Can We Make Simple In Situ Decompression of the Ulnar Nerve at the Elbow Still Easier?

BACKGROUND: In situ decompression and transposition are equally effective in cubital tunnel syndrome treatment. Both are traditionally performed in the supine position. OBJECTIVE: To validate our surgical technique for in situ decompression in the lateral decubitus position, comparing results with other techniques used in our institutions. METHODS: A retrospective study was performed from January 2009 to February 2016, of 188 patients with cubital tunnel syndrome 115 males, 73 females; mean age, 53.44 ± 12.12 years standard deviation (range, 18-84 years) treated with in situ decompression in the lateral or supine positions or transposition (subcutaneous or submuscular). The lateral decubitus group received local anesthesia and the remainder received a brachial plexus block. Clinical and electrophysiologic results between these 4 groups were compared. RESULTS: There were no statistically significant demographic differences between groups. Results were better in in situ decompression groups compared with transpositions. Mean follow-up was 1511.1 ± 770.57 days standard deviation (range, 310-4203 days). There were no recurrences or residual elbow pain/dysesthesia/anesthetic scar/hyperesthesia/neuroma in the lateral decubitus group. Complication and recurrence rates were in direct correlation to incision size. The worst results were seen in transpositions, particularly in the submuscular group. In situ decompression in the supine position had better results than transpositions but worse than those performed in lateral decubitus. Smaller surgical wound correlates with a reduction in operating time, costs, complication rates, and time out of work. CONCLUSIONS: In situ decompression is equally as effective as ulnar nerve transpositions but with fewer complications and recurrences. In the lateral decubitus position, the retroepicondylar tunnel is more accessible, allowing smaller incisions and better results.

[Detection of methicillin resistance and identification of Staphylococcus spp. from positive blood culture bottles using the mecA and nucA genes with the LightCycler System]. / Detección de la resistencia a meticilina e identificación de Staphylococcus spp. en hemocultivos positivos amplificando los genes mecA y nucA con el sistema LightCycler.

INTRODUCTION: The aim of this study was to evaluate the feasibility of detecting Staphylococcus aureus and coagulase-negative staphylococci (CoNS) and of identifying methicillin resistance directly in positive BACTEC blood culture bottles using the LightCycler system. METHODS: One hundred thirty-one positive blood culture bottles in which Gram-positive cocci in cluster were observed after Gram staining and 40 positive bottles with microorganisms other than staphylococci were studied. A molecular assay based on an automated DNA extraction protocol with a MagNA Pure LC instrument was used. Oligonucleotide primers and fluorescence-labeled hybridization probes were designed for amplification and sequence-specific detection of both a 408-pb fragment within the mecA gene and a 279-pb fragment within the S. aureus-specific nucA gene. RESULTS: All the bottles that yielded methicillin-resistant S. aureus (MRSA), methicillin-sensitive S. aureus (MSSA) or methicillin-resistant CoNS (MRCoNS) strains were correctly identified by the nucA and mecA PCR assays. One bottle that yielded a mixed culture of MSSA and MRCoNS gave positive results for both genes. In the 21 bottles with methicillin-susceptible CoNS (MSCoNS), nucA PCR were negative, but two of these bottles gave positive results for the mecA gene. The sensitivity and specificity of the nucA gene assay were 100%. The sensitivity and specificity of the PCR assay for detection of methicillin resistance with the mecA gene were 100% and 97.5%, respectively. CONCLUSION: This is a sensitive and highly specific method for identifying staphylococci in positive blood cultures, allowing discrimination between methicillin-susceptible and -resistant strains in less than 3 hours after Gram stain.

Detección de la resistencia a meticilina e identificación de Staphylococcus spp. en hemocultivos positivos amplificando los genes mecA y nucA con el sistema Light Cycler / Detection of methicillin resistance and identification of Staphylococcus spp. from positive blood culture bottles using the mecA and nucA genes with the LightCycler System

INTRODUCCIÓN. El objetivo de este trabajo fue evaluarla eficacia del sistema LightCycler para la detección de Staphylococcus aureus y estafilococos coagulasa negativos(ECN), y la identificación de resistencia a meticilina directamente en botellas Bactec de hemocultivos positivos. MÉTODOS. Se procesaron 131 botellas de hemocultivos positivos en los que se observaron cocos grampositivos en racimos tras la tinción de Gram y 40 botellas con microorganismos diferentes a estafilococos. Para la extracción del ADN se utilizó el sistema automático MagNAPure LC (Roche Diagnostic). Los cebadores y las sondas dehibridación se diseñaron para la amplificación y detección de las secuencias específicas de un fragmento de 408 pb del gen mecA y de un fragmento de 279 pb del gen nucA. RESULTADOS. Todas las botellas con cepas de S. aureusresistente a meticilina (SARM), sensible a meticilina(SASM) o ECN resistentes a meticilina (ECNRM) fueron correctamente identificados mediante reacción en cadena de la polimerasa (PCR) de los genes nucA y mecA. Una botella con un cultivo mixto de SASM y ECNRM dio resultados positivos para ambos genes. Las 21 botellas con cepas de ECN sensible a meticilina (ECNSM) fueron correctamente identificadas con el gen nucA, pero dos de ellas fueron positivas para el gen mecA. La sensibilidad y la especificidad fueron del 100% para el gen nucA, y del 100 y 97,5%, respectivamente, para el gen mecA. CONCLUSIÓN. Este es un método sensible y específico para la identificación de estafilococos en hemocultivos, y permite también la identificación de cepas resistentes a meticilina en un tiempo máximo de 3 h a partir de la visualización de la tinción de Gram (AU)

INTRODUCTION. The aim of this study was to evaluate the feasibility of detecting Staphylococcus aureus and coagulase-negative staphylococci (CoNS) and of identifying methicillin resistance directly in positive BACTEC blood culture bottles using the LightCycler system. METHODS. One hundred thirty-one positive blood culture bottles in which Gram-positive cocci in cluster were observed after Gram staining and 40 positive bottles with microorganisms other than staphylococci were studied. A molecular assay based on an automated DNA extraction protocol with a MagNA Pure LC instrument was used. Oligonucleotide primers and fluorescence-labeled hybridization probes were designed for amplification and sequence-specific detection of both a 408-pb fragment within the mecA gene and a 279-pb fragment within the S. aureus-specific nucA gene. RESULTS. All the bottles that yielded methicillin-resistant S.aureus (MRSA), methicillin-sensitive S. aureus (MSSA) ormethicillin-resistant CoNS (MRCoNS) strains were correctly identified by the nucA and mecA PCR assays. One bottle that yielded a mixed culture of MSSA and MRCoNSgave positive results for both genes. In the 21 bottles with methicillin-susceptible CoNS (MSCoNS), nucA PCR were negative, but two of these bottles gave positive results forthe mecA gene. The sensitivity and specificity of the nucA gene assay were 100%. The sensitivity and specificity of the PCR assay for detection of methicillin resistance with the mecA gene were 100% and 97.5%, respectively. CONCLUSION. This is a sensitive and highly specific method for identifying staphylococci in positive blood cultures, allowing discrimination between methicillin-susceptible and –resistant strains in less than 3 hours after Gramstain (AU)