Useless Tests Research Articles

Chronic Knee Pain is the Paramount Presentation in Patients with Nail-Patella Syndrome

Background: Arthralgia in connection with patellar instability have been studied thoroughly in a number of pediatric and adult patients. Small and dysplastic patellae accompanied by hypoplasia of the lateral femoral condyle may results in recurrent subluxation or dislocation of the patellae, knee discomfort and pain. We aimed to detect the underlying etiology of every single patient. Patients and Methods: A total of seven children presented with long term painful knee joints have been refered from the departments of rheumatology. We added adult female patient of a-35-years-old. She was a chronic client of rheumatology clinics since her postadulthood. In addition to her early life knee pain. Recently she experienced additional chronic pain of the groin (located at the posterior buttocks). All our patients showed episodes of knee pain with variable intensity as a constant complaint and all received antirheumatic treatments for years despite the negative results of the implemented tests. In order to commence the diagnostic process, clinical and radiological phenotypic characterization were the main core of our stratregy followed by molecular genetic confirmation. Results: Seven unrelated children (aged from 8-17 years old) were consistent with the diagnosis of Nail- Patella syndrome. The adult female patient of a-35-years-old- manifested patellar instability since her early childhood. Her clinical phenotype was totally compatible with the diagnosis of Nail-Patella syndrome. Surprisingly, the clinical examination of the female patient and the standing AP pelvis radiograph revealed massive encroachment of the medial aspect of the femoral neck and the lesser trochanters onto the ischium. The latter resulted in the diagnosis of Ischiofemoral Impingement (IFI) syndrome. Her genetic tests showed heterozygous mutation in the LIM-homeodomain protein LMX1B on chromosome 9q33. Conclusion: Arthralgia associated with abnormal gait (mostly antalgic gait and waddling gait) was the paramount clinical presentation in all our patients. Dysplasia of the nails and patellar instability were the characteristic clinical findings in our patients with the definite diagnosis of osteo-onychodysplasia syndrome. We approached to the diagnosis from the first session of clinical examination. Interestingly, the constant groin pain in the adult female patient which has been totally overlooked by other instutions, were in favor of the diagnosis of Ischiofemoral Impingement (IFI) syndrome. As well as the existing abnormality of the elbows associated with defective pronation and supination as due to impingement of the olecranon. The task of establishing the diagnostic process in complex clinical conditions is the most challenging. Sadly speaking, none of the aforemnetioned dignostic criteria attracted the attention of dozens of clinicians. Admistering medications to overcome knee pain through dozens of useless laboratory tests were the main false issue. Clinicians who are actively involved in clinical diagnosis with minimal dependency on laboratory aid are generally at the forefront of their medical fields.

Chronic Knee Pain is the Paramount Presentation in Patients with Nail-Patella Syndrome

Background: Arthralgia in connection with patellar instability have been studied thoroughly in a number of pediatric and adult patients. Small and dysplastic patellae accompanied by hypoplasia of the lateral femoral condyle may results in recurrent subluxation or dislocation of the patellae, knee discomfort and pain. We aimed to detect the underlying etiology of every single patient. Patients and Methods: A total of seven children presented with long term painful knee joints have been refered from the departments of rheumatology. We added adult female patient of a-35-years-old. She was a chronic client of rheumatology clinics since her postadulthood. In addition to her early life knee pain. Recently she experienced additional chronic pain of the groin (located at the posterior buttocks). All our patients showed episodes of knee pain with variable intensity as a constant complaint and all received antirheumatic treatments for years despite the negative results of the implemented tests. In order to commence the diagnostic process, clinical and radiological phenotypic characterization were the main core of our stratregy followed by molecular genetic confirmation. Results: Seven unrelated children (aged from 8-17 years old) were consistent with the diagnosis of Nail- Patella syndrome. The adult female patient of a-35-years-old- manifested patellar instability since her early childhood. Her clinical phenotype was totally compatible with the diagnosis of Nail-Patella syndrome. Surprisingly, the clinical examination of the female patient and the standing AP pelvis radiograph revealed massive encroachment of the medial aspect of the femoral neck and the lesser trochanters onto the ischium. The latter resulted in the diagnosis of Ischiofemoral Impingement (IFI) syndrome. Her genetic tests showed heterozygous mutation in the LIM-homeodomain protein LMX1B on chromosome 9q33. Conclusion: Arthralgia associated with abnormal gait (mostly antalgic gait and waddling gait) was the paramount clinical presentation in all our patients. Dysplasia of the nails and patellar instability were the characteristic clinical findings in our patients with the definite diagnosis of osteo-onychodysplasia syndrome. We approached to the diagnosis from the first session of clinical examination. Interestingly, the constant groin pain in the adult female patient which has been totally overlooked by other instutions, were in favor of the diagnosis of Ischiofemoral Impingement (IFI) syndrome. As well as the existing abnormality of the elbows associated with defective pronation and supination as due to impingement of the olecranon. The task of establishing the diagnostic process in complex clinical conditions is the most challenging. Sadly speaking, none of the aforemnetioned dignostic criteria attracted the attention of dozens of clinicians. Admistering medications to overcome knee pain through dozens of useless laboratory tests were the main false issue. Clinicians who are actively involved in clinical diagnosis with minimal dependency on laboratory aid are generally at the forefront of their medical fields.

Glucocorticoid induced adrenal insufficiency in children: Morning cortisol values to avoid LDSST.

Glucocorticoid-induced adrenal insufficiency (GI-AI) is a common side effect of glucocorticoid therapy. However, its diagnosis currently relies on the realization of a Low Dose Short Synacthen Test (LD-SST) that requires an outpatient hospital and several blood samples. Our goal was to evaluate whether morning cortisol values could predict the response to LD-SST, in children, to avoid useless dynamic tests and facilitate diagnosis of glucocorticoid induced adrenal insufficiency. We recorded data of 91 pediatric patients who underwent a LD-SST in our center between 2016 and 2020 in a retrospective observational study. We selected LD-SST realized following administration of supra-physiologic doses of glucocorticoids during more than 3 weeks and performed at least four weeks after treatment was stopped. Adrenal deficiency was defined as a plasma cortisol concentration inferior to 500 nmol/l at LD-SST. Glucocorticoid-induced adrenal insufficiency was diagnosed in 60% of our cohort. Morning cortisol values were predictive of the response to the LD-SST (AUC ROC 0.78). A plasma cortisol concentration of less than 144 nmol/l predicted glucocorticoid induced adrenal insufficiency with a specificity of 94% and a value over 317 nmol/l predicted recovery of the HPA axis with a sensitivity of 95%. We did not find any other predictive factor for glucocorticoid-induced adrenal insufficiency. Morning cortisol values can safely assess recovery of the HPA axis in children treated chronically with glucocorticoids. Using these thresholds, more than 50% of LD-SST could be avoided in children.

A New Fast Intersection Algorithm for Sorted Lists on GPU

Set intersection algorithms between sorted lists are important in triangles counting, community detection in graph analysis and in search engines where the intersection is computed between queries and inverted indexes. Many researches use GPU techniques for solving this intersection problem. The majority of these techniques focus on improving the level of parallelism by reducing redundant comparisons and distributing the workload among GPU threads. In this paper, we propose the GPU Test with Jumps (GTWJ) algorithm to compute the intersection between sorted lists using a new data structure. The idea of GTWJ is to group the data, of each sorted list, into a set of sequences. A sequence is identified by a key and is handled by a thread. Intersection is computed between sequences with the same key. This key allows skipping data packets in parallel if the keys do not match. A counter is used to avoid useless tests between cells of sequences with different lengths. Experiments on the data used in this filed show that GTWJ is better in terms of execution time and number of tests.

Hybrid swarm intelligence-based software testing techniques for improving quality of component based software

Being a time-consuming and costly activity, software testing always demands optimization and automation. Software testing is an important activity to achieve quality and customer satisfaction. This paper presents a comparative evaluation of different hybrid automated software testing techniques using the concepts of soft computing for overall quality enhancement. A comparison between three hybrid automation techniques is carried out i.e., hybrid ant colony optimization-genetic algorithms (ACO-GA), hybrid artificial bee colony (ABC)-Naïve Bayes, hybrid ABC-GA along with three parent approaches. The comparison is made by applying these hybrid techniques for the selection of minimized test suites thus reducing overall testing effort and eliminating useless or redundant test cases. The experimental results prove the efficiency of these hybrid approaches in different scenarios. The impact of automated testing techniques for quality enhancement is assessed in terms of defect density and defect detection percentage.

Qualitative and Quantitative Dosage of the Anti M-Type Phospholipase A2 Receptor Autoantibody: One-Year Experience in Quebec's Reference Center.

Background:Quantification of the M-type phospholipase A2 receptor antibodies (anti-PLA2R) is now an essential tool for diagnosis and management of primary membranous nephropathy (MN). Since October 2018, Hôpital Maisonneuve-Rosemont (HMR) has been designated as Quebec’s reference center for serum anti-PLA2R antibody testing by the Institut National d’Excellence en Santé et Services Sociaux (INESSS), the regulatory body on drugs and tests usage in Quebec.Objectives:To describe the 2-step method of serum qualitative and quantitative anti-PLA2R antibody testing during its first year of use in Quebec and analyze its diagnostic value in the province’s population.Design:Retrospective cohort study.Setting:Single-center academic teaching hospital in Quebec, Canada.Patients:All patients who had a serum anti-PLA2R antibody test analyzed at HMR from October 1, 2018, to October 1, 2019, were included in the study.Measurements:Serum anti-PLA2R antibodies were screened by indirect immunofluorescence tests. If results were positive or undetermined, it was followed by a quantitative enzyme-linked immunosorbent assay (ELISA) test. Both tests were based on a commercial kit developed by the same company.Methods:We calculated sensitivity, specificity, predictive value, and likelihood ratio for both tests, using kidney biopsy findings performed at HMR as the gold standard.Results:In Quebec, a total of 1690 tests were performed among 1025 patients during the study year. A small proportion of these patients (8%) were followed at HMR. Patients tested at HMR and in the rest of Quebec had similar characteristics. Test validity was only characterized for patients tested at HMR. Sensitivity and specificity were, respectively, 58% and 100% for the qualitative test, and 71% and 100% for the quantitative test. The combined net sensitivity was 42% and the net specificity 100%. The net positive and negative predictive value were 100% and 84% respectively, whereas the net negative likelihood ratio was 0.58.Limitations:As the detailed analysis was only possible in the small proportion of patients clinically followed at HMR, there is a possible selection bias. Another potential selection bias was the focus on patients who were selected to have a kidney biopsy, probably because of more severe disease, higher probability of glomerulonephritis, or lesser number of comorbidities. Given the retrospective nature of this study, there was no systematic kidney biopsy or serum PLA2R antibody testing performed. Finally, we were unable to provide detailed information on the timing between immunosuppressive therapy and anti-PLA2R results.Conclusions:Serum anti-PLA2R antibody testing was widely used in Quebec during its first year of availability. A 2-step approach, using a qualitative test first, followed by a quantitative test if the results are positive or undetermined, appears efficient to avoid useless quantitative testing in negative patients and to better characterize undetermined results on immunofluorescence.Trial registration:Due to the retrospective nature of this study, no trial registration was performed.

Accessing the discriminatory performance of FRAIL-NH in two-class and three-class frailty and examining its agreement with the frailty index among nursing home residents in mainland China

BackgroundFRAIL-NH has been commonly used to assess frailty in nursing home residents and validated in many ethnic populations; however, it has not been validated in mainland China, where such an assessment tool is lacking. This study aimed to (1) assess the discriminatory performance of FRAIL-NH in two-class frailty (non-frail+ pre-frail vs. frail) and three-class frailty (non-frail vs. pre-frail vs. frail), based on the Frailty Index (FI), (2) determine the appropriate cutoff points for FRAIL-NH that distinguish two-class and three-class frailty, and (3) examine the agreement in classification between FRAIL-NH and FI.MethodsA cross-sectional study of 302 residents aged 60 years or older from six nursing homes in Changsha was conducted. The FRAIL-NH scale and 34-item FI were used to measure frailty. Two-way and three-way receiver operating characteristic (ROC) curves were used to estimate the performance of FRAIL-NH. Cohen’s Kappa statistics were used to examine the agreement between these two measures.ResultsThe agreement between FRAIL-NH and FI ranged from 0.33 to 0.55. Regardless of what FI cutoff points were based on, the volume under the ROC surface (VUS) for FRAIL-NH from the three-way ROC were higher than the VUS of a useless test (1/6), and the area under the ROC curve (AUC) for FRAIL-NH from the two-way ROC were higher than the clinically meaningless value (0.5). When using FI cutoff points of 0.20 for pre-frail and 0.45 for frail, FRAIL-NH cutoff points of 1 and 9 in classifying three-class frailty had the highest VUS and the largest correct classification rates. Whichever FI was chosen, the performance of FRAIL-NH in distinguishing between pre-frailty and frailty, and between non-frailty and pre-frailty was equivalent. According to FRAIL-NH, the proportion of individuals with frailty misclassified as pre-frailty was higher than that of individuals with non-frailty misclassified as pre-frailty.ConclusionFRAIL-NH can be used as a preliminary frailty screening tool in nursing homes in mainland China. FI should be further used especially for those classified as pre-frailty by FRAIL-NH. It is not advisable to simply combine adjacent two classes of FRAIL-NH to create a new frailty variable in research settings.

Professional or Patsy?

Professional or Patsy?

Semiparametric Estimation of Receiver Operating Characteristic Surface

Receiver operating characteristic curve analysis is widely used in biomedical research to assess the performance of diagnostic tests. Estimation of receiver operating characteristic curves based on parametric approach has been widely used over years. However, this is limited by the fact that distribution of almost all diseases in epidemiology cannot be established quite easily. Semi parametric methods are robust as it allows computability and the distributions based on this are flexible. Furthermore, there is need for generalization of the receiver operating characteristic curve (since, the analysis largely assumes that test results are dichotomous) to allow tests to have more than two outcomes. The receiver operating characteristic curve was generalized to constitute a surface, which uses volume under the surface (VUS) to measure the accuracy of a diagnostic test. Dirichlet process mixtures of normals, which is a robust model that can handle nonstandard features in data in modelling the diagnostic data, were used to model the test outcomes. Semiparametric Dirichlet process mixtures of normals for receiver operating characteristic surface estimation were fitted using Markov Chain Monte Carlo with simple Metropolis Hastings steps. The Semi-parametric simulation results indicate that even when the parametric assumption holds, these models give accurate results as the volume under the surface (VUS) for both methods were greater than 1/6, the value of a “useless test”. Graphically, the semiparametric receiver operating characteristic surface has the appealing feature of being continuous and smooth, thus allowing for useful interpretation of the diagnostic performance at all thresholds.

Myoglobin: still a useful biomarker in 2017?

The clinical biologist plays a role as a consultant for the relevant use of biological examination. Advisory activities of the medical laboratory may help physician in diagnosis or therapeutic algorithm, avoiding redundant ordering or useless tests. In this context, we performed a review of literature about the clinically interest of myoglobin assays. The indications of myoglobin's assays appear fairly limited. It is no longer mentioned in the European guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. In patients with rhabdomyolysis myoglobin is neither a diagnostic nor a prognostic criterion. Its interest in predicting the occurrence of acute renal failure is also discussed. The most recent clinico-biological score (such as the McMahon score) do not integrate it. In this context, we decided to stop performing myoglobin assay.

Italian guidelines for the management and treatment of neonatal cholestasis.

Hyperbilirubinemia is a frequent condition affecting newborns during the first two weeks of life and when it lasts more than 14 days it is defined as prolonged jaundice. This condition requires differential diagnosis between the usually benign unconjugated hyperbilirubinemia and the pathological conjugated hyperbilirubinemia, that is mainly due to neonatal cholestasis. It is important that the diagnosis of neonatal cholestasis be well-timed to optimize its management, prevent worsening of the patient’s outcome, and to avoid premature, painful, expensive, and useless tests. Unfortunately, this does not always occur and, therefore, the Task Force on Hyperbilirubinemia of the Italian Society of Neonatology presents these shared Italian guidelines for the management and treatment of neonatal cholestasis whose overall aim is to provide a useful tool for its assessment for neonatologists and family pediatricians.

New Advances in Diagnosis of Latent Tuberculosis Infection: A Review Article

Context: It has been estimated that one-third of the world’s population are suffering from latent tuberculosis infection (LTBI). In order to control tuberculosis in high-risk groups proper diagnosis and treatment is essential. Evidence Acquisition: Useless and expensive tests such as unfocused population-based tests can lead to futile and unnecessary treatments. Targeted screening approaches and individualization of LTBI treatment protocols must be a priority. Results: Diagnostic methods with immune based tests such as the tuberculin skin test (TST) or interferon gamma release assays (IGRA) can accurately detect LTBI. However, interferon-gamma release assays have higher specificity than TST in Bacille Camette-Gurin (BCG)-vaccinated populations; both tests are precise to identify latent tuberculosis. However, it is of great concern that both tests have insignificant roles in predicting risk of progression to active tuberculosis. Conclusions: Here we review the clinical applications, advantages, and limitations of the tuberculin skin test and interferon-gamma release assays and provide an overview of the most recent systematic reviews conducted for the comparison of these tests.

Irritable bowel syndrome: a disease still searching for pathogenesis, diagnosis and therapy.

Irritable bowel syndrome (IBS) is the most frequently diagnosed functional gastrointestinal disorder in primary and secondary care. It is characterised by abdominal discomfort, pain and changes in bowel habits that can have a serious impact on the patient's quality of life. The pathophysiology of IBS is not yet completely clear. Genetic, immune, environmental, inflammatory, neurological and psychological factors, in addition to visceral hypersensitivity, can all play an important role, one that most likely involves the complex interactions between the gut and the brain (gut-brain axis). The diagnosis of IBS can only be made on the basis of the symptoms of the Rome III criteria. Because the probability of organic disease in patients fulfilling the IBS criteria is very low, a careful medical history is critical and should pay particular attention to the possible comorbidities. Nevertheless, the severity of the patient's symptoms or concerns sometimes compels the physician to perform useless and/or expensive diagnostic tests, transforming IBS into a diagnosis of exclusion. The presence of alarming symptoms (fever, weight loss, rectal bleeding, significant changes in blood chemistry), the presence of palpable abdominal masses, any recent onset of symptoms in patient aged over 50 years, the presence of symptoms at night, and a familial history of celiac disease, colorectal cancer and/or inflammatory bowel diseases all warrant investigation. Treatment strategies are based on the nature and severity of the symptoms, the degree of functional impairment of the bowel habits, and the presence of psychosocial disorders. This review examines and discusses the pathophysiological aspects and the diagnostic and therapeutic approaches available for patients with symptoms possibly related to IBS, pointing out controversial issues and the strengths and weaknesses of the current knowledge.

An unusual case of chest pain: ultrasonographic diagnosis of Mondor’s disease

Mondor’s disease is characterized by superficial thrombophlebitis affecting the subcutaneous veins, especially those of the anterolateral thoracoabdominal wall. Thrombophlebitis is usually a subcutaneous, tender, painful cord-like induration, usually found in the breast or the axilla. It typically affects middle-aged women. Thus, we believe the case of a 48-year-old male patient admitted to the emergency room for chest pain with a palpable, non-erythematous, and painful cord-like structure localized in the anterior chest wall and the abdomen to be of interest. He had had a mild thoracic trauma. Doppler analysis showed a thrombosis of the superficial vein of the thorax. The patient was treated by Fondaparinux Sodium 2.5 mg subcutaneously per day for 30 days. Evolution was favorable. Although uncommon, Mondor’s disease has to be recognized to avoid useless diagnosis testing and to deliver a specific treatment.

Lichen Sclerosus in Women

I read the article by Becker with great interest as it raises awareness for a widely unknown pathology. Lichen sclerosus is still often regarded as a rare disease that affects mainly older women; the reason for this is that for a long time it was recognized only during the later stages. Now we suspect that up to 1% of women are affected, little girls and young women among them. Many patients have gone through many useless diagnostic tests and therapies (anti-infective drugs). My youngest patient was 3 years old. In women and perhaps also in men, early diagnosis and treatment are crucial for the disease course since appropriate treatment helps to mostly avoid late sequelae such as uncontrollable pruritus, atrophy, synechiae, and degenerative changes. Histological analysis is not always required—a close look, preferably using a colposcope, and experience are usually sufficient. The symptoms of chronic pruritus, discrete white coloration, and skin injuries such as dermatorrhagia and rhagades subsequent to permanent scratching) and exclusion of fungal infections enable a clinical diagnosis more readily. Treatment with corticosteroid ointment is standard treatment in women today and yields the best results during the early stages. However, fatty ointment without any water is equally as important. The skin loses its elasticity as a result of the sclerosis and is then more prone to injury and providing an entry point for micro-organisms in this densely colonized area. The skin is relieved by consistent application of water free oil based care products, which reduce inflammatory reactions and damage to the epithelium; furthermore, it helps to limit the amount of corticosteroid that is required. Unfortunately this is a little known fact with regard to the anogenital region.

Mondor disease: a case report in ED

Mondor disease is a form of superficial thrombophlebitis affecting the subcutaneous veins, specifically of the anterolateral thoracoabdominal wall. Clinical presentation is commonly a subcutaneous, tender, painful cordlike induration, usually founded in the breast or axilla. It affects typically middle-aged women. A 36-year-old patient was admitted to the emergency department to a chest discomfort and to discovery of a palpable, nonerythematous, and painful cordlike structure running from the inferior pole of her left breast to the left iliac pit. She had no history of trauma, injury, or intensive physical activity. Ultrasonography confirmed thrombosis of the thoracoepigastric vein. A thrombophilic workup performed 2 years ago was normal. The patient was treated by enoxaparin 1 mg/kg per day for 30 days. Evolution was favorable. The etiology of Mondor disease remains unclear. Predisposing factors are mainly trauma, excessive physical activity, surgery, infections. Ultrasonography is used to confirm the diagnosis. Coagulation tests should be performed to exclude hypercoagulability condition. In the past, symptomatic approach with anti-inflammatory drugs was proposed. Recent guidelines suggest prophylactic or intermediate doses of low-molecular-weight heparin for at least 4 weeks. Although uncommon, Mondor disease has to be recognized to avoid useless diagnosis testing and to deliver a specific treatment.

A novel tool for user-friendly estimation of natural, diagnostic and professional radiation risk: Radio-Risk software

BackgroundAwareness of radiological risk is low among doctors and patients. An educational/decision tool that considers each patient’ s cumulative lifetime radiation exposure would facilitate provider–patient communication. AimThe purpose of this work was to develop user-friendly software for simple estimation and communication of radiological risk to patients and doctors as a part of the SUIT-Heart (Stop Useless Imaging Testing in Heart disease) Project of the Tuscany Region. MethodsWe developed a novel software program (PC-platform, Windows OS fully downloadable at http://suit-heart.ifc.cnr.it) considering reference dose estimates from American Heart Association Radiological Imaging 2009 guidelines and UK Royal College of Radiology 2007 guidelines. Cancer age and gender-weighted risk were derived from Biological Effects of Ionising Radiation VII Committee, 2006. ResultsWith simple input functions (demographics, age, gender) the user selects from a predetermined menu variables relating to natural (e.g., airplane flights and geo-tracked background exposure), professional (e.g., cath lab workers) and medical (e.g., CT, cardiac scintigraphy, coronary stenting) sources. The program provides a simple numeric (cumulative effective dose in milliSievert, mSv, and equivalent number of chest X-rays) and graphic (cumulative temporal trends of exposure, cancer cases out of 100 exposed persons) display. ConclusionsA simple software program allows straightforward estimation of cumulative dose (in multiples of chest X-rays) and risk (in extra % lifetime cancer risk), with simple numbers quantifying lifetime extra cancer risk. Pictorial display of radiation risk may be valuable for increasing radiological awareness in cardiologists.

Apport des méthodes d’imagerie non invasives pour l’évaluation de la maladie coronaire

Several cardiovascular imaging techniques have seen major technical improvements in recent years. Visualization of coronary arteries--so important for diagnosis and patient management--is routinely performed by coronarography, but new, less invasive techniques such as computed tomography are now available. Evaluation of myocardial function, which may be impaired in case of myocardial hypoperfusion, can now be achieved non invasively by means of echocardiography or scintigraphy. New imaging techniques, and MRI in particular, can provide useful complementary information. Knowledge of the respective advantages and limitations of these techniques is crucial if physicians are to use them appropriately in their daily practice, thereby avoiding redundant or useless tests and improving patient management.

Call for a slower approach to health care reform

Call for a slower approach to health care reform

Pachydermodactyly – Just a sign of emotional distress

Pachydermodactyly (PDD) is a benign, asymptomatic soft tissue swelling affecting the skin of the lateral aspects of the proximal interphalangeal joints of the fingers II-IV, mostly in young adolescent males, and could be interpreted as a consequence of tic-like behaviour as an obsessive-compulsive disorder in male adolescents. The differential diagnosis includes numerous diseases; a rapid clinical recognition of PDD would avoid many useless and expensive diagnostic tests. There is no effective medical treatment for PDD, but discontinuation of the tic-like mechanical traumatisation generally leads to a marked amelioration of the finger swelling. In this article we review the world literature, which contains 87 additional cases on this topic.