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Osler's nodes Pictures, Definition, Symptoms, Causes, Treatment

Osler's nodes are small red tender nodules located in the fingertip and at the proximal end and the lateral edge of the nails. They grow over a period of several days to weeks. Janeway lesions are little different from from osler's nodes because they often appeared as non-tender hemorrhagic or nodular lesions on the palms and feet. Clinically both are cardinal manifestations of subacute bacterial endocarditis.

At the beginning of these nodes, patients might feel nerve pain or neurological pain. Although these nodes originally considered to be derived via immune system response. It is proposed that the microembolization along with micro-abscess is occurred due to vasculitis triggered by immunomodified hypersensitivity. Osler's nodes may appear at any time during subacute cutaneous lupus erythematosus and may take several hours to a few days to settle down. They may also be due to infective endocarditis.

Osler's nodes usually ranges from 0.5cm to 1cm and appear as painful brownish or reddish subcutaneous papules on feet, finger tips, toes and palms. Many researchers are still trying to find out exact underlying pathophysiology that triggers such kinds of nodes. However, current clinical data suggests that these nodes are occurred due to immune system hypersensitivity.

Osler's nodes Pictures

Osler's nodes Pictures, Definition, Symptoms, Causes, Treatment

Osler's nodes Pictures, Definition, Symptoms, Causes, Treatment

Osler's nodes Symptoms

Physically, osler's nodes are quite similar to janeway lesions so, it is difficult to differentiate them without examining further via microscopical or histological examination. However, some commonly observed features of osler's nodes during clinical practice are

  • Nodules like appearance at finger tips, palms, toes and feet
  • Reddish brown in color
  • Painful
  • Itching
  • Feeling of tenderness
  • Slightly raised with pale surface

Osler's nodes Causes

Exact etiological factors that drive the whole process are still not fully understood but many immunologist believe that infective endocarditis, subacute cutaneous lupus erythematosus and gonococcal infection are strongly associated with such kind of nodes and lesions. Hypersensitive immune system is another factor that triggers such phenomenon.

Osler's nodes Treatment

Osler's nodes usually last several hours to a few days to settle down. However, root cause treatment is necessary otherwise they might appear again at some point. If osler's nodes appear due to infective process then then primary problem should be treated accordingly to avoid further progression. Similarly, if immune system is main culprit then anti-allergic drugs should be used to reduce hypersensitivity of immune system.
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Hollenhorst plaque Images, ICD-10, Definition, Symptoms, Causes, Treatment

Hollenhorst plaques are cholesterol emboli found at the bifurcation of the retinal arteries. The source of these emboli is generally the heart or carotid arteries. They are usually unilateral and occur in elderly patients with advanced atherosclerosis. Symptoms of fugitive alteration of vision may accompany these emboli.

Light yellow deposit usually stick to the peripheral artery at the bifurcation of a peripheral arteriole due to which they cause occlusion of branch retinal artery. This often appears larger than the artery where it is and sometimes you can even see it during migrating down. Migration can be facilitated by lightly massaging the eyeball. It is an arterial cholesterol embolism from an atheromatous plaque ulcer in a proximal artery, usually the internal carotid artery.

Usually embolism associated with retinal artery are often termed as hollenhorst plaque. Due to insignificant symptoms they often diagnosed during routine checkups but appearance of several emboli over time in the arterial tree gives temporary vision loss for seconds at a time. Loss of vision occurs because a temporary artery occlusion occurs, followed by a break of embolism, the components are taken down into the fine capillary system. Larger embolism can be lodged in a vessel permanently and cause massive ischemia in the part of the retina, with permanent loss. In some cases, larger emboli settle down in retinal artery with no obvious symptom in general. This is usually due to the blood flowing around the embolus and continuing retinal tissue supply.

Hollenhorst plaque Images

Hollenhorst plaque Images, ICD-10, Definition, Symptoms, Causes, Treatment

Hollenhorst plaque Images, ICD-10, Definition, Symptoms, Causes, Treatment

Hollenhorst plaque Symptoms

Usually patient remains asymptomatic in case of small emboli. It is often diagnosed during routing examination of eye. If the large sized emboli deposit in retinal artery then sudden vision loss just for few second or blurry vision for few seconds might be a major symptom of Hollenhorst plaque. Usually white color deposits occur due to deposition of calcium while yellowish appearance reveals the deposition of cholesterol.

Hollenhorst plaqueCauses

There number of causes that trigger hollenhorst plaque. These are diabetes mellitus, atherosclerosis, hypercholesterolemia, blood thickening, geriatric patients. However, about 60% cases of hollenhorst plaque are mainly due to diabetes mellitus so, patients having diabetes are more prone get hollenhorst plaque.

Hollenhorst plaque Treatment

Hollenhorst plaque is alarming condition because patient is at high risk to have hemorrhage, stroke, myocardial infarction, circulatory disorder etc. A prompt strategy to minimize such problems is usage of blood thinning agents like aspirin, low molecular weight heparin and anti-clotting agents.  Similarly, if patient is diabetic he must control his/her diabetes by using insulin or other anti-diabetic agents like metformin etc.

Hollenhorst plaque ICD-10

Following code is used for Hollenhorst plaque in ICD-10

H34.219--Partial retinal artery occlusion, unspecified eye--Billable
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Gingival hyperplasia Classification, Symptoms, Causes, Treatment

Hyperplasia of the gums is a slowly progressive and gradual proliferation of the gums in the dental arch of the jaw and mandibular, caused by inflammatory or non-inflammatory factors. Hyperplasia of the gums can be either diffused or focal. Gingival hyperplasia is considered as non malignant kind of hypertrophy around gums. The association with dental disease is most commonly observed factor in case of gingival hyperplasia.

The other most commonly observed conditions that are associated with gingival hyperplasia are exposure to immunosuppressive drugs and genetic predispositions. Clinical manifestations associated with gingival hyperplasia are visible swelling in the cheek area and difficulty in eating. The diagnosis is derived through in-depth oral cavity examination, X ray assessment of dental disease, associated ultrasound and visible external edema. Histological examination provides better results to confirm diagnosis especially in case of findings like fibrous connective tissue and thick or dense epithelium etc.

Generally, gingival hyperplasia is classified into three main categories depending upon their underlying causes or etiological factors.

Drug induced Gingival hyperplasia

About 60-70% cases of gingival hyperplasia are somehow induced by drug therapy like anti-convulsants such as phenytoin, Immunosuppressive drugs such as cyclosporine and calcium channel blockers such as nifedipine.

Dental disease related Gingival hyperplasia

Periodontitis and other gingival pathological conditions are often associated with abnormal proliferation of gum cells leading to gingival hyperplasia. It has also been proposed that dental braces may also act triggering factor for gingival hyperplasia.

Genetically induced Gingival hyperplasia

Though, cases in which genetic predisposition is observed are somehow less than above mentioned factors but still genetic susceptibility remains an obvious cause of gingival hyperplasia.

Gingival hyperplasia Classification, Symptoms, Causes, Treatment

 Gingival hyperplasia Symptoms

Symptoms of gingival hyperplasia are common in almost all cases in which some are visible through naked eye while others can be seen via histological examination. These symptoms are as follows

  • Swelling around gums
  • Abnormal proliferation of gums cells
  • Redness
  • Pus formation around gums
  • Dental plaque can also be seen in case of poor oral hygiene.
  • Bruising 
  • Bad breath
  • Loose teeth
  • Feeling of tenderness around gums 

Gingival hyperplasia Causes

It is not so much to find out obvious cause associated with gingival hyperplasia. As mentioned above drug therapies are on top that induce such kind of hyperplasia. Eaxct underlying mechanism that drives such proliferation of gum cells is still not fully understood in case of drug induced gingival hyperplasia. Other causes that play important role in pathogenesis of gingival hyperplasia are dental braces, oral cavity surgeries, oral and mucousal infections, poor oral hygiene and genetic predisposition.

Gingival hyperplasia Treatment

As far as treatment is concerned, first you need to find out underlying cause of gingival hyperplasia. Suppose if you having such problem due to drug therapy then consult with health care provider and shift your therapy to alternatives or second line therapies. If your routine drug therapy is not that much necessary then abruptly discontinue it. Use mouthwash that contains chlorhexidine gluconate because it readily kills oral cavity micro-organisms. It is strongly recommend that wash you teeth after every six months from any professional dentist because it is very beneficial in reducing risk of tooth problems.
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