- E-O technique is superior to E-C technique in manikins during single person bag mask ventilation performed by novices. [Randomized Controlled Trial]
- JCJ Clin Monit Comput 2014; 28(3):269-73
- Conventional E-C technique of mask holding is unreliable during single person bag mask ventilation (BMV) due mainly to leak around the mask and inexperience of the persons. In this manikin study, con...
Conventional E-C technique of mask holding is unreliable during single person bag mask ventilation (BMV) due mainly to leak around the mask and inexperience of the persons. In this manikin study, conventional E-C technique was compared with E-O technique during single person BMV both with experienced (n = 50) and novice (n = 50) volunteers. The E-O technique involved encircling the mask neck with the web between thumb and index finger while the other digits provided chin lift. Two independent observers recorded the chest expansion as 1 (nil), 2 (minimal), 3 (moderate) and 4 (good). For analysis ideal and average chest expansion were clubbed as acceptable. E-C technique in experienced volunteers showed acceptable results in 49 (31 + 18) occasions, while with novices acceptable is 39 (17 + 22). With E-O technique, expansion was acceptable in 47 (38 + 9) experienced volunteers, and acceptable in 46 (32 + 14) novices. (P = 0.003). In cross over analysis for experienced volunteers, similar chest expansion was obtained on 30 occasions with both techniques, E-C better than E-O on 8 and E-O better than E-C on 12 occasions. Novices had comparable results on 17 occasions, E-C better than E-O on 8 and E-O better than E-C on 25 occasions (P = 0.016). The conventionally taught E-C technique of single person BMV provides acceptable chest expansion on most occasions with experienced operators than novices. Novices should use E-O technique as the first choice for single person BMV. Both techniques may be used interchangeably when one fails.
- Clubbed fingers: radiological evaluation of the nail bed thickness. [Journal Article]
- CAClin Anat 2008; 21(4):314-8
- It is established that there is an increase in soft tissue of the clubbed digits as demonstrated on previous histopathological examinations. In the present study, the nail bed thickness was assessed ...
It is established that there is an increase in soft tissue of the clubbed digits as demonstrated on previous histopathological examinations. In the present study, the nail bed thickness was assessed and measured on plain radiographs of index fingers in two groups of patients: one group with lung disease and fingers clubbing and one group of normal controls. A vertical x-ray beam was used with a focus-film distance of 1.0 m, with the index finger placed in lateral view directly over the film, without anti-diffusion grid. Three investigators, blinded to prevent bias measured the thickness of soft tissues between the nail root and the terminal phalanx on the radiographs. This method was used to evaluate a group of 85 clinically clubbed (hyponychial angle > 192.0 degrees) adult patients with lung disease and a control group of a 100 normal adult individuals with no clubbing (hyponychial angle < 188.0 degrees). The mean nail bed thickness in the patients with clubbing (n = 85) was 3.88 +/- 0.55 mm (3.00-5.50 mm). In comparison, in the normal subjects (n = 100), the mean was 2.38 +/- 0.27 mm (1.75-3.10 mm), revealing a significant difference (P < 0.001). Only two normal individuals presented nail bed thickness >or=3.0 mm. A good interobserver agreement on the measurements was found (P > 0.900). The radiographic evaluation of the nail bed thickness was easily performed, with good interobserver concordance. It is possible to distinguish between clubbed from nonclubbed fingers, in vivo, using plain radiograph.
- Clubbing: an update on diagnosis, differential diagnosis, pathophysiology, and clinical relevance. [Review]
- JAJ Am Acad Dermatol 2005; 52(6):1020-8
- Finger clubbing can be a striking physical finding. At other times, the presence of clubbing is difficult to establish by subjective examination alone and the profile angle or distal phalangeal to in...
Finger clubbing can be a striking physical finding. At other times, the presence of clubbing is difficult to establish by subjective examination alone and the profile angle or distal phalangeal to interphalangeal depth ratio are needed to confirm the finding. Most microscopic and imaging studies of clubbed fingers reveal hypervascularization of the distal digits. Recent research shows that when platelet precursors fail to become fragmented into platelets within the pulmonary circulation, they are easily trapped in the peripheral vasculature, releasing platelet-derived growth factor and vascular endothelial growth factor, promoters of vascularity and, ultimately, clubbing. Clinically, clubbing is associated with a number of neoplastic, pulmonary, cardiac, gastrointestinal, infectious, endocrine, psychiatric, and multisystem diseases. In narrowing the differential diagnosis, we recommend a detailed history and physical examination accompanied by focused laboratory and imaging studies. An algorithm for the evaluation of newly diagnosed clubbing is suggested.
- Vascular endothelial growth factor (VEGF)-A and platelet-derived growth factor (PDGF) play a central role in the pathogenesis of digital clubbing. [Journal Article]
- JPJ Pathol 2004; 203(2):721-8
- Digital clubbing is associated with many unrelated serious diseases but its pathogenesis remains a clinical enigma. It has been hypothesized that platelet clusters impacting in the distal vasculature...
Digital clubbing is associated with many unrelated serious diseases but its pathogenesis remains a clinical enigma. It has been hypothesized that platelet clusters impacting in the distal vasculature mediate the morphological changes of clubbing. Since the multifunctional cytokines vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) are released on platelet aggregation and are hypoxically regulated, the present study has examined their role in clubbing using immunohistochemistry. Basic fibroblast growth factor (bFGF), transforming growth factor-beta 1 (TGF-beta1), microvessel density, carbonic anhydrase IX (CAIX), hypoxia inducible factor (HIF)-1alpha, and HIF-2alpha were also measured. There was a significant increase in VEGF (p = 0.01), pKDR (p = 0.03), PDGF (p = 0.017), and HIF-1alpha and HIF-2alpha (p = 0.004 and p = 0.004, respectively) expression together with a significant increase in microvessel density (p = 0.03) in the stroma in clubbed digits compared with controls. There was no difference in CAIX (p = 0.25), TGF-beta1 (p = 0.66) or bFGF (p = 0.18) between affected and control groups. These findings suggest that VEGF and PDGF are released after platelet impaction and that their expression is hypoxically enhanced in the stroma after capillary occlusion. VEGF may synergize with PDGF in inducing the stromal and vascular changes present in digital clubbing.
- Clubbed fingers: the claws we lost? [Journal Article]
- MHMed Hypotheses 2004; 62(3):321-4
- Clubbed digits resemble the human embryonic fingers and toes, which look like the digits of a claw. Clubbed digits, thus, may represent the return of the embryonic claw and may even represent the cla...
Clubbed digits resemble the human embryonic fingers and toes, which look like the digits of a claw. Clubbed digits, thus, may represent the return of the embryonic claw and may even represent the claws man has lost during evolution, if ontogenesis really recapitulates phylogenesis. We put forward the hypothesis that secondary clubbing, like gynecomastia, is caused by a pathologic condition, which alters hormone levels in the blood, leading to the activation of 'dormant' genes, resulting in the development of an organ. However, the nature of the diseases that cause clubbing suggests that these hormones may actually be cytokines, acting as hormones. The nature of these cytokines is not known. They may be identified by comparing their blood levels or the combination of their blood levels to the presence or absence of clubbing, but also to the degree of clubbing and its disappearance after treatment of the primary disease.
- The rational clinical examination. Does this patient have clubbing? [Review]
- JAMAJAMA 2001 Jul 18; 286(3):341-7
- CONCLUSIONS: We recommend use of the profile angle and phalangeal depth ratio as quantitative indices in identifying clubbing. Clinical judgment must be exercised in determining the extent of further evaluation for underlying disease when these values exceed 180 degrees and 1.0, respectively.
- [Pachydermoperiostosis]. [Case Reports]
- HHautarzt 1995; 46(6):429-35
- Pachydermoperiostosis (Friedreich-Erb-Arnold syndrome, Touraine-Solente-Golé syndrome) is a rare disease with an autosomal dominant mode of inheritance; it occurs almost exclusively in men. A report ...
Pachydermoperiostosis (Friedreich-Erb-Arnold syndrome, Touraine-Solente-Golé syndrome) is a rare disease with an autosomal dominant mode of inheritance; it occurs almost exclusively in men. A report of typical pachydermoperiostosis in a 31-year-old man is presented. Associated features were clubbed digits of the hands and feet with watch-crystal nails, thickening of the skin and soft tissues, hyperhidrosis of hands and feet, hyperplasia of the sebaceous glands with seborrhoea, gynaecomastia, and ophthalmic abnormalities that had been present since puberty. Radiological examination revealed periosteal hyperostosis of the short and long bones. Endocrine disturbances were not detected. Skin biopsies showed hypertrophy of the skin and skin appendages. Primary (idiopathic, hereditary) pachydermoperiostosis should be distinguished from secondary (symptomatic) forms of the disease, which are often associated with lung tumours.
- Digital clubbing. A case study. [Case Reports]
- JAJ Am Podiatr Med Assoc 1993; 83(11):641-4
- In this case, it is difficult to assess whether the severity of the clubbed digits is a result of a purely hereditary nature, liver pathology, chronic respiratory ailments, or a combination of the ab...
In this case, it is difficult to assess whether the severity of the clubbed digits is a result of a purely hereditary nature, liver pathology, chronic respiratory ailments, or a combination of the above. The abnormal liver function test may not be related to the digital clubbing. Instead, they may be the result of the alcohol abuse. The case does appear to be hereditary because his siblings and mother all have clubbed digits and there is a higher frequency in blacks. The authors believe that this case affords an opportunity to make the podiatrist aware of the possibilities that should be considered the differential diagnosis when examining a patient with clubbed digits. It is important to fully work up a patient with clubbed digits even if the presentation is that of hereditary clubbing. Severe clubbing may be the result of a mild hereditary form that was worsened by an underlying systemic condition, such as malignancy, toxicosis, endocrinopathy, and neuropathy.
- [Pachydermoperiostosis--report of a case and review of 121 Japanese cases]. [Case Reports]
- NHNihon Hifuka Gakkai Zasshi 1991; 101(4):461-7
- A case of 23 years old man with idiopathic pachydermoperiostosis is reported. He showed cutis verticis gyrata, clubbed fingers and periosteal new bone formation without any causative basic disorder. ...
A case of 23 years old man with idiopathic pachydermoperiostosis is reported. He showed cutis verticis gyrata, clubbed fingers and periosteal new bone formation without any causative basic disorder. His serum level of FSH, LH, estradiol and estriol were elevated, but their significance was not clear. Histological examination of the skin from the forehead revealed sebaceous hyperplasia and dermal thickening, where deposit of alcian blue and colloidal iron positive substance were detected. The deformed forehead and eyelids were corrected by plastic surgery. One hundred and twenty one cases of pachydermoperiostosis reported so far in Japan are briefly reviewed. Most of them were male (94.1%), about one fourth had a family history. The principal features are: clubbing of the digits (88.4%), periosteal new bone formation (94.1%), coarsening of the facial features with furrowing of the skin of the face (72.7%) and cutis verticalis gyrata (59.5%). Arthralgia (40.5%), hyperhidrosis of the feet and hands (44.6%), gastric hypertrophy (8 cases), gastric ulcers (5 cases) and endocrine abnormalities (17 cases) were also reported.
New Search Next
- A study of capillary morphology in the digits of patients with acquired clubbing. [Journal Article]
- ARAm Rev Respir Dis 1989; 140(4):1063-6
- We sought to determine the capillary morphology in patients with clubbing to compare it with that in subjects without clubbing. Subjects were placed in the clubbed or nonclubbed groups on the basis o...
We sought to determine the capillary morphology in patients with clubbing to compare it with that in subjects without clubbing. Subjects were placed in the clubbed or nonclubbed groups on the basis of caliper measurements of their index fingers. In each subject, photomicrographs of eight fingers were done focusing on the dorsal skin just proximal to the base of the nail. Each photomicrograph was randomly graded with respect to the presence and extent of plexus formation, the presence of arborized loops, and the presence of splayed loops. Comparison of the plexus score, presence of arborized loops, and presence of splayed loops were significantly different between the clubbed and nonclubbed groups (p less than 0.001 in all three analyses). Only a plexus score of 2 or greater demonstrated a useful degree of sensitivity and specificity (89 and 90%, respectively). We concluded that a significant difference in the morphologic features of the capillaries existed between nonclubbed subjects and those with acquired clubbing.