Complications arising from a misdiagnosed giant lipoma of the hand and palm: a case report

<p>Abstract</p> <p>Introduction</p> <p>Lipomas are benign tumors which may appear in almost any human organ. Their diagnosis rate in the hand region is not known.</p> <p>Case Presentation</p> <p>We present the case of a 63-year-old Greek Caucasian woman with a giant lipoma of the hand and palm which was not initially diagnosed. After repeated surgical decompression of the carpal tunnel the patient was referred with persisting symptoms of median and ulnar nerve compression and a prominent mass of her left palm and thenar eminence. Clinical examination, magnetic resonance imaging, nerve conduction study and biopsy, revealed a giant lipoma in the deep palmar space (8.0 × 4.0 × 3.75 cm), which was also infiltrating the carpal tunnel. She had already undergone two operations for carpal tunnel syndrome with no relief of her symptoms and she also ended up with a severed flexor pollicis longus tendon. Definitive treatment was performed by marginal resection of the lipoma and restoration of the flexor pollicis longus with an intercalated graft harvested from the palmaris longus. Thirty months after surgery the patient had a fully functional hand without any neurological deficit.</p> <p>Conclusion</p> <p>Not all lipomas of the wrist and hand are diagnosed. Our report tries to emphasize the hidden danger of lipomas in cases with carpal tunnel symptoms. The need for a high index of suspicion in conjunction with good clinical evaluation and the use of appropriate investigative studies is mandatory in order to avoid unnecessary operations and complications. Marginal excision of these tumors is restorative.</p

TÉTANO NA POPULAÇÃO GERIÁTRICA: PROBLEMÁTICA DA SAÚDE COLETIVA? TÉTANO EN LA POBLACIÓN GERIÁTRICA: PROBLEMÁTICA DE LA SALUD COLECTIVA? TETANUS IN THE GERIATRIC POPULATION: IS THIS A COLLECTIVE HEALTH PROBLEM?

O tétano é uma doença infecciosa, não contagiosa, causada pelo bacilo Clostridium tetani que penetra no organismo através de ferimento. A disfunção psicomotora facilita acidentes entre os idoso e a cobertura vacinal é baixa nesta população contribuindo para letalidade alta. Este estudo tem como objetivo refletir sobre a situação do homem idoso, com relação ao tétano, dentro da perspectiva da Saúde Coletiva. Trata-se de Estudo de Caso realizado com dois pacientes idosos, do sexo masculino, portadores de tétano acidental, internados num hospital do município de Fortaleza. A coleta de dados se deu entre março e abril de 1998. A análise mostra a ausência de cobertura vacinal e da implantação da profilaxia de emergência. Os dois pacientes evoluíram para óbito confirmando alta mortalidade por tétano entre este grupo etário. A reflexão crítica aponta para urgência de abordagem de saúde coletiva.<br>El tétano es una enfermedad infecciosa, no contagiosa, causada por el bacilo Clostridium Tetani que penetra en el organismo a través de una herida. El disturbio psicomotor facilita accidentes entre las personas mayores y la protección por vacunas en esta población es baja, lo que contribuye para un alto índice de mortalidad. Este estudio tiene como objetivo la reflexión sobre la situación del adulto mayor, con relación al tétano, dentro de la perspectiva de la Salud Colectiva. Se trata de un estudio de caso con dos pacientes ancianos, del sexo masculino, portadores del tétano accidental, internados en un hospital del municipio de Fortaleza. La recolección de datos de hizo entre marzo y abril de 1998. El análisis muestra la ausencia de cobertura de la vacuna y de una implementación de profilaxis de emergencia. Los dos pacientes fallecieron, lo que confirma la alta mortalidad por el tétano en este grupo de edad. La reflexión crítica, denota la urgencia de un abordaje desde la salud colectiva.<br>Tetanus is an infectious non-contagious disease caused by the bacillus Clostridium tetani, which penetrates in the organism through wounds. Psychomotor dysfunction facilitates accidents among elderly people and vaccinal coverage is low in this population, thus contributing to high lethality. This study aimed at reflecting on the situation faced by elderly people in relation to tetanus in the perspective of Collective Health. It is a Case Study conducted with two elderly males who had accidental tetanus and were hospitalized in a hospital in the municipality of Fortaleza. Data collection took place from March to April, 1998. The analysis showed the absence of vaccinal coverage as well as of the implementation of emergency prophylaxis. The two patients' conditions developed to death, which confirmed the high mortality due to tetanus in this age group. The critical reflection pointed out the urgency of a collective health approach

Inhibition of nitric oxide synthesis for four days induces vascular abnormalities and myocardial infarct areas but not significant arterial hypertension Inibição da síntese do óxido nítrico durante quatro dias induz anormalidades vasculares e áreas de infarto miocárdico, porém, não induz hipertensão arterial significativa

BACKGROUND: Nitric oxide is an endothelium vasorelaxing factor and at least in some cases is the main cause of arterial hypertension, which is one of the most important risk factors of cardiovascular diseases. In Brazil, cardiovascular diseases are the first cause of mortality, representing about 30% of the total deaths. The L-NAME (N&#969;-nitro-arginine-methyl-ester) blocks the nitric oxide synthesis necessary to maintain the normal arterial pressure. OBJECTIVE: To study lesions in myocardium due to the inhibition of nitric oxide synthesis during four days (via L-NAME oral administration, concentration: 75 mgs versus 100 mL-1). METHODS: Fourteen normotensive young adults Wistar rats were submitted, during four days, to L-NAME. Six rats were utilized as the Control Group. At day 4 of the experiment, the animals were anesthetized, weighed, and their thoraxes were opened, and the cardiotomy was performed. The hearts were weighed, fixed, and processed using routine methods, and they were sectioned in 3 µm and stained. RESULTS: Abnormalities were observed in the wall of arterial vessels of any dimension, as vascular damage with increasing wall thickness related mainly to proliferation of arterial smooth muscle cell in submitted animals. Proliferation of cells in the intimal layer and its thickening were also observed in small arterial vessels (arteriole). Infarct areas were present. CONCLUSIONS: The present data suggested that inhibition of nitric oxide synthesis for four days induces vascular abnormalities and myocardial infarct areas, but not arterial hypertension.<br>CONTEXTO: O óxido nítrico é um fator de relaxamento vascular e, pelo menos em certos casos, é a principal causa de hipertensão arterial no ser humano. A hipertensão arterial é um importante fator de risco de doenças cardiovasculares. No Brasil, as doenças cardiovasculares são a primeira causa de mortalidade, representando cerca de 30% do total de óbitos. O L-NAME (N&#969;-nitro-arginina-metil-éster, Sigma Chemical, St. Louis) bloqueia a síntese do óxido nítrico necessária para a manutenção da pressão arterial normal. OBJETIVO: Estudar as lesões miocárdicas ocorridas por razão da inibição da síntese do óxido nítrico durante quatro dias (por meio da administração oral de L-NAME em concentração de 75 mgs versus 100 mL-1). MÉTODOS:Quatorze ratos Wistar jovens normotensos adultos foram submetidos durante quatro dias ao L-NAME. Seis foram utilizados como Grupo Controle. Aos quatro dias de experimento, os animais foram anestesiados, pesados, os tórax foram abertos e a cardiomiotomia foi efetuada. Os corações foram pesados, fixados e processados usando métodos de rotina e cortados em 3 µm de espessura e corados. RESULTADOS: As anormalidades foram observadas nas paredes arteriais de vasos de todos os calibres, como, por exemplo, o aumento da parede arterial relacionada principalmente à proliferação das células musculares lisas dos animais submetidos ao bloqueio do óxido nítrico. Também foi identificada proliferação das células da túnica íntima e seu espessamento nos vasos arteriais de pequeno calibre (arteríolas). Áreas de infarto estavam presentes. CONCLUSÕES: Os resultados sugerem que a inibição do óxido nítrico durante quatro dias induz anormalidades vasculares e áreas de infarto do miocárdio, contudo, não induz hipertensão arterial

Ascorbic acid for the healing of skin wounds in rats

BACKGROUND: Healing is a complex process that involves cellular and biochemical events. Several medicines have been used in order to shorten healing time and avoid aesthetic damage. OBJECTIVE: to verify the topical effect of ascorbic acid for the healing of rats' skin wounds through the number of macrophages, new vessels and fibroblast verifications in the experimental period; and analyse the thickness and the collagen fibre organization in the injured tissue. METHODS: Male Rattus norvegicus weighing 270 ± 30 g were used. After thionembutal anesthesia, 15 mm transversal incisions were made in the animals' cervical backs. They were divided into two groups: Control Group (CG, n = 12) - skin wound cleaned with water and soap daily; Treated Group (TG, n = 12) - skin wound cleaned daily and treated with ascorbic acid cream (10%). Samples of skin were collected on the 3rd, 7th and 14th days. The sections were stained with hematoxylin-eosin and picrosirius red for morphologic analysis. The images were obtained and analysed by a Digital Analyser System. RESULTS: The ascorbic acid acted on every stage of the healing process. It reduced the number of macrophages, increased the proliferation of fibroblasts and new vessels, and stimulated the synthesis of thicker and more organized collagen fibres in the wounds when compared to CG. CONCLUSION: Ascorbic acid was shown to have anti-inflammatory and healing effects, guaranteeing a suiTable environment and conditions for faster skin repair