[Surgical Treatment for Lung Cancer Associated with Hypertrophic Pulmonary Osteoarthropathy].

Hypertrophic pulmonary osteoarthropathy( HPO) is a rare paraneoplastic manifestation of lung cancer that causes joint pain, joint swelling, and limited range of motion. Two surgical cases of lung cancer with HPO are presented. Case1:A 43-year-old female was referred to our department with a diagnosis of cStage ⅡB left hilar lung cancer. She had difficulty in walking due to arthralgia caused by HPO. Left pneumonectomy was performed and the arthralgia disappeared on the first postoperative day. The patient is being well after surgery without relapse of joint symptoms. Case2:The patient was a 65-year-old male with cStage ⅡA right lung cancer. The symptoms of HPO appeared after he was found to have lung cancer. After right upper lobectomy, the arthralgia disappeared on the first postoperative day. Currently, he is receiving adjuvant chemotherapy, without relapse of joint symptoms.

[A Case of Hypertrophic Pulmonary Osteoarthropathy Associated with Pulmonary Pleomorphic Carcinoma].

Hypertrophic pulmonary osteoarthropathy(HPO)is a tumor-associated syndrome that features the triad of clubbed fingers, periosteal bone growth in long bones, and arthritis, and is often associated with an adenocarcinoma or squamous cell carcinoma. This report presents details of a case of HPO associated with pleomorphic carcinoma, which was relieved by treatment. A 47-year-old woman was presented with a complaint of generalized arthralgia. A physical examination showed swollen joints in the body and clubbed fingers. Chest CT revealed a mass shadow in the left upper lobe and ultrasound- guided biopsy findings led to a diagnosis of non-small cell lung cancer. Furthermore, bone scintigraphy indicated symmetrical accumulation in bones and joints throughout the body. A right upper lobectomy was performed along with combined chest wall resection and mediastinal lymph node dissection with an open chest, and the presence of lung cancer complicated with HPO was indicated. Pathological examination results revealed a diagnosis of pleomorphic carcinoma(pT4N0M0, Stage ⅢA). Systemic arthralgia was resolved on the first postoperative day. One year after surgery, a solitary brain metastasis developed and was removed, with no recurrence at the time of writing. Joint symptoms related to HPO can be expected to improve with treatment of pulmonary lesions, thus aggressive procedures for diagnosis and treatment are desirable.

Atypical and incomplete pulmonary hypertrophic osteoarthropathy in the left distal femur: a case report.

BACKGROUND: Pulmonary hypertrophic osteoarthropathy (PHO) is a rare paraneoplastic syndrome that mainly occurs in patients with lung cancer. Most symptoms occur symmetrically, and unilateral symptoms without clubbing are infrequent. This report presents the case of a rare atypical symptom that was highly suspected of being PHO. CASE PRESENTATION: A 77-year-old woman with swelling and severe pain in the left femur for 2 months was referred to our hospital. Radiography revealed a remarkably osteogenic thickening and sclerotic lesion in her distal femur. Preliminary diagnoses of malignant bone tumor and hematological tumor were made based on laboratory test results, radiological examination, and clinical manifestation. A needle biopsy was performed, which ruled out the diagnosis of malignant bone tumors. A low-grade bone tumor was still suspected. After that, en bloc resection was performed, followed by replacement of the femur with a mega-prosthesis. Pathological analysis revealed no malignant tumor cells, and immunohistochemical staining for CDK4 and MDM2 yielded negative results. Meanwhile, pulmonary large cell carcinoma was identified on biopsy. Based on published studies, a diagnosis of atypical PHO was made according to clinical and imaging manifestations. CONCLUSIONS: This is an infrequent case of PHO with unilateral symptoms in the left femur. When clinical manifestations and radiological findings are inconsistent with the pathological results, the possibility of benign lesions with malignant clinical manifestations or imaging features should be carefully considered.

Osteoid Osteoma of the Distal Phalanx of the Ring Finger with Clubbed Finger Deformity: A Case Report.

Osteoid osteoma of the distal phalanx is very rare. We describe a case of osteoid osteoma of the distal phalanx of the ring finger with clubbed finger deformity that improved after tumour removal. A 50-year-old left-handed man presented with a history of right ring finger pain without any trauma. The distal phalanx of the ring finger had tender, redness, and a clubbed finger deformity. Plain radiography indicated a circular radiolucent area in the centre of the lesion. Computed tomography and gadolinium enhanced magnetic resonance imaging indicated presence of a nidus. The lesion was removed via the transungual approach. Histopathological examination confirmed the presence of an osteoid osteoma. His pain was immediately relieved after surgery. At the 2-year followup, he had no pain and the clubbed finger deformity had improved. In cases where clubbed finger deformity involves only one finger, the possibility of chronic osteomyelitis or osteoid osteoma should be considered.

Graft Infection Masquerading as Rheumatologic Disease: a Rare Case of Aortobifemoral Graft Infection Presenting as Hypertrophic Osteoarthropathy.

BACKGROUND: Prosthetic vascular graft procedures are a common treatment modality for peripheral vascular disease. A relatively common complication is graft infection, occurring at a rate of 0.5-5%. When they occur, graft infections are associated with significant morbidity and mortality. Vascular graft infections also represent a diagnostic and therapeutic challenge for the physician METHODS: Here, we report a case where the rare finding of secondary hypertrophic osteoarthropathy was an important indication of underlying aortic graft infection that was initially misdiagnosed. A review of the literature revealed 34 cases of vascular graft infection associated with hypertrophic osteoarthropathy. RESULTS: The mean interval from surgery to time of infection was approximately 5 years. Mortality was 35%. When combined with hypertrophic osteoarthropathy, vascular graft infection was complicated by an aortoenteric fistula in 53% of the cases. CONCLUSION: The complexity of this case highlights the challenges physicians face in order to diagnose and treat this condition.

[Bronchial carcinoma and knee pain. Secondary hypertrophic osteoarthropathy]. / Bronchialkarzinom bei Knieschmerzen. Die sekundäre hypertrophe Osteoarthropathie.

Secondary hypertrophic osteoarthropathy (HOA), also known as Marie-Bamberger syndrome, is a rare neoplastic syndrome featuring clubbing of the tips of the digits, periosteal proliferation and synovial effusion of adjacent joints. We report a case where a patient without any other known medical condition developed persistent arthralgia and mobility restriction after bruising the left knee. As the initial X-ray examination of the knee showed a distinct periosteal proliferation of the left femoral bone, extended diagnostics were initiated during which a bronchial carcinoma was identified. After surgical removal of the primary tumor the symptoms of irritation in the knee joint recovered totally.

Single clubbed finger caused by an enchondroma of the distal phalanx: an unusual clinical presentation.

Single clubbed finger is an extremely rare condition that may show the presence of an underlying neoplasm of the distal phalanx. We describe a case of clubbing in a young adult patient with an enchondroma of the ring finger distal phalanx. The patient had a history of antecedent trauma to the left ring finger, suggesting the diagnosis of intraosseous epidermoid cyst rather than enchondroma. The lesion was successfully treated by curettage and packing of the bony defect with a synthetic bone substitute. Histologically, the tumour consisted of small, uniform chondrocytes without cytologic atypia. At the seven months follow-up, the patient had no evidence of recurrence, with a nearly normal-looking finger. We suggest that enchondroma should be considered in the differential diagnosis of clubbing in a single digit.

[Hypertrophic osteoarthropathy associated with pulmonary tuberculosis]. / Ostéoarthropathie hypertrophique pneumique associée à la tuberculose pulmonaire.

Hypertrophic osteoarthropathy is a syndrome frequently described in intrathoracic diseases, especially malignant ones. The association with lung tuberculosis is rarely reported. The authors describe the case of a 35-year-old patient, a smoker, hospitalised for lung cavitation associated with hypertrophic osteoarthropathy. The assessment of the aetiology was negative and the patient underwent lung surgery. The histopathological examination concluded as to chronic pulmonary tuberculosis. This report aims at alerting physicians about the possibility of hypertrophic osteoarthropathy in non malignant diseases, especially pulmonary tuberculosis which is still endemic in our country.

Surgically cured hypoglycemia secondary to pleural solitary fibrous tumour: case report and update review on the Doege-Potter syndrome.

The association of paraneoplastic hypoglycemia [Doege-Potter syndrome] and finger clubbing [Pierre-Marie-Bamberg syndrome] with pleural solitary fibrous tumour is rare. We present a previously unpublished but typical example of this rare occurrence together with a detailed updated literature review of previously published cases of pleural SFT discussing the histopathology of SFT; pathophysiology of the hypoglycemia and finger clubbing; treatment and outcome of pleural SFT. The patient, a 57-year-old African male was admitted at our hospital with recurrent episodes of hypoglycemia. He was found to have digital clubbing and decreased breath sounds in the right lower chest but no other significant clinical findings. His insulin level measured during an episode of hypoglycemia was undetectable. Chest radiograph and CT-scan revealed a lobulated mass in the right chest which was diagnosed to be SFT on histology. Surgical excision of the mass resulted in cure of the hypoglycemic episodes and rapid regression of the clubbing. Less than 65 cases of pleural SFT manifesting with hypoglycemia with or without finger-clubbing have been published in the English literature. The mean diameter of these tumours manifesting with hypoglycemia is 20 cm, 54% being benign while 42% were malignant. They predominantly present in the 6th-8th decade, average age of 64 years and a slight male preponderance at 58%. Complete surgical resection remains the most important predictor of clinical outcome in terms of recurrence and metastases, while providing instant cure for the hypoglycemia and rapid resolution of the finger clubbing.

[Reversal of digital clubbing in surgically treated lung cancer patients]. / Regressão do hipocratismo digital em pacientes com câncer de pulmão tratados cirurgicamente.

OBJECTIVE: To objectively evaluate the reversal of digital clubbing (DC) in a series of surgically treated lung cancer patients, and to review the literature on the subject. METHODS: Sixty-one patients with non-small cell lung cancer--40 with and 21 without DC--were treated by pulmonary resection. Eleven (18%) received additional postoperative radiation therapy. Preoperatively, as well as on postoperative days 7, 18, and 90, the hyponychial angle (HA) and the distal phalangeal depth/interphalangeal depth (DPD/IPD) ratio were determined on profile shadow projections of the index fingers. A review of the literature on reversal of DC (1954-2007) was also performed. RESULTS: From the preoperative period to postoperative day 90, HA decreased from 200.5 +/- 5.0 masculine to 193.3 +/- 6.8 masculine (p < 0.001), and the DPD/IPD ratio decreased from 1.014 +/- 0.051 mm to 0.956 +/- 0.045 mm (p < 0.001) in the group of 40 patients with DC. The HA and the DPD/IPD ratio decreased in 33 (82.5%) but remained the same in 7 (1.7%), 6 with unfavorable evolution. In the 21 patients without DC, HA (184.5 +/- 5.5 masculine) and the DPD/IPD ratio (0.937 +/- 0.046 mm) remained unchanged after surgery. In the literature (1954-2007), we found 52 cases, 5 of which were lung cancer cases, in which reversal of DC, observed in several clinical conditions, was explicitly reported. CONCLUSION: In most lung cancer patients, DC resolves after effective surgical treatment of the tumor, as can occur in patients with other conditions.

Regressão do hipocratismo digital em pacientes com câncer de pulmão tratados cirurgicamente / Reversal of digital clubbing in surgically treated lung cancer patients

OBJETIVO: Estudar, por meio de avaliações objetivas, a ocorrência de regressão do hipocratismo digital (HD) em pacientes com câncer de pulmão, tratados cirurgicamente, e revisar a literatura sobre o assunto. MÉTODOS: Sessenta e um pacientes com câncer de pulmão não-pequenas células-40 com e 21 sem HD-foram tratados por cirurgia de ressecção pulmonar. Onze deles (18 por cento) também receberam radioterapia pós-operatória. No período pré-operatório e no 7º, no 18º e no 90º dia pós-operatório, o ângulo hiponiquial (AH) e a relação entre as espessuras falangeana distal e interfalangeana (EFD/EIF) foram determinados sobre imagens da sombra dos dedos indicadores em perfil. Uma revisão da literatura sobre regressão do HD (1954-2007) também foi efetuada. RESULTADOS: Do período pré-operatório ao 90º dia pós-operatório, o AH diminuiu de 200,5 ± 5,0º para 193,3 ± 6,8º (p < 0,001), e a relação EFD/EIF, de 1,014 ± 0,051 mm para 0,956 ± 0,045 mm (p < 0,001) no grupo de 40 pacientes com HD. Em 33 (82,5 por cento), o AH e a relação EFD/EIF diminuíram, mas, em 7 (1,7 por cento), 6 com evolução desfavorável, esses valores não se reduziram. Nos 21 pacientes sem HD, tanto o AH (184,5 ± 5,5º) como a relação EFD/EIF (0,937 ± 0,046 mm) permaneceram inalterados após a cirurgia. Na literatura (1954-2007) foram encontrados 52 casos em que a regressão do HD, observada em diversas condições clínicas, foi explicitamente referida, 5 dos quais eram casos de câncer de pulmão. CONCLUSÕES: O HD em pacientes com câncer de pulmão regride na maioria dos casos após tratamento cirúrgico efetivo do tumor, o que pode também ocorrer em pacientes com outras condições.

OBJECTIVE: To objectively evaluate the reversal of digital clubbing (DC) in a series of surgically treated lung cancer patients, and to review the literature on the subject. METHODS: Sixty-one patients with non-small cell lung cancer-40 with and 21 without DC-were treated by pulmonary resection. Eleven (18 percent) received additional postoperative radiation therapy. Preoperatively, as well as on postoperative days 7, 18, and 90, the hyponychial angle (HA) and the distal phalangeal depth/interphalangeal depth (DPD/IPD) ratio were determined on profile shadow projections of the index fingers. A review of the literature on reversal of DC (1954-2007) was also performed. RESULTS: From the preoperative period to postoperative day 90, HA decreased from 200.5 ± 5.0º to 193.3 ± 6.8º (p < 0.001), and the DPD/IPD ratio decreased from 1.014 ± 0.051 mm to 0.956 ± 0.045 mm (p < 0.001) in the group of 40 patients with DC. The HA and the DPD/IPD ratio decreased in 33 (82.5 percent) but remained the same in 7 (1.7 percent), 6 with unfavorable evolution. In the 21 patients without DC, HA (184.5 ± 5.5º) and the DPD/IPD ratio (0.937 ± 0.046 mm) remained unchanged after surgery. In the literature (1954-2007), we found 52 cases, 5 of which were lung cancer cases, in which reversal of DC, observed in several clinical conditions, was explicitly reported. CONCLUSION: In most lung cancer patients, DC resolves after effective surgical treatment of the tumor, as can occur in patients with other conditions.

[Correction of finger clubbing in primary hypertrophic osteoarthropathy (Touraine-Solente-Gole syndrome)]. / Korrektur der Trommelschlegelfinger unter ästhetischen Aspekten bei hereditärer hypertropher Osteoarthropathie (Touraine-Solente-Gole-Syndrom).

Finger clubbing can be a single physical finding. In Touraine-Solente-Gole syndrome, the primary form of hypertrophic osteoarthropathy, it is mostly associated with bone pain, hyperhydrosis, pachydermy and wrinkling of the forehead. In other cases, the presence of clubbing is associated with neoplastic, pulmonary, cardiac or other diseases and is then called Bamberger-Pierre-Marie syndrome, the secondary type of hypertrophic osteoarthropathy. The patient's history and careful physical examination, sometimes accompanied by laboratory and imaging studies, leads to the diagnosis. A patient with hereditary hypertrophic osteoarthropathy and its clinical symptoms is presented. Surgical correction of the clubbing fingers is demonstrated in the paper with bilateral resection and shortening of the nail bed, nail matrix and resection of soft tissue. Clubbing fingers are rare, but they might be part of a syndrome or a symptom of other diseases. Reconstructive surgery for aesthetic reasons can be performed.

Tríada de Herbst: acropaquías, hipoproteinemia y anemia ferropénica, asociadas a reflujo gastroesofágico / The Herbst triad: finger clubbing, hypoproteinemia and iron deficiency anemia associated with gastroesophageal reflux

El reflujo gastroesofágico asociado a hernia hiatal puede presentarse en la clínica bajo formas inhabituales tales como el síndrome de rumiación, el síndrome de Sandifer (esofagitis por reflujo, anemia ferropénica y peculiares movimientos de torsión de la cabeza) o la denominada tríada de Herbst que incluye anemia ferropénica, hipoproteinemia y acropaquías. Presentamos un nuevo caso de este excepcional y llamativo complejo sindrómico ya que su desconocimiento puede conducir al desarrollo de complicaciones y retraso en la corrección quirúrgica del reflujo gastroesofágico

Gastroesophageal reflux with hiatal hernia has been associated with unusual presentations, including rumination syndrome, Sandifer syndrome (reflux esophagitis, iron deficiency anemia and head cocking) and the Herbst triad (iron deficiency anemia, hypoproteinemia and finger clubbing). We report a new case of this rare disease. Lack of awareness of gastroesophageal reflux as a possible cause of these striking symptoms could lead to complications and delayed surgery

Effective symptomatic relief of hypertrophic pulmonary osteoarthropathy by video-assisted thoracic surgery truncal vagotomy.

Various modalities for the treatment of hypertrophic pulmonary osteoarthropathy (HPOA) associated with lung cancer have been suggested since 1958. Although the etiology remains speculative, unilateral vagotomy on the side of the lung cancer achieves symptomatic relief. We report a case of a 50-year-old woman with disabling HPOA and inoperable lung cancer who experienced effective pain relief and regained full mobility after video-assisted thoracoscopic surgery was used to perform truncal vagotomy. This relatively safe and simple procedure should be considered for terminal lung cancer patients with intractable HPOA.

[Surgical management of neuropathy and osteoarthropathy of the diabetic food]. / Chirurgisches Vorgehen bei Neuropathie und Osteoarthropathie des diabetischen Fusses.

Along with angiopathy, neuropathy and osteoarthropathy are the most important effects of diabetes mellitus with regard to the foot. Because diagnosis in cases of these two consequences are very frequently wrong and too late, the diagnostic procedure and differential diagnosis will be discussed first. The goal of surgical and conservative treatment is a functioning foot and not amputation and provision of a prosthesis. The five types of osteoarthropathy together with the operative procedure for each are introduced: at the forefoot, resection of from one to all metatarsal radii whilst sparing the toes; at the metatarsus, the removal of projecting fragments; at the dorsal foot, resectioning arthroplasty. The operative procedures usual in traumatology cannot simply be transferred to osteoarthropathy. Arthrodeses and spongiosa grafting are doomed to failure in the neuropathic area, or at least carry the onus of a much longer period of convalescence. Resectioning arthroplasty for constructing a stiff pseudarthrosis is an alternative. The results are, however, only lasting if perfect orthopedic care and regular care and checking of the feet are guaranteed thereafter.

Hypertrophic pulmonary osteoarthropathy associated with granulomatous Pneumocystis carinii pneumonia in AIDS.

A case of hypertrophic pulmonary osteoarthropathy (HPOA) in a HIV-infected patient with granulomatous Pneumocystis carinii pneumonia is described. This is the third case of HPOA associated with AIDS reported in the literature. Granulomatous P. carinii pneumonia is an unusual manifestation of P. carinii infection. Surgical treatment of this condition may lead to the dramatic spread of P. carinii causing a fulminant course with fatal outcome.