Distribution of hyoscyamine and scopolamine in Datura stramonium

The production of hyoscyamine and scopolamine in Datura stramonium has been investigated in the different plant parts, at different stages of their life cycle. Maximum contents were found in the stems and leaves of young plants, hyoscyamine being always the predominant component.

Botanical drugs and preparations in the traditional medicine of West Azerbaijan (Iran)

We present the results of an investigation of the traditional ethnobotany and ethnomedicine of West Azerbaijan (Iran). In this region medicinal plants are often the only easily accessible health care alternative for most of the population in rural areas and in fact folk herbal medicine is the most used remedy to cure common diseases. In this paper we present the most frequently used native species and the most common preparations made from them, in order to preserve the plant popular knowledge, which has traditionally been only an oral one.

Quality control of aromatic drugs reported in European Pharmacopoeia 3rd edition

The apparent current explosion of interest and commercial activity in the area of herbal products should be followed by accurate quality control. In this work, the authors carried out the specific quality assays of all the aromatic drugs reported in European Pharmacopoeia. For each drug, several samples of different brands were bought in pharmacies, herbalist's shops, or supermarkets. The worst results were obtained in the assay for the essential oil content and this is very negative as the medicinal activities of these drugs are ascribed to their essential oil content. The samples of different brands yielded very different results from a qualitative point of view. In most cases, the analyzed samples were very far from the acceptable qualitative standards that they definitely lacked any health benefits.

Chronic GBR 12909 administration differentially alters prodynorphin gene expression compared to cocaine

The effect of the selective dopamine uptake inhibitor 1-[2-[bis(4-flourophenyl)methoxy]ethyl]-4-[3-phenylpropyl]piperazine dihydrochloride (GBR 12909) was examined on prodynorphin gene expression. GBR 12909 or vehicle was continuously infused for 7 days via osmotic minipump, or injected daily into male rats. Both continuous infusions and daily injections of GBR 12909 produced significant decreases in prodynorphin expression in the hypothalamus (37% and 31% decreases, respectively). There were no significant changes in the caudate putamen, hippocampus or nucleus accumbens. One injection of GBR 12909 had no effects on prodynorphin expression in any of the brain regions studied, suggesting that the effect in the hypothalamus is not an acute effect. As previously reported for other treatment regimens, continuous infusion of cocaine produced a 35% significant decrease in the hypothalamus, consistent with the effects of GBR 12909. In contrast to GBR 12909, however, cocaine also produced a significant increase in prodynorphin expression in the caudate putamen. Thus, chronic inhibition of dopamine uptake can regulate prodynorphin expression in the hypothalamus. In contrast, the increase in the caudate putamen following cocaine administration may not be related to the inhibition of dopamine uptake, since it was not produced by a selective dopamine uptake inhibitor. These findings suggest that regulation of prodynorphin gene expression by cocaine in the caudate putamen may be mediated by the inhibition of norepinephrine or serotonin uptake, by a combination of effects on two or three monoamine transporters, or by a mechanism unrelated to transporter inhibition.

Interferon adjuvant to radical nephrectomy in Robson stages II and III renal cell carcinoma: a multicentric randomized study

PURPOSE

Because interferon gave promising results in the management of metastatic renal cell carcinoma in the 1980s, a multicentric randomized controlled trial was planned to compare adjuvant recombinant interferon alfa-2b (rIFNalpha2b) with observation after radical nephrectomy in patients with Robson stages II and III renal cell carcinoma. Overall and event-free survival were to be evaluated together with prognostic factors.

PATIENTS AND METHODS

Overall and event-free survival curves for 247 patients (124 controls and 123 treated) were estimated by the Kaplan-Meier method and compared using the log-rank test. Cox's multiple regression models were adopted to perform a joint analysis of treatment and prognostic factors.

RESULTS

The 5-year overall and event-free survival probabilities were 0.665 and 0.671, respectively, for controls and 0.660 and 0.567, respectively, for the treated group; the differences were not statistically significant (2P = .861 for overall and 2P = .107 for event-free survival with the log-rank test). Regarding prognostic factors, only grade, pT, and pN demonstrated a significant prognostic role. First-order interactions of treatment with pT and pN category were investigated; a significant interaction was found between pN and treatment. A harmful effect of rIFNalpha2b in the 97 treated pN0 patients and a protective effect in the 13 treated pN2/pN3 patients were statistically significant.

CONCLUSION

Adjuvant rIFNalpha2b is not indicated after radical nephrectomy for renal cell carcinoma. The protective effect in the small group of pN2/pN3 patients requires further investigation.

Illness behavior, emotional stress and psychosocial factors among asymptomatic HIV-infected patients

BACKGROUND

Over the last years the way in which patients with chronic physical illness respond to their illness (illness behavior) has been explored by several studies. This study sought to examine characteristics of illness behavior and to investigate the association between illness behavior and psychosocial and clinical variables among asymptomatic HIV-infected subjects.

METHODS

Seventy-three asymptomatic HIV+ outpatients completed self-report questionnaires to evaluate illness behavior (Illness Behavior Questionnaire), psychological stress symptoms (Brief Symptom Inventory), personality variables (External Locus of Control and Courtauld Emotional Control Scales) and social support (Social Provision Scale).

RESULTS

Psychological morbidity ('caseness' = 34%) was associated with a pattern of illness behavior characterized by conviction of disease progression, irritability, dysphoria, psychological perception of illness and low denial. Individual capacity to express emotions, adequate levels of social support and low levels of depression, as well as clinical variables (high number of CD4+ cells, recent notification of HIV infection and nonintravenous drug use category) influenced a more adaptive illness behavior. Psychological stress and low CD4+ cell count were the main predictors of the affective dimension of illness behavior.

CONCLUSIONS

Psychosocial variables resulted to influence the tendency to interpret illness in a nonadaptive way in asymptomatic HIV-infected subjects. Such variables merit to be routinely examined within the doctor-patient relationship in AIDS clinics.

Effects of an antisense oligonucleotide to pronociceptin and long-term prevention of morphine actions by nociceptin

To further characterize the anti-opioid action of the neuropeptide nociceptin, we examined the effects of the repeated intracerebroventricular (i.c.v.) treatment (once daily for 4 days) with an antisense oligodeoxynucleotide complementary to pronociceptin mRNA, in the rat. We also investigated possible changes of the antinociceptive and hyperthermic effects induced by the i.c.v. administration of morphine, in rats i.c.v. pretreated with nociceptin 3 h before. The pretreatment with the antisense oligodeoxynucleotide, but not with a mismatched sequence (used as a control), caused an increase in spontaneous locomotor activity and produced a potentiation of the antinociceptive effect of a submaximal dose of i.c.v. morphine (1 microgram/rat). The i.c.v. pretreatment with nociceptin (2 nmol/rat, 3 h before) prevented both the antinociceptive and the hyperthermic effects of morphine (10 microgram/rat i.c.v.). These results strengthen the hypothesis of an anti-opioid action of nociceptin at supraspinal level and suggest that the neuropeptide may exert long-term modulatory effects.

Nd:YAG laser surgery for the excision of pilonidal cysts: a comparison with traditional techniques

BACKGROUND AND OBJECTIVE

Nd:YAG laser photothermal ablation has been accepted as a treatment modality for hemorrhoidal disease. There is little reported on its use in treating pilonidal disease. We hypothesized that laser would be an excellent tool for pilonidal cystectomy, facilitating improved outcome and patient satisfaction.

STUDY DESIGN/MATERIALS AND METHODS

A 5-year retrospective study was performed comparing Nd:YAG laser to the standard surgical technique. A telephone questionnaire addressing the length of time the cyst was debilitating both preoperatively and postoperatively as well as length of convalescent time before return to work was administered. Pain was assessed by using an analog pain scale.

RESULTS

Operative time for the traditional pilonidal cystectomy was 20 minutes longer than Nd:YAG laser cystectomy. Postoperative hospital stay was similar. Laser patients returned to work an average of 2.4 days earlier, and their postoperative pain was less than those treated traditionally.

CONCLUSION

In an era when the medical consumer makes decisions based on the efficacy of treatment by using criteria such as pain, length of hospitalization, and speed of return to work, Nd:YAG lasers have emerged as a surgical tool that can fulfill these criteria for certain procedures. Patient postoperative satisfaction after laser excision was greater when compared with those who had traditional excisions. Postoperative pain was less, as was the pain experienced during the first week of recovery. Cost for both was comparable.

Supraspinal and spinal effects of [Phe1psi(CH2-NH)Gly2]-nociceptin(1-13)-NH2 on nociception in the rat

A new derivative of the neuropeptide nociceptin (NC) has recently been developed. This molecule, the pseudopeptide [Phe1psi(CH2-NH)Gly2]-nociceptin(1-13)-NH2 was found to antagonize NC inhibitory effects in peripheral smooth muscle preparations in vitro. However, contrasting results have appeared as regards its pharmacodynamic profile in the CNS. Here, we investigated the pseudopeptide effects, in vivo, on nociceptive responses in the rat. [Phe1psi(CH2-NH)Gly2]-nociceptin(1-13)-NH2 was administered intracerebroventricularly (i.c.v.) or intrathecally (i.t.) (alone or in combination with NC), and tail-flick latencies (TFL) to radiant heat were assessed. I.c.v. [Phe1psi(CH2-NH)Gly2]-nociceptin(1-13)-NH2 (1-10 nmol/rat) caused a short-lasting decrease (5 min) of TFL and did not antagonize the threshold lowering effect of i.c.v. NC (1 nmol/rat). At the spinal level, the i.t. administration (0.2-10 nmol/rat) of [Phe1psi(CH2-NH)Gly2]-nociceptin(1-13)-NH2 produced a dose-dependent and long-lasting antinociceptive effect that was not modified by the administration of a high dose (30 nmol/rat i.t.) of the opioid antagonist naloxone. The i.t. co-administration of the pseudopeptide (10 nmol/rat) did not block the antinociceptive effect of i.t. NC (10 nmol/rat). These data indicate that the pseudopeptide behaves as an NC agonist at supraspinal and spinal levels in the rat tail-flick test of nociception. These different profiles in the periphery and the CNS could suggest differences between central and peripheral NC receptor/s and provide a basis for further development of antagonist molecules suitable for their characterization.

Human immunodeficiency virus-related risk behavior among Italian psychiatric inpatients

This study evaluated at-risk behavior for human immunodeficiency virus (HIV) infection among Italian psychiatric inpatients. One hundred patients with mental disorders consecutively admitted to an acute psychiatric unit over a 1-year period were studied using a self-report questionnaire. In these patients, 53.1% reported sex with multiple partners, 35.4% with occasional partners, 57% with prostitutes, and 6.7% with intravenous (i.v.) drug users (i.v.DUs). Forty-three percent never used condoms during sexual intercourse, 23% used drugs intravenously, and 20% shared needles. Only one third of the patients were tested for HIV, and two tested seropositive ([HIV+] prevalence, 5.8%). Most patients (62%) reported no concern about the risk of HIV infection. The rate of HIV risk behaviors was higher among psychiatric patients versus a control group of 90 healthy people. These findings indicate an alarming rate of HIV risk behaviors among Italian psychiatric inpatients and the need for closer attention to HIV assessment and education in mental health settings.

Methamphetamine alters prodynorphin gene expression and dynorphin A levels in rat hypothalamus

Chronic administration of morphine or cocaine affects opioid gene expression. To better understand the possible existence of common neuronal pathways shared by different classes of drugs of abuse, we studied the effects of methamphetamine on the gene expression of the opioid precursor prodynorphin and on the levels of peptide dynorphin A in the rat brain. Acute (6 mg/kg, intraperitoneally, i.p.) and chronic (6 mg/kg, i.p. for 15 days) methamphetamine markedly raised prodynorphin mRNA levels in the hypothalamus, whereas no effect was observed in the hippocampus. Dynorphin A levels increased after chronic treatment in the hypothalamus and in the striatum, whereas no significant changes were detected after acute treatment. These results indicate that methamphetamine affects prodynorphin gene expression in the hypothalamus, which may be an important site (also for its relevant neuroendocrine correlates) for opioidergic mechanisms activated by addictive drugs.

HIV-risk behaviour and knowledge about HIV/AIDS among patients with schizophrenia

BACKGROUND

Recent literature has demonstrated that psychiatric patients, particularly those with a diagnosis of schizophrenia, may be at high risk for HIV infection. In fact, HIV-risk behaviour, such as intravenous drug with sharing needles, promiscuity associated with unprotected sex and high-risk sexual activity after using drugs has been reported by a substantial proportion of mentally ill patients.

METHODS

In order to examine this problem in Italy, HIV-risk taking behaviour and knowledge about HIV/AIDS was investigated among 91 schizophrenic patients by using two self-report questionnaires (HIV-Risk Behaviour Questionnaire; AIDS-Risk Behaviour Knowledge Test).

RESULTS

One-third of the patients reported having been tested for HIV infection and one tested seropositive (prevalence 3.4%). A high proportion of patients reported HIV-risk behaviour, such as injected drugs use (22.4%) and engaging in high risk sexual activity (e.g. multiple partners, 58%; prostitutes, 45%; occasional partners, 37%). Condoms were 'never used' by 41% of the patients and 'almost never used' by another 25%. In spite of these behaviours, 65% reported no concern of HIV infection. Knowledge about AIDS was lower among psychiatric patients than a healthy control group. Patients with long-lasting illness and numerous psychiatric admissions were less acknowledgeable about HIV infection. Certain misconceptions on HIV transmission were related to HIV risk behaviour.

CONCLUSIONS

These results indicate the urgent need for HIV educational programmes within mental health community-care settings.

Frontal lobe dysfunction in obsessive-compulsive disorder and major depression: a clinical-neuropsychological study

Neuropsychological findings support a hypothesized relationship between obsessive-compulsive disorder (OCD) and the frontal lobe. The aim of the present study was to compare findings of neuropsychological tests of frontal lobe function in 28 OCD patients and 29 patients with major depressive disorder (MDD), all diagnosed according to DSM III-R criteria. The patient groups were homogeneous for educational level, handedness, duration of illness, and sex distribution. All 57 subjects received a battery of tests sensitive to frontal lobe dysfunction as well as the Wechsler Memory Scale (WMS). Clinical symptomatology in the MDD and OCD groups was assessed with the Hamilton Rating Scale for Depression and the Yale-Brown Obsessive-Compulsive Scale, respectively. The only significant difference between the two diagnostic groups for any of the neuropsychological indices, with age as a covariate, was in the Object Alternation Test, in which OCD patients had a significantly higher number of perseverative responses. Test performances were not correlated with clinical symptomatology or severity of illness. Our preliminary results confirm the hypothesis that there is a selective impairment of orbito-frontal cortex in OCD and seem to exclude the existence of specific frontal lobe dysfunction in MDD, even though the two disorders show clinical similarities.

Haplotype HLA-B8-DR3 confers susceptibility to hepatitis C virus-related mixed cryoglobulinemia

Our aim was to investigate whether host genetic factors are involved in the onset of hepatitis C virus (HCV)-related mixed cryoglobulinemia (MC). We studied 25 consecutive patients presenting with a full-blown clinical picture of MC by physical examination, blood chemistry, assessment of cryoglobulins and their composition, nonorgan-specific autoantibodies, antibodies to HCV, serum HCV RNA, and HLA polymorphism. Biopsies of liver, bone marrow, and minor salivary glands were also performed in a number of patients. HLA results were compared with those of normal controls and patients with chronic HCV infection without MC and negative for autoimmune phenomena (pathological controls). Type II MC was found in 14 of 25 patients (56%), and type III MC was found in the remaining 11 (44%). All patients were positive for antibodies to HCV and/or serum HCV RNA. HLA-B8 was found in 40% (10 of 25) of patients compared with 10. 1% (38 of 377) of normal controls (P = .00003, Pcorrected = .0005, relative risk [RR] 5.9) and 6.7% (2 of 30) of pathological controls (P = .007, Pcorrected = not significant). As for class II HLA molecules, only DR3 was significantly more frequent in MC patients (40%, 10 of 25) than in normal controls (15.1%, 57 of 377; P = .003, Pcorrected = .03, RR 3.7). Odds ratio (OR) for the risk of developing MC was calculated in patients positive for B8 and/or DR3, and the highest OR (8.2) was observed in individuals possessing both. The results suggest that the development of HCV-related MC is associated with HLA-B8 and DR3 markers.

[Role of hyperbaric oxygen in the treatment of necrotizing infections of the soft tissues]

The Authors report their experience in the treatment of soft tissue necrotizing infections. The correct "timing" of the association of surgery, antibiotics and hyperbaric oxygen therapy is stressed. The good clinical results obtained in the patients examined confirm the usefulness of an early treatment modulated according to the needs of each single patient.

Efficacy and tolerability of ketoprofen 200 mg controlled-release cps vs indomethacin 50 mg cps in patients with symptomatic hip osteoarthritis. A multicentre study

BACKGROUND

An open-label, randomised, multicentre study was carried out to compare the efficacy and tolerability of indomethacin capsules and ketoprofen controlled-release capsules in the symptomatic treatment of coxarthrosis.

MATERIALS AND METHODS

113 out-patients were enrolled: 57 were assigned to receive indomethacin 50 mg twice daily and 56 ketoprofen 200 mg once daily for 4 weeks.

RESULTS

Indomethacin and ketoprofen proved equally effective in relieving osteoarticular pain and stiffness and in improving the quality of life of patients. There was essentially no difference as to gastrointestinal adverse events which occurred in 25% of patients on indomethacin and in 27% of those on ketoprofen. Indomethacin caused more non-gastrointestinal untoward effects, especially CNS effects (headache and dizziness: 11%) which were not observed with ketoprofen. Indomethacin was discontinued because of adverse events in a larger proportion of patients (20%) than ketoprofen (11%).

Calcific chronic lateral epicondylitis: a histological and ultrastructural study

Fragments of insertion tissue from right arm common extensor muscle have been collected from a 25-year patient with chronic lateral epicondylitis. Specimens, processed for light (LM) and electron (EM) microscopy, evidentiated a variety of degenerative alterations, such as focal hyalinosis, lipoidosis, collagen fiber redistribution, calcifications and vascular changes. Evidence of collagen normal function maintenance and turnover have been also observed in tenocytes.

Substance use among the mentally ill: a comparison of Italian and American samples

Thirty-six patients with long-standing psychotic illness randomly selected among attenders at two community centers of Bologna were interviewed as were their therapists, in order to determine prevalence and patterns of substance use, reasons for use and effects on illness. Protocols were the same as used in previous research carried out in Boulder, Colorado. For all substances, except stimulants and over-the-counter products, prevalence rates were lower in the Bologna sample than in Boulder. Overall lifetime rates of substance use were significantly lower in the Bologna sample. Nevertheless 47.2% of the Bologna sample had a lifetime moderate to severe drug use and nearly two-thirds of the sample had a current drug use of some severity. Reasons for use equally reflected attempts to alleviate unpleasant emotional states and recreational purposes. Patients with high degrees of psychopathology had significantly lower scores on severity of drug use.

The selective breakdown of frontal functions in patients with obsessive-compulsive disorder and in patients with schizophrenia: a double dissociation experimental finding

In an our recent preliminary study, we reported the neuropsychological finding of a double dissociation in the frontal lobe functioning between 25 OCD patients and 25 schizophrenics. The first group performed normally in the Wisconsin Card Sorting Test (WCST), which is considered sensitive to Dorso-Lateral Prefrontal Cortex (DLPFC) dysfunctions and abnormally to the Object Alternation Test (OAT), which has been proposed as a tool sensitive to Orbito-Frontal Cortex (OFC); on the other hand, schizophrenics performed abnormally to the WCST and normally to the OAT. The present study, conducted on a new sample of 60 schizophrenic in-patients, 60 OCD in-patients and 30 normal subjects, matched according to age, educational level, handedness and duration of illness, confirms our preliminary data and it suggests a more selective impairment of OFC system in OCD and of DLPFC in schizophrenia. Moreover, schizophrenic patients with paranoid subtype showed worse WCST performance compared to non-paranoid subtype. Our results could open some interesting perspectives about the neuroanatomical systems involved in these two major psychiatric illnesses and so, about their pharmacological treatment, on the basis of the prominent catecholaminergic characterization of the DLPFC and, respectively, the cholinergic innervation of the OFC.

Isolated peripheral enthesitis and/or dactylitis: a subset of psoriatic arthritis

OBJECTIVE

To identify isolated peripheral enthesitis and/or dactylitis as a subset of psoriatic arthritis (PsA) and to define the clinical characteristics of these patients.

METHODS

We examined 401 unselected patients with PsA seen in 3 Italian rheumatological centers over a 6 month period. The diagnosis of PsA was based upon the clinical experience of a rheumatologist. The clinical features of patients with PsA were assessed by clinical examination and review of the patients' charts, evaluating the presence of peripheral arthritis, spinal involvement, dactylitis, and enthesitis. A series of 483 rheumatological patients without psoriasis and spondyloarthropathy (European Spondylarthropathy Study Group criteria) seen consecutively in a one month period constituted the control group.

RESULTS

14 patients (3.5%) presented isolated episodes of peripheral enthesitis and/or dactylitis. No patient developed peripheral arthritis and/or axial involvement during the followup period (median 30 mo; range 3-72 mo). 10/14 patients (71%) presented at least one episode of finger and/or toe dactylitis. 5 of these 10 patients (50%) had additional episodes of peripheral enthesitis (Achilles tendinitis, plantar fasciitis, and posterior tibial tendinitis). Episodes of Achilles tendinitis and/or plantar fasciitis were present in 8/14 patients (57%). 3 of these 8 patients (37%) had associated peripheral enthesitis in other sites as well: lateral epicondyle, insertion of the patella tendon into the inferior pole of the patella, femoral quadriceps, and posterior tibial tendons. An additional case had posterior tibial tendinitis and 2 episodes of toe dactylitis. None of these 14 cases presented radiological evidence of sacroiliitis and only one of the 13 typed was HLA-B27 positive. 12 patients (2.4%) of the control group had episodes of peripheral enthesitis (11 plantar fasciitis and one Achilles tendinitis). No patient had episodes of dactylitis. The frequency of isolated Achilles tendinitis and/or dactylitis was significantly higher in patients with PsA compared to controls (3.5 vs 0.2%; p = 0.001).

CONCLUSION

In some patients PsA can occur only with peripheral enthesitis, particularly Achilles tendinitis, and/or dactylitis. These patients may represent a subset of PsA, not defined by Moll and Wright and spondyloarthritis classification criteria, and poorly recognized in the studies on PsA.

Iliolumbar ligament ossification in undifferentiated seronegative spondyloarthropathy

The case of a man suffering from undifferentiated seronegative spondyloarthropathy (uSpA) without spine involvement and with iliolumbar ligament ossification is reported. Unlike a similar previously published case showing ossification only of the middle part of the left ligament, our patient had ossification of the whole course of both ligaments.

Kindled seizure-induced c-fos and prodynorphin mRNA expressions are unrelated in the rat brain

Levels of mRNA for c-fos and prodynorphin were studied by in situ hybridization in adjacent coronal sections taken from kindled rats 30-60 min after the last seizure. Within this time frame, expression of both genes was induced in multiple brain areas. Anatomical colocalization of the induced gene expressions was found in the hippocampus. Induction of c-fos in the dentate gyrus was bilateral and symmetrical in a subgroup of rats, ipsilateral in another subgroup and absent in a third subgroup. However, no relative increase was observed in the ipsilateral compared with the contralateral prodynorphin expression in the dentate gyrus when c-fos expression was induced ipsilaterally only. These observations suggest that, at variance with other experimental situations, Fos is not involved in the mechanisms of kindled seizure-induced activation of prodynorphin transcription in the rat forebrain.

Dactylitis in patients with seronegative spondylarthropathy. Assessment by ultrasonography and magnetic resonance imaging

OBJECTIVE

To establish by means of ultrasound and magnetic resonance imaging (MRI) the role of tenosynovitis and arthritis in determining the "sausage-like" aspect of finger dactylitis and to compare the results of the 2 examinations.

METHODS

Twelve dactylitic fingers and their corresponding normal contralateral fingers belonging to 10 patients who met the Amor criteria for the diagnosis of seronegative spondylarthropathy (SpA) were studied by ultrasonography and MRI.

RESULTS

MRI revealed a significant increase in the volar bone-to-skin distance in dactylitic fingers with respect to that of the normal contralateral fingers (P < 0.001). This increase was due to distension of the flexor synovial sheaths (P < 0.00001) by fluid collection. Peritendinous soft tissues were not involved, since these were found to be significantly thicker in the normal fingers (P < 0.05). Of the 36 joints of the 12 dactylitic fingers, only 1 showed capsule distension. Using MRI as the "gold standard," ultrasonography showed a 100% sensitivity and specificity for flexor tenosynovitis, but lacked sensitivity for joint involvement because it failed to reveal joint capsule distension in the only joint involved. Similarly, physical examination showed a 100% sensitivity and specificity for flexor sheath involvement.

CONCLUSION

Dactylitis is due to flexor tenosynovitis. Enlargement of the finger joint capsule is not an indispensable condition for the "sausage-like" feature. Physical examination is a sufficient method for the diagnosis of dactylitis.