grocery是什么意思英语翻译（这个单词你认识吗）

原创 Alpha Jun 阿尔法医学英语 前天

大家可能都认识acromegaly (肢端肥大症)，

但对于acropachy 可能比较陌生，

我们从词源学的角度来解析这个单词，然后从一道题来了解这个体征的临床意义。

Acromegaly 和 acropachy 同有一个共同的词根：acro- 在医学中意为肢端的意思。其实它是一个很常用的词根，通常为“顶点”、“最高点”的意思。很多词汇由这个词根构成：

Acro- 和 词根 -nym (名字)构成的单词：acronym，意为首字母构成的缩略语。这在医学中很常用，可以帮助记忆。比如: ABG - arterial blood gas, DNR - do not resuscitate, NKDA - no known drug allergies, PPE - personal protection equipment, ECMO - extracorporeal membrane oxygenation, AIDS - acquired immune deficiency syndrome, 等等等等。

Acro- 和 词根 – polis (城市) 构成的单词：acropolis 意为“卫城”

Acro- 和 词根 – phobia (害怕) 构成的单词：acrophobia意为“恐高”

Acropachy 中的另一词根为- pachy，意为thick，就是皮糙肉厚的意思。

pachyderm 厚皮动物,-derm,皮,词源同dermatology.如大象即厚皮动物。

Acropachy 临床上就是杵状指，finger clubbing，但通常见于一种病。我们来看一下下面这道习题，可以更好地了解这个单词，这个体征，以及相对应的疾病：

Case

A 56-year-old woman complains of fatigue, bilateral knee pain with weight bearing activities, and a 15-lb weight gain in the past 2 years. Laboratory tests ordered by her primary care physician showed a positive antinuclear antibody test, and she was referred to Rheumatology for evaluation. She has a past medical history of hypertension, acid reflux disease, type 2 diabetes mellitus, Graves’ disease, thyroidectomy, radio iodine treatment, and lumbar laminectomy. She has smoked 1 pack of cigarettes daily for the past 40 years. Her current medications are lisinopril, metformin, levothyroxine, and omeprazole. She reports no history of oral ulcers, chest pain, deep vein thrombosis/pulmonary embolism, seizures, or stroke. She has chronic dyspnea on exertion, which has worsened in the past 2 years.

On examination she is 5 ft 8 in tall and weighs 195 lb. Her skin and oral mucosa appear dry. Moderate thinning of hair and exophthalmos is noted. Diffuse nonpitting swelling of both hands, feet, and legs is present. There is thickened, indurated dry skin with scaling on both lower legs and dorsal feet. Clubbing of fingernails is present. There is joint space tenderness medially over both knees. The rest of the physical examination is normal.

An echocardiogram and computed tomography (CT) scan of the abdomen and pelvis 2 months ago were normal. CT scan of the chest showed mild emphysematous changes. Radiography of the hands and feet shows fluffy and spiculated periostitis of multiple phalangeal and carpal bones. Irregular periosteal new bone formation is present in both distal medial tibias. Severe medial joint space narrowing is noted in both knees.

Laboratory results are below.

Laboratory Test, Units

Result

Reference Range

Aminotransferase, serum alanine (ALT), U/L

30

10–40

Aminotransferase, serum aspartate (AST) U/L

30

10–40

Antinuclear antibodies

1:160

1:40 or less

Calcium, serum, mg/dL

11.1

8.6–10.2

Creatinine, serum, mg/dL

0.9

0.7–1.5

Hematocrit, blood, %

37

Female: 37–47

Hemoglobin, blood, g/dL

12

Female: 12–16

Leukocyte count, cells/μL

7500

4000–11,000

Platelet count, PLT/µL

187,000

150,000–450,000

Thyroid-stimulating hormone, serum, μU/mL

2.1

0.5–4.0

25-Hydroxyvitamin D, serum, ng/mL

15

20–60

Question：

Which of the following is the most likely diagnosis?

A. Hyperparathyroidism

B. Pachydermoperiostosis

C. Secondary hypertrophic osteoarthropathy

D. Thyroid acropachy

正确答案：D thyroid acropachy

Rationale

The patient has a history of Graves’ disease with physical findings of thyroid ophthalmopathy and diffuse soft tissue nonpitting edema of all 4 limbs consistent with myxedema/thyroid dermopathy. The presence of clubbing and the characteristic radiographic findings confirm the diagnosis of thyroid acropachy. Acropachy is a late complication of autoimmune thyroid dysfunction, occurring chronologically after ophthalmopathy and dermopathy. In a long-term retrospective review of 40 patients with thyroid acropachy from Mayo Clinic (median follow-up, 9.7 years), more than half of patients were diagnosed 1 to 2 years after the diagnosis of thyroid dysfunction and ophthalmopathy, in both euthyroid and hypothyroid patients. In most patients, acropachy is asymptomatic, although some patients with advanced periostitis report bone pain and arthralgia. Thyroid acropachy predominantly involves the hands and feet and only rarely the long bones of the forearms and lower legs. Clubbing of fingernails is a key clinical feature of thyroid acropachy. Increased glycosaminoglycan and fibroblast proliferation within bones (like those seen in thyroid ophthalmopathy and dermopathy) are thought to underlie radiographic changes. Treatment of acropachy is to identify and treat the underlying thyroid dysfunction. The long-term outcomes of acropachy have not been well studied, with attention focused instead on concurrent ocular and dermatologic manifestations.

Hyperparathyroidism causes subperiosteal bone resorption often noted in hand radiographs, most characteristically affecting the radial aspects of the proximal and middle phalanges of the second and third fingers and sometimes the medial aspect of the tibia, femur, or humerus. These radiographic changes are distinct from those seen in thyroid acropachy. Although mild hypercalcemia is present in this patient, it is in the setting of profound vitamin D deficiency, and hence more likely due to secondary hyperparathyroidism (which is not associated with radiographic changes).

Hypertrophic osteoarthropathy (HOA) causes severe diffuse arthralgias—unlike thyroid acropachy, which tends to be asymptomatic as in this patient. Clubbing is classically present in HOA, but this patient does not have the expected concurrent severe pulmonary disease, pulmonary malignancy, or chronic infection seen with HOA. Radiographic changes of HOA differ from those of thyroid acropachy. Radiographs show symmetric laminal periosteal proliferation in classic pulmonary osteoarthropathy. In contrast, characteristic subperiosteal spiculated, frothy, or lacy appearance is seen in acropachy, often asymmetrically.

Pachydermoperiostosis, also known as primary hypertrophic osteoarthropathy, presents in childhood in its most severe forms. Less severe cases can present in early adulthood and are characterized by hypertrophic skin changes, coarsening of facial features (similar to acromegaly), arthralgias, joint enlargement, and radiographic changes. Clubbing is usually but not always present.

Educational Objective: Describe the presenting features of thyroid acropachyReferences:

Fatourechi V, Ahmed DD, Schwartz KM. Thyroid acropachy: report of 40 patients treated at a single institution in a 26-year period. J Clin Endocrinol Metab. 2002;87(12):5435-5441.Gul M, Katz J, Chaudhry AA, Hannah-Shmouni F, Skarulis M, Cochran CS. Rheumatologic and imaging manifestations of thyroid acropachy. Arthritis Rheumatol. 2016;68(7):1636.

Jadidi J, Sigari M, Efendizade A, Grigorian A, Lehto SA, Kolla S. Thyroid acropachy: a rare skeletal manifestation of autoimmune thyroid disease. Radiol Case Rep. 2019;14(8):917-919.

简单来讲：Graves’ disease会导致这种体征，即使甲状腺功能正常（euthyroid）。

Thyroid acropachy

甲状腺肢端病

怎么样，通过一道题，我们可以学到很多东西。

我们的题库里，每一道题都是一个很好的案例，所有的讲解都有文献支持。既能学习医学英语，又能提高临床知识。可以点击了解详情：

美国医学生都看的医学习题，每天10分钟，让你不一样

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供稿：Alpha Jun

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Alpha Jun

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