The differences between these two cutaneous presentations of Infectious endocarditis have always been a bit tricky for me. Finally I decided to solve that problem and here it is:
Osler nodes: Osler’s nodes (painful, palpable, erythematous lesions most often involving the pads of the fingers and toes). Caused by immune complexes (they want you to know that for Step 2). Infectious endocarditis and Roth spots are also due to immune complexes–>immune vasculitis.
Janeway lesions (nontender, macular lesions most commonly involving the palms and soles). Janeway lesions occur more frequently in endocarditis caused by Staphylococcus aureus. Janeway lesions are caused by septic emboli. Subcutaneous abscesses are found on histologic examination.
We can add to the picture and splinter hemorrhages aka fingernail hemorrhage: narrow, red to reddish-brown lines of blood beneath the nails. They run in the direction of nail growth and are named splinter hemorrhages because they look like a splinter beneath the fingernail. The hemorrhages may be caused by tiny clots that damage the small capillaries under the nails or by vessel damage from swelling of the blood vessels (vasculitis). [medlineplus]
The most common cause for splinter hemorrhages is trauma to the nail. [umm]
PICTURE (Credit Children’s Hospital Boston): The lesions in Figures A-C were tender and represent Osler’s nodes, while the lesion in Figure D was nontender and represents a Janeway lesion.
For more pictures showing the differences between Osler Nodes and Janeway Lesions visiter119test.
July 16, 2012 By Maureen Salamon
(HealthDay) — Evidence is building that poor sleep patterns may do more than make you cranky: The amount and quality of shuteye you get could be linked to mental deterioration and Alzheimer’s disease, four new studies suggest.
Inadequate shuteye associated with mental decline in four new studies.
Too little or too much sleep was equated with two years’ brain aging in one study. A separate study concluded that people with sleep apnea — disrupted breathing during sleep — were more than twice as likely to develop mild thinking problems or dementia compared to problem-free sleepers. Yet another suggests excessive daytime sleepiness may predict diminished memory and thinking skills, known as cognitive decline, in older people.
“Whether sleep changes, such as sleep apnea or disturbances, are signs of a decline to come or the cause of decline is something we don’t know, but these four studies … shed further light that this is an area we need to look into more,” said Heather Snyder, senior associate director of medical and scientific relations for the Alzheimer’s Association in Chicago, who was not involved in the studies.
The studies are scheduled for presentation Monday at the Alzheimer’s Association annual meeting in Vancouver.
The largest of the studies, which examined data on more than 15,000 women in the U.S. Nurses’ Health Study, suggested that those who slept five hours a day or less, or nine hours a day or more, had lower average mental functioning than participants who slept seven hours per day. Too much or too little sleep was cognitively equivalent to aging by two years, according to the research, which followed the women over 14 years beginning in middle age.
The study also observed that women whose sleep duration changed by two hours or more a day from mid- to later life had worse brain function than participants with no change in sleep duration — a finding that held true regardless of how long they usually slept at the beginning of the study.