Glomus Tumor – Repost

 Updated 3/2017-- photos and all links removed as many are no longer active and it's easier than checking each one.

I first posted this early in my blog life, October 29, 2007.  It amazed me how the comment section of this post has become more of a forum than just comments.  I would also recommend checking out this post by Dr David Nelson which shows some great operative photos.

A glomus tumor is a rare benign tumor of the hand. It constitutes 1–5% of the soft-tissue tumors in the hand. It arises from the   glomus body which is a neuromyoarterial apparatus described by P. Masson in 1924. The normal glomus body is an arteriovenous shunt that is composed of an afferent arteriole, an anastomotic vessel (Sucquet-Hoyer canal), a collecting vein, and a capsular portion. It resides in the stratum reticulum of the skin. There are large numbers in the subungual region and in the distal pad of the digits. The glomus body is a controlled arteriovenous anastomosis or shunt between the terminal vessels thought to be important in regulating peripheral blood flow in the digits, which secondarily controls peripheral blood pressure and body temperature.

Glomus tumors affect women two to three times more often than men. Most are in the 30-50 year age group. Most occur in the subungual area (approximately 50%), but can occur on the finger tip pulp, the palm, wrist, forearm and foot. Glomus tumor can occur near the tip of the spine, where it may arise from the glomus coccygeum. Glomus tumors have also been described in locations where the glomus body does not normally occur. These unusual sites include the patella, bone, chest wall, eyelid, colon, rectum, and cervix. Over 75% of glomus tumors occur in the hand.

Symptoms usually consist of a triad

• severe paroxysmal pain--the pain can be excruciating and is described as a burning or bursting
• localized tenderness
• extreme cold sensitivity

Physical exam reveals a blue-pink tender mass that can often be seen through the nail plate or skin. When the mass is growing beneath the nailbed (subungual), it can displace the nailbed dorsally. When the lesion is beneath the nail matrix, it can produce a longitudinal ridging of the nail plate. Placing the involved digit or extremity in ice water will reproduce the pain within 60 seconds. Typically, the mass is usually less than 7 mm in diameter, so can be very difficult to palpate even when not beneath the nail. There are two clinical findings described, particularly in relation to the painful subungual solitary glomus tumors. They are the Hildreth's sign and Love's test. Hildreth's sign is disappearance of pain after application of a tourniquet proximally on the arm. Love's test consists of eliciting pain by applying pressure to a precise area with the tip of a pencil. Routine laboratory studies have no role in diagnosis of glomus tumor.

X-rays of the finger may show bone erosion, ranging from a small concave defect to a sharply defined radiolucent lesion seen in the region of the tuft of the phalanx. There is often a thin sclerotic margin about the defect as a secondary reaction to the tumor pressure. Standard magnetic resonance imaging (MRI) can be used to detect glomus tumors.

The tumor consist of a highly organized, well-encapsulated mass consisting of glomus cells, curled blood vessels, and a large number of nerves within or adjacent to the lesion. This explains the great sensitivity of the glomus tumor.

Treatment is surgical. Surgical approach will vary depending on the location of the tumor. The glomus tumor is always well encapsulated and can usually be "shelled out" with little or no difficulty. When excision is complete, the prognosis is excellent for full recovery with no recurrence.

REFERENCES
Glomus Tumor by Henry DeGroot, III MD--bonetumor.org
Glomus Tumor at Wheeless Textbook of Orthopedics
Subungual glomus tumor by Dr. K.-- MSKcases
Glomus Tumor of the Finger Tip and MRI Appearance by David H Kim, MD--Iowa Orthop J. 1999; 19: 136–138.
Two cases of subungual glomus tumor; Murthy PS, Rajagopal R, Kar PK, Grover S; Indian J Dermatol Venereol Leprol 2006;72:47-9
Glomus Tumor by Michael B Reynolds, MD--eMedicine Article

SurgeXperiences 224 is Up!

 Updated 3/2017-- all links removed as many are no longer active and it's easier than checking each one.

This edition (224) of SurgeXperiences is hosted by Karen, Just Up the Dose. You can read this edition here.

As this is the first blog carnival I've ever hosted, the theme for this week is 'My First Time'. Thanks to everyone who sent submissions, and to those of you whose posts I've used without asking permission - thanks as well. Let's get cracking!

The host of the next edition (225), June 14th, has not been announced. The deadline for submissions is midnight on Friday, June 12th. Be sure to submit your post via this form.

SurgeXperiences is a blog carnival about surgical blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit.

Here is the catalog of past SurgeXperiences editions for your reading pleasure. If you wish to host a future edition, please contact Jeffrey who runs the show here.

Balls Quilt Top

This quilt top is a log cabin variation that produces curves by using two different width of “logs.”  I made it with no one in particular in mind, but recently gave it to my cousin Gail.  She was a rock of support this past few weeks.   She had mentioned that our Aunt Earlene was going to help her learn to quilt.  This will get her started.  The top is 51 in X 66 in.

Here are two photos to show off some of the fabrics.

Stroke During Coronary Bypass Surgery – an Article Review

My mother died last Tuesday.  She had her coronary bypass surgery just one week before that day.  It was during her CABG that she had her strokes.  Yes, strokes, plural.  She was one of those 1.5% who suffer macroemboli cerebral strokes during coronary bypass surgery. 

I went looking for information on it earlier this week.  I went through my training without ever seeing this complication.  Like everyone, I never thought my family would be the one.  I think it is better to go to surgery, NOT thinking you will be the “statistic” as far as complications go.  Anyone having surgery, SHOULD go into it feeling hopeful and thinking everything will go perfectly.

The article referenced below is a good review of this complication – stroke during coronary bypass surgery. The study is a retrospective review of 6682 consecutive coronary bypass patients who only had the CABG procedure and not other simultaneous procedures, such as carotid endarterectomy.

They list the possible sources of the emboli as the ascending aorta, carotid arteries, intracerebral arteries, or intracardiac cavities.  They state that they believe the most likely source is the ascending aorta, for the following reasons:

First, the ascending aorta is the site of surgical manipulations during CABG, whereas mechanical contact is not made with the other potential sources of emboli.  Embolization of atherosclerotic debris is most likely to occur during aortic  cannulation/decannulation, cross-clamp application/removal, and construction of proximal anastomoses. However, embolization of atherosclerotic debris may also occur when the aorta is not being surgically manipulated, due to the ‘sandblast’ effect of CPB.

Second, the majority of our independent predictors of stroke – elderly age, left ventricular dysfunction, previous stroke/TIA, diabetes, and peripheral vascular disease – are strongly associated with atherosclerosis of the ascending aorta. 

Third, our chart review suggested that the most common probable cause of stroke was atherosclerotic emboli from the ascending aorta. Palpable lesions in the ascending aorta were noted in a large proportion of stroke patients.

The fourth reason we believe the ascending aorta is the likely source of macroemboli is because of ancillary autopsy data. …….

Note the second reason given above – the independent predictors of stroke.  My mother was over 74 yr so fell into the elderly age risk factor group.  She was also a type 2 diabetic.  She was noted to have a small abdominal aneurysm and some renal artery stenosis on the angiogram (an accidental pickup).  So she had three of the four independent risk factors.

REFERENCES

Stroke during coronary bypass surgery: principal role of cerebral macroemboli;  Eur J Cardiothorac Surg 2001;19:627-632; Michael A. Borger, Joan Ivanov, Richard D. Weisel, Vivek Rao, Charles M. Peniston

Heavy Rains Bring Mosquitoes

 Updated 3/2017-- all links removed as many are no longer active and it's easier than checking each one.

Arkansas, like many other parts of the country, has had lots of rain over the last month.  Many areas have suffered flooding.  The farmers have had difficulty getting their crops planted.  All this heavy rain is perfect for one thing --  mosquitoes to lay their eggs and breed.

So while the farmers may suffer a reduced crop, there will most likely be an explosion in the population of the mosquitoes in the next few weeks.  The increase in mosquitoes may mean an increase in the diseases they carry, like West Nile.

Mosquito Control authorities advise residents to make sure there isn't any standing water near their homes. If there is something in the yard that collects water,  empty it every time it rains.

The Center for Disease Control and Prevention (CDC) recommends the use of mosquito repellents with DEET, Picaridin, oil of lemon eucalyptus, or IR3535 as the active ingredient.  DEET and Picaridin are characterized as “conventional repellents” and Oil of Lemon Eucalyptus, PMD, and IR3535 as “biopesticide repellents”, which are derived from natural materials.  For more information on repellent active ingredients go here.

When using insect repellents keep these precautions in mind:

• Apply repellents only to exposed skin and/or clothing (as directed on the product label.) Do not use repellents under clothing.
• Never use repellents over cuts, wounds or irritated skin.
• Do not apply to eyes or mouth, and apply sparingly around ears. When using sprays, do not spray directly on face—spray on hands first and then apply to face.
• Do not allow children to handle the product. When using on children, apply to your own hands first and then put it on the child. You may not want to apply to children’s hands.
• Use just enough repellent to cover exposed skin and/or clothing. Heavy application and saturation are generally unnecessary for effectiveness. If biting insects do not respond to a thin film of repellent, then apply a bit more.
• After returning indoors, wash treated skin with soap and water or bathe. This is particularly important when repellents are used repeatedly in a day or on consecutive days. Also, wash treated clothing before wearing it again. (This precaution may vary with different repellents—check the product label.)
• If you or your child get a rash or other bad reaction from an insect repellent, stop using the repellent, wash the repellent off with mild soap and water, and call a local poison control center for further guidance. If you go to a doctor because of the repellent, take the repellent with you to show the doctor.

Note  the label for products containing oil of lemon eucalyptus specifies that they should not to be used on children under the age of three years. Other than those listed above, EPA does not recommend any additional precautions for using registered repellents on children or on pregnant or lactating women,. For additional information regarding the use of repellent on children, please see CDC’s Frequently Asked Questions about Repellent Use.

Shout Outs

 Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

See First is this week's host of Grand Rounds. You can read it here.

Blogs make it possible for these voices to be heard, and we’re very fortunate to have a great variety of blogs and bloggers to feature in this edition of Grand Rounds. These stories and these people need a more prominent place in the public mind, and I’m hopeful I can play a small part in that with this week’s edition.

The submissions this week come from as far away as Australia, South Africa and the UK, and as close to home as my hometown. But on the web these are all local calls, so I’ve categorized the more than 2 dozen submissions this week into a few topics.

Better Health featured a post by Dr Charles Smith on  Ten Tips for Overcoming Your Headaches.  The tips are from my classmate, Dr Lee Archer.  Check them out.

But, there are some really basic things about dealing with chronic headaches that we should never forget to try. So, without further ado, here is his advice:

1. First and foremost, taking pain medication everyday is definitely not a good idea. Daily pain medication tends to perpetuate headaches. This is true for over-the-counter medications like Excedrin and BC powders, as well as prescription medications …….

Dr Isis, On Becoming a Domestic and Laboratory Goddess, continues "The Letters to Our Daughters Project".

• Dr Pascale Lane (May 1, 2009)
• Dr. Barbara Goodman (May 4, 2009)
• Wendee Holtcamp (May 9, 2009)
• Janet Stemwedel (May 10, 2009)
• Dr. Pamela Carmines (May 14, 2009)
• Dr. Hannah Carey (May 16, 2009)
• Dr. Hannah Jang-Condell (May 23, 2009)
  Check out MedGadget’s  1800s Surgical Kit – Unboxing (photo credit). 
  

  To help us on our voyage through the kit, Medgadget has enlisted our friend Dr. Laurie Slater, whose website Phisick showcases a formidable collection of medical and surgical antiques. Being more knowledgeable on such matters than us, he has kindly offered to act as our guide. From the confines of this post / interview, we'll explore the surgical kit, touch on surgery in the 1800s, and get you thinking about the days when you'd probably dress like these gentlemen.

This week Dr Anonymous will be discussing Podcamp Ohio this week.    I hope you will join us. The show begins at 9 pm EST.

Grieving

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

We buried my mother last Friday, May 22, 2009.  I find myself moving through each day trying to get things back to normal, but unsure I will ever accomplish that goal.  I was never very good at picking up the phone to call my mom though I did on her birthday and on holidays.  I was good at writing her notes.  Over the past several years I have written her at least one note/letter each month and an e-mail now and then.  My father died when I was only eight, so I have some experience with grief.  Still this is different, magnified.  I am now an orphan.

I do not believe I am as good a writer as Meghan O'Rourke.   She has written a series of articles dealing with the loss of her mother which I found thanks to Christian Sinclair, MD (PalliMed).  Ms O’Rourke lost her mother to cancer on Christmas day.  I know what she means when she says:

Since my mother's death, I have been in grief. I walk down the street; I answer my phone; I brush my hair; I manage, at times, to look like a normal person, but I don't feel normal.

As Christian puts it in his post:

She researches the medical literature, and thankfully finds the Yale study on Kubler-Ross stages/states from 2007. She makes many literature references including CS Lewis' A Grief Observed, Shakespeare's Hamlet, Sogyal Rinpoche's The Tibetan Book of Living and Dying, multiple poets and Joan Didion's The Year of Magical Thinking. She even talked with Holly Prigerson, the lead researcher on the Coping with Cancer study.
This series is a must read for anyone in hospice and palliative care. Use each article as a discussion point at your next team meeting. Feel free to post other ways to use these articles in the comments.

I would add that these articles might be a “must read” for any of us who are grieving for our mothers, fathers, brothers, sisters, etc on this Memorial Day or any other day.

SurgeXperience 224 – Call for Submissions

Updated 3/2017-- photos and all links removed as many are no longer active and it's easier than checking each one.

The SurgeXperience 224 will be hosted by Karen, Just Up the Dose, on May 31st.  The deadline for submissions is midnight on Friday, May 29th.  Be sure to submit your post via this form. 

If you haven’t read her blog yet, you need to check it out.  Here is a small sample of a recent post "it could be worse"

...if you think you're having a bad day.
Yesterday, an unbooked lady* came in to labour ward and promptly delivered a pair of slightly premature, low birth-weight twins. Surprise!
Once she was cleaned up, the labour ward sister did her booking bloods, and it turns out she has syphilis. Surprise surprise!
After that, we got the pret-test counsellor in and... you guessed it... she has HIV as well. Surprise surprise surprise!

SurgeXperiences is a blog carnival about surgical blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit.

Here is the catalog of past SurgeXperiences editions for your reading pleasure. If you wish to host a future edition, please contact Jeffrey who runs the show here.

Tactile QOV Top

Here is another Quilt of Valor Foundation (QOV) quilt top.  This one is a “tactile” top.  It is made of denims, flannels, chenille, velvet, and cotton.    The top allowed me to use some fabric scraps.

The quilt is machine pieced.  It measures 50 in X 60 in.  There are actual pockets which I hope the long-arm quilter will be able to leave functional. 


Related Posts
Tactile Quilts (June 10, 2007)
Another Tactile Quilt (November 21, 2007)

Theda Ann Sowell (1934 – 2009)

Updated 3/2017-- photo and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

My mother died peacefully Tuesday, May 19, 2009, in the presence of some of her family.  We were fortunate to have had a lovely Mother’s Day with her.  We had given her a digital camera which she was so very excited about learning to use.  Her grand-daughter Krystal showed her the basics while we ate lunch together.  She promptly took some photos at the restaurant table.  The next morning she was trying to take photos of birds at her bird feeder when she had her heart attack. 

This past week while attending her “deathbed” at the hospital, family and friends came and went, sharing wonderful stories about her and us.  It was a time of grieving, but also of celebration of her life.  We have continued to try to do so as we have gone through the steps of planning the funeral.  We are so very grateful to all our extended family, friends, co-workers, etc who have held us in their thoughts and prayers.  Thank you.

You can read her obituary here and my previous posts here and here.

10 year old Girl with Breast Cancer

 Updated 3/2017-- photos and all links removed as many are no longer active and it's easier than checking each one.

I caught this story on ABC Good Morning America Tuesday while sitting with my mother.  Life is often tough, isn’t it and Hannah Powell-Auslam, 10 years old, is finding that out early. 

It is estimated that at least 180,000 women will be told by their doctors this year that they have breast cancer.  Most of these women are over 30 years old.  As Hannah’s mother Carrie Auslam told reports from KCAL-TV in Los Angeles. "Ten-year-olds don't get breast cancer."

So now 10 year old Hannah has to face a disease which woman 4 times her age find difficult to face.  It is a time when she should simply have to worry about which clothes to wear and what music to listen to and which movie to see. 

The family has a  Web site documenting Hannah's fight against her cancer.  She has undergone her breast surgery.  It is most likely that she will have to have chemotherapy.  I wish her well.

Related Posts

Breast Self Exam (BSE) (October 2008)

Mammograms (October 2008)

Breast Cancer Screen in Childhood Cancer Survivors – An Article Review (February 2009)

Indications for Breast MRI – an Article Review (March 2009)

Shout Outs

Updated 3/2017-- photos and all links removed as many are no longer active and it's easier than checking each one. 

Healthcare Technology is this week's host of Grand Rounds. You can read it here.

Welcome to this special edition of Grand Rounds, the Best of the Medical Blogosphere, focusing on Health Care Reform. The tapestry woven through these exceptional articles demonstrates the many dimensions of the health reform challenge.

The latest edition of Change of Shift (Vol 3, No 23)  is hosted by Kim over at Emergiblog!   You can find the schedule and the COS archives at Emergiblog. 

Welcome to Change of Shift, the blog carnival by, about and for nurses!
There is no Star Trek theme, although I did actually go see the movie again, hence the enhanced post title…
If you would like to take the helm of a future Change of Shift voyage, please send a message (see contact button above) and the Communications Officer will schedule a date for you!
Like the latest Star Trek movie, this edition of Change of Shift will make you smile and get you all riled up at the same time!
But enough about my delusions of Star Fleet, on with the main attraction!

 Updated 3/2017-- photos and all links removed as many are no longer active and it's easier than checking each one.

Dr Isis, On Becoming a Domestic and Laboratory Goddess, continues "The Letters to Our Daughters Project".

• Dr Pascale Lane (May 1, 2009)
• Dr. Barbara Goodman (May 4, 2009)
• Wendee Holtcamp (May 9, 2009)
• Janet Stemwedel (May 10, 2009)
• Dr. Pamela Carmines (May 14, 2009)
• Dr. Hannah Carey (May 16, 2009)

This week Dr Anonymous will be discussing Blog World Expo.  I hope you will join us. The show begins at 9 pm EST.