,4 PU, P = 0,006, no protocolo a 15 ºC; 305,2 ± 121,0 versus 437,9 ± 119,8 PU, P = 0,01, no protocolo a 10 ºC). Nos controles houve declínio significativo do FPD após EF, em comparação aos valores basais apenas no tempo de um minuto após EF a 15 ºC (P = 0,001) e nos tempos de 1 e 25 minutos após EF a 10 ºC (P = 0,005; P = 0,001, respectivamente). Nos pacientes com ES, houve declínio significativo do FPD nos tempos de 1, 4 e 10 minutos após ambos EFs (P < 0,000; P = 0,002; P = 0,014, EF a 15 ºC; P < 0,000; P = 0,004; P = 0,001, EF a 10 ºC, respectivamente). CONCLUSÃO: LDI demonstrou baixa perfusão em polpa digital em condições basais e elevado declínio de perfusão com retardo na recuperação após EF na ES. A quantificação do fluxo sanguíneo pelo LDI pode ser útil para o seguimento longitudinal da doença e para a monitoração de intervenções terapêuticas na ES.

OBJECTIVES: The objective of this study was to investigate the dynamic behavior of the blood flow of the microvascular circulation of the fingertips before and after two cold stimuli (CS), using Laser Doppler Imaging with different intensities in patients with systemic sclerosis (SSc) and in healthy individuals. PATIENTS AND METHODS: Fourteen SSc patients (51.2 ± 5.5 years) with Raynaud's phenomenon and 12 healthy controls (44.8 ± 9.0 years) were included in this study. Two CS protocols (submersion of the hands in water at 10 ºC or 15 ºC for 1 minute) were performed on the same day. Mean fingertip blood flow (FBF) of four digits of the left hand was measured using LDI (Moor LDI-VR, Moor Instruments) at baseline and at 1, 4, 10, 25, and 40 minutes after CS. RESULTS: Baseline blood flow was significantly lower in both CS protocols in SSc patients when compared to controls (312.9 ± 102.7 vs 465.4 ± 135.4 PU, P = 0.006 at 15 ºC; 305.2 ± 121.0 vs 437.9 ± 119.8 PU; P = 0.01 at 10 ºC). In the control group, a significant decrease in FBF after CS, when compared to baseline, was observed 1 minute (P = 0.001) after CS at 15 ºC and at 1 (P = 0.005) and 25 minutes (P = 0.001) after CS at 10 ºC. In SSc patients, a significant decrease in FBF was observed in both CS protocols at 1, 4, and 10 minutes (P < 0.000; P = 0.002; P = 0.014, after CS at 15 ºC; P < 0.000; P = 0.004; P = 0.001, after CS at 10 ºC). CONCLUSIONS: Laser Doppler Imaging showed lower baseline fingertip perfusion and further reduction after CS in SSc patients compared to controls. Quantification of fingertip blood flow by LDI may be useful in the longitudinal monitoring of the disease status and therapeutic interventions in SSc.

Comparison of Blood Glucose Measurements Using Samples Obtained from the Forearm, Finger Skin Puncture, and Venous Serum / 대한진단검사의학회지

BACKGROUND: Blood glucose testing (BGT) at the forearm minimizes the pain experienced during sampling of capillary blood. We compared the BGT results for forearm sampling with those for standard finger skin puncture and venous serum to evaluate the clinical validity of forearm BGT. METHODS: BGT was performed on the finger (G(F)) and forearm (G(A)) with a portable glucometer in 555 subjects, including 61 diabetic patients, under fasting conditions. BGT with venous serum (G(V)) was followed within an hour in 514 subjects. Simple linear regression, intraclass correlation, and Passing-Bablok regression analyses were performed using the G(A)-G(F) and G(A)-G(V) data. RESULTS: G(A) showed an excellent linear relationship with both G(F) and G(V) with a Pearson correlation coefficient (r) of 0.97 (P<0.0001) in the patient group, which was similar to the findings in the normal group except for the lower r values. The mean bias between G(A) and G(F) and between G(A) and G(V) were within +/- 10 mg/dL in both groups. The intraclass correlation coefficients were slightly smaller than the corresponding r values, but they showed the same tendency in both groups. In the Passing-Bablok analyses, the 95% confidence intervals of the slope and intercept parameters were <+/-20% of unity and <+/-20 mg/dL, respectively, which were within the acceptable ranges. All 3 statistical analyses supported the satisfactory agreement of G(A) with G(F) or G(V). CONCLUSIONS: BGT at the forearm was highly consistent with the standard BGT, thereby confirming its applicability in clinical practice for self-testing under steady fasting conditions.

Digital arterial injury leading to gangrene of the thumb

An unusual case of a blunt and penetrating injury to the thumb is described. A laterally displaced epiphyses of the first metacarpal divided the digital artery and a penetrating injury in the first web space inflicted on the medial digital artery resulting in a total vascular interruption leading to gangrene and ultimate amputation. Such injuries are rare in children but proper assessment and examination could have prevented the end result

Assessment of the efficacy of an indigeniously developed pulse oximeter dental sensor holder for pulp vitality testing.

Current routine methods of assessment of pulp vitality rely on stimulation of nerve fibres and give no direct indication of blood flow within the pulp. Pulse oximeter is a proven, atraumatic method of measuring vascular status, by evaluating oxygen saturation. This study explores the use of customized dental pulse oximeter sensor holder to assess pulpal vascular oxygen saturation in permanent teeth. Pulse oximeter readily differentiated between known vital and nonvital teeth. Vital teeth consistently provided oxygen saturation values that were lower than the values recorded on the patient's fingers. Pulse oximeter is an accurate, atraumatic clinical alternative to the present electrical and thermal methods of assessing pulp vitality in teeth.

Anatomical study of the extensor apparatus of the fingers

Twenty eight human adult hands of fresh and preserved cadavers were included in this study. Eight of them were injected with red latex to study the arterial supply of the extensor apparatus. Careful dissection was done to demonstrate the parts of the extensor apparatus of the fingers and their arterial supply. The present study illustrated the complex structure of the extensor apparatus of the fingers which is formed of the tendinous and ligamentous portions. The intertendinous connection between the tendon of extensor digitorum to the index and middle fingers was always thin and weak. Variations and anomalies in the tendons that inserted in the extensor expansion of the fingers were encountered. Thumb had its own definite extensor expansion similar to a great extent to that of the other fingers. The components of the extensor apparatus received their blood supply from branches of the proper palmar digital arteries and dorsal metacarpal arteries and/or dorsal digital arteries

Surgical Treatment of Digital Ischemia Occurred after Radial Artery Catheterization

Permanent ischemic injury of the hand after radial artery cannulation is rare, but several cases of thromboembolism after the cannulation leading to amputation of affected limb or digits have been reported. A 48-yr-old man undergoing spine surgery showed normal modified Allen's test and had no preoperative vascular disease. We inserted 20-G radial artery catheter for the continuous monitoring of the blood flow and serial blood sampling. There was no specific event during the operation and the catheter was removed immediately after the operation. The signs and symptoms of the circulatory impairment of the radial artery developed four days after the operation and aggravated thereafter. Through the angiographic study, we found the total occlusion of the radial artery and some of its branches. After an emergent surgical exploration of the radial artery for removal of the thrombus and vein graft for the defect of the artery on the 8th postoperative day, the ischemic signs and symptoms disappeared and the radial pulse was restored.

Arterias metatarsianas plantares en el hombre / Plantar metatarsal arteries in man

El principal elemento arterial del pie es el arco plantar profundo (APP), del cual se originan entre otras, las aa. metatarsianas plantares (AMP), responsables por la irrigación de parte de la región plantar profunda y de los dedos. Con el objetivo de aportar detalles anatómicos y biométricos a la cirugía e imagenología del pie, estudiamos el número de AMP, origen, trayecto y calibre de las mismas. El estudio fue realizado en 50 pies de 25 cadáveres de individuos adultos, brasileños, de ambos sexos. Las arterias fueron inyectadas con látex neoprene (Artifix L14) teñido de rojo, para luego disecar la región plantar por planos. Observamos 3 AMP en 5 casos (10 por ciento), de las cuales, 2 no tenían la 2ª AMP (4 por ciento del total) y 3 la 4ª AMP (6 por ciento). La presencia de 4 AMP fue encontrada en 43 pies (86 por ciento) y sólo en 2 (4 por ciento) se encontraron 5 AMP. Las 1ª y 2ª AMP se originaron del APP o de la arteria dorsal del pie, mientras que las 3ª y 4ª AMP siempre provinieron del APP. Cuando las arterias fueron otorgadas por el APP, en 6 por ciento de los casos las 1ª y 2ª AMP se originaron de un tronco común, situación que también ocurrió con las 2ª y 3ª AMP (10 por ciento) y con las 3ª y 4ª AMP (8 por ciento). La 1ª AMP transcurrió por el primer espacio interóseo en 92 por ciento de los casos y las 2ª, 3ª y 4ª AMP lo hicieron por el espacio correspondiente en 100 por ciento. El calibre promedio de la 1ª AMP fue de 1,73 mm, el de la 2ª de 1,43 mm, el de la 3ª de 1,54 mm y de la 4ª de 1,52 mm. La 1ª AMP fue más calibrosa que la 2ª AMP en ambos lados. Estas cuatros arterias alcanzan las comisuras interdigitales y son fundamentales para la irrigación de los dedos del pie

Estudo anatômico da vascularizaçäo cutânea do dorso dos dedos e sua aplicaçäo no retalho desepidermizado do homodigital / Anatomical study on cutaneous vascularization of the dorsal region of fingers and the principal applied to the homodigital desepidermized flap

O autor apresenta o estudo anatômico da vascularização cutânea do dorso dos dedos - 144 dígitos - e sua aplicação no retalho desepidermizado homodigital - 22 pacientes -. Foram utilizados 18 cadáveres, não-formolizados, com distribuição eqüitativa entre os dedos indicador, médio, anular e mínimo. A idade média foi de 58 anos e 7 meses (extremos 47 e 76 anos), 88,9 por cento eram do sexo masculino e 55,6 por cento corresponderam à raça branca. A análise estatística dos resultados demonstrou a existência de dois ramos constantes ao nível da falange proximal e média provenientes de cada artéria colateral palmar, formando um sistema anastomótico dorsal ao nível das articulações metacarpofalângicas, interfalângicas proximais e distais. A série clínica correspondeu a 22 pacientes que apresentavam perda de substância ao nível dorsal dos dedos. A idade média foi de 24 anos e 6 meses (extremos 6 e 67 anos), 68,2 por cento eram do sexo masculino. O agente etiológico mais freqüente foi a queimadura (54,5 por cento), seguindo-se o esmagamento com 31,9 por cento. O dedo médio foi mais freqüentemente acometido com 45,8 por cento e a falange média com 46,9 por cento. O retalho foi sempre homodigital, proximal à perda de substância,, desepidermizado, transposto sobre a perda de substância e posterior enxertia de pele parcial sobre o retalho. O tamanho médio dos 24 retalhos variou de acordo com a perda de substância. Ao metacarpo -5 casos, 49xl7 mm; à falange proximal -11 casos, 24xl6 mm; e, à falange média -8 casos, l2xl4 mm. Foi constatado em um caso, necrose de 15 por cento da superfície total do enxerto de pele. Baseado nesses resultados anatômicos e clínicos o autor conclui que é possível a realização de um retalho desepidermizado homodigital às perdas de substância cutânea da face dorsal dos dedos

Vascularizaçäo da articulaçäo interfalangiana proximal / Proximal interphalangeal join vascularization

Os autores apresentam os resultados da dissecçao cadavérica de 100 dígitos. Analisam a vascularizaçao da articulaçao interfalangiana proximal (IFP), através de estudo microscópico, em que foram utilizados látex colorido e poliéster CPLS 1108 adicionado ao carbonato de chumbo; este foi injetado equitativamente 50 veces na artéria colateral radial e ulnal de cada dígito, após a ligadura da artéria colateral oposta ao nível da articulaçao interfalangiana distal (IFD). Na maior parte dos casos, três ramos vascularizam a IFP, com dois sistemas: um proximal e um distal em relaçao à IFP. Os resultados foram: grupo I (2º e 5º quirodáctilos) - a ligadura dos ramos distais ou proximais à artéria acarretou a ausência de coloraçao, respectivamente, dos elementos distais ou proximais à IFP; grupo II (3º e 4º quirodáctilos) - a ligadura dos ramos distais ou proximais à artéria ocasionou coloraçao quantitativamente superior à do grupo I. Este estudo da vascularizaçao da IFP demonstrou diferenças importantes segundo o dígito em estudo e a precariedade do sistema radial do 2º quirodáctilo e ulnal do 5º, proporcionando nova forma de pensar na escolha da via de abordagem cirúrgica dessa articulaçao.

Irrigación de los dedos en el bovino / Irrigation of the digits in the bovine

Se procura lograr un mejor conocimiento de la irrigación de los dedos en el bovino, dada la importancia que ésta adquiere frente a los cuadros clínicos abordados por la patología quirúrgica. Se examinaron 10 manos de ejemplares adultos y 5 fetos bovinos, previamente inyectados con celuloide coloreado. En los bovinos adultos la aplicación del celuloide se realizó a partir del tercio proximal de los matacarpianos, en tanto qu en los fetos fue en la arteria axilar. También se realiza inyección de solución de contraste para obtención de placas radiográficas. Los resultados revelan el comportamiento de la arteria metacarpiana dorsal III, en el 100 por ciento de los casos, originada a partir de la red dorsal del carpo hasta la formación del rodete coronario y la formación del arco terminal.

Finger replantation

The objetive of this study was to determine the influence of the following factors on the survival rate of replanted digits: patient's age, typeand level of amputation, time of ischemia, number of arteries and veins anastomosed and types of vascular rapir. A total of 60 digits were replanted by the author from 1980 to 1990. The results showed no significant corrrelation between the survival rate and the factors studied. However, the surgeon's experience played an important role in the survival rate of replanted digits

Vascularizaçäo dos tendöes flexores dos dedos da mäo: estudo experimental em cadáveres / Vascularization of flexor tendons of the fingers: experimental study in cadavers

Os autores realizam o estudo das características da irrigaçäo dos tendöes flexores do antebraço e mäo, assim como das áreas de irrigaçäo seletivas das artérias ulnal e radial. O estudo foi feito em 22 cadáveres, com injeçäo intra-arterial de soluçäo contrastante, para realçar a trama vascular à inspeçäo anatômica e permitir o estudo radiológico. Mostram a importância do epitendäo na vascularizaçäo dos tendöes flexores e seu padräo vascular e demonstram a suficiência das artérias radial e ulnal, isoladamente, em manter a circulaçäo ao nível do antebraço e mäo