Core Signs Research Articles

A pilot investigation into the efficacy of a signing training strategy for staff working with adults with intellectual disabilities

Accessible summary We taught staff some useful signs to help them to communicate with people. We asked staff if they liked the different ways of teaching we used. We tested staff trained to see if they remembered the signs.We found out that: Trained staff could do the signs better than untrained staff. Staff who had been taught liked the different ways of teaching that we used. Only a few staff used the signs a lot when they were communicating with people.SummaryTo contribute to increasing the quality and quantity of communication between staff and adults with intellectual disabilities, training was undertaken to enhance the awareness and knowledge of signing as a method of communication. Multidisciplinary team members, residential and day centre staff were trained to use 20 core signs. Training methods employed included: a training session; a training video; and a training card showing the 20 signs. Caregiver knowledge of the 20 signs was assessed between 6 and 12 months following implementation of the training. Information was also collected about the level of exposure to each of the training methods, and about staff perceptions of the usefulness and effectiveness of the different training types. Training was considered effective by staff, especially the formal training. Trained staff were significantly more accurate at signing, although this knowledge and capability did not often translate into everyday use of signs.

Is tonic immobility the core sign among conventional peritraumatic signs and symptoms listed for PTSD?

BackgroundPrevious studies suggested the importance of peritraumatic reactions as predictors of PSTD symptoms severity. Despite mounting evidence that tonic immobility occurs under intense life threats its role as predictor of PTSD severity remains by and large understudied. The objective of this study was to investigate the role of peritraumatic reactions (tonic immobility, panic and dissociation) as predictors of PTSD symptoms severity. MethodsParticipants were 32 victims of urban violence with PTSD diagnosed through the SCID-I. In order to evaluate PTSD symptoms at baseline, we used the Post-Traumatic Stress Disorder Checklist — Civilian Version. To assess peritraumatic reactions we employed the Physical Reactions Scale, the Peritraumatic Dissociative Experiences Questionnaire and Tonic Immobility questions. As confounding variables, we considered negative affect (measured by the Positive and Negative Affect Schedule — Trait Version), sex and time elapsed since trauma. ResultsTonic immobility was the only predictor of PTSD symptoms severity that kept the statistical significance after controlling for potential confounders. LimitationsThis study was based on a relatively small sample recruited in a tertiary clinic, a fact that may limit the generalizability of its findings. The retrospective design may have predisposed to recall bias. ConclusionsOur study provides good reason to conduct more research on tonic immobility in PTSD with other samples and with different time frames in an attempt to replicate these stimulating results.

Schizophrenia and 22q11.2 deletion syndrome

22q11.2 deletion syndrome (22qDS) is a genetic syndrome associated with a chromosome 22q11.2 deletion and variable phenotypic expression that commonly includes schizophrenia. Approximately 1% of patients with schizophrenia have 22qDS. The schizophrenia in 22qDS appears broadly similar to that found in the general population with respect to core signs and symptoms, treatment response, neurocognitive profile, and MRI brain anomalies. However, individuals with a 22qDS form of schizophrenia typically have distinguishable physical features, have a lower IQ, and may differ in auxiliary clinical features. IQ, length of 22q11.2 deletions, and COMT functional allele do not appear to be major risk factors for schizophrenia in 22qDS. Ascertainment biases and small sample sizes are limitations of most studies. Larger studies over the lifespan and continuing education about this underrecognized condition are needed. 22qDS-schizophrenia is an important genetic subtype and a valuable model of neurodevelopmental mechanisms involved in the pathogenesis of schizophrenia.

The sensitivity and psychometric properties of a brief computer-based cognitive screening battery in a depression clinic

At present, there is poor accuracy in assessing cognitive and vegetative symptoms in depression using clinician or self-rated measures, suggesting the need for development of standardized tasks to assess these functions. The current study assessed the psychometric properties and diagnostic specificity of a brief neuropsychological screening battery designed to assess core signs of depression; psychomotor retardation, attention and executive functioning difficulties, and impaired emotion perception within an outpatient psychiatry setting. Three hundred eighty-four patients with mood disorders and 77 healthy volunteers participated. A large percentage of patients met diagnostic criteria for Major Depressive Disorder alone (49%) or with another comorbid psychiatric disorder (24%). A brief, 25-min battery of computer-based tests was administered to control participants and patients measuring the constructs of inhibitory control, attention, visual perception, and both executive and visual processing speed. The patient groups performed significantly worse than the control group regardless of diagnosis on visual perception and attention accuracy and processing speed factors. Surprisingly, the anxiety disorder group performed better than several other psychiatric disorder groups in inhibitory control accuracy. Developing valid and reliable measures of cognitive signs in mood disorders creates excellent opportunities for tracking cognitive status prior to initiation of treatment, and allows for reliable retest following treatment.

A fossil galaxy cluster: an X-ray and optical study of RX J1416.4+2315

We present a detailed X-ray and optical study of a distant fossil system RX J1416.4+2315 (z=0.13), combining Chandra and XMM-Newton observations, optical photometry and spectroscopy. X-ray emitting hot gas imaged by both the Chandra and XMM-Newton shows a globally relaxed spatial distribution, supporting the idea that fossil groups are old galaxy systems with no recent mergers. However, the diffuse X-ray emission shows signs of asymmetries in the core of the system. With a mean gas temperature of ~ 4.0 keV and total gravitational mass of 3.1 x 10^14 solar mass, within the virial radius, this is better described as a fossil galaxy cluster rather than a fossil group. The temperature profile shows no sign of a significant cooler core despite a cooling time dropping to 5 Gyr within the resolved core. We find a mass concentration parameter c_200 ~ 11 which is relatively high for a cluster of this mass, indicative of an early formation epoch. Using the spectroscopically identified cluster members we present the galaxy luminosity function for this fossil system. We measure the velocity dispersion of the galaxies to be ~ 700 km/s based on 18 confirmed members. The dynamical mass is nearly twice the total gravitational mass derived from the X-ray analysis. The measured R-band mass-to-light ratio, within the virial radius, is ~ 440 M/L (solar) which is not unusual for clusters of galaxies. The central giant elliptical galaxy has discy isophotes and spectral features typical of elliptical galaxies.

A Successful Surgical Case: Inflammatory Abdominal Aortic Aneurysm with Distinct Abdominal Pain, Is It Really an Aortic Rupture?

A 75-year-old woman was admitted to our hospital with a chief complaint of distinct abdominal pain. At first we suspected rupture of an abdominal aortic aneurysm because of the presence of a pulsatile abdominal mass. However, the computed tomography with contrast enhancement revealed an infrarenal abdominal aortic aneurysm with marked thickening of the aneurysmal wall (mantle core sign) and left hydronephrosis. Left hydronephrosis was caused by rigid adherence of the adjacent left ureter to the aneurysmal wall. We diagnosed an unruptured inflammatory abdominal aortic aneurysm and performed elective surgical replacement of the abdominal aorta using a Y-shaped woven Dacron graft. We avoided urological intervention for the hydronephrosis to prevent injury to the ureter because marked thickening of the aneurysmal wall and rigid adherence of adjacent structures decrease after surgery. Recognition of abdominal aortic aneurysm with careful diagnostic management before surgery can help determine the operative strategy.

Features of the metabolic syndrome present in survivors of bone marrow transplantation in adulthood

Chatterjee et al1 report five female adult recipients of bone marrow transplantation (BMT) presenting with core signs of metabolic syndrome. They state that no data are available on metabolic syndrome in adult BMT recipients for haematological malignancy. In March 2004, we reported the incidence of features of the metabolic syndrome in a group of 16 adult recipients of BMT.2

Entropy scaling in galaxy clusters: Insights from anXMM-Newtonobservation of the poor cluster A1983

An XMM-Newton observation of the cool (kT=2.1 keV) cluster A1983, at z=0.044, is presented. Gas density and temperature profiles are calculated for the inner 500 h_{50}^{-1} kpc (~0.35 r_200). The outer regions of the surface brightness profile are well described with a beta model with beta=0.74, but the central regions require the introduction of a second component. The temperature profile is flat at the exterior with a slight dip towards the centre. The total mass profile, calculated assuming hydrostatic equilibrium, is consistent with an NFW profile, but with a low concentration parameter c=3.75 +/- 0.74. The M/L_B ratio profile shows that, at large scale, light traces mass to a reasonable extent, and the M/L_B ratio at 0.35 r_200 is consistent with the trends with mass observed in the optical. The M_Fe/L_B ratio is about two times less than that observed for a cluster at 5 keV. The gas mass fraction rises rapidly to level off at ~200 kpc; the value at 0.35 r_200 is ~8%. The scaling properties of the emission measure profile are consistent with the empirical relation \mgas \propto \Tx^{1.94}, and not with the self-similar relation \mgas \propto \Tx^{1.5}. Comparison of the entropy profile of A1983 with that of the hot cluster A1413 shows that the profiles are well scaled using the empirically determined relation S \propto \Tx^{0.65}, suggesting that the slope of the S-T relation is shallower than in the self-similar model. The form of the entropy profiles is remarkably similar, and there is no sign of a larger isentropic core in the cooler cluster. These data provide powerful agruments against preheating models. In turn, there is now increasing observational support for a trend of f_gas with system mass, which may go some way towards explaining the observed scaling behaviour. (Abridged.)

Introduction

Although we know much more now than we did 50 years ago about autism, the nature, origin and even the definition of the condition are still debated and remain largely unknown. This special issue begins with a review of the facts about autistic disorders, as they are known at present. In their introduction, Elizabeth Hill & Uta Frith (2003) remind the reader that autism is no longer regarded as a rare disease. They provide examples of genetic and brain research that targets the biological causes of autism and they review the three major cognitive theories that are currently used to explain the core signs and symptoms of autism. Much more is known now about autism than was known only a few years ago, and there is justified hope that our understanding of autism will continue to accelerate at a fast pace. This issue contains examples of the cutting edge of research and highlights some of the most burning questions. Some of these relate to the diagnosis of Asperger syndrome (AS), the identification of subgroups in the autism spectrum and early signs of autistic disorder. Other questions relate to the brain abnormalities that underlie the putative cognitive deficits and whether these can be made visible through magnetic resonance imaging. The shared assumption among the contributors is that autism is a neurodevelopmental disorder that gives us a unique window on the relationship between mind and brain. The research reported elaborates the key theories that have been put forward to explain the signs and symptoms of autism. These theories try to explain the selective impact of brain abnormality on some of the most high–level mental functions, such as social insight, empathy and information processing style.

A review of common sleep disorders.

What should clinicians know about sleep disorders? This article briefly introduces the reader to sleep medicine and succinctly reviews common sleep disorders. First, the authors describe the diagnostic tools unique to sleep medicine: the over-night polysomnogram and the multiple sleep latency test. Next, the authors review essential features of a subset of the sleep, described in the International Classification of Sleep Disorders-Revised, that sleep disorder specialists commonly evaluate, diagnose, and treat. The disorders reviewed include the intrinsic and circadian rhythm subsets of the dyssomnias group and the parasomnia group of sleep disorders. The authors identify the core signs and symptoms, polysomnogram findings, multiple sleep latency test findings, and treatment of these disorders.

Impaired glucose tolerance and dyslipidaemia as late effects after bone-marrow transplantation in childhood

This follow-up study aimed to assess the frequency of late effects on glucose and lipid metabolism after bone-marrow transplantation in childhood. 23 long-term survivors (median age 20 years) were studied 3-18 years after bone-marrow transplantation and compared with 23 healthy controls matched for age and sex and with 13 patients in remission from leukaemia. 12 (52%) of the 23 bone-marrow transplantation patients had insulin resistance, including impaired glucose tolerance in six and type 2 diabetes in four. The core signs of the metabolic syndrome (hyperinsulinaemia and hypertriglyceridaemia combined), were found in nine (39%) of the bone-marrow transplantation patients compared with one (8%) of the 13 leukaemia patients and none of the healthy controls (p=0.0015). The frequency of insulin resistance increased with the time since bone-marrow transplantation. Abdominal obesity, but not overweight, was common among the patients with insulin resistance. Long-term survivors of bone-marrow transplantation are at substantial risk of insulin resistance, impaired glucose tolerance, and type 2 diabetes even at normal weight and young age. They also develop typical signs of the metabolic syndrome. We advocate measurement of serum lipids, fasting blood glucose, and serum insulin for the follow-up of all patients who undergo transplants in childhood, to be continued regularly and possibly life-long.

A CASE OF FOURNIER'S GANGRENE ASSOCIATED WITH RECTAL CANCER

A patient with Fournier's gangrene associated with advanced rectal cancer who could not be saved because of rapidly deteriorated course is reported. A 75-year-old man complaining of tarry stool revealed apple core sign in the rectum Rb on a barium enema study, and was admitted to the hospital with a diagnosis of rectal cancer. At a digital examination of the rectum, a whole-circumference tumor was palpated. No perianal abnormalities were noted, but swellings in the same region and scrotum were confirmed and incision drainage was performed. Two days later a swelling with crackling sensation covering from the perineum to right lateral abdominal region continuously appeared. Emergency operation was performed where an incision drainage and a removal of necrosed tissues were performed. The patient was associated with postoperative disseminated intravascular coagulation (DIC) and consequent adult respiratory distress syndrome (ARDS), and was managed by artificial respiration. But the patient's condition deteriorated and died on the 6th postoperative day. There have been only one domestic case and two foreign cases in which Fournier's gangrene was associated with rectal cancer before operation as far as we could review. In all cases, rectal cancers perforated the rectal wall and this direct invasion of cancer caused perianal abscess.

A CASE OF OVARIAN METASTASIS FROM A RECTAL CANCER

It is relatively uncommon that rectal cancer metastasizes to the ovary. This time we experienced a case of rectal cancer with bilateral ovarian cancer which were resected on an one-step approach. A 42-year-old woman was seen at the hospital because of abdominal tumor and constipation. Abdominal echography revealed a large cystic tumor in the right ovary. As to tumor markers, CEA and CA 125 were as high as 1, 000ng/ml and 79U/ml respectively and a malignant tumor of the digestive system was suspected. Barium enema study revealed apple core sign in the rectum. Abdominal CT scan and MRI revealed a large cystic tumor in the right ovary. With a suspicion of metastatic ovarian tumor from rectal cancer or primary ovarian tumor, low anterior resection for the rectal cancer, bilateral oophorectomy and uterectomy were performed simultaneously. Postoperative course was uneventful. Histological grading of the rectal cancer was se, ly1, v1, n1, P2, H0, and stage IV. Histological diagnosis of the resected specimen material of the rectum was well differentiated adenocarcinoma and not only the right ovary but also the left ovary had metastatic foci from the rectal cancer. It is considered that bilateral oophorectomy should be performed when metastatic ovarian tumor of rectal cancer is diagnosed, because bilateral ovarian metastases can occur in a high rate.

Diagnoses among referrals to a Swedish clinic specialized in temporomandibular disorders

The purpose was to describe the distribution of diagnoses among all referrals to a clinic specialized in temporomandibular disorders (TMD). A series of 1500 consecutive patients, evaluated by 1 dentist, were diagnosed according to the criteria of The International Classification of Diseases, 9th Revision, Clinical Modification: ICD-9-CM. Some referrals (12%) were never evaluated, were symptom-free, or were forwarded to other clinics. Various dental, neurogenic, occlusal, dentofacial, and other problems occurred. Vague orofacial pain was common, as was tension-type headache (6% each). More than 5% of the patients were affected by systemic disorders with manifestations in the temporomandibular joints. About half of all referrals could be strictly diagnosed with TMD. Myalgia was diagnosed as the main complaint in 19%. Internal derangement 'clicking' (15%) and 'closed lock' (6%) were more common than traumatic/unspecified arthritis (6%) or osteoarthrosis (5%). A combination of myalgia and clicking appears to be the core sign in patients referred with TMD.

A CASE OF CARCINOMA OF THE DESCENDING COLON PRESENTING WITH AN ABSCESS OF THE ABDOMINAL WALL

Invasion into the abdominal wall of a carcinoma of the colon may produce an abscess of the abdominal wall and on rare occasions this may be the presenting sign of the carcinoma. A 48-year-old man was admitted to the hospital because of a tumor in the left upper quadrant of the abdomen. Colonoscopy showed a type 3 tumor and a whole-circumferential stenosis in the desescending colon. Abdominal ultrasonogram revealed an echogenic mass about 5 cm in size in the left upper quadrant. Computed tomogram demonstrated a low density area about 5 cm in size with air in the mass. Lower gastrointestinal fluoroscopy revealed apple core sign in the descending colon, and defluxion and collection of barium from the anal side of the tumor to the left lateral wall. From these findings, the case was diagnosed as abscess formation due to invasion into the abdominal wall of cancer of the descending colon, and a transverse colostomy and drainage of the abscess cavity were performed. After 26 days after the operation when his general condition improved, a left hemicolectomy was performed. The resected tumor was 70×60mm in size and perforated portion was obscure. Histological diagnosis was mucinous adenocarcinoma.

Extrapyramidal signs in patients with probable Alzheimer disease.

To examine whether extrapyramidal signs (EPSs) were associated with more rapid progression of Alzheimer disease (AD). Cross-sectional with longitudinal follow-up and the likelihood of arriving at 4 end points: Mini-Mental State Examination score of less than 9, Blessed Dementia Rating Scale score for activities of daily living of 15 or more, institutionalization, and death using a proportional hazard model with 6 variables: overall EPSs, bradykinesia, tremors, abnormal gait, cogwheel rigidity, and postural instability. Multidisciplinary behavioral neurology research clinic. We examined the individual EPS characteristics of 164 patients with mild-moderately probable AD, free of neuroleptic medication, participating in a longitudinal study of dementia. Patients with AD with EPSs (n= 51 [31%]) were older (P>.001) and had lower Mini-Mental State Examination scores (P=.003) than those without EPSs at study entry. Bradykinesia was present in 35 (69%) of the 51 patients with EPSs, abnormal gait in 18 (35%), rigidity in 10 (20%), postural instability in 10 (20%), tremors in 7 (14%), and oral-mandibular dyskinesia in 2 (4%). Using proportional hazard analysis with time-dependent covariates for overall EPSs and individual EPSs, adjusted by age at study entry, education, Mini-Mental State Examination score, and Blessed Dementia Rating Scale score for activities of daily living, the development of EPSs was associated with time to institutionalization (P<.001) but not with cognitive (eg, Mini-Mental State Examination score <9) or functional (eg, Blessed Dementia Rating Scale score > or = 15) decline or death. However, when we examined severity of the EPSs, as measured by the New York University Parkinson's Disease Scale, the development of EPSs was associated with functional decline (P=.005). Of the individual EPSs, rigidity predicted death (P<.001) and institutionalization (P=.03), whereas tremors predicted functional decline (P=.02). In this cohort, the presence or absence of EPSs is related to time to institutionalization, but not to severe cognitive or functional impairment or death. However, when severity of the extrapyramidal phenomenon is taken into account, EPSs are related to functional decline. Further, it appears that a subgroup of patients with AD with EPSs, where cogwheel rigidity and tremors are the core signs, can have a worse outcome.

A Case of Familial Adenomatous Polyposis Associated with Colon Cancer, Ureteral Cancer and Two Early Gastric Cancers

Abstract:A rare case of Familial Adenomatous Polyposis (FAP), associated with colon cancer, ureteral cancer and two early gastric cancers, is reported. A 42‐year‐old male was admitted to our hospital for evaluation of bloody stools and macrohematuria. There were six FAP patients in his family line, spanning four generations, and five had developed colon cancers. A barium enema revealed diffuse and scattered polyposis throughout the colon and an apple core sign in the descending colon. Abdominal CT disclosed right hydronephrosis with a markedly dilated ureter. Surgery was undertaken and included total colectomy, mucosal proctectomy, ileoanal anastomosis and right nephrectomy with ureteral resection, under a diagnosis of colon cancer and complete right ureteral stenosis. The resected specimens revealed a colon cancer in the descending colon, 50×32×15 mm in size and a ureteral cancer in the lower part of the right ureter, 30×16×16 mm in size.Four years later, he visited our hospital for detailed gastric examination, because gastric abnormalities had been pointed out in a health screening examination. Upper Gl X‐ray and endoscopic studies disclosed two cancerous lesions in the gastric antrum, one being a lie lesion in the anterior wall and the other a Ha + lie lesion in the posterior wall. Subtotal gastrectomy was performed and histological study revealed that invasiveness was limited to the submucosa in both lesions. No case of FAP associated with ureteral cancer has previously been reported and only 28 cases with associated gastric cancer have appeared in the Japanese literature.

Simulations of X-ray clusters

We present simulations of the formation and evolution of galaxy clusters in the cold dark matter cosmogony. Clusters with a wide range of mass were selected from previous N-body models, and were resimulated at higher resolution using a combined N-body/Smooth Particle hydrodynamics code. The effects of radiative cooling on the gas are neglected. While many present-day clusters are predicted to be undergoing mergers, the density profiles of those that are approximately in equilibrium are all very similar, both for the gas and for the dark matter. These profiles show no sign of a uniform-density core and steepen gradually from the centre outwards. The standard β-model is a reasonable fit over most of the radius range observable in real clusters. However, the value obtained for the slope parameter βf increases with the outermost radius of the fit. Temperature profiles of different simulated clusters are also similar. Typically the temperature is almost uniform in the regions that emit most of the X-ray flux but drops at larger radii. The gas temperature and dark matter velocity dispersion in equilibrium clusters give values of βT≡ μmp σ2DM/KT which are consistent with unity provided an X-ray emission-weighted temperature is used. Larger values of βT are found in merging objects where there is a transient boost in the velocity dispersion of the system. Thus βT> 1 may be an observational indicator of merging in real clusters. The similar structure of clusters of differing mass results in scaling relations between the X-ray and dynamical properties of clusters identified at any given redshift. These scalings are inconsistent with the observed slope of the luminosity-temperature relation or the observed sense of evolution of the cluster luminosity function. This suggests that the central properties of intracluster medium are determined by non-gravitational process such as radiative cooling or substantial pre-heating at high redshift.

A CASE OF PRIMARY JEJUNAL CANCER FOUND ON UPPER GI BARIUM STUDIES

Primary small bowel cancer is relatively rare and presents difficulty in preoperative diagnosis. We experienced a case of primary jejunal cancer which was successfully diagnosed by upper gastrointestinal series preoperatively. A 39-year-old woman was seen at the hospital because of an upper abdominal pain. Upper gastrointestinal series revealed a displacement at the greater curvature of the body of stomach and an apple core sign in the jejunum. The patient was diagnosed as having a primary jejunal cancer. Partial excision of the jejunum was carried out. The patient is doing well as of 3.5 years after the operation. Our experience with this case would emphasize the importance that we should entertain a possible presence of small bowel cancer for exploring some lesion in the upper gastrointestinal organs, leading to early detection and improved longterm outcome of the disease.

TWO CASES OF SIGMOID DIVERTICULITIS SHOWING APPLE CORE SIGN

Apple core sign in barium enema is assumed to be characteristic of advanced ulcer-forming colon cancer invading the subserosa with a size of more than 3 cm in diameter. We experienced two cases of sigmoid colon diverticulitis with apple core sign on preoperative barium enema. In both cases colonoscope could not pass through the stenosis. Although biopsies taken from that region showed no malignancy, possibility of carcinoma could not be excluded and laparotomy was performed. Case 1 was a 64-year-old man. Barium enema revealed an apple core sign with diverticula at the sigmoid colon. Sigmoidectomy was performed. Histological diagnosis was inflammatory stenosis resulted from diverticulitis, and there was no malignant findings. Case 2 was a 47-year-old man. Left hemicolectomy was performed because of an apple core sign at the sigmoid colon and diverticular in the descending and sigmoid colon demonstrated on the barium enema. Histological examination of the resected colon revealed diverticulitis. These two cases suggest that colon diverticulitis can demonstrate an apple core sign due to the fibrous hyperplasia of the serosa caused by chronic inflammation in the adjacent plural diverticula.