亚洲免费av电影一区二区三区,日韩爱爱视频,51精品视频一区二区三区,91视频爱爱,日韩欧美在线播放视频,中文字幕少妇AV,亚洲电影中文字幕,久久久久亚洲av成人网址,久久综合视频网站,国产在线不卡免费播放

        ?

        Terry's nail:an overlooked physical finding in cirrhosis

        2013-06-11 08:06:00BARANB,SOYEROM,KARACAC

        To the Editor:

        Nail changes are important findings of physical examination,which may be the only initial sign of a serious systemic illness.Skin and nail abnormalities are frequently associated with chronic liver disease,however these findings are mostly overlooked due to ignoring hand examination.One of these unrecognized nail findings in liver disease is Terry's nail.We present a patient with decompensated cirrhosis and hepatocellular carcinoma who has a previously unnoticed nail discoloration which eventually diagnosed as Terry's nail.The patient was a 65-year-old woman with a diagnosis of cryptogenic cirrhosis.She was referred to our hospital for evaluation of recent decompensation,and a thorough work-up revealed 2 lesions compatible with hepatocellular carcinoma.A nail discoloration previously overlooked was noted during the physical examination (Fig.).The proximal parts of herfingernails were white with a loss of lunula and a zone of normal pink at the distal edge of the nails,which extends a few milimeters to the proximal in the middle.A diagnosis of Terry's nail was made.

        Fig.Terry's nails associated with cirrhosis.Note the white discoloration of proximal nails and loss of lunula.

        Terry's nail is a non-specific finding associated with many clinical conditions including chronic liver and kidney diseases,congestive heart failure,diabetes mellitus and aging.[1]A study[2]suggested that decreased vascular supply to nail bed is responsible for the discoloration but tissue biopsies showed that nail abnormality is due to distal telangiectasia.This nail abnormality was first described in 1954 by Richard Terry,[3]who found that in 82 of 100 cirrhotic patients alcoholic liver disease was the most common etiology.Subsequent reports defined that Terry's nail was common in liver cirrhosis,however Salem et al[4]reported no patients with Terry's nail in their cohort.They explained this finding by inclusion of the insufficient number of patients with alcoholic cirrhosis and hepatocellular carcinoma.

        Our patient was considered unsuitable for other therapies of hepatocellular carcinoma and listed for orthotopic liver transplantation.It is evident that hand examination and nail findings can give important clues in the management of patients with liver disease.

        Bulent Baran,Ozlem Mutluay Soyer and Cetin Karaca

        Department of Gastroenterohepatology,

        Istanbul Faculty of Medicine,

        Istanbul University,Capa 34390,

        Fatih,Istanbul,Turkey

        Tel:00902124142000;

        Fax:00902126319743;

        Email:cetinkaraca@yahoo.com

        1 Nia AM,Ederer S,Dahlem KM,Gassanov N,Er F.Terry's nails:a window to systemic diseases.Am J Med 2011;124:602-604.

        2 Holzberg M,Walker HK.Terry's nails:revised definition and new correlations.Lancet 1984;1:896-899.

        3 Terry R.White nails in hepatic cirrhosis.Lancet 1954;266:757-759.

        4 Salem A,Gamil H,Hamed M,Galal S.Nail changes in patients with liver disease.J Eur Acad Dermatol Venereol 2010;24:649-654.

        热99精品| 精品视频一区二区三区在线观看| 亚洲中文字幕久久精品无码a| 国产精品99久久久久久宅男| 国产性一交一乱一伦一色一情| 白色白色白色在线观看视频| 日本伊人精品一区二区三区| 乌克兰粉嫩xxx极品hd| 国产女人精品视频国产灰线| 手机在线免费av网址| 91久久精品色伊人6882| 亚洲伊人色欲综合网| 亚洲熟妇AV一区二区三区宅男| 久久综合老鸭窝色综合久久| 五月激情综合婷婷六月久久| 蜜桃麻豆www久久囤产精品| 日韩秘 无码一区二区三区| 精品国产污黄网站在线观看| 亚洲色一区二区三区四区| 亚洲欧洲∨国产一区二区三区| 毛片av在线播放亚洲av网站| 中文字幕亚洲一区视频| 女人高潮内射99精品| 国产精品丝袜黑色高跟鞋| 精品丝袜一区二区三区性色| 亚洲国产中文字幕在线视频综合| 国产女人高潮叫床视频| 亚洲欧洲精品成人久久曰不卡| 亚洲情精品中文字幕99在线| 免费观看mv大片高清| 日日躁夜夜躁狠狠躁超碰97 | 亚洲一区二区av偷偷| 插入日本少妇一区二区三区 | 国产99久久久国产精品~~牛| 久久精品亚洲中文字幕无码网站 | 亚洲AV成人无码久久精品老人| 97国产精品麻豆性色| 人妻少妇精品中文字幕专区| 亚洲精品中文字幕无码蜜桃| 日韩在线视频不卡一区二区三区| a黄片在线视频免费播放|