Hand syndrome

Fisher CM (1965c) The vascular lesion in lacunae. Trans Am Neurol Assoc 90 243-5 243-245 Fisher CM (1967) A lacunar stroke. The dysarthria-clumsy hand syndrome. Neurology 17 614-617 Fisher CM (1977) Bilateral occlusion of basilar arterybranches. 

GeschwindN (1975) The apraxias neural mechanisms of disorders of learned movement. Am Sci 63 188-195 Geschwind DH, Iacoboni M, Mega MS et al (1995) Alien hand syndrome interhemispheric motor disconnection due to a lesion in the midbody of the corpus callosum. Neurology 45 802-808... 

While physicians may not recognize up to 80% of lacunes (Tuszynski et al. 1989), several clinical syndromes have been correlated with relevant lacunes detected at subsequent autopsy. Five of these are regarded as the classic lacunar syndromes pure motor hemiparesis, sensorimotor stroke, pure sensory hemiparesis, dysarthria clumsy hand syndrome, and ataxic hemiparesis (Donnan et al. 2002 Fisher 1982 Bamford 2001). Pure motor stroke is the commonest lacunar syndrome in clinical practice, while pure sensory stroke is encountered less frequently. The involvement of the face, arm and leg of one side is the characteristic feature of the first three syndromes while reductions of consciousness, cognitive or visual field defects are absent. Even though lacunar infarcts have been linked to lacunar syndromes, the latter are of course not specific for this stroke subtype and mimicked by cortical infarcts, intracerebral hematomas, and non-vascular causes (Bogousslavsky et al. 1988 Bamford 2001). 

Secondary consequences of neurological disability include painful shoulder, shoulder-hand syndrome, contractures and falls. Physiotherapists and other members of the multidisciplinary team should have expertise in managing these problems. 

Phenytoin is the only widely used hydantoin and, unless otherwise specified, effects discussed here refer to phenytoin. Other hydantoin derivatives include ethotoin (rINN), mephenytoin (rINN), and albutoin (rINN) (all of which are obsolete), and fosphenytoin (rINN). The latter is a water-soluble prodrug that is rapidly hydrolysed to phenytoin after intravenous or intramuscular injection. It causes fewer adverse reactions near the injection site (pain, phlebitis, tissue necrosis, purple hand syndrome) than phenytoin. 

Williams, S.R., Clark, R., and Dunford, J. (1995). Hunan hand syndrome. Annals of Emergency Medicine 25 5. 

A patient with bilateral thenar hypoplasia resembling a mild form of Holt-Oram syndrome developed bradycardia when she took therapeutic doses of lithium it resolved on withdrawal [14 ]. However, the Holt-Oram syndrome is often called the heart-hand syndrome because cardiovascular abnormalities are common in this genetic disorder [15 ], suggesting that either lithium may have interacted with the TBX5 gene product or the bradycardia was serendipitous. 

Daniel CR III, Gupta AK, Daniel MP, Daniel CM (1997) Two feet-one hand syndrome a retrospective multicenter survey. Int J Dermatol 36 658-660... 

Dry-hands syndrome is seen more frequently in atopic patients who touch strong acids (sulphuric, chlorhyd-ric, nitric, etc.) (Kiec-Swierczynska 1987) without due protection and who present a pruriginous xerosis on... 

As the science of indoor air quality has matured, indoor air professionals have realized that many indoor air contaminants and the associated health effects are linked to specific types of buildings and their characteristics. For example, radon is primarily an indoor air concern in homes because of the ease with which it can be transported inside residential construction from the soil beneath. On the other hand. Sick Building Syndrome (SBS) primarily afflicts office building occupants who experience acute health and comfort effects that appear to be linked to time spent in a specific building. 

Capecitabine is used for the treatment of colorectal and breast cancers. It is contraindicated in patients with known hypersensitivity to capecitabine or any of its components or to 5-fluorouracil and in patients with known dihydropyrimidine dehydrogenase (DPD) deficiency. The use of capecitabine is restricted in patients with severe renal impairment. The drag can induce diarrhea, sometimes severe. Other side effects include anemia, hand-foot syndrome, hyperbilirubinemia, nausea, stomatitis, pyrexia, edema, constipation, dyspnea, neutropenia, back pain, and headache. Cardiotoxicity has been observed with capecitabine. A clinically important drag interaction between capecitabine and warfarin has been demonstrated. Care should be exercised when the drag is co-administered with CYP2X9 substrates. 

Cessation of prolonged heavy alcohol abuse may be followed by alcohol withdrawal or life-threatening alcohol withdrawal delirium. Typical withdrawal symptoms are autonomic hyperactivity, increased hand tremor, insomnia and anxiety, and are treated with benzodizepines and thiamine. Alcoholism is the most common cause of thiamine deficiency and can lead in its extreme form to the Wernicke s syndrome that can be effectively treated by high doses of thiamine. 

Association of Pain, neuropathic pain is defined as pain initiated or caused by a primary lesion, dysfunction in the nervous system". Neuropathy can be divided broadly into peripheral and central neuropathic pain, depending on whether the primary lesion or dysfunction is situated in the peripheral or central nervous system. In the periphery, neuropathic pain can result from disease or inflammatory states that affect peripheral nerves (e.g. diabetes mellitus, herpes zoster, HIV) or alternatively due to neuroma formation (amputation, nerve transection), nerve compression (e.g. tumours, entrapment) or other injuries (e.g. nerve crush, trauma). Central pain syndromes, on the other hand, result from alterations in different regions of the brain or the spinal cord. Examples include tumour or trauma affecting particular CNS structures (e.g. brainstem and thalamus) or spinal cord injury. Both the symptoms and origins of neuropathic pain are extremely diverse. Due to this variability, neuropathic pain syndromes are often difficult to treat. Some of the clinical symptoms associated with this condition include spontaneous pain, tactile allodynia (touch-evoked pain), hyperalgesia (enhanced responses to a painful stimulus) and sensory deficits. 

Children younger than 3 years of age can present with dactylitis (hand-foot syndrome), which is painful swelling of the hands and feet. 

Liposomal doxorubicin Myelosuppression, palmar-plantar erythrodysesthesia (hand-foot syndrome) Alopecia, infusion reactions, stomatitis, fatigue, nausea, vomiting... 

Fluorouracil Inhibition of the enzyme thymidylate synthase, the rate-limiting step in thymidine formation. Dose-limiting Myelosuppression and mucositis with bolus administration Diarrhea and hand-foot syndrome with continuous infusion Additional toxicities Skin discoloration, nail changes, photosensitivity, and neurologic toxicity... 

Warning signs to report to the physician (depends on regimen used) include fever, diarrhea, mucositis, and hand-foot syndrome. 

Doxorubicin 3 hours cycles 1 2 and then infused over 1 hour thereafter repeat every 28 days mucositis, alopecia, flushing, shortness of breath, hypotension, headaches, cardiotoxicity, hand-foot syndrome dysfunction. 2. Do not give if total bilirubin is greater than 5 mg/dL. 

Capecitabine 1 800-2500 mg/m2 PO as divided dose twice for 14 consecutive days, followed by 1 week of rest 29% Myelosuppression, hand-foot syndrome, nausea/vomiting, edema, stomatitis, diarrhea, cardiotoxicity, rash 1. Monitor for PPE and recommend regular use of lotions on hands and feet. 

Capecitabine -converted to 5-FU preferentially by tumor cells pyrimidine analogue antimetabolite inhibits thymidylate synthase -mucocutaneous effects (stomatitis, mucositis) -diarrhea -bone marrow suppression -nausea and vomiting -palmar-plantar erythrodysethesias (hand-foot syndrome) -fatigue... 

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