clubbing (See club)

1 a team of professional baseball players who play and travel together; "each club played six home games with teams in its own division" [syn: baseball club, ball club, nine]

2 a formal association of people with similar interests; "he joined a golf club"; "they formed a small lunch society"; "men from the fraternal order will staff the soup kitchen today" [syn: society, guild, gild, lodge, order]

3 stout stick that is larger at one end; "he carried a club in self defense"; "he felt as if he had been hit with a club"

4 a building occupied by a club; "the clubhouse needed a new roof" [syn: clubhouse]

5 golf equipment used by a golfer to hit a golf ball [syn: golf club, golf-club]

6 a playing card in the minor suit of clubs (having one or more black trefoils on it); "he led a small club"; "clubs were trumps"

7 a spot that is open late at night and that provides entertainment (as singers or dancers) as well as dancing and food and drink; "don't expect a good meal at a cabaret"; "the gossip columnist got his information by visiting nightclubs every night"; "he played the drums at a jazz club" [syn: cabaret, nightclub, nightspot]

1 unite with a common purpose; "The two men clubbed together"

2 gather and spend time together; "They always club together"

3 strike with a club or a bludgeon [syn: bludgeon] [also: clubbing, clubbed]clubbing n : a condition in which the ends of toes and fingers become wide and thick; a symptom of heart or lung disease

English

Pronunciation

• Rhymes: -ʌbɪŋ

Verb

clubbing

1. present participle of club

Noun

1. The practice of frequenting nightclubs.

   We're going clubbing tonight.

   I don't like clubbing.

2. An instances of using a club.

   There was an outbreak of near-fatal clubbings in that area.

In medicine, clubbing, finger clubbing, or digital clubbing is a deformity of the fingers and fingernails that is associated with a number of diseases, mostly of the heart and lungs. Idiopathic clubbing can also occur. Hippocrates was probably the first to document clubbing as a sign of disease, and the phenomenon is therefore occasionally called Hippocratic fingers.

Signs and symptoms

Clubbing develops in five steps:

1. Fluctuation and softening of the nail bed (increased ballotability)
2. Loss of the normal <165° angle ("Lovibond angle") between the nailbed and the fold (cuticula)
3. Increased convexity of the nail fold
4. Thickening of the whole distal (end part of the) finger (resembling a drumstick)
5. Shiny aspect and striation of the nail and skin

Schamroth's test or Schamroth's window test (originally demonstrated by South African cardiologist Dr Leo Schamroth on himself) is a popular test for clubbing. When the distal phalanges (bones nearest the fingertips) of corresponding fingers of opposite hands are directly apposed (placed against each other back to back), a small diamond-shaped "window" is normally apparent between the nailbeds. If this window is obliterated, the test is positive and clubbing is present.

Diagnosis

When clubbing is encountered in patients, doctors will seek to identify its cause. They usually accomplish this by obtaining a medical history— particular attention is paid to lung, heart, and gastrointestinal conditions —and conducting a clinical examination, which may disclose associated features relevant to a diagnosis. Additional studies such as a chest x-ray may also be performed.

• • Interstitial lung disease
  • Tuberculosis
  • Suppurative lung disease: lung abscess, empyema, bronchiectasis, cystic fibrosis
  • Pulmonary hypertension
  • Mesothelioma
  • It is worth noting that clubbing is not associated with chronic obstructive pulmonary disease (COPD). Indeed, the presence of clubbing in a patient with COPD should prompt a search for an underlying (lung) cancer.
• Heart disease:
  • Any disease featuring chronic hypoxia
  • Congenital cyanotic heart disease (most common cardiac cause)
  • Subacute bacterial endocarditis
  • Atrial myxoma (benign tumor)
• Gastrointestinal and hepatobiliary:
  • Malabsorption
  • Crohn's disease and ulcerative colitis
  • Cirrhosis, especially in primary biliary cirrhosis
  • Other liver diseases (in the "hepatopulmonary syndrome", a complication of cirrhosis)

• Others:
  • Hyperthyroidism (thyroid acropachy)
  • Familial and racial clubbing and "pseudoclubbing" (people of African descent often have what appears to be clubbing)
  • Vascular anomalies of the affected arm such as an axillary artery aneurysm (in unilateral clubbing)

HPOA

A special form of clubbing is hypertrophic pulmonary osteo-arthropathy, known in continental Europe as Pierre Marie-Bamberger syndrome. (In dogs the condition is known as hypertrophic osteopathy.) This is the combination of clubbing and thickening of periosteum (connective tissue lining of the bones) and synovium (lining of joints), and is often initially diagnosed as arthritis. It is commonly associated with lung cancer.

Primary HOA

Primary hypertrophic osteo-arthropathy is HPOA without signs of pulmonary disease. This form has a hereditary component, although subtle cardiac abnormalties can occasionally be found. It is known in continental Europe as the Touraine-Solente-Golé syndrome. This condition has been linked to mutations in the gene on the fourth chromosome (4q33-q34)coding for the enzyme 15-hydroxyprostaglandin dehydrogenase (HPGD); this leads to decreased breakdown of prostaglandin E2 and elevated levels of this substance.

Pathophysiology

The exact cause for sporadic clubbing is unknown, and there are numerous theories as to its cause. Vasodilation (distended blood vessels), secretion of growth factors (such as platelet-derived growth factor and hepatocyte growth factor) from the lungs, and other mechanisms have been proposed. The discovery of disorders in the prostaglandin metabolism in primary osteo-arthropathy has led to suggestions that overproduction of PGE2 by other tissues may be the causative factor for clubbing.

See also

• Periosteal reaction
• Clubbed thumb (unrelated congenital deformity)

References