1/55. Distant and delayed mitomycin C extravasation.mitomycin C is a vesicant chemotherapeutic agent used to treat solid tumors. Its ability to cause delayed and remote tissue injury after intravenous administration is reported in the literature. Two cases of delayed and distant mitomycin C extravasation injury occurred in our institution. In both patients, no evidence of acute extravasation was visible during or immediately after administration. Within 48 hours, one patient reported erythema, burning, and pain in the hand contralateral to the administration site. The second patient developed three distinct ulcerated lesions on her forearm within 6 weeks of receiving the agent. The lesions, located at sites of venipunctures, occurred 12-15 cm proximal to the site of mitomycin infusion. Because the drug has the potential to cause such unusual and unanticipated tissue injuries, health care professionals and patients should be aware of this hazard.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
2/55. Autologous keratinocytes cultured on benzylester hyaluronic acid membranes in the treatment of chronic full-thickness ulcers.keratinocytes were obtained from three patients with chronic full-thickness ulcers of different aetiologies. The cells were isolated, cultured and then seeded on to a membrane composed of benzylester hyaluronic acid. Once the keratinocytes had become subconfluent, the keratinocyte-containing matrix sheets were then applied as autologous grafts to the patients' ulcers. Results indicate that autologous grafting of keratinocytes cultured on benzylester hyaluronic acid membranes provides improved graft handling, reduces total time required for tissue cultivation and enhances cellular vitality because of the possibility of grafting at a subconfluent non-differentiated stage.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
3/55. A case of hand ulceration in the diabetic foot clinic--a reminder of hand neuropathy in 'at risk' patients.BACKGROUND: A case of hand ulceration in a diabetic patient with known lower extremity complications is presented. Although often asymptomatic, quantitative testing in patients indicates reduced hand sensation in patients with lower extremity neuropathy. hand neuropathy may occasionally lead to anaesthetic injuries, particularly in certain 'manual' occupations, as seen in our patient. CONCLUSIONS: education on hand care is virtually nonexistent in most clinic settings, and our case highlights the need for more awareness on this potentially troublesome complication.- - - - - - - - - - ranking = 11keywords = hand (Clic here for more details about this article) |
4/55. mixed connective tissue disease associated with skin defects of livedoid vasculitis.A 21-year-old woman who had a 2-year history of mixed connective tissue disease (MCTD) developed rapidly evolving ulcers consistent with livedoid vasculitis (LV) in all distal extremities. She presented clinically with Raynaud's phenomenon, polyarthritis and swollen hands; serologically with high titres of ANA and anti-nRNP; and immunogenetically with HLA-DR4 and HLA-DR53. Although there was initial success in treatment except for the skin defects over the ankles, the patient died from disseminated intravascular coagulation. We suggest that LV may be a poor prognostic manifestation in MCTD.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
5/55. A case of basal cell carcinoma of the skin in a patient with systemic sclerosis.A 46-year-old man complained of pain and stiffness in both hands. Most of his fingertips were shortened, and Raynaud's phenomenon was evident. The skin on his face and hands was hard and taut. An ulcerating mass measuring 3.2 x 2.5 cm was found on his left infraorbital area. biopsy revealed basal cell carcinoma. Antinuclear antibody and anti-topoisomerase I antibody were strongly positive. A high-resolution computed tomography (CT) scan of the lungs revealed interstitial fibrosis. Esophageal manometry showed low lower esophageal sphincter pressure and gastroesophageal reflux. Under the diagnosis of basal cell carcinoma accompanying systemic sclerosis (SSc), surgical excision of the mass was performed, and immunosuppressant and vasodilator therapies were conducted.- - - - - - - - - - ranking = 2keywords = hand (Clic here for more details about this article) |
6/55. Sensory radicular neuropathy.A patient had sensory radicular neuropathy. The patient demonstrated features characteristic of this entity: (1) recurrent trophic ulcerations of the hands and feet, (2) onset in early adulthood, (3) distal, dissociated loss of pain and temperature sensation far out of proportion to the loss of other sensory perceptions, and (4) complete sparing of motor function.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
7/55. Deficiency of the decorin core protein in the variant form of ehlers-danlos syndrome with chronic skin ulcer.decorin belongs to a family of small leucine-rich dermatan sulfate proteoglycans that are involved in the control of matrix organization and cell growth. Here, we described a patient whose skin glycosaminoglycans showed extremely decreased amount of dermatan sulfate compared with a normal control skin. This patient presented clinical features of ehlers-danlos syndrome with a chronic skin ulcer. Western blotting revealed that the deficiency of dermatan sulfate was due to the defect of decorin core protein. Beta-xyloside, an initiator of dermatan sulfate glycosaminoglycan chain elongation, enhanced the synthesis of dermatan sulfate in the fibroblasts of the patient to a similar extent to that of control. This result indicated that the enzymes for the elogation of dermatan sulfate side chains were normal. Northern blotting demonstrated remarkable reduction of decorin mRNA level, while biglycan mRNA level was concomitantly increased and procollagen alpha1(I) mRNA level was normal. cDNA and exons sequencing analysis showed there was no mutation in decorin gene of the patient. IL-1beta stimulated decorin expression to about 140% in control fibroblasts while about 110% in patient fibroblasts. On the other hand, TGF-beta1 resulted in 40% reductions of decorin expression in both control and patient fibroblasts. These data suggested that reduced decorin expression of fibroblasts from the patient of Ehlers-Danlos syndrome may be due to abnormalities in the regulatory regions, which is responsible for the IL-1beta stimulation.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
8/55. Multiple herpetic whitlow lesions in a patient with chronic lymphocytic leukemia.Herpetic whitlow, a herpes simplex virus infection involving the digits, most commonly presents as a vesicular eruption involving a single digit. diagnosis of herpetic whitlow can usually be made with the history of exposure, the characteristic vesicular eruption, and a positive Tzank smear and/or viral culture. We describe a case of herpetic whitlow in a patient finishing 6 cycles of chemotherapy for refractory chronic lymphocytic leukemia that presented with a bilateral, multi-digit, crusted eruption of the hands. This is an illustrative case of an immunocompromised host status altering appearance and course of cutaneous disease such that the history and physical exam alone may not help in diagnosing atypical presentations of herpetic infections. This case underscores the necessity for clinico-histopathologic correlation.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
9/55. Ulceration caused by cytotoxic drugs.Five cases of severe ulceration of the dorsum of the hand and forearm, caused by the large extravasation of a cytotoxic agent, administered for haematological disorders, are presented.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
10/55. More than 13 years of hypereosinophila associated with clonal CD3-CD4 lymphocytosis of TH2/TH0 type.A 65-year-old Japanese woman was referred to our hospital because of hypereosinophilia lasting for more than 10 years, and skin ulceration, especially on the hands. Closer examination revealed the clonal proliferation of CD3-CD4 t-lymphocytes. The patient had generalized pruritus without severe end-organ involvement and high serum levels of IgE. A diagnosis of monoclonal CD3-CD4 T-lymphocyte-associated idiopathic hypereosinophilic syndrome (HES) was made based on these findings. This case showed that this newly recognized entity of HES is not restricted to Western countries. The abnormal T-cell clone was not merely TH2 type but was clearly TH2/TH0 type. Although this disease is considered prelymphoma, this patient did not develop lymphoma during more than 13 years of follow-up. Therefore, in some patients, clonal CD3-CD4 lymphocyte-associated HES may take a more indolent course. In this subgroup, the control of clinical manifestations seems very important. In the present case, treatment with hydroxyurea quite dramatically improved the intractable skin manifestations, although the treatment lessened only the number of peripheral eosinophils and not the number of clonal CD3-CD4 t-lymphocytes.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
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