V kazuistice prezentujeme případ patnáctiletého chlapce se vzácnou primární imunodeficiencí, tzv. syndromem XMEN. Tento syndrom je charakterizován zvýšenou náchylností k chronické EBV infekci a lymfoproliferacím asociovaným s EBV, dalšími klinickými znaky bývají sinopulmonární infekce, otitidy, lymfadenopatie, dysgamaglobulinemie a autoimunitní cytopenie. XMEN syndrom je způsoben mutacemi genu MAGT1, který kóduje přenašeč hořečnatých kationtů magnesium transporter protein 1. Klíčovým bodem kazuistiky je strastiplná diagnostická cesta pacienta, jemuž přes postupné návštěvy celé řady specialistů chybělo komplexní zhodnocení stavu a zachycení souvislostí různých klinických symptomů, které přinesla až návštěva v ambulanci alergologa/klinického imunologa
In this case report, we present a case of a 15 year old boy with a rare primary immunodeficiency called XMEN syndrome. XMEN syndrom is characterized by increased susceptibility to chronic EBV infection and EBV-associated lymphoproliferation, sinopulmonary and ear infections, lymphadenopathy, dysgammaglobulinemia, and autoimmune cytopenias. XMEN disease is caused by loss of function mutations in the gene MAGT1, which codes magnesium transporter protein 1.The critical point of the case report is the difficult diagnostic journey of the patient, who, despite a series of visits to several specialists, lacked a comprehensive assessment of his condition. A visit to an allergist/ clinical immunologist only gave a grasp of the context of various clinical symptoms.
Trigger finger (TF) is a prevalent hand condition characterized by impaired tendon gliding and pulley thickening, leading to pain and functional limitations. This narrative review explores TF's functional assessment, sonographic findings, and conservative treatments. Tools like the Quinnell Grading System and Jamar Dynamometer effectively quantify severity and function, while ultrasound identifies hypoechoic A1 pulley thickening (> 0.62 mm) and tendon snapping. Conservative treatments, including splinting and tendon gliding exercises, reduce pain by 70% within weeks. Ultrasound-guided corticosteroid injections and percutaneous A1 pulley release improve outcomes with minimal complications. Integrating imaging and personalized therapies optimizes TF management, reducing surgical reliance.
In the clinical evaluation of upper extremity embolism cases, the anamnesis should focus on identifying potential triggering risk factors. The physical examination may reveal sensory deficits, aiding in the determination of ischemia stages. Imaging diagnosis is crucial, with computed tomography (CT) angiography being the preferred examination due to its ability to provide detailed information about arterial anatomy across multiple planes and clear visualization of adjacent structures. Compared to magnetic resonance imaging angiography, CT angiography offers faster results with minimal distortion, despite the exposure to radiation and contrast use. Doppler ultrasonography is another valuable tool in suspected arterial thromboembolism cases, particularly in emergency settings. It offers advantages over CT angiography as it is non-invasive, cost-effective, and does not involve radiation or contrast administration. We present the case of a 68-year-old man who reported a nodule in the medial region of his right thumb for three months. Initially, he experienced significant local pain and limited movement, which gradually improved over time with the use of analgesic medication. Ultrasonography revealed thrombosis in the princeps pollicis artery, and the patient commenced treatment with acetylsalicylic acid. After four months, the patient reported a marked reduction in the nodule size along with pain improvement.
- MeSH
- lidé MeSH
- palec ruky * krevní zásobení MeSH
- senioři MeSH
- trombóza * diagnóza diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
The cerebellum, a lateralised organ, plays a crucial role in motor control. Still, its involvement in hand and foot dominance remains inadequately understood, primarily in the right and left-side dominant population. A potential manifestation of this lateralisation is the neocerebellar extinction syndrome, previously linked to mild muscle hypotonia and moderate passivity in the non-preferred hand. A more precise understanding of the cerebellum's role in limb dominance patterns could provide valuable insights into motor learning, rehabilitation therapies, and neuroplasticity. This study explored the relationship between physiological neocerebellar extinction syndrome and hand/ft dominance in left and right-side dominant individuals. Data were collected from 80 university participants (40 left-side dominant, 40 right-side dominant, mean age = 24.7 ± 0.92 years) during controlled limb falls using 3D kinematic analysis. In these falls, theoretically suggested hypotonia in non-dominant limbs was analysed through attenuation coefficients and frequency differences. Using a linear mixed model, we found significantly lower hand attenuation in the non-dominant hand-(β = 0.10, p < 0.001), showing hypotonia compared to the dominant hand regardless of upper limb side dominance. Foot preference and dominance had minimal influence on leg attenuation or frequency, although right-footed, right-dominant individuals demonstrated significantly higher leg oscillation frequency, likely due to increased proximal muscle mass. Our findings suggest that distinct differences in cortical representation, lateralised control, and pathway specialisation exist due to the unique demands of each limb's motor functions, which are pronounced more neocerebellar extinction syndrome in the upper extremities. Therefore, the results showed potentially new perspectives on the cerebellum's nuanced role in motor control and laterality. The differential effects observed between the upper and lower limbs point to distinct cerebellar pathways and hypotonia. This work could significantly enhance the precision of therapeutic approaches and broaden our knowledge of laterality in motor function.
- MeSH
- biomechanika MeSH
- dospělí MeSH
- funkční lateralita * fyziologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- mozeček * patofyziologie MeSH
- noha (od hlezna dolů) fyziologie MeSH
- ruka MeSH
- svalová hypotonie patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY: Rhizarthrosis-osteoarthritis of the thumb carpometacarpal (CMC) joint is usually a primary idiopathic disease. Total joint arthroplasty (TJA) is one of the surgical treatment options for symptomatic advanced thumb CMC arthritis. This retrospective study aims to evaluate the mid-term functional and radiological results of TJA with the minimum follow-up period of 3 years after the surgery. MATERIAL AND METHODS: Presented are the results of 136 total trapeziometacarpal joint replacements in the group of 105 patients consisted of 96 women and 9 men. Used prostheses were ELiS® implant (27 cases), Ivory® implant (42 cases), Touch® Dual mobility (67 cases). The follow-up period was minimally 3 years postoperatively. In all the patients, along with range of motion and radiologic evaluation of implant position, the function and pain of operated joint were evaluated using DASH and VAS score at regular intervals pre- and postoperatively. RESULTS: At a mean of 85 months (range 38-126 months) post-operatively, patients in 116 cases (85%) reported full satisfaction and absence of symptoms and difficulties. In 12 cases (9%) some slight residual post-exercise pain was reported. In eight cases (6%) patients suffered from episodic rest-pain, but with a lower intensity than in the preoperative period. Postoperatively, the patients declared subjective improvement in hand function. The total DASH score and VAS score decreased in all patients, while ROM increased. The course of all of TJA surgeries was complication-free. Five patients needed revision surgery. In two patients a dislocation has occurred and in three cases a loosening of the cup's implant was reported. The most frequent postoperative complication was the occurrence of transient paraesthesias of the thumb in eight cases (6%). CONCLUSIONS: TJA is the method of choice in management of advanced symptomatic osteoarthritis of the thumb CMC joint. Mastering surgical technique, TJA represents safe and effective treatment method in advanced degenerative changes of the thumb CMC joint and it's benefits exceed possible perioperative and postoperative risks.
- MeSH
- artroplastiky kloubů * metody MeSH
- dospělí MeSH
- karpometakarpální klouby * chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- osteoartróza * chirurgie MeSH
- palec ruky * chirurgie MeSH
- protézy kloubů MeSH
- retrospektivní studie MeSH
- rozsah kloubních pohybů MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Recent reviews have highlighted conflicting findings regarding the validity of finger flexor strength and endurance tests in sport climbers, often due to small sample sizes and low ecological validity of the tests used. To address these gaps, 185 male and 122 female climbers underwent maximal finger flexor strength, intermittent and continuous finger flexor endurance, and the finger hang tests in a sport-specific setting to determine the predictive and concurrent validity of these tests. The finger hang test showed the strongest relationship to climbing ability for both sexes (R ≈ 0.75). However, despite its widespread use as an endurance test, the finger hang was found to be primarily determined by finger strength, explaining 65% and 80% of the variance in males and females, respectively. Finger strength emerged as the dominant factor, explaining the majority of variance in climbing ability (males 68%; females 64%), followed by intermittent endurance (males 28%; females 34%). These findings emphasize finger strength as the primary predictor of climbing ability and highlight the importance of intermittent endurance testing for assessing climbing-specific endurance of the finger flexors. No significant differences were found between male and female climbers in finger flexor strength and endurance when normalized to body mass.
- MeSH
- dospělí MeSH
- fyzická vytrvalost * fyziologie MeSH
- horolezectví * fyziologie MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- prsty ruky * fyziologie MeSH
- reprodukovatelnost výsledků MeSH
- sexuální faktory MeSH
- síla ruky fyziologie MeSH
- svalová síla fyziologie MeSH
- zátěžový test metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- validační studie MeSH
Infekce ruky je běžný a častý problém, se kterým se setkává chirurg ve své ambulanci. Příčiny jsou pestré – od poranění přes chirurgický zákrok po šíření infekce z jiného místa na těle. Také původci infekce jsou různí, nejčastěji jsou to sice bakterie, ale je potřeba myslet i na viry, plísně a samozřejmě i na problém diagnostiky po napadení parazity a také na vzácné příčiny infektů. Diagnostika musí být rychlá, léčba bez zbytečného otálení a v odůvodněné situaci co nejagresivnější. Tím se vyhneme závažným komplikacím a následkům infekce na tak složité struktuře, jako ruka je. Cílem článku je poskytnout přehled o problematice, potažmo poskytnout informace umožňující včasnou diagnostiku. Jsou navrženy terapeutické možnosti a výkony s důrazem na moderní, tedy aktivní přístup k této problematice, zmíněna je možná prevence infekce na ruce. Článek si klade za cíl zlepšit klinickou praxi v péči o ruku s infektem.
Hand infection is a common and frequent problem encountered by surgeons in their outpatient clinics. The causes are varied, ranging from trauma to surgical intervention and to the spread of infection from elsewhere on the body. The causative agents of infection are also varied, and although bacteria are the most common ones, viruses, fungi, and, of course, the problem of diagnosis after parasite infestation as well as rare causes of infections must also be considered. The diagnosis should be quick and the treatment should be as aggressive as possible without undue delay in a justified situation. This will avoid serious complications and consequences of infection on such a complex structure as the hand. The aim of this article is to provide an overview of the problem, and to provide information to support early diagnosis. Therapeutic options and interventions are proposed, with an emphasis on a modern, i.e. active, approach to the problem. Possible prevention of infection on the hand is mentioned. The article aims to improve clinical practice in the care of the hand with infection.
PURPOSE: Arterial variations of the upper limb may bear high importance for many clinical procedures, including the use of flaps in plastic surgery. We present a feasible way for visualization and confirmation of presence of these variations. METHODS: All variations were detected by ultrasonography and confirmed by Color Doppler Imaging. Proper documentation was taken in order to present our findings. RESULTS: We report a case of a 19-year-old female who showed two concomitant arterial variations of the forearm and the hand bilaterally. These two variations were the persistent median artery and the superficial dorsal branch of the radial artery which both significantly contributed to the blood supply of the hand. All examinations were performed by the same investigator and all findings were reviewed by an experienced sonographist. CONCLUSION: An unusual arrangement of the arterial system can be easily detected. We present a feasible way to prevent iatrogenic injuries and increase utilization of anatomical variants knowledge in surgery by using ultrasound prior to planning surgical procedures.
- MeSH
- arteria radialis * diagnostické zobrazování chirurgie MeSH
- chirurgické laloky krevní zásobení MeSH
- lidé MeSH
- mladý dospělý MeSH
- paže MeSH
- ruka diagnostické zobrazování krevní zásobení MeSH
- zápěstí * diagnostické zobrazování chirurgie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
OBJECTIVE: The aim of the present study was to illustrate the (potential) diagnostic role of high resolution US images in assessing the elementary lesions of dactylitis. METHODS: Using high-frequency US machines/probes, we matched the micro-anatomical cadaveric architecture of the digit with multiple sonographic findings of dactylitis. High-sensitive color/power Doppler assessments have also been performed to evaluate the digital microvasculature. DISCUSSION: Modern US equipment/features guarantee prompt and in-depth B-mode and color/power Doppler imaging of tiny anatomical structures of the digit which are usually not properly visible with standard US machines. More specifically, hypervascularization of the digital subcutaneous tissue, fibrous pulleys of flexor tendons, dorsal synovial pads as well as pathological changes of the distal entheseal anchorage network can be accurately detected. CONCLUSION: In clinical practice, high-end US equipment can be used to accurately assess the digits in patients with dactylitis. This way, simple and convenient sonographic diagnosis of different elementary lesions can be timely established.
- MeSH
- diferenciální diagnóza MeSH
- fibróza diagnóza terapie MeSH
- kalcinóza diagnóza patologie terapie MeSH
- kožní manifestace * MeSH
- lidé MeSH
- prsty ruky krevní zásobení patologie MeSH
- Raynaudova nemoc MeSH
- systémová sklerodermie * komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
