Exercise induced chronic compartment syndrome of the first dorsal interosseous compartment of the hand: a case report.
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ABSTRACT:
SUBMITTER: Chopra R
PROVIDER: S-EPMC2787223 | biostudies-other | 2009 Dec
REPOSITORIES: biostudies-other
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Project description:Mixed alien hand syndrome is a rare disease reported in the literature. The mixed callosal-frontal variant of alien hand syndrome is associated with uncoordinated hand movements, and patients may present with an involuntary grasp reflex and intermanual conflict. There are few videos in the existing literature on the comparison of patients' condition before and after recovery of the symptoms of mixed alien hand syndrome. We presented the prognosis of mixed alien hand syndrome in the form of a video. In addition, we have included some videos on the comparison of the condition of patients before and after recovery of the symptoms of mixed alien hand syndrome. A 57-year-old woman presented with left-handed intermanual conflict and right-handed involuntary grasp reflex due to infarction of the frontal lobe and corpus callosum. She was diagnosed with a mixed callosal-frontal variant of alien hand syndrome. Her left hand counteracted the purposeful movements of the right hand. However, the intermanual conflict disappeared after 3 months of therapy, including drug treatment and verbal-cue rehabilitation, and she regained normal coordination of her hand movements. Her prognosis was good despite the large corpus callosum lesions. The uncoordinated hand movements of the patient affected her daily life and caused psychological problems. Initiating rehabilitation early was important and necessary for her to regain coordination. It is possible that the verbal-cue training method played an important role in the recovery of the patient. Therefore, this method of rehabilitation deserves consideration and can be adopted in larger cohort studies as we presented only a single case. The possible mechanisms behind the verbal-cue exercise require further studies, and this patient had a good prognosis despite severe corpus callosum injury, which may merit further investigation.
| S-EPMC8455835 | biostudies-literature
Project description:IntroductionThere are several disease entities subsumed under the heading Necrotizing Enterocolitis (NEC).1The infectious enterocolitis that causes bowel necrosis.2Spontaneous Intestinal Perforation which is linked to the use of Indocin to hasten closure of a patent ductus arteriosus (PDA); the perforation occurs in bowel that is well perfused and viable.3Perforations that occur in bowel that is obstructed by thick or inspissated meconium (Awolaran and Sheth, Sept 2021) [1].4The uncommon variant that is associated with the abdominal compartment syndrome.Case reportA case is presented in which a preemie suddenly developed massive abdominal distension. The neonatologist embarked upon the usual work-up and therapeutic interventions but was stymied by the inability to pass an orogastric tube to relieve the abdominal distension.DiscussionThe purpose of this report is not to criticize the neonatologist, but to emphasize the difference between this case, complicated by the abdominal compartment syndrome, and the usual case of NEC.ConclusionThis is an unusual manifestation of NEC; and in my experience, it is uniformly fatal. Like many diseases with a fulminant course, our therapeutic efforts seem always too little, too late.Perhaps, by calling attention to this unusual association, its dismal outcome may be altered.
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Project description:BACKGROUND:The Holt-Oram Syndrome (HOS) or the Heart-Hand syndrome is considered as an overt autosomal hereditary disease with a complete influential effect and variable expression that emerges due to a genetic mutation. It can be vividly characterized by heart disorders and deficiencies in hand structure. Despite the existing genetic heterogeneity, the variable integration between HOS and the T-BX5 gene from the T-BOX Gene Complex has been observed during which various mutations have been reported in the affected patients. The T-BOX Gene Complex is located on chromosome 12 (12 q 24.1), and is able to encode a copying factor. That has a conservative motive with 180 amino acids. The deficiencies in only 1/3 of patients have been observed caused by the mutation of this gene. CASE REPORT:This case was a 10-year-old child with hand disorders, incomplete growth of clavicle, moving problems in elbow joint and shoulder, disorder in ventricle and auricle walls. The disease was diagnosed as HOS, based on clinical examination and drawing the family tree diagram. It was impossible to investigate molecular mutation due to inaccessibility to the patient. CONCLUSION:By investigating the family members and their deficiencies and imaging disorder variables according to different reports as well as parents' state of health, the HOS can be defined as an overt heredity resulting from a new mutation in the germinating layer of sexual cells in one of the parents. There is a weak possibility that the disease results from a mosaic mutation in the male parent's testicle or the female parent's ovum. In this case, the probability for the disease to be repeated in parents' next children will be guessed between 1 and 50%.
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Project description:IntroductionA compartment syndrome (CS) occurs when increased pressure within an anatomic compartment leads to inadequate perfusion. Although rare, gluteal CS can be encountered when an unconscious person has a prolonged period of immobilization.Presentation of caseA 20-year-old male with history of polysubstance abuse leading to passing out, presented with right buttock and lower extremity pain, increased creatinine phosphokinase (CPK), and acute renal failure. Physical examination and MRI confirmation supported gluteal CS. Patient was taken to the OR for gluteal fasciotomy. Afterwards, the pain improved, the CPK and creatinine trended to normal. He was discharged home on day 7.DiscussionCS can occur in any part of the body with fascial compartments. Increased compartmental pressure causes compression of vessels and nerves in the area that can lead to ischemia and necrosis. CS can occur after trauma, excessive fluid resuscitation, or surgery. It is also reported due to the prolonged periods of immobilization and increasing pressure on dependent areas. Often, intra-compartmental pressure is measured to confirm the diagnosis. The mainstay of treatment is fasciotomy.ConclusionDue to the rarity of gluteal compartment syndrome, the diagnosis is often delayed. If the affected area is ischemic for a significant amount of time, it can lead to sciatic nerve palsy, paresthesias, paralysis and muscle necrosis. Patients may experience irreversible damage after the syndrome and as such providers should be cognizant of this clinical entity to make an early diagnosis of gluteal compartment syndrome.
| S-EPMC6637251 | biostudies-literature
Project description:Introduction and importanceThe abdominal compartment syndrome (ACS) is defined as new-onset organ failure induced by sustained elevated intra-abdominal pressure (IAP). Surgical decompression to decrease IAP may be performed in addition to supportive therapy.Case presentationA 42-year-old woman with a history of type 2 diabetes, dyslipidemia, alcohol disorder (130 g of daily alcohol intake), and schizophrenia presented to the emergency department with worsening abdominal pain and anorexia for 2 days. On arrival, her Glasgow Coma Scale score was 14 (E3V5M6). Physical examination revealed tachypnea with a respiratory rate of 26 breaths/min; other vital signs were stable. She was diagnosed with severe acute pancreatitis and required massive transfusions to stabilize her hemodynamic status from the time of admission to the intensive care unit (ICU). Acute blood purification was initiated. Bilateral pleural effusions increased from the second day, and despite the evacuation of the intraluminal contents, muscle relaxation was initiated because her IAP had increased to 52 mmHg and remained the same. Therefore, midline fasciotomy was performed instead of a midline incision through the linea alba on day 4, and the patient was managed with negative pressure wound therapy thereafter. Blood purification was completed on day 15, extubation was performed on day 17, and the patient was discharged from the ICU on day 29.Clinical discussion and conclusionMidline fasciotomy can have a decompressive effect in patients with primary ACS. This technique may be an alternative to decompressive laparotomy because of its less invasive nature.
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Project description:Exertional compartment syndrome of the leg is a condition that can cause chronic debilitating pain in active persons during a variety of aerobic activities. Nonoperative treatments using stretching protocols and activity modifications are often unsuccessful, and thus several operative strategies have been used to treat this condition. A novel technique for endoscopically assisted fasciotomy for chronic exertional compartment syndrome is described. By use of a small laterally based incision and an arthroscope, polydioxanone sutures are passed percutaneously along the anterior and lateral compartments with the Spectrum suture-shuttling device (ConMed Linvatec, Largo, FL). These sutures are used to retract the skin and subcutaneous tissues over the respective compartments. This method allows excellent visualization of the intercompartmental septum, the superficial peroneal nerve, and all perforating vessels. The anterior and lateral compartments can be safely and completely released with this minimally invasive approach. The patient is allowed to return to full activity at 6 weeks postoperatively, because of the decreased soft-tissue disruption.
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Project description:Takotsubo syndrome usually occurs immediately following a physical or emotional trigger. In some cases, a triggering stress may not be evident. A delayed manifestation of the syndrome may account for such cases. An asymptomatic 69-year-old woman presented for a routine cardiac check-up, which revealed normal electrocardiogram (ECG), echocardiography, and exercise ECG. She did not complain of any chest pain during or immediately after the tests. After about 24 h, she developed chest pain for which she was admitted with the provisional diagnosis of acute coronary syndrome. ECG showed dynamic T-wave changes with QTc prolongation. Cardiac biomarkers were mildly elevated. Characteristic reversible left ventricular dysfunction in absence of coronary stenosis ultimately led to the diagnosis of Takotsubo syndrome. Our case represents a delayed occurrence of Takotsubo syndrome triggered by a treadmill exercise stress test, which manifested about 24 h following the stressor. Such delayed manifestation may account for those cases of Takotsubo syndrome where no immediate triggering stressor is evident.
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Project description:Triple A syndrome 3A (Allgrove syndrome) is a rare autosomal recessive multiorgans dysfunction characterized by alacrima, achalasia which is the absence of esophageal muscle peristalsis and lower sphincter failure to relax and adrenal insufficiency. About third of patient additional features like neurological and autonomic manifestations reported (making the syndrome 4A), the spectrum of neurological symptoms varies including gait disturbances, parkinsonism, muscle wakeness, mental retardation, peripheral sensory and motor neuropathy. Here we reported A 18 years old male, who had postnatal recurrent conjunctivitis so alacrima was diagnosed, in the sventh years he developed achalasia signs; dysphagia and regurgitation and laparscopic surgical myotomy and fundoplication were done, when he became 16 he presented to our clinic for poor appetite, weight loss,and failure to thrive. Assessment of ACTH, cortisol, ACTH stimulation test confirmed he had adrenal insufficiency and physical examination showed he had foots deformity due to muscular atrophy caused by neuropathy.treatment performed by managing symptoms of the condition(replacement of glucocorticoids, surgical correction of achalasia, artificial tears).The follow-up was over a period of 6 months and we noted a great improvement of patient's condition.
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Project description:Hand-Foot-Genital Syndrome (HFGS) is a dominantly inherited condition and one of the rarest cases encountered in clinical practice. It might be presented with a wide variety of limb malformations and urogenital defects manifestations. In this report, a unique and novel case of HFGS accompanied with Embryonal Rhabdomyosarcoma of the urinary bladder is described in a two-year-old male. The patient was admitted to the hospital in order to investigate a progressively enlarging mass in the lower abdomen. During hospitalization, oliguria was noted by resident physicians. However, hypospadias and dysmorphic abnormalities, demonstrated upon physical examination, were the cornerstone in the diagnosis of HFGS. An accurate visual examination of the abdomen showed dilated superficial veins, and abdominal rigidity appeared through palpation. Furthermore, the radiologic evaluation showed delayed ossification of carpal bones, and abdominal CT scan revealed a necrotic mass in the hypogastric region measuring 12 × 10 cm. A biopsy was performed through which the mass was confirmed as Embryonal Rhabdomyosarcoma of the urinary bladder. The kidney function follow-up showed normal results. Neoadjuvant chemotherapy was started to diminish the tumor size. However, the patient eventually passed away during the treatment phase. This report emphasizes the need for a high index of suspicion to establish early detection of Embryonal Rhabdomyosarcoma in each newborn diagnosed with Hand-Foot-Genital Syndrome (HFGS) to avoid potential fatal consequences.
| S-EPMC7820788 | biostudies-literature
Project description:INTRODUCTION:High-energy trauma of the hand often causes tissue loss involving bone, tendon and skin and is sometimes accompanied by devascularization of digits. Bone stabilization is the first step in the management of such injuries. MATERIALS AND METHODS:A young patient presented composite tissue loss of the dorsum of his right (dominant) hand following an accident with a surface planer. Tissue loss involved the diaphyses of the first 4 metacarpals, tendons and skin with almost complete amputation of the 3rd finger. Bone stabilization comprised osteosynthesis using pins associated with cement to fill the bone defect. Hunter tendon rods were used for tendon repair and a pedicle groin flap (McGregor) was used to achieve skin coverage. The cement was replaced with autologous cortico-cancellous bone graft combined with bone paste (Nanostim) 3 months after the cement stabilization. RESULTS:Eleven months after the accident, the patient was able to return to work as a carpenter. Pinch and Grasp strength in the injured hand were half that in the contralateral hand, but there was no loss of sensitivity. Mobility was very satisfactory with a Kapandji score of 9 and a mean TAM of 280°. The patient can write, open a bottle and does not feel limited for everyday activities. Radiographically, the bone of the 3 reconstructed metacarpals appears consolidated. CONCLUSION:The induced membrane technique allowed the reconstruction of small bone deficits in the long bones of the hand in a two-step procedure, the first step taking place in an emergency context of composite tissue trauma.
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