Dupuytren’s contracture

Hand condition in which the fingers are forced into a claw shape and cannot be used. The first symptoms are small lumps on the fibrous sheet under the palm of the hand. The tendons of the fingers adhere to the fibrous sheet, or fascia, which shrinks at a later stage, pulling the tendons and bending the fingers; they cannot be straightened even if the patient uses his other hand. The condition usually starts with the Characteristic condition of the hand in little or ring finger, and in severe cases the little, ring and middle fingers can be pulled against the palm of the hand, but it is usually treated by surgery before it reaches this stage. Treatment is by removal of the lumps on the fascia to release the fingers. The hand can be used normally again, although the fingers may be stiff for some time, and there is a risk that the contracture may recur. Growth disturbance in children in which annual growth is slow, and the final height attained abnormally small. Growth to a normal height requires optimal nutrition, the absence of metabolic or other chronic deficiencies, correct growth hormone levels, normal puberty – and parents of more or less. Normal height. Deviations from the norm are of two kinds. Usually the growth disturbance is proportional, but in the case of some metabolic disorders (including some hereditary metabolic disorders) bodily proportions are also altered; growth of the limbs is much more restricted than that of head and body. From birth, in others the growth spurt is delayed (delayed puberty); in the latter case normal height will probably be reached after puberty. A growth curve from birth can be of great significance in examining the causes of slow growth, and thus regular height and weight records should be kept. Treatment must be by treatment of the cause. Artificial growth hormones can be supplied, and sex hormones may assist in cases of delayed puberty, although they can have the effect of stopping growth sooner. Chances of establishing normal growth vary with the cause; they are not very high with hereditary metabolic disorders. By Shigella bacteria (bacillery dysentery) or – only rarely in Europe -amoeba (amoebic dysentery). Infection is through food or by contact. The disorder is always epidemic in character, occurring most often in the late summer. After 1 to 4 days a serious clinical picture emerges consisting of high fever (39 to 40°C), abdominal convulsions and diarrhoea. Faeces contain mucus

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