Foundations of Clinical Research: Applications to Practice, 2nd Edition, Leslie Gross Portney, Mary P. Watkins. Prentice Hall, Upper Saddle River, NJ (2000), 752 pages. $60

Die vorliegende Leitlinie umfasst ein neues und aktualisiertes Konzept der Behandlung und Pravention von erwachsenen Patienten mit ambulant erworbener Pneumonie und lost die bisherige Leitlinie aus dem Jahre 2009 ab. Sie wurde entsprechend den Masgaben zur Methodologie einer S3-Leitlinie erarbeitet und verabschiedet. Hierzu gehoren eine systematische Literaturrecherche und -bewertung, die strukturierte Diskussion der aus der Literatur begrundbaren Empfehlungen sowie eine Offenlegung und Bewertung moglicher Interessenskonflikte. Die Leitlinie zeichnet sich aus durch eine Zentrierung auf definierte klinische Situationen, eine aktualisierte Masgabe der Schweregradbestimmung, Empfehlungen zu einer individualisierten Auswahl der initialen antimikrobiellen Therapie sowie zur primaren und sekundaren Pravention.

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Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention – Update 2016

Heterogeneity of root and nerve ultrasound pattern in CIDP patients

https://rapm.bmj.com/content/rapm/early/2021/10/01/rapm-2021-103031.full.pdf

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group.

To update the 2012 European Society of Musculoskeletal Radiology (ESSR) clinical consensus guidelines for musculoskeletal ultrasound referral in Europe. Twenty-one musculoskeletal imaging experts from the ESSR participated in a consensus study based on a Delphic process. Two independent (non-voting) authors facilitated the procedure and resolved doubtful issues. Updated musculoskeletal ultrasound literature up to July 2017 was scored for shoulder, elbow, wrist/hand, hip, knee, and ankle/foot. Scoring of ultrasound elastography was included. The strength of the recommendation and level of evidence was scored by consensus greater than 67% or considered uncertain when the consensus was consensus less than 67%. A total of 123 new papers were reviewed. No evidence change was found regarding the shoulder. There were no new relevant articles for the shoulder, 10 new articles for the elbow, 28 for the hand/wrist, 3 for the hip, 7 for the knee, and 4 for the ankle/foot. Four new evidence levels of A were determined, one for the hip (gluteal tendons tears), one for the knee (meniscal cysts), one for the ankle (ankle joint instability), and one for the foot (plantar plate tear). There was no level A evidence for elastography, although for Achilles tendinopathy and lateral epicondylitis evidence level was B with grade 3 indication. Four new areas of level A evidence were included in the guidelines. Elastography did not reach level A evidence. Whilst ultrasound is of increasing importance in musculoskeletal medical practice, the evidence for elastography remains moderate. • Evidence and expert consensus shows an increase of musculoskeletal ultrasound indications.
 • Four new A evidence levels were found for the hip, knee, ankle, and foot.
 • There was no level A evidence for elastography.

Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus.

Introduction

The aims of this study were to identify factors affecting the measurement of nerve cross-sectional area (CSA) and to establish normal reference values for nerve ultrasonography of the upper extremity.



Methods

Ninety-seven age-matched, healthy individuals were enrolled. Ultrasonographic tests were performed by tracing nerves from the axilla to the distal arm. CSA was measured at the following locations: median nerve (carpal tunnel inlet, forearm, antecubital fossa, midhumerus); ulnar nerve (wrist, 2 cm proximal to the wrist, forearm, cubital tunnel outlet and inlet, midhumerus); radial nerve (spiral groove, antecubital fossa); and musculocutaneous nerve (proximal humerus).



Results

The CSA reference values differed between the measured points along the path of each nerve. Nerve CSA correlated significantly with weight, body mass index, height, and gender; however, the CSA ratio (distal/proximal) did not correlate with demographic factors.



Conclusions

The normal reference values may be helpful in diagnosis of pathologies involving these nerves. Muscle Nerve 47: 864–871, 2013

Reference values for nerve ultrasonography in the upper extremity.

Introduction: Neuromuscular ultrasound is a painless, radiation-free, high-resolution imaging modality for assessment of the peripheral nervous system. The purpose of this study was to use neuromuscular ultrasound to assess the changes that occur in the median nerve after steroid injection for carpal tunnel syndrome (CTS). Methods: Ultrasound and nerve conduction studies were performed at baseline and 1 week, 1 month, and 6 months after steroid injection in 19 individuals (29 wrists) with CTS. Results: Significant changes were noted in median nerve cross-sectional area (P < 0.001), mobility (P = 0.001), and vascularity (P = 0.042) at the distal wrist crease after steroid injection, and the nerve cross-sectional area correlated with symptom score and electrodiagnostic parameters. Changes in the ultrasonographic parameters were seen within 1 week of injection. Conclusions: These findings suggest neuromuscular ultrasound is potentially helpful for the assessment of individuals undergoing treatment for CTS, as typical changes can be expected after successful treatment injection. Muscle Nerve 44: 25–29, 2011

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Median Nerve Changes Following Steroid Injection for Carpal Tunnel Syndrome

Introduction: The aim of this study was to determine normal reference values for cross-sectional area (CSA) and the correlation between demographic factors and CSA in the cervical roots and brachial plexus trunks using ultrasonography. Methods: Ninety-five age-matched healthy individuals were studied. Ultrasonographic tests were performed via nerve tracing from the cervical root to the brachial plexus trunk. The CSA of each nerve was measured in the C5–8 ventral roots and brachial plexus (trunk level). Results: Normal values of each cervical root were: C5, 5.66 ± 1.02 mm2; C6, 8.98 ± 1.65 mm2; C7, 10.43 ± 1.86 mm2; and C8, 10.76 ± 2.02 mm2. Values for the brachial plexus were: upper trunk, 16.70 ± 2.88 mm2; middle trunk, 14.01 ± 2.70 mm2; and lower trunk, 13.75 ± 2.57 mm2. The side-to-side discrepancy was 11.91 ± 11.11%. Body mass index (BMI) and height correlated frequently with nerve CSA. Conclusions: These reference values may be helpful in investigating pathologies involving the cervical area. Muscle Nerve 46: 711–716, 2012

Measurement of cross‐sectional area of cervical roots and brachial plexus trunks

Introduction: The aim of this study was to improve our understanding of the pathophysiology of carpal tunnel syndrome (CTS) and to highlight the ultrasonographic cross-sectional area (CSA) ratio as a tool for assessing outcomes by investigating postoperative changes. Methods: Twenty-four individuals with CTS were evaluated using the Boston questionnaire, nerve conduction studies, and ultrasound, preoperatively and at 3 weeks and 3 months postoperatively. Results: Improved symptom scores, decreased CSA, and decreased CSA ratio were observed in the first 3 weeks, but functional improvement was also observed after 3 weeks postoperatively. The ratios between the CSA at the sites of enlargement and unaffected areas correlated significantly with the Padua classification, although the coefficient was not superior to the coefficient of CSA at the maximal swelling site. Conclusions: Symptoms improved more rapidly than function after surgery. Measurement of the ultrasonographic CSA ratio may provide clinicians with a useful assessment tool after surgery. Muscle Nerve, 2012

Carpal tunnel syndrome: Clinical, electrophysiological, and ultrasonographic ratio after surgery.

Introduction: Cross-sectional area (CSA) reference values of lower extremity nerves using ultrasonography have only been reported in a few studies and have been limited to white populations. Methods: For this study, 94 healthy Korean volunteers were recruited for measurement of the CSA at 7 sites of lower extremity nerves. The side-to-side difference in CSA was calculated for each nerve, and reference ranges were derived. External validity evaluation for the reference values was performed with 10 newly recruited volunteers at a different institution. Results: Nerve CSA was correlated significantly with body mass index, weight, and height; however, the absolute value of the side-to-side difference had no significant correlation with demographic factors. The external validity was adequate for all sites, ranging from 80% to 100%. Conclusions: The lower extremity nerve CSA values obtained in this study may provide normal reference values for the Asian population. Muscle Nerve 50: 564–570, 2014

Sun Jae Won

Papers

Reference values for nerve ultrasonography in the upper extremity.

Median Nerve Changes Following Steroid Injection for Carpal Tunnel Syndrome

Measurement of cross‐sectional area of cervical roots and brachial plexus trunks

Carpal tunnel syndrome: Clinical, electrophysiological, and ultrasonographic ratio after surgery.

Cross-sectional area reference values of nerves in the lower extremities using ultrasonography.