Surgical decompression of an accessory bicipital aponeurosis associated with median neuropathy in the antecubital fossa: A case report

Background: Accessory muscles in the arm are well-known anatomical variants which have been hypothesized as sources of neurovascular compression syndromes. We report a rare presentation of neuropathy secondary to an accessory biceps aponeurosis causing compression of the median nerve in the antecubital fossa. Case Description: A 65-year-old man presented with a 5-year history of numbness and pain associated with arm flexion. Electromyography was normal and exam revealed mild weakness in the median nerve distribution; however, magnetic resonance imaging demonstrated an accessory biceps tendon overlaying the median nerve in the antecubital fossa. The patient underwent surgical decompression of the median nerve with detachment of the accessory tendon resulting in clinical improvement. Conclusion: Anomalous biceps musculature should be considered in the workup and treatment of proximal median neuropathy.

Myotendinous pseudomasses: an imaging review

A mass or a tumor may not always be an underlying cause for a clinically apparent swelling. A wide range of myotendinous disorders can present as pseudomasses. These include muscle/myofascial hernia, tendon tears, benign hypertrophy, accessory muscles, tendon xanthomas, diffuse myositis, and exertional compartment syndromes. We have briefly reviewed these lesions highlighting their typical radiological findings and have also highlighted the role of different imaging modalities and the role of dynamic imaging. Although rare, radiologists should be aware of these entities to avoid mislabeling a pseudomass as a mass or malignancy and to detect the abnormality in not-so-apparent masses.

Effects of Using the Surgical Mask and FFP2 during the 6-Min Walking Test. A Randomized Controlled Trial

During the COVID-19 pandemic, the use of masks has been recommended as a containment measure. The mask is a hindrance to normal breathing that causes discomfort. This could put more work on the respiratory accessory muscles, and, consequently, these muscles could see their tone increase. For this reason, during this clinical trial (registered in clincaltrials.gov, number: NCT04789603), it was observed whether the use of the mask produced changes in the distance traveled, in the heart rate, in the oxygenometry, in the self-perceived dyspnea and in the tone of accessory respiratory muscles during a 6-min walk test (6MWT). Fifty healthy volunteers were recruited and carried out the 6MWT on three occasions. They carried out the 6MWT in various situations: using an FFP2/N95 mask, using a surgical mask, and without using a mask. The distance walked, the heart rate, the oxygen therapy, the tone of the accessory respiratory muscles, and the self-perceived dyspnea were recorded in each situation. Significant differences were found between the three situations in terms of self-perceived dyspnea FFP2/N95 > surgical mask > no mask. However, there are no differences between the experimental situations during the 6MWT in terms of distance travelled, heart rate, oxygenometry or respiratory muscle tone.

A comparison of consumer response using paper and digital ballots for eating quality assessment of beef steaks

A consumer study was conducted to determine if consumers scored beef palatability traits differently on paper vs. digital ballots. Beef subprimals were collected to represent four treatments with inherent variation in eating quality: USDA Select eye round aged 7 d postmortem, USDA Select strip loin aged 7 d postmortem, USDA Choice tenderloin aged 21 d postmortem, and USDA Prime strip loin aged 21 d postmortem. Accessory muscles, external fat, and connective tissue were removed from subprimals. Muscles were fabricated into 2.5 cm steaks and further divided into 2 equal halves for consumer testing. Consumers (n = 360) were served eight samples divided into two blocks representing the two ballot types. Select longissimus lumborum samples were always served in the first and fifth position to start each ballot block, with the remaining three treatments served in a randomized order between the latter three positions within each ballot block. Consumers rated each steak sample for tenderness, juiciness, flavor liking, and overall liking on either a paper or digital ballot, and then rated the paired steak halves on the opposite ballot during the second block of sample testing. Ballot type influenced (P < 0.02) all traits, as consumers scored tenderness, juiciness, flavor liking, and overall liking greater (P < 0.05) on paper ballots compared to digital ballots, regardless of treatment. The smallest margin between paper and digital ballots was observed for tenderness, where scores only differed by 1.8 units. However, juiciness, flavor liking, and overall liking all differed by 3.4 units in favor of paper ballots. Consumers scored palatability traits greater on paper ballots compared to digital ballots, and these findings were consistent across a range of eating quality outcomes. These results should be considered when comparing past consumer testing results using paper balloting systems to those where digital ballots were used.

A review on the effect of kinesiotaping on lung function and perception of dyspnea in COPD patients

Background: Chronic obstructive pulmonary disease (COPD) is complicated by the presence of frequent and recurrent acute exacerbations. The patients are asymptomatic and stable in the early stages. They develop weakness of primary respiratory muscles and use accessory muscles, which lead to postural changes. The forward head posture is very common in COPD patients due to increased usage of accessory muscles and aging changes. Kinesiotaping application has been used to correct posture and lung function recently. Objective: The aim of this paper is to review the evidence on the effect of Kinesiotaping on lung function and posture in COPD patients. Methods: The research articles published in the major databases, including Web of Science, Pubmed, and Google Scholar, were searched from January 2010 to January 2021 to be included in the review. Twenty-one articles were retrieved, and five articles were selected for the review based on the inclusion criteria. Results: The studies indicate that Kinesiotaping of the thoracic wall in COPD patients has an immediate effect on accessory inspiratory muscle activity, chest expansion, pulmonary function, and postural alignment. Further research is required to determine the long-term effects of this special taping method in comparison with conventional therapy in COPD patients. Conclusion: The application of kinesiotaping as an adjunct to conventional breathing exercises in COPD patients helps in improving lung function, posture and reduces the perception of dyspnea.

Hand Masses

Hand and wrist soft tissue masses may be classified as pseudotumors, benign neoplasms, or malignant neoplasms. The vast majority of hand lesions are benign. Consideration of the location of the lesion and its imaging characteristics often leads to a specific diagnosis. Pseudotumors discussed in this article are ganglion cysts, accessory muscles, and inflammatory lesions. True tumors are described according to their tissue type: nerve sheath tumors, adipocytic tumors, so-called fibrohistiocytic tumors, pericytic tumors, and vascular lesions. We also outline the imaging features of masses encountered in the hand and wrist.

Abstract 108: Work of Breathing Scale to Assess Need of Intubation in Covid-19 Pneumonia

COVID-19 pneumonia presents in most patients with significant hypoxemia but without substantial impairment of lung compliance that would increase the work of breathing (WOB) to levels requiring invasive mechanical ventilation. Thus, the ability to assess the WOB independent of the oxygen needs could help guide management and possibly avoid intubation. We previously developed and implemented in our ICU a WOB scale based on respiratory physiology ranging from 1 to 7 by assigning points to the respiratory rate level and the use of respiratory accessory muscles. We analyzed the use of our WOB scale in 10 patients admitted to our ICU with severe COVID-19 pneumonia. All patients had radiographic evidence of extensive lung disease with significant hypoxemia and multiple risk factors associated with poor outcome. Hypoxemia was successfully managed using high-flow nasal cannula. The WOB level was measured every 4 hours. The maximum WOB was 4.3 ± 0.9, contributed primarily by the respiratory rate with a score of 3.6 ± 0.5 but with infrequent use of respiratory accessory muscles. All 10 patients survived without need of intubation. For comparison, three other patients who needed intubation had a maximal work of breathing within the preceding 24 hours of 5.3 ± 1.2 with a respiratory rate score of 3.7 ± 0.6, as in non-intubated patients, but with more often use of respiratory accessory muscles. Our data suggest that patients with COVID-19 pneumonia can be supported for extended periods using HFNC despite tachypnea provided there is only infrequent use of respiratory accessory muscles, corresponding to a WOB scale ≤ 4, prompting closer assessment for possible intubation when WOB > 4. This approach would be especially advantageous under conditions of high disease intensity when avoidance of intubation is likely to result in a better outcome.

Clinical Presentations and Outcomes of Industrial Chlorine Gas Exposure Incidence in Oman

Objective: The main objective was to study different clinical presentations and outcomes of patients after acute industrial chlorine gas exposure in Oman with evaluation of overall incident management to help develop a chemical exposure incident protocol. Methods: This was a retrospective observational study of 15 patients exposed to chlorine gas after an accidental chlorine gas leak in a metal melting factory in Oman. Results: Six (40%) patients were admitted and nine (60%) patients were discharged from the emergency department (ED) after initial management. The important post-chlorine gas exposure clinical symptoms were eye irritation (66.6%), cough (73.3%), shortness of breath (40.0%), chest discomfort (66.6%), rhinorrhea (66.6%), dizziness (40.0%), vomiting (46.6%), sore throat (13.3%), and stridor (53.3%). Important signs included tachycardia (40.0%), tachypnea (40.0%), wheeze (20.0%), and use of accessory muscles for breathing (20.0%). Signs and symptoms of eye irritation, rhinorrhea, tachycardia, tachypnea, wheeze, and use of accessory muscles for breathing have shown significant correlation with outcome (admission) having P value of <.05. Conclusion: In the presented acute chlorine gas exposure incidence, 15 exposed persons were brought to the ED, out of which six were admitted and nine were discharged after symptomatic treatment. Signs and symptoms of eye irritation, rhinorrhea, tachycardia, tachypnea, wheeze, and use of accessory muscles of breathing show significant relation with the outcome of admission.