DIGITAL CLUBBING AND HYPERTROPHIC OSTEOARTHROPATHY: THE UNDERLYING MECHANISMS

摘要: Finger clubbing has been recognized as a sign of pulmonary disease since the observations Hippocrates (460-375 BC) and Aretaeus (AD 81-138). During second half nineteenth century pachydermoperiostosis (Friedreich 1868) hypertrophic osteoarthropathy (HOA) (Bamberger 1889, 1891; Marie 1890) were described. Initially they confused with acromegaly, to which bear superficial resemblance Most early authors distinguished these conditions from finger clubbing, but Locke (1915), in review reported cases, noted that HOA was invariably associated clubbing. He proposed an stage this view found wide acceptance over next 40 years. However, although have many causes common, their prevalence individual diseases is very different. Clubbing almost universal cyanotic congenital heart common primary biliary cirrhosis, cryptogenic fibrosing alveolitis subacute bacterial endocarditis; uncommon (Williams et al. 1963; Epstein 1979). In addition it now can occur without (Holling & Brodey 1961). It probably better at present consider separate entities similarities. Much difficulty distinguishing between arisen because confusion definitions. Both are essentially descriptive terms. painless uniform swelling soft tissues terminal phalanx digit, not so clearly defined. usually regarded condition affecting both bones joints characterized by radiological signs periosteal new bone formation (Ginsburg Fischer 1964). changes may be otherwise typical examples pain, ankle oedema, joint pain or stiffness synovial effusions. such patients, syphilis, scurvy poisoning fluorine, strontium, vitamin A D should excluded cause similar reaction (Salih Halim 1978). More rarely clinical features obvious there no abnormalities (Horn 1980). ggmTechnetium pyrophosphate scans more sensitive than radiographs detecting (Lokich 1977) useful difficult cases. occurs 90% patients other (Hammarsten O’Leary 1957) often gross. Coury (1960) considers essential feature minority view. is, definition, secondary some condition. Pachydermoperiostosis mimic exactly its presenting therefore diagnosed certainty only excluding all HOA. family history