Hypothenar hammer syndrome

The relatively rare Hypothenar Hammer Syndrome is presented and discussed, illustrated by two cases. Percutaneous blockage of the stellate ganglion is suggested in order to prevent the amputation of the affected finger or fingers.     

Hypothenar hammer syndrome followed by systemic sclerosis

We describe the first case of bilateral hypothenar hammer syndrome (HHS) followed by systemic sclerosis (SSc) that was associated with silica exposure (Erasmus syndrome). The patient was a woman smoothing tiles in an earthenware factory who presented with bilateral digital ischemia associated with Raynaud's phenomenon. HHS was diagnosed, based on an angiographic study showing aneurysm of the ulnar arteries and occlusions of multiple digital arteries. Pulmonary silicosis was also diagnosed on pulmonary tomodensitometry. Two years later digital swelling with acroosteolysis developed. The FANA test was positive (titer 1:640) and anticentromere antibody tests were also positive. Esophageal manometry showed dysmotility of the lower esophagus. These findings were consistent with a diagnosis of SSc.     

Hypothenar hammer syndrome: an occupational cause of Raynaud's phenomenon

Hypothenar hammer syndrome is an uncommonly recognized, occupationally associated cause of Raynaud's phenomenon, induced by traumatic compromise of the vascular supply to the hand. Two patients are presented, one with preexisting Raynaud's phenomenon who sought attention after the development of cutaneous ulcers. The features of the syndrome are reviewed, and the importance of its recognition in the appropriate occupational setting as a potentially curable form of Raynaud's phenomenon is emphasized.     

Hypothenar hammer syndrome in a patient with rheumatoid arthritis: a mimic of vasculitis

A 50-yr-old right-handed man with RA suddenly developed painfuldiscoloration of the middle, ring and little fingers of theleft hand. He smoked 20 cigarettes per     

Hypothenar hammer syndrome. Form of reversible Raynaud's phenomenon

Hypothenar hammer syndrome is a reversible yet uncommonly encountered cause of Raynaud's phenomenon. Characteristic findings include coldness in the dominant hand of a male, absence of triphasic color change and thumb involvement, and occupational or recreational use of the hand as a hammer. Angiography demonstrates the specific findings of irregularity or occlusion of the ulnar artery, downstream occluded proper digital arteries, and intraluminal emboli at the sites of distal obstruction. A vulnerable area of traumatic occlusion is provided by the anatomic relationship of the superficial branch of the ulnar artery to the hamate bone and the palmar aponeurosis. Pathologic studies separate the hypothenar hammer syndrome from clinically similar vasculitis. It is important to recognize the hypothenar hammer syndrome as a distinct entity because treatment is curative and consists of resection of the affected vascular segment and avoidance of the aggravating conditions.     

Gnathostomiasis: Report of a case and brief review

Nematodes of the genus Gnathostoma can cause a spectrum of disease in humans. This includes a distinctive syndrome of intermittent migratory subcutaneous swellings, central nervous system involvement with high morbidity and mortality and occasionally, involvement of other organs. Gnathostomiasis is endemic in southern and eastern Asia, particularly Thailand, but has recently been reported from Ecuador and Mexico. Diagnosis is usually based on clinical, epidemiological and serological findings. A recent study suggests that treatment with albendazole is effective. This report describes a patient diagnosed in Canada in whom evidence of pericarditis was associated with gnathostomiasis and in whom treatment with albendazole appears to have been effective.     

Vaginitis: case reports and brief review

Vaginitis is the most frequently gynecologic diagnosis encountered by physicians who provide primary care to women. Accurate diagnosis can be elusive, complicating treatment. Most experts believe that up to 90% of vaginitis cases are secondary to bacterial vaginosis, vulvo-vaginal candidiasis, and trichomoniasis. The diagnosis of vaginitis is based on the patient's symptoms, the physical examination, the findings of microscopic examination of the wetmount and potassium hydroxide (KOH) preparations, and the results of the pH litmus test. Additional cultures and testing may be needed for difficult-to-diagnose cases.     

Endogenous bacterial endophthalmitis: a case report and brief review

The bacterial endogenous endophthalmitis is a slightly frequent pathology with a poor visual prognosis that needs a precocious diagnosis and treatment. We present the case of a diabetic patient who presented a Escherichia coli bacteremia of urinary origin, with endogenous endophthalmitis, meningitis and spondylitis. She was treated with intravenous and topic antibiotics, obtaining a cessation in the progression of the disease and preserving the capacity for luminous perception in the eye.     

Capillaria hepatica: a spurious case with a brief review

A 12-year-old Bunun aboriginal school student in Sanmin District Kaohsiung County, Southern Taiwan, was found to have Capillaria hepatica eggs in the feces during a survey on intestinal parasitic infection in 1997. Moreover, this student was also infected with Trichuris trichiura and Ascaris lumbricoides. The C. hepatica eggs were light yellowish-brown in color, 54 (40-60) microns in length and 29 (25-35) microns in width with a 3 (3-4) microns thick shell and two colorless egg plugs 7 (5-9) x 6 (5-8) microns. This is the eighth case of human spurious C. hepatica infection in Taiwan. In addition to the reporting of this case, the genuine and spurious infections of C. hepatica in humans as well as its infection in rats around the world are briefly reviewed.     

Giant appendiceal mucocele: Report of a case and brief review

Mucocele of the appendix is a rare lesion, characterized by distension of the lumen due to accumulation of mucoid substance. This disease is often asymptomatic and pre-operative diagnosis is rare. If untreated, one type of mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and to histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadenocarcinoma. In this paper, we report a case of a 51-year-old woman with a mobile, painless mass in the right lower quadrant of abdomen caused by a giant appendiceal mucocele. Imaging showed a large, tubular,cystic structure extending below from the inferior wall of the cecum. Surgery revealed a giant retro-cecal appendix measuring 17 cm in length and 4 cm in diameter. The final pathologic diagnosis was mucocele caused by mucinous cystadenoma.     

Giant appendiceal mucocele： Report of a case and brief review

Mucocele of the appendix is a rare lesion, characterized by distension of the lumen due to accumulation of mucoid substance. This disease is often asymptomatic and pre-operative diagnosis is rare. If untreated, one type of mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and to histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadenocarcinoma. In this paper, we report a case of a 51-year-old woman with a mobile, painless mass in the right lower quadrant of abdomen caused by a giant appendiceal mucocele. Imaging showed a large, tubular, cystic structure extending below from the inferior wall of the cecum. Surgery revealed a giant retro-cecal appendix measuring 17 cm in length and 4 cm in diameter. The final pathologic diagnosis was mucocele caused by mucinous cystadenoma.     

Neurocysticercosis:A case report and brief review

Neurocysticercosis(NCC) is one of the seven neglected endemic zoonoses targeted by the World Health Organization.It is considered a common infection of the nervous system caused by the Tanenia solium and is known to be the primary cause of preventable epilepsy in many developing countries.NCC is commonly resulted by the ingestion of Tanenia solium eggs after consuming undercooked pork,or contaminated water.The parasite can grow in the brain and spinal cord within the nervous system,causing severe headache and seizures beside other pathological manifestations.Immigration and international travel to endemic countries has made this disease common in the United States.NCC can be diagnosed with computed tomography and magnetic resonance imaging of the brain.The treatment of the NCC including cysticidal drugs(eg.,albendazole and praziquantel),and neurosurgical procedure,depending upon a the situation.A patient of Asian origin came to our clinic with complaints of dizziness,headaches and episodes seizures for the past twelve years without proper diagnosis.The computed tomography and magnetic resonance imaging scans indicated multilobulated cystic mass in the brain with the suspicion of neurocysticercosis.     

Disseminated histoplasmosis: case report and brief review

Disseminated Histoplasmosis is a severe and often-fatal opportunistic infection when left untreated among patients with AIDS. Occurring in 3-5 percent of patients with AIDS living in the areas of endemicity, this infection should be suspected in patients with a CD4 cell count of <150 cells/microL presenting with non-specific clinical signs such as fever, weight loss, and lymphadenopathy. We report our experience to increase awareness of the clinical spectrum of disseminated histoplasmosis and its similarity to other infections and malignancies and update the reader on recommended therapeutic modalities.     

Hydatid cyst of the pancreas: a case report and brief review

A 45-year-old male farmer had noticed a swelling of the left side of his hypochondrium that persisted for six months. He had no history of severe abdominal pain, jaundice, fever, or weight loss. On evaluation, the patient was found to have hydatid cyst of the pancreas. He was managed surgically. In this case report, we emphasize the preoperative diagnosis in hydatid cyst of the pancreas.     

Capillary leakage syndrome: a case report and a review

Capillary leakage Syndrome (CLS) is a rare clinical syndrome, that was first described in 1960, characterized by acute episodes of generalized edema, hemoconcentration, hypoproteinemia and monoclonal gammopathy, in the vast majority of cases. We describe a 39-year-old man with anasarca, bilateral pleural and pericardial effusions, ascites and diffuse alveolo-intersticial edema. Clinical and laboratory findings were consistent with an acute episode of CLS. Treatment with prednisone, furosemide and aminophylline was started, which lead to a gradual improvement in 48 hours. Pathophysiologically there is an increase in capillary permeability with the extravasation of fluid and plasmatic proteins to the extravascular space that can lead to hypovolaemic shock. In the second phase there is a reentry of the fluid overload leading to pulmonary edema. The etiology of this hyperpermeability still remains unclear. The role of cytokines has become central in the comprehension of pathophysiology of CLS. Adhesion molecules are probably also involved in the genesis of capillary leakage. CLS treatment remains empirical. However, at present it seems that the association of steroids with furosemide, aminophylline and terbutaline are capable of controlling the clinical manifestation of the acute episodes in most cases. To our knowledge no prophylatic therapy has clearly proven its efficacy. There are only a few series analyzing the long-term evolution of patients with CLS. Further studies are necessary with the objective to collect enough patients with CLS to observe natural history of the disease and evaluate the efficacy of empiric treatments.