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The authors report the case of a male patient who owned a tropical aquarium and who developed a M. marinum skin infection of the wrist. The clinical findings and microbiological features of the case are described, as are the difficulty in providing a prompt diagnosis, and the need for surgical treatment and the use of antibiotics to treat the infection.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Work-related musculoskeletal disorders of the upper limbs are a frequent complaint and their pathogenetic mechanism is often related to mechanical overload of the body region involved without traumatic events. The occupational origin of such disorders is much debated, since the clinical pictures are often not specific and may be found in subjects who do not perform hazardous work tasks. A better understanding of the relationship between clinical symptoms, diagnosis, and functional capacity would provide a deeper knowledge in decision making for return to work and rehabilitation strategies. In this paper we present a case study of a worker using scissors who developed De Quervain's syndrome in the dominant hand. A methodology for the biomechanical investigation of the work task and the possible occupational aetiology of the clinical picture are discussed according to the findings of the specific literature.
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Tendon ruptures are a frequent problem in patients affected by rheumatoid arthritis. The aim of the present study was to further characterize the known macroscopic changes of tendon tissue by micromorphological methods. Flexor and extensor tendon samples (n = 28) in rheumatoid arthritis were investigated by light- and transmission electron microscopy. In all cases, marked alterations in fibril architecture and structure were found. The fibril diameter showed a higher variability (range = 20-490 nm, x = 98.9 nm, s = 49.1 nm) in comparison with the control group of normal tendons (range = 20-290 nm, x = 119.0 nm, s = 34.9 nm). The average distance between the major bands in rheumatoid arthritis was reduced (from 57.3 nm down to 54.8 nm). Rare minor bands were detected. Oxytalan and mature elastic fibres were destroyed. These findings suggest that a causal correlation exists between altered matrix substructure and insufficient function of the tendon tissue in rheumatoid arthritis.
A 55-year-old female patient presented with a painless swelling in the palm of the right hand, causing restriction of the third finger. Magnetic resonance imaging revealed a synovial lesion in the flexor tendon sheath of the third finger, showing heterogenous contrast. Open biopsy and histopathological studies showed a granulomatous infectious reaction of the synovial tissue. A diagnosis of tuberculosis was made, after which antituberculosis treatment was instituted. Total regression was achieved after nine months of medical treatment without further extensive surgical measures. At the end of nine months, the movements of the finger were found to be normal and painless.
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Tuberculosis was first described in 1756 by Acrel in a case report. Subsequent reports of musculoskeletal tuberculosis documented the uncommon occurrence of hand and wrist involvement. The two cases presented here demonstrate the difficulty in eradicating the organism even with modern regimens of chemotherapy. Intraoperative Gram's stain and frozen sections were useful to rule out other etiologies. Firm diagnosis must be established by tissue culture. The first case appeared cured after thorough initial debridement and had no recurrence for 36 years. While recurrences are common in patients treated with debridement alone, most appear within one year after the index procedure. The amount of time that elapsed in this case is unusual and serves as a sobering reminder that tuberculosis may recur at a time distant from the initial procedure. The second patient had tuberculosis diagnosed elsewhere and was treated twice with antituberculous chemotherapy. Although the first course of therapy for six months may have been inadequate, the second course with multiple drugs for 18 months would certainly be considered adequate; yet he had a recurrence in his wrist eight months after completing treatment. These two cases illustrate the fastidious nature of the Mycobacterium tuberculosis organism and the need for a combined treatment protocol of meticulous surgical debridement and combined chemotherapy.