Edema Of Hands Research Articles

A Multi-Center Trial to Evaluate the Safety and Toxicity of Nanoxel<sup>®</sup>-M in Breast Cancer Patients

Purpose: Nanoxel®-M is a low-molecular-weight, non-toxic, biodegradable, docetaxel-loaded methoxy-poly (ethylene glycol)-block-poly (D,L-lactide) (mPEG-PDLLA) micellar formulation. We conducted a multicenter trial to evaluate the safety and toxicity of Nanoxel®-M and the quality of life (QoL) of Korean breast cancer patients treated with this formulation.Methods: Patients received adjuvant Nanoxel®-M with a schedule comprising four alternating cycles of doxorubicin with cyclophosphamide, followed by either Nanoxel®-M or Nanoxel®-M with cyclophosphamide after surgery for early breast cancer. We analyzed hematological and non-hematological toxicity profiles and alterations in patient QoL using the Korean version of the European organization for research and treatment of cancer core 30-item quality of life questionnaire. Fifty-five operable breast cancer patients with stage II or III disease were enrolled from four centers in Korea.Results: Regarding safety and toxicity profiles, grade 3/4 toxicity presented as anemia in 0.5%, neutropenia in 61.8%, febrile neutropenia in 4.5%, mucositis in 1.4%, and edema in 0.5% of patients during 220 total cycles. However, all-grade thrombocytopenia was not observed among hematological toxicities. No grade 3/4 nausea, vomiting, diarrhea, hand foot syndrome, dyspnea, allergic reaction, edema, or peripheral neuropathy were observed. Furthermore, no vehicle-related hypersensitivity reactions occurred when using Nanoxel®-M.Conclusion: Our findings indicate that Nanoxel®-M could be used to treat operable breast cancer patients, compare favorably with docetaxel in terms of hypersensitivity reactions and the incidence of taxane-induced peripheral neuropathy, and is associated with a similar incidence of febrile neutropenia.

Management of Endothelial Dysfunction in Systemic Sclerosis: Current and Developing Strategies.

Systemic Sclerosis (SSc) is an autoimmune disease marked by dysregulation of the immune system, tissue fibrosis and dysfunction of the vasculature. Vascular damage, remodeling and inadequate endothelial repair are hallmarks of the disease. Since early stages of SSc, damage and apoptosis of endothelial cells (ECs) can lead to perivascular inflammation, oxidative stress and tissue hypoxia, resulting in multiple clinical manifestations. Raynaud's phenomenon, edematous puffy hands, digital ulcers, pulmonary artery hypertension, erectile dysfunction, scleroderma renal crisis and heart involvement severely affect quality of life and survival. Understanding pathogenic aspects and biomarkers that reflect endothelial damage in SSc is essential to guide therapeutic interventions. Treatment approaches described for SSc-associated vasculopathy include pharmacological options to improve blood flow and tissue perfusion and, more recently, cellular therapy to enhance endothelial repair, promote angiogenesis and heal injuries. This mini-review examines the current knowledge on cellular and molecular aspects of SSc vasculopathy, as well as established and developing therapeutic approaches for improving the vascular compartment.

Clinical Effects of Korean Red Ginseng in Postmenopausal Women With Hand Osteoarthritis: A Double-Blind, Randomized Controlled Trial

Background: Although many menopausal Asian women use herbal remedies for joint pain, there are no studies evaluating the efficacy of Korean red ginseng on osteoarthritis symptoms in postmenopausal women. The purpose of this study is to analyze antioxidant enzyme activity, oxidative stress markers, and pain scores before and after red ginseng consumption, to assess its effect in postmenopausal women. Methods. This prospective, double-blind, randomized controlled trial enrolled 52 postmenopausal women who presented with hand edema and/or pain and were diagnosed as degenerative arthritis of the hand. Patients were randomly assigned to the red ginseng (RG) group (supplemented with 3 g/d of RG for 12 weeks) or the placebo group. Changes in pain and Disability of the Arm, Shoulder, and Hand (DASH) scores, antioxidant enzyme, oxidative stress markers, serum estradiol levels, and endometrial thickness were analyzed. Results. The pain score and DASH score were significantly improved in the RG group (both p < 0.05). The improvement of pain score at rest, during work or sport, and DASH score was significant compared to that of the placebo group. The superoxide dismutase level increased (p < 0.05) and the malondialdehyde level decreased (p < 0.05) significantly in the RG group, while none of the antioxidative factors showed a significant change in the placebo group. Serum estradiol levels and endometrial thickness were not affected by RG supplementation. Conclusion. RG may be an effective dietary supplement for postmenopausal women with degenerative osteoarthritis of the hand. It may relieve pain and improve antioxidative activity without the risk of endometrial thickening.

Effectiveness of manual therapy in patients with distal radius fracture: a systematic review and meta-analysis

ABSTRACT Objective To determine the effectiveness of manual therapy (MT) for functional outcomes in patients with distal radius fracture (DRF). Methods An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that included MT techniques with or without other therapeutic interventions in functional outcomes, such as wrist or upper limb function, pain, grip strength, and wrist range of motion in patients older than 18 years with DRF. Results Eight clinical trials met the eligibility criteria; for the quantitative synthesis, six studies were included. For supervised physiotherapy plus joint mobilization versus home exercise program at 6 weeks follow-up, the mean difference (MD) for wrist flexion was 7.1 degrees (p = 0.20), and extension was 11.99 degrees (p = 0.16). For exercise program plus mobilization with movement versus exercise program at 12 weeks follow-up, the PRWE was −10.2 points (p = 0.02), the DASH was −9.86 points (p = 0.0001), and grip strength was 3.9 percent (p = 0.25). For conventional treatment plus manual lymph drainage versus conventional treatment, for edema the MD at 3–7 days was −14.58 ml (p = 0.03), at 17–21 days −17.96 ml (p = 0.009), at 33–42 days −15.34 ml (p = 0.003), and at 63–68 days −13.97 ml (p = 0.002). Conclusion There was very low to high evidence according to the GRADE rating. Adding mobilization with movement and manual lymphatic drainage showed statistically significant differences in wrist, upper limb function, and hand edema in patients with DRF.

AN ATYPICAL PRESENTATION OF LEMIERRE'S SYNDROME

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Lemierre's syndrome involves recent oropharyngeal infection, clinical or radiological evidence of internal jugular vein thrombosis, and isolation of anaerobic pathogens, most commonly Fusobacterium necrophorum. We present an atypical presentation of Lemierre's syndrome. CASE PRESENTATION: A 28-year-old male with a history of left second metacarpal neck fracture status post open internal reduction and pin removal one month prior presented with malaise, chills, and hand pain. His review of systems were significant for fever, headache, sore throat, productive cough, pleuritic chest pain, and dyspnea. He was febrile, tachycardic, and hypoxic. Examination revealed edema and erythema of the left hand and wrist, tenderness to palpation, and a bounding radial pulse. Laboratory investigations revealed a white cell count of 7.7 Thou/mcL, C-reactive protein 28.65 mg/dL, lactic acid 5.1 mmol/L, and procalcitonin 74.64 ng/mL. Chest X-ray showed bibasilar infiltrates. Computed tomography (CT) of the left hand showed soft tissue edema and emphysema of the wrist, hand, and forearm. He was diagnosed with sepsis due to left upper extremity necrotizing fasciitis and underwent fasciotomy with debridement. Wound cultures had no growth. Blood cultures grew Fusobacterium necrophorum. CT angiography of the pulmonary arteries revealed septic emboli. Venous duplex of the upper extremities revealed a chronic complete thrombus of the right internal jugular vein. Transthoracic echocardiogram showed no evidence of endocarditis. The diagnosis of Lemierre's Syndrome was made. The patient was discharged on enoxaparin and metronidazole for treatment. DISCUSSION: Lemierre's syndrome was first characterized by Dr. Andre Lemierre in 1936.1 The incidence decreased significantly with widespread usage of beta-lactam antibiotics in pharyngiitis.1 Due to antibiotic stewardship, the incidence has increased.1 Our patient presented with fever, left hand pain, and concern for necrotizing fasciitis with low suspicion of Lemierre's syndrome. Upon review, he did have elements consistent with the typical presentation of Lemierre's. Fever and sore throat are predominant symptoms; late sequelae involve septic emboli to the lungs resulting in chest pain and shortness of breath.3 Despite the increase in incidence of Lemierre's syndrome since physicians began practicing antibiotic stewardship, it is still rare. It is important to keep this as a differential as the mortality is around 5% if left untreated.1 CONCLUSIONS: The incidence of Lemierre's Syndrome continues to rise with the practice of antibiotic stewardship. It is crucial to consider this potentially fatal diagnosis when the clinical picture is consistent with Lemierre's syndrome. REFERENCE #1: Karkos PD, Asrani S, Karkos CD, et al. Lemierre's syndrome: A systematic review. Laryngoscope. 2009;119(8):1552-1559. doi:10.1002/lary.20542 REFERENCE #2: Lee WS, Jean SS, Chen FL, Hsieh SM, Hsueh PR. Lemierre's syndrome: A forgotten and re-emerging infection. J Microbiol Immunol Infect. 2020;53(4):513-517. doi:10.1016/j.jmii.2020.03.027 REFERENCE #3: Olivier JB, Al-Hourani K, Bolland B. Lemierre's syndrome; a rare cause of septic arthritis. BMJ Case Rep. 2017;2017:bcr2017220110. Published 2017 May 12. doi:10.1136/bcr-2017-220110 DISCLOSURES: No relevant relationships by Mikhail de Jesus, source=Web Response no disclosure on file for Jason Jacob; No relevant relationships by Rafae Shaikh, source=Web Response No relevant relationships by Asiya Tafader, source=Web Response

28283 Efficacy and tolerability of early initiation of sirolimus for kaposiform hemangioendothelioma in an extreme premature infant

Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor most commonly affecting children <6 months of age. It is associated with Kasabach-Merritt phenomenon (KMP), a life-threatening consumptive coagulopathy with severe thrombocytopenia. Although no standard treatment algorithm exists, the mTOR inhibitor sirolimus has proven effective in clinical KHE mass reduction and management of KMP. Literature regarding sirolimus for KHE in children <1 month of age is sparse, with the youngest report to date in an 8-day old term male; long term efficacy and safety continues to be an important area of study. A 26.5 week extreme premature female, born via C-section secondary to maternal hemolysis-elevated liver enzymes-low platelet (HELLP) syndrome, was noted at birth to have a 4.0 × 3.5 cm purpuric, thin expanding plaque over her right upper trunk with ipsilateral hand edema. Punch biopsy was performed; ultrasound was consistent with cutaneous/subcutaneous vascular anomaly. Histopathology showed a vascular proliferation within the dermis/ subcutis, characterized by nodules of spindled endothelial cells (GLUT1-) surrounded by ectatic vascular spaces, degenerated erythrocytes, and CD61+ fibrin thrombi, consistent with KHE. Platelet level decreased from 147 on day of life (DOL) 1 to 51 by DOL 4. Fibrinogen was 244 [170-450] and D-dimer 2,079 [0-500], with a trend to 141 and 1207, respectively, by DOL 6. Sirolimus was started on DOL 6; no platelet transfusion was required. She has remained on drug and stable without adverse event. Blood counts stabilized with remarkable reduction in the size of her tumor.

Randomised controlled prospective study of the use of adhesive elastic tape for the control of hand oedema in patients with a wrist fracture treated in a cast: a study protocol

BackgroundWrist fractures are a common occurrence, affecting patients of all ages. Wrist fracture patients often develop oedema and the presence of a cast increases the risk. The use of adhesive elastic tape is indicated for oedema control, but there is no definitive evidence of its effectiveness. This study aims to evaluate the effectiveness of the tape in control of hand oedema in wrist fracture patients with a forearm cast. MethodsWe present a study protocol for a randomised controlled trial with blinded data processing. We will apply the tape to the intervention group after cast application, while the control group will receive the standard treatment. We will evaluate the circumference difference between baseline (T0) and the 7-day follow-up (T1) of both the thumb and of the other 4 fingers merged together. We will collect data regarding re-attendance to the Orthopedic Emergency Room due to “intolerance to the plaster cast”. Sample size calculations resulted in a required total of 220 participants (110 per group). Ethical approval for the study has been obtained. DiscussionWe aim to demonstrate that the use of tape improves the tolerability of the cast by reducing the oedema formation, the feeling of constriction and pain. Trial registrationClinicalTrial.gov Identifier: NCT04683887.

Two case reports of local envenoming by the Spotted grass snake, Psammophylax rhombeatus (Linnæus, 1758) (Serpentes, Psammophiidae)

Two cases of bites by a South African psammophiid snake, Psammophylax rhombeatus, are described and analyzed. These are the first detailed reports of local envenoming by a Psammophylax spp. While handling a wild-collected 1 m P. rhombeatus, the snake inflicted a protracted bite proximal to the metacarpophalangeal joint of digit #5, left hand of a 24−year-old male amateur herpetologist. Local edema persisted for three days, but no pain or other signs or symptoms including non-specific autonomic effects (e.g. headache, nausea) occurred. In a second case, a 28−year-old male herpetologist-photographer was repositioning a 0.58 m female P. rhombeatus in order to photograph the snake and her egg clutch, when the snake bit the metacarpophalangeal joint of digit #5, left hand, and briefly advanced its jaws. The bite caused mild local pain, progressive edema of the left hand, and arthralgia; resolution required almost 1 week. Bites from non-front-fanged snakes such as these by P. rhombeatus are uncommonly reported in comparison with those described for front-fanged snakes (e.g. Viperidae, Elapidae). Therefore, documentation of bites even with minimal effects provides information essential for the construction of an accurate medical risk profile for these less-known species.

Dalla Kawasaki Disease alla MIS-C: l’esperienza di Bergamo

Kawasaki disease (KD), although rare (affects about 15 children out of 100,000/year) and self-limiting, it is the second most frequent cause of pediatric acquired heart disease in Western countries. The classic KD is diagnosed by fever and at least 4 clinical signs between conjunctivitis, mucositis, polymorphic rash, erythema and edema of hands and feet or lymphadenopathy; if clinical signs are less than 4 the incomplete KD can be diagnosed together with specific laboratory criteria. Since March 2020, at the time of the greatest spread of the SARS-CoV-2 epidemic in our province, we found over 20 children, admitted to the Pediatrics of our hospital, with clinical pictures very similar to Kawasaki disease. In addition to signs of mucocutaneous inflammation, some children had a significant systemic inflammation with severe heart involvement, up to shock in some cases. In the next months, similar cases were reported in areas of the world with a high spread of the virus, and the scientific community coined the name of Multisystem Inflammatory Syndrome in Children (MIS-C) for this form linked to SARS-CoV-2. KD conventional therapy based on intravenous immunoglobulin, acetylsalicylic acid and systemic steroids resolved the inflammation in all children. This article critically discusses the common characteristics of the two diseases and hypothesizes that they belong to the same pathological condition with a wide spectrum of clinical manifestations; it proposes the diagnostic framework for this new inflammatory condition based on clinical and laboratory characteristics and, finally, outlines the principles of treatment.

Manifestações cutâneas em paciente com Síndrome inflamatória multissistêmica pediátrica temporariamente associada ao SARS-CoV2: relato de caso

OBJECTIVES: To describe the cutaneous manifestations presented by a patient with pediatric multisystemic inflammatory syndrome (MIS-C) temporarily associated with SARS-CoV-2. METHODS: Female patient, 10 years old, presenting arthralgia in the wrists and ankles, edema in hands and feet, persistent fever, appearance of diffuse, and itchy maculopapular rash associated with odynophagia and productive cough. Evolution of the rash to violaceous lesions on the face, trunk and limbs (upper and lower), in addition to the appearance of vesicles on the face, within 48 hours. CBC suggestive of an infectious condition, with CRP 307mg/L (insert reference value) and ESR 61mm. RT-PCR for SARS-CoV-2 positive. RESULTS: Diagnosis of pediatric multisystemic inflammatory syndrome temporarily associated with SARS-CoV2. Transferred to ICU for monitoring and intravenous human immunoglobulin initiated. Good evolution, with the disappearance of injuries and discharge with outpatient follow-up. CONCLUSION: MIS-C has several dermatological manifestations and pediatricians must be attentive to the diagnosis, not limited to a specific presentation. In this case report, the importance of referral to tertiary referral centers for better case management and timely recognition of the syndrome in these patients is emphasized.

Late postoperative complications of arteriovenous fistula for hemodialysis

&amp;lt;p&amp;gt;The vascular approach is a prerequisite for performing hemodialysis, but their &amp;quot;weak points&amp;quot; are different and frequent complications. Modern guidelines recommend native arteriovenous fistula (AVF) as the first choice of vascular approach because it is characterized by the longest survival and the least complications compared to other vascular approaches. All complications of AVF can be divided into intraoperative, early, and late postoperative. This paper presents the late postoperative complications of AVF, their frequency, causes, diagnosis and treatment. The most important late postoperative complications are: stenosis, thrombosis, aneurysm or pseudoaneurysm formation, infection, hand edema, hematoma, ischemic steal syndrome, ischemic neuropathy, congestive heart failure. Large differences in the frequency of each complication in earlier studies can be explained by differences in surgical technique, localization of AVF, diagnostic methods, but, above all, differences between the presented groups of patients. It is described that the age of patients, sex, underlying disease, the presence of comorbid conditions and various metabolic and immune disorders characteristic of chronic renal failure, as well as the way of using and caring for AVF significantly affect the occurrence of AVF complications. One of the main predictors of AVF success and survival is the quality of the patients' blood vessels, and therefore careful examination of blood vessels before approaching AVF creation is of particular importance. The creation, use and care of AVF is the task of the team of health professionals who take part in the treatment of these patients, and successful treatment requires their good cooperation, as well as cooperation with patients.&amp;lt;/p&amp;gt;

Fever and a Multifocal, Erythematous, Nodular Rash in an 18-month-old Boy

1. Angelique E. Boutzoukas, MD* 2. Jared Kusma, MD* 3. Joshua R. Watson, MD† 4. Bonita Fung, MD‡ 5. Christopher P. Ouellette, MD†,§ 1. *Pediatric Residency Program, 2. †Division of Infectious Diseases, 3. ‡Department of Anatomic Pathology and Laboratory Medicine, and 4. §Host Defense Program, Nationwide Children’s Hospital, Columbus, OH A previously healthy 18-month-old boy presents to the emergency department after 6 days of cough, rhinorrhea, daily fever, irritability, and progressive rash with extremity swelling. On admission, he is febrile to 38.2°C and ill-appearing. Physical examination is notable for lip and tongue erythema, a sandpaper-like exanthem on his back and extremities with scattered petechiae, and tense bilateral hand and feet edema and erythema. In addition, multiple erythematous, tender, indurated, nodular lesions (2 to 3 cm in diameter) are present on the chest, abdomen, right arm, and left hand (Fig 1). Figure 1. Numerous, tender erythematous nodular lesions localized to chest and abdomen. Laboratory evaluation is notable for leukocytosis (white blood cell count of 40,000/mm3 [40 × 109/L] with 49% segmented neutrophils, 41% band forms) and an elevated erythrocyte sedimentation rate (103 mm/hour), C-reactive protein (25.9 mg/dL [2,466.7 nmol/L]), aspartate aminotransferase (63 U/L [1.05 ukat/L]), and alanine aminotransferase (46 U/L [0.77 ukat/L]). Urinalysis shows evidence of pyuria (18 white blood cell/high power field) and proteinuria (100 mg/dL). A blood culture is obtained, and intravenous clindamycin 10 mg/kg every 8 hours is initiated to target typical skin organisms. Given the unusual nodular rash, dermatology is consulted and performs a skin biopsy of a nodule on the abdomen. Blood culture results reveal the first clue, and histopathologic analysis of the skin biopsy reveals the diagnosis. Given the initial presentation, he was hospitalized with an initial differential diagnosis including Kawasaki disease (KD), toxic shock syndrome (TSS), a serum sickness-like reaction, native valve infective endocarditis with cutaneous emboli, …

Clinical Efficacy and Safety of Injection of Stromal Vascular Fraction Derived from Autologous Adipose Tissues in Systemic Sclerosis Patients with Hand Disability: A Proof-Of-Concept Trial.

Background: Stromal vascular fraction (SVF) has recently emerged as a potential therapeutic modality, due to its multipotent cellular components in tissue regeneration. Systemic sclerosis (SSc) is a progressive autoimmune disease that results in hand disability by skin fibrosis and microangiopathies. We performed an open-label study to investigate the efficacy and safety of SVF injection in SSc patients (Clinical Trial number: NCT03060551). Methods: We gathered 20 SSc patients with hand disability, planning for a 24-week follow-up period. SVF was extracted from autologous adipose tissues, processed by the closed system kit, and injected into each finger of SSc patients. We observed various efficacy and safety profiles at each follow-up visit. Results: Among the 20 initially enrolled patients, eighteen received SVF injection, and were completely followed-up for the whole study period. Patients received 3.61 × 106 mesenchymal stem cells into each finger on average. Skin fibrosis, hand edema, and quality of life were significantly improved, and 31.6% of active ulcers were healed at 24 weeks after injections. Semiquantitative results of nailfold capillary microscopy were ameliorated. There was no single serious adverse event related to the procedure. Conclusions: Injection of SVF derived from autologous adipose tissues is tolerable, and shows clinical efficacy in SSc patients.

Randomized Controlled Trial of Compression Interventions for Managing Hand Burn Edema, as Measured by Bioimpedance Spectroscopy.

Compression, a common treatment of choice for the management of edema, is one intervention that is applied with little objective understanding of the optimal parameters of application or efficacy in acute burn wounds. The aim of this study was to determine the effectiveness of different methods of compression for the management of hand edema following burn injury. The primary hypothesis tested was that in acute hand burn injury, the application of cohesive bandage will reduce edema faster than a generic compression glove. It is a randomized controlled study of 100 patients presenting with hand burn injury. Compression was randomized to one of the three methods of application: 1) spiral application of Coban to fingers, figure of eight to hand and wrist; 2) pinch application of Coban to fingers, spiral application to hand and wrist; or 3) a generic compression glove (control condition). Bioimpedance spectroscopy was used to measure hand volumes. Hand and wrist range of movement, pain scores, and QuickDASH were recorded. One hundred patients (68 males) demonstrated significant reductions in hand volumes, using all compression methods. Both methods of applying Coban resulted in significantly greater reductions in edema compared to the generic compression glove. Notwithstanding compression method, all range of movement measures improved, with significant improvement in thumb opposition (P = .046), hand span (P = .020), and wrist flexion (P = .020). QuickDASH decreased between sessions (P < .001). Different methods of applying Coban are superior to generic compression gloves for managing acute hand burn edema.

Grip Exercise of Non-Paretic Hand Can Improve Venous Return in the Paretic Arm in Stroke Patients: An Experimental Study in the Supine and Sitting Positions.

Objective: This study aims to determine the effect of grip exercise by the non-paretic hand on venous return in the paretic arm in stroke in sitting and supine positions.Methods: The study population included 21 stroke patients (mean age, 59.5 years). The diameter (mm) and time-averaged mean velocity (TAMV) (cm/s) of the axillary vein on the paretic side were measured by ultrasound during three distinct conditions: resting, rhythmic non-resistive grip exercise, and resistive exercise (30% of maximum grip strength) in supine and sitting positions. The venous flow volume (ml/min) was calculated using the obtained data.Results: In the supine and sitting positions, the venous flow volume during rhythmic non-resistive and resistive exercises was increased in comparison to resting, which resulted in more increased venous flow volume by rhythmic resistive grip exercise than by non-resistive grip exercise (both, p=0.01).Conclusion: Grip exercise by the non-paretic hand was found to be effective for increasing the venous flow volume in the paretic hand, and resistive grip exercise caused the greatest increase. Our results suggest that rhythmic handgrip exercise may be clinically useful for reducing the incidence of hand edema in stroke patients.

Chronic Thrombocytopenia as the Initial Manifestation of STIM1-Related Disorders.

Pediatric thrombocytopenia has a wide differential diagnosis, and recently, genetic testing to identify its etiology has become more common. We present a case of a 16-year-old boy with a history of chronic moderate thrombocytopenia, who later developed constitutional symptoms and bilateral hand edema with cold exposure. Laboratory evaluation revealed evidence both of inflammation and elevated muscle enzymes. These abnormalities persisted over months. His thrombocytopenia was determined to be immune mediated. Imaging revealed lymphadenopathy and asplenia, and a muscle biopsy was consistent with tubular aggregate myopathy. Ophthalmology evaluation noted photosensitivity, pupillary miosis, and iris hypoplasia. Genetic testing demonstrated a pathogenic variant in STIM1 consistent with autosomal dominant Stormorken syndrome. Our case is novel because of the overlap of phenotypes ascribed to both gain-of-function and loss-of-function pathogenic variants in STIM1, thereby blurring the distinctions between these previously described syndromes. Pediatricians should consider checking muscle enzymes when patients present with thrombocytopenia and arthralgia, myalgia, and/or muscle weakness. Our case highlights the importance of both multidisciplinary care and genetic testing in cases of chronic unexplained thrombocytopenia. By understanding the underlying genetic mechanism to a patient's thrombocytopenia, providers are better equipped to make more precise medical management recommendations.

Physical activity level and age contribute to functioning problems in patients with breast cancer-related lymphedema: a multicentre cross-sectional study.

Breast cancer survivors face a high risk of developing breast cancer-related lymphedema (BCRL). Besides physical symptoms such as swelling, BCRL can have a psychosocial impact and lead to problems in daily functioning. Understanding contributing variables to problems in functioning yields possibilities to improve treatment modalities and consequently patients' quality of life. Therefore, the aim of this study was to explore the association between patient-, lymphedema-, and cancer treatment-related variables with problems in functioning in patients with BCRL. A cross-sectional study was performed in 185 patients with BCRL. Problems in daily functioning (dependent variable) were evaluated with the Lymph-ICF-UL questionnaire. Following independent variables were analysed by bi-variate and multivariable analyses, including a stepwise regression analysis: patient-related variables (age, BMI, physical activity level, education), lymphedema-related variables (excessive arm volume, duration of lymphedema, total pitting score, presence of hand edema, hardness of the tissue, lymphedema stage), and cancer treatment-related variables (type of surgery, surgery at the dominant side, radiotherapy, chemotherapy, hormone therapy, immunotherapy, TNM-classification). The Lymph-ICF-UL mean total score was 38% (± 21), representing a moderate amount of problems in general functioning. Multivariable regression analyses revealed that lower physical activity level and lower age are contributing factors to more problems in daily functioning. Stepwise regression analysis indicated that up to 8% of the variance in problems in functioning could be explained by physical activity level and age of patients with BCRL. Especially patients with low physical activity level and younger patients experience more problems in functioning. For the determination of certain causal interactions, future longitudinal studies including other independent variables that might explain a higher amount of problems in functioning in this population, are warranted. The study makes part of a double-blind, multi-center, randomized controlled trial (EFforT-BCRL trial), which is registered in clinicaltrials.gov (NCT02609724). CME reference S58689, EudraCT Number 2015-004822-33.

78 Optimising Compression for the Management of Acute Hand Burn Edema

Abstract Introduction Compression, a common treatment of choice for the management of edema, is one intervention which is applied with little objective understanding of the optimal parameters of application or efficacy in a patient with an acute burn wound. The aim of this study was to determine the effectiveness of different methods of compression for the management of hand edema following burn injury. The hypothesis tested was: in alert acute hand burn injury patients, application of cohesive bandage will reduce edema faster than an off the shelf compression glove. Methods A randomized control study of 100 patients presenting with hand burn injury. Compression was randomized to one of three methods of application - 1) spiral application of cohesive bandage to fingers, figure of eight to hand and wrist; 2) pinch application or cohesive bandage to fingers, spiral application to hand and wrist; or 3) an off-the-shelf compression glove (control condition). Repeated volume measures of the hand were recorded using water displacement volumetry. The results were analysed using multi-level mixed effects regressions. Outcome measures were hand and wrist active range of movement, pain VAS and QuickDASH. ROM measures were collected with and without compression in situ. Patients were provided with a home exercise program including standardized exercises to optimize venous and lymphatic outflow, and exercises tailored depending on the location of the patients’ injury. Standard instruction to patients was to continue using their hand with the compression in situ, and to elevate at rest and overnight. Results One hundred patients (68 males) demonstrated significant reductions in hand volumes, using all compression methods (10.0–14.5mL, p&amp;lt; 0.001). There was no evidence of difference between methods of compression for managing edema. All ROM measures improved, with significant improvement in hand composite finger flexion (p=0.001), hand span (p=0.022) and wrist flexion (p=0.022). QuickDASH decreased between sessions (p&amp;lt; 0.001) indicating reduced upper limb disability. There was no evidence of differences in ROM measures between compression methods. Conclusions There is no evidence of difference between these methods of compression for managing acute hand burn edema. ROM improves with reductions in hand burn edema. Applicability of Research to Practice For the management of acute edema following hand burn injury, this study demonstrates that compression can be applied by therapists of different experience, using methods they are familiar with, to positively influence edema following hand burn injury.

Effect of the contralateral needling therapy on post-stroke shoulder-hand syndrome

To observe the effect contralateral needling of in improving pain, edema and limb dysfunction in stroke patients with shoulder-hand syndrome. A total of 62 patients with post-stroke shoulder-hand syndrome were divided into a control group and an observation group, 31 cases in each one. The routine treatment with internal medicine and rehabilitation manipulation was adopted in the two groups. Additionally, the routine acupuncture treatment was used in the control group and the contralateral needling techniques was applied in the observation group. The needles were retained for 30 min. The treatment was given once a day for 5 days a week and consecutively for 4 weeks. Before and after treatment, the score of the modified Fugl-Meyer assessment scale (FMA scale), the score of the visual analogue scale (VAS), the score of the hand edema rating and the score of the modified Barthel index (ADL score) were evaluated. The total effective rate was 90.32% (28/31) in the observation group and was 67.74% (21/31) in the control group. The effective rate in the observation group was higher than that in the control group (P<0.05). VAS score, the score of the hand edema rating, FMA score and ADL score were obviously improved as compared with those before treatment in each group and the scores in the observation group were better than those of the control group (P<0.05). The contralateral needling therapy of acupuncture is effective for relieving pain and edema as well as improving the motor function of the affected limb in the patients with post-stroke shoulder-hand syndrome.

Trisomy 12p Syndrome Presenting with Fetal Growth Restriction and Polyhydramnios

A 39-year-old nulliparous woman was referred at 36+6 weeks gestational age, and a prenatal fetal ultrasonography examination found fetal growth restriction (2,190 g <5%), polyhydramnios (amniotic fluid index: 31.76 cm), and absent end-diastolic flow in the umbilical artery. A male baby was born, and fetal dysmorphism including round face, long philtrum, low-set ears, chest retraction, edematous hands and feet, and a simian line on both hands were identified. He was diagnosed with trisomy 12p [der(18)t(12;18)(p11.2;p11.31)] by chromosomal study. The father’s chromosomes appeared normal; however, the mother’s chromosomes had a balanced translocation identified as t(12;18)(p11.2;p11.31). Patent ductus arteriosus, germinal matrix hemorrhage, and hemivertebrae were diagnosed, and respiratory distress, hyperinsulinemic hypoglycemia, and hypothyroidism were also detected. The combination of fetal growth restriction and polyhydramnios may be a significant sign of chromosomal abnormalities, and targeted sonography and a chromosomal analysis should be offered prenatally in such cases.