Limited value of ultrasound assessment in patients with poor outcome after carpal tunnel release surgerys

[EN] OBJECTIVE: To determine the value of ultrasonography in the assessment of patients with idiopathic carpal tunnel syndrome (CTS) and poor outcome after carpal tunnel release. METHODS: A total of 88 consecutive patients with CTS (104 hands) underwent open surgical release of the median nerve. Ultrasound (US) examination was performed blind to any patient's data. The median nerve area at tunnel inlet and outlet, the retinaculum distance, and the flattening ratio were measured. The main outcome variable was the patient's overall satisfaction using a five-point Likert scale (1 = worse, 2 = no change, 3 = slightly better, 4 = much better, 5 = cured) at 3 months postoperatively. Pre- and postoperative ultrasonographic findings in relation to clinical outcome were analysed. RESULTS: Improvement (scores 4 or 5 on the Likert scale) was recorded in 75 hands (72%). After carpal tunnel release, the cross-sectional area at tunnel inlet decreased from a mean of 14.2 to 13.3 mm2 in the group with clinical improvement and also from a mean of 12.5 to 11.6 mm2 in the group with no change or slight improvement. No significant changes in the cross-sectional area at tunnel outlet, retinaculum distance, and flattening ratio were observed. CONCLUSION: Reduction of the median nerve cross-sectional area at tunnel inlet at 3 months after carpal tunnel release was similar in patients reporting cure or great improvement and in those with slight or no improvement. Ultrasonography is of limited value in assessment of patients with poor outcome after median nerve release.

Coupling between upper ocean layer variability and size-fractionated phytoplankton in a non-nutrient-limited environment

[EN] We describe the coupling between upper ocean layer variability and size-fractionated phytoplankton distribution in the non-nutrient-limited Bransfield Strait region (BS) of Antarctica. For this purpose we use hydrographic and size-fractionated chlorophyll a data from a transect that crossed 2 fronts and an eddy, together with data from 3 stations located in a deeply mixed region, the Antarctic Sound (AS). In the BS transect, small phytoplankton (<20 μm equivalent spherical diameter [ESD]) accounted for 80% of total chl a and their distribution appeared to be linked to cross-frontal variability. On the deepening upper mixed layer (UML) sides of both fronts we observed a deep subducting column-like structure of small phytoplankton biomass. On the shoaling UML sides of both fronts, where there were signs of restratification, we observed a local shallow maximum of small phytoplankton biomass. We propose that this observed phytoplankton distribution may be a response to the development of frontal vertical circulation cells. In the deep, turbulent environment of the AS, larger phytoplankton (>20 μm ESD) accounted for 80% of total chl a. The proportion of large phytoplankton increases as the depth of the upper mixed layer (ZUML), and the corresponding rate of vertical mixing, increases. We hypothesize that this change in phytoplankton composition with varying ZUML is related to the competition for light, and results from modification of the light regime caused by vertical mixing.