1/4. Hypertrophic pulmonary osteoarthropathy: control of pain and symptoms with pamidronate.This case presents a patient with hypertrophic osteoarthropathy of the lower extremities that developed secondary to congenital cyanotic heart disease. The major clinical manifestation was severe bilateral leg pain. The pain that was debilitating in nature completely resolved following a single administration of 60 mg pamidronate. Hypertrophic osteoarthropathy (HOA) is an acquired, uncommon disorder of obscure etiology. It has been described mainly in association with chronic suppurative pulmonary diseases, bronchogenic carcinoma and lung metastases, cystic fibrosis, and cyanotic congenital malformations of the heart.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/4. Hypertrophic osteoarthropathy in cystic fibrosis.Seven adult patients with cystic fibrosis who had radiological evidence of hypertrophic osteoarthropathy were reviewed. In five of the patients symptoms were particularly pronounced at times of acute infective exacerbations; appropriate treatment of the infective episodes resulted in reduction or resolution of the bone pain and joint effusions. Despite this symptomatic relief periosteal changes persisted radiologically and their chronic nature was indicated by changes in the midshafts of long bones. Four of the seven patients had transient gynaecomastia or mastalgia related to infective exacerbations. It is hypothesised that a neuroendocrine mechanism--namely, release of vasoactive intestinal polypeptide--might account for the osteoarthropathy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/4. Colonic hamartomatous polyposis associated with hypertrophic osteoarthropathy.A 7-year-old girl with an unremarkable family history was admitted with complaints of diarrhea containing mucus and blood, abdominal pain, weight loss and fever for 10 months. Although her symptoms, physical examination and laboratory results were highly suggestive of inflammatory bowel disease, radiologic studies and colonoscopy demonstrated multiple colonic polyps. A bilateral and symmetric lamellar periosteal reaction and osteopenia were present on her extremity radiographs. The chest radiograph and thoracic CT scan were normal. The histologic nature of the polyps was determined as hamartoma. One month after subtotal colectomy, the patient's symptoms resolved and she gained 7 kg in weight. The association of generalized juvenile polyposis and hypertrophic osteoarthropathy has previously been described in five cases; arteriovenous malformations were present in four of them. In our case the polyps were hamartomatous and localized in the colon, without associated arteriovenous malformation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/4. Digital clubbing. A case study.In this case, it is difficult to assess whether the severity of the clubbed digits is a result of a purely hereditary nature, liver pathology, chronic respiratory ailments, or a combination of the above. The abnormal liver function test may not be related to the digital clubbing. Instead, they may be the result of the alcohol abuse. The case does appear to be hereditary because his siblings and mother all have clubbed digits and there is a higher frequency in blacks. The authors believe that this case affords an opportunity to make the podiatrist aware of the possibilities that should be considered the differential diagnosis when examining a patient with clubbed digits. It is important to fully work up a patient with clubbed digits even if the presentation is that of hereditary clubbing. Severe clubbing may be the result of a mild hereditary form that was worsened by an underlying systemic condition, such as malignancy, toxicosis, endocrinopathy, and neuropathy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |