High-resolution ultrasound visualization of the recurrent motor branch of the median nerve: normal and first pathological findings

Purpose To evaluate in a prospective study the possibility of visualization and diagnostic assessment of the recurrent motor branch (RMB) of the median nerve with high-resolution ultrasound (HRUS). Materials and methods HRUS with high-frequency probes (1822 MhZ) was used to locate the RMB in eight fresh cadaveric hands. To verify correct identification, ink-marking and consecutive dissection were performed. Measurement of the RMB maximum transverse-diameter, an evaluation of the origin from the median nerve and its course in relation to the transverse carpal ligament, was performed in both hands of ten healthy volunteers (n=20). Cases referred for HRUS examinations for suspected RMB lesions were also assessed. Results The RMB was clearly visible in all anatomical specimens and all volunteers. Dissection confirmed HRUS findings in all anatomical specimens. Mean RMB diameter in volunteers was 0.7 mm 0.1 (range, 0.61). The RMB originated from the radial aspect in 11 (55%), central aspect in eight (40%) and ulnar aspect in one (5%) hand. Nineteen (95%) extraligamentous courses and one (5%) subligamentous course were detected. Three patients with visible RMB abnormalities on HRUS were identified. Conclusion HRUS is able to reliably visualize the RMB, its variations and pathologies. Key Points Ultrasound allows visualization of the recurrent motor branch of the median nerve. Ultrasound may help clinicians to assess patients with recurrent motor branch pathologies. Patient management may become more appropriate and targeted therapy could be improved.(VLID)354468

Staphylococcal toxic shock syndrome associated with disseminated intravascular coagulopathy leading to compartment syndrome of the lower extremity

We report a case of a 56-year old multimorbid male patient who was transferred to our specialized burn center with a combination of extensive blistering with underlying deep tissue necrosis, disseminated intravascular coagulation and compartment syndrome to the left lower extremity. He was treated with high doses of intravenous antibiotics, above the knee amputation and multiple necrosectomy but died after 51 days due to multi organ failure.We believe that a rare combination of infection causing severe toxic shock syndrome leading to disseminated intravascular coagulation that then caused atraumatic compartment syndrome was responsible for this condition. Keywords: Staphylococcal toxic shock syndrome, Disseminated intravascular coagulopathy, Compartment syndrom

Quality Improvement through a Reminder System in an Outpatient Department for Thyroid Disease

Abstract We discuss a reminder system that automatically interprets the results of routine biochemical tests for thyroid hormones. We measured serum levels of thyroid stimulating hormone (TSH

Die Pflanzenareale : [Welt] : Sammlung kartographischer Darstellungen von Verbreitungsbezirken der lebenden und fossilen Pflanzen-Familien, -Gattungen und -Arten / 1/1 Saxifraga 1 : (Karte 1-3)

von A. Engler. Acer L. 1 : (Karten 4-5) / von F. Pax. Casuarina Forst : (Karte 6) / von L. Diels. Die Verbreitung der Arten der Gattung Soldanella L. : (Karte 7-8) / von F. Vierhapper. Pinus Pinea L. : (Karte 9) / von M. Rikli. Genista anglica L. : (Karte 10) / E. HannigExlibrisstempel: "Bibliothek des Botanischen Gartens u. Museums Berlin Dahlem" Exemplar der ETH-BI

Journal of Immunology Research / The Antiseptic Octenidine Inhibits Langerhans Cell Activation and Modulates Cytokine Expression upon Superficial Wounding with Tape Stripping

Ideal agents for the topical treatment of skin wounds should have antimicrobial efficacy without negative influence on wound healing. Octenidine (OCT) has become a widely used antiseptic in professional wound care, but its influence on several components of the wound healing process remains unclear. In the present study, we have used a superficial wound model using tape stripping on human full-thickness skin ex vivo to investigate the influence of OCT on epidermal Langerhans cells (LCs) and cytokine secretion pattern of skin cells during wound healing in a model without disruption of the normal skin structure. Histological and immunofluorescence studies showed that OCT neither altered human skin architecture nor the viability of skin cells upon 48 hours of culture in unwounded or wounded skin. The epidermis of explants and LCs remained morphologically intact throughout the whole culture period upon OCT treatment. OCT inhibited the upregulation of the maturation marker CD83 on LCs and prevented their emigration in wounded skin. Furthermore, OCT reduced both pro- and anti-inflammatory mediators (IL-8, IL-33, and IL-10), while angiogenesis and growth factor mediators (VEGF and TGF-1) remained unchanged in skin explant cultures. Our data provide novel insights into the host response to OCT in the biologically relevant environment of viable human (wounded) skin.(VLID)510715