Conservative Treatment of Ulnar Nerve Compression at the Elbow: A Systematic Review and Meta-Analysis.

Background The clinical results of conservative treatment options for ulnar compression at the elbow have not been clearly determined. The aim of this review was to evaluate available conservative treatment options and their effectiveness for ulnar nerve compression at the elbow. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a systematic review and meta-analysis of studies was performed. Literature search was performed using Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). Results Of the 1,079 retrieved studies, 20 were eligible for analysis and included 687 cases of ulnar neuropathy at the elbow. Improvement of symptoms was reported in 54% of the cases receiving a steroid/lidocaine injection (95% confidence interval [CI], 41-67) and in 89% of the cases using a splint device (95% CI, 69-99). Conclusions Conservative management seems to be effective. Both lidocaine/steroid injections and splint devices gave a statistically significant improvement of symptoms and are suitable options for patients who refuse an operative procedure or need a bridge to their surgery. Splinting is preferred over injections, as it shows a higher rate of improvement.

Rare Tumors Causing Median Nerve Compression in Adults-A Narrative Review.

The median nerve can be compressed due to a tumor along the course of the median nerve, causing typical compression symptoms or even persistence or recurrence after an operation. The aim of this review is to provide a comprehensive overview of rare tumors described in recent publications that cause median nerve compression and to evaluate treatment options. The PubMed, Embase, and Web of Science databases were searched for studies describing median nerve compression due to a tumor in adults, published from the year 2000 and written in English. From 94 studies, information of approximately 100 patients have been obtained. Results The rare tumors causing compression were in 32 patients located at the carpal tunnel, in 21 cases in the palm of the hand, and 28 proximal from the carpal tunnel. In the other cases the compression site extended over a longer trajectory. There were 37 different histological types of lesions. Complete resection of the tumor was possible in 58 cases. A total of 8 patients presented for the second time after receiving initial therapy. During follow-up, three cases of recurrence were reported with a mean follow-up period of 11 months. The most common published cause of median nerve compression is the lipofibromatous hamartoma. Besides the typical sensory and motor symptoms of median nerve compression, a thorough physical examination of the complete upper extremity is necessary to find any swelling or triggering that might raise suspicion of the presence of a tumor.

Anatomic Variations and Malformations as Rare Causes of Median Nerve Compression in Adults: A Narrative Review.

OBJECTIVE: The median nerve can become compressed at multiple points in the arm, causing carpal tunnel-, pronator-, anterior interosseous-, or lacertus syndrome. Anatomical variations are potential reasons of persisting or recurrent symptoms of median nerve compression and are often recognized late. The objective of this study is to provide a comprehensive list of rare anatomical variations and malformations causing median nerve compression. METHODS: A total of 62 studies describing median nerve compression due to an anatomical structure in adults published from 2000 in English were included. The findings were: 35 tenomuscular, 16 vascular causes, and 4 cases with nerve involvement. Only 1 osseous and 18 combined anomalies caused compression. In 18 cases, the anomaly was found in the proximal forearm. RESULTS: In 44 cases, the median nerve was surgical released and 35 anomalies were completely resected. Persistent or recurrent symptoms were present in 13 cases. During follow-up, 1 case of recurrence was reported.Standard operative option for median nerve compression consists of an open median nerve release. CONCLUSIONS: In case of persistent or recurrent carpal tunnel syndrome, unilateral symptoms, the presence of a palpable mass, manifestation of symptoms at young age and pain in the forearm or upper arm, the surgeon has to rule out the presence of an anatomical anomaly. Complete resection of the anomaly is not always necessary. The surgeon should be aware of potential anomalies to avoid inadvertent damage at surgery.

Keys to discern the Phoenician, Punic and Roman mining in a typical coastal environment through the multivariate study of trace element distribution.

Trace element concentrations in the Cartagena Bay coastal record reveal a contribution of natural processes. However, the influence of anthropogenic factors predominates in the last three millennia, particularly aerosol deposition linked to mining and industrial activities in the area. The coastal record of Cartagena can be considered a preserved environment, suitable to search for regional human activity fingerprinting, specifically that related to the deposition of heavy metals such as Pb and Cu. A multivariate statistical analysis was carried out to clarify the geochemical behaviour of trace and major elements. Our study design represents a novel approach to assign natural contributions, such as eolian and riverine input, to coastal deposits, and organic matter preservation under anoxic environments. Therefore, synergies obtained by the simultaneous study of multivariate statistics and enrichment factors allow robust conclusions about palaeoenvironmental evolution and human activities. Anthropogenic influence suggested that Pb mining and metallurgy began during the Chalcolithic period, with considerable inputs of Pb and Cu to atmospheric pollution during Phoenician, Punic and Roman times.

Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer.

BACKGROUND: Immediate breast reconstruction (IBR) after mastectomy has shown to be oncologically safe and to improve quality of life in breast cancer patients. However, most women undergoing mastectomy do not undergo IBR. In this study, we aim to identify breast surgeon-related factors in considering IBR and factors affecting patients' decision to choose for IBR. METHODS: Retrospective analysis of the records of breast cancer patients who underwent mastectomy with or without IBR between 2010 and 2013. We documented all information whether or not a patient underwent IBR after mastectomy. RESULTS: Of 437 patients, 97 (22.2%) underwent IBR, 89.8% of which received tissue expanders. Patient who did not undergo IBR had a higher age (62.2 versus 51.9 years, P<0.001) and higher body mass index (BMI) (27.0 versus 24.3, P<0.001). Hundred three patients declined IBR, mainly because considering reconstruction as too much trouble. In 128 cases the breast surgeon did not offer IBR, mostly because of the predicted need for post mastectomy radiation. Approximately 11% of the patients were not informed about IBR. CONCLUSIONS: Anticipated radiation therapy, higher age and higher BMI were important breast surgeon-related factors in refraining from IBR. Almost one third of all patients declined IBR. In almost 10% of all patients, IBR was not discussed.

Adaptation of soil physical measurement techniques for the delineation of mud and lakebed sediments at Neusiedler See.

For many water management issues of shallow lakes with non-consolidated sediments hydrographic surveys of the open water area and reed belt areas are required. In the frame of water management strategy for the steppe lake Neusiedler See, located between Austria and Hungary, a hydrographic survey was conducted. In the open water area (water depth ≥1 m) a sediment echosounder was used. To validate these measurements and to distinguish between water, mud, and sediment layers in the shallow lake and reed belt area additional measurements were needed. As no common standard methods are available yet, we developed a measurement system based on two commonly applied soil physical measurement techniques providing reproducible physical values: a capacitive sensor and a cone penetrometer combined with GNSS-positioning enable dynamic measurements of georeferenced vertical water-mud-bedsediments profiles. The system bases on site-specific calibrated sensors and allows instantaneous, in situ measurements. The measurements manifest a sharp water-mud interface by a sudden decline to smaller water content which is a function of the dielectric permittivity. A second decline indicates the transition to compacted mud. That is concurrently the density where the penetrometer starts registering significant penetration resistance. The penetrometer detects shallow lakebed-sediment layers. Within the lake survey this measurement system was successfully tested.