US-guided therapy of calcific tendinopathy: clinical and radiological outcome assessment in shoulder and non-shoulder tendons.

PURPOSE: To analyze the effectiveness and complication rate of ultrasound (US)-guided perforation and lavage using a two-needle technique with 16 - 18 G needles in the treatment of patients with calcific tendinopathy in the shoulder, elbow, hip, and knee by radiological and clinical follow-up. MATERIALS AND METHODS: A retrospective chart review was performed and 40 patients (13 male, 27 female; mean age, 53.5 years; range 24 -74 years) were identified as having received US-guided perforation and lavage due to symptomatic calcific tendinopathy of the rotator cuff tendons, triceps, extensor and flexor tendons at the elbow, rectus femoris tendon and patellar tendons. The radiographic outcome was assessed by comparison of the size and quality of the calcification before and 6 weeks after the procedure. On US images, the quality of the acoustic shadow was assessed, together with other alterations of the tendon and surrounding tissue. Patients were interviewed by telephone to assess the clinical outcome regarding pre-treatment and post-treatment pain and tendon function. RESULTS: 34 shoulder tendons and 6 non-shoulder tendons were identified. The mean calcium reduction was 39.9 mm(2) (range, 0 - 215; p < 0.001), while 80 % of patient showed a resolution of more than 60 % resulting in good clinical improvement. A very low complication rate was found (1 partial tear). CONCLUSION: The US-guided perforation and lavage technique is an effective and safe treatment for rotator cuff calcifications as well as for other body tendons. Although the two-needle technique and large needles were used in this study, a very low complication rate was detected.

The beta-binomial model for host specificity among organisms in trophic interactions.

In this paper, we present a new stochastic model where the host specificity among organisms in trophic interactions in a community, say parasite-host interactions, is estimated by a beta-binomial model. The expected proportion of the host species in a community that a given parasite species is utilizing is modeled as a realization from an inhomogeneous Poisson process, where the rate of this process is assumed to be proportional to a beta probability distribution. The observed number of host species utilized by the parasites is then binomially distributed with the number of trials equaling the number of different host species in the sample. When the degree of polyphagy is estimated by the parameters of the beta-binomial model, quantities like community host specificity and the expected total number of parasite species that will utilize the host species in the community can be predicted as functions of the number of host species available. The predictions can then be applied in analysis of, e.g., symbiotic interactions among organisms, local species richness, and community structure.