Shear-wave elastography in the diagnosis of ulnar tunnel syndrome.

An interesting alternative to traditional diagnostic techniques of the upper extremity nerve entrapments might be an ultrasound elastography that has started to gain attention in recent research. The aim of this preliminary study was to verify whether a quantitative analysis of the ulnar nerve stiffness by shear-wave elastography can be used to diagnose ulnar tunnel syndrome (UTS), an ulnar nerve neuropathy at Guyon's canal. The study included 46 patients (39 women) and 39 healthy controls (34 women). All diagnoses in patients and controls were confirmed with nerve conduction studies. Measurements of nerve stiffness were taken at three levels: Guyon's canal (G), distal forearm (DF), and mid forearm (MF). Additionally, the ulnar nerve cross-sectional area at the canal's level was determined by ultrasonography. Patients with UTS presented with significantly greater nerve stiffness than the controls (mean, 99.41 kPa vs. 49.08 kPa, P < 0.001). No significant intergroup differences were found in the nerve elasticity at DF and MF levels (P < 0.836 and P < 0.881, respectively). An ulnar nerve stiffness value of 80 kPa and G:DF and G:MF ratios equal to 1.5 provided 100% sensitivity, specificity, and positive and negative predictive values in the detection of the syndrome. The mean nerve cross-sectional area in the Guyon's canal was significantly greater in patients than in the controls (4.63 mm2, range, 2-7 mm2 vs. 3.23 mm2, range, 2-5 mm2, P < 0.001). In conclusion, we believe that shear-wave elastography has the potential to become a useful adjunct diagnostic test for UTS.

Continuous alternating inhaled antibiotic therapy in CF: A single center retrospective analysis.

INTRODUCTION: The efficacy of inhaled antibiotics to treat chronic Pseudomonas aeruginosa pulmonary infection in patients with cystic fibrosis (CF) has been well established. Few data are available on the value of continuous alternating inhaled antibiotic therapy (CAIT), a strategy increasingly used in the management of CF. OBJECTIVE: To investigate the effect of CAIT on clinical outcome in adult CF patients treated at the University Hospital Leuven. METHODS: Patients with a documented CF diagnosis who received inhaled antibiotics between March 2010 and January 2015 were retrospectively evaluated. In patients receiving CAIT patient characteristics, recorded spirometry data and number of IV antibiotic days were collected retrospectively at fixed time intervals, from 6months before to one year after the start of the 2nd inhaled antibiotic. For patients on inhaled antibiotic monotherapy (IAMT), the same data were obtained at similar intervals during the study period. RESULTS: A total of 49 of 89 patients using chronic inhaled antibiotic therapy received CAIT. Patients receiving CAIT had a lower baseline FEV1 and were more likely to be homozygous for F508del compared to patients receiving IAMT. FEV1 deteriorated on average by a factor of 0.904 per year (95% CI: 0.851-0.960) prior to the start of CAIT. The initiation of CAIT was associated with an average improvement in FEV1 by a factor of 1.148 per year (95% CI: 1.068-1.236, p=0.0002). The analysis of specific types of antibiotics revealed evidence of positive effects of adding COLI to TOBI and COLI to AZLI. We found no effect of the initiation of CAIT on the number of IV antibiotic days (p=0.80). CONCLUSION: CF patients with more advanced lung disease are more likely to receive CAIT. In this patient group, CAIT was associated with a significant improvement in FEV1. Further data are warranted to identify the value of CAIT.

A new look at the shoulder anterior capsuloligamentous complex complementing the insertion of the subscapularis tendon-Anatomical, histological and ultrasound studies of the lesser tuberosity enthesis.

PURPOSE: The aim of this study was to examine the relation between the anterior capsuloligamentous complex (ACLC - recognized as a single structure composed of the anterior capsule and its ligaments: medial glenohumeral ligament and anterior bundle of inferior glenohumeral ligament) and the subscapularis tendon with their footprints on the lesser tuberosity. METHODS: In this study, 19 fresh cadaveric shoulder specimens were examined: 13 in morphometric measurements and 6 were examined in a histological study. The subscapularis tendon and the ACLC were dissected until their insertion onto lesser tuberosity. Measurements of both dissected structures and their footprints on the lesser tuberosity were taken with a standard caliper. Six shoulders for histological examination were dissected without separation of the subscapularis tendon from the ACLC and longitudinal and transverse section samples were taken. Additionally, two of these six shoulders underwent ultrasound assessment before final sample preparation. RESULTS: Two well-isolated structures were clearly identifiable: muscle with its tendinous chords and the ACLC, forming together the anterior wall of the joint. The ACLC insertion complemented the tendon insertion - superiorly the thickest part of the tendon stayed in contact with the thinnest part of the ACLC and inferiorly the relation was opposite - the ACLC insertion reached its maximum transverse length. This reciprocal relation was similar to superior and posterior rotator cuff tendon-capsule complex. The footprint on the lesser tuberosity, being purely fibrocartilage enthesis, was composed in 45% of the ACLC insertion. Also the fibers run of the tendon and the ACLC were different: histologic assessment confirmed the tight fusion of the tendon and the ACLC, though those two layers were easily identified as their fibers never mixed. CLINICAL RELEVANCE: Better understanding of the anterior shoulder compartment anatomy simplifies an understanding of some arthroscopic procedures. The shape of the footprint, an importance of a broad superior part of the subscapularis tendon and its relation to the ACLC could be an anatomic proof and explanation for already existing surgical activities: subscapularis release and repair and soft tissue or bony procedures (Latarjet) in anterior shoulder instability. We declare that the experiments comply with the current law of the country in which they were performed (i.e. Polish law).