External Sign Research Articles

CORR Insights®: What is the Best Clinical Test for Assessment of the Teres Minor in Massive Rotator Cuff Tears?

A s the authors of the current study eloquently state, ‘‘The teres minor seems to be a forgotten muscle in the evaluation and management of rotator cuff disorders.’’ This statement is especially true in the setting of massive rotator cuff tears. However, recent research has allowed us to gain an understanding of the importance of the teres minor as it relates to clinical and functional outcomes in massive cuff tears. Simovitch et al. [5] demonstrated that a functional teres minor with less fatty infiltration (Grade 0, 1, or 2) resulted in an improved Constant score and better external rotation after reverse shoulder arthroplasty. Further, a recent study [4] found that the teres minor will hypertrophy when there is an infraspinatus tear, suggesting an overlap of function and the potential to gain function for external rotation even in patients with large posterosuperior rotator cuff tears. The current study focuses on our ability as clinicians to detect the function of the teres minor in massive rotator cuff tears, and determine the role the teres minor has in clinical outcomes. With the data presented, it appears that external rotation lag sign is an excellent test for teres minor dysfunction and can be used to predict teres minor dysfunction and clinical outcomes after reverse shoulder arthroplasty. This is important in educating the patient in the expected post-operative function after reverse shoulder arthroplasty.

G494 Extreme childhood obesity: an external sign of psychosocial and emotional problems

Methods Evaluation of referrals of families referred to Tier 3 obesity service for children 4–12 years with BMI > 98 th centile (or 91 st centile with complexity), previously unengaged. Project ethos based in principles of systemic family psychotherapy, approached the problem following NICE 2013 guideline Childhood Obesity. Family therapist, dietician, activities specialist and paediatrician, offered a comprehensive outreach approach including home visits. Initial assessment explored causes and complications of obesity including Strengths and Difficulties questionnaire SDQ and assessment of child’s mental health. Goals were set with families including parenting/family therapy. Families were seen fortnightly for 3 months, assessed 3 monthly, up to 1 year. Results 144 referred: School Nursing Team (71); Community Paediatricians (37); Others (36). 120/144 (83%) met criteria for clinic. Of these 72/120(60%) accepted first appointment (no response from 20/120(16%), declined by 28/120(23%)) Ethnicity of children: White 19%, Black British/African/Caribbean 60%, Other 20%. English as additional language 33/72(46%), 9 requiring interpreter. All were >98 th centile BMI. Almost all children engaged stabilised BMI z scores at 3 months. (20/23 (87%). Frequent psychosocial factors identified includied lone parent 27/72(38%); siblings/parent physically disabled;12/72(17%); no parent employed 17/72(24%), current/previous social services 12/72(17%), domestic violence 9/72(13%), parental mental illhealth:8/72(11%). Neurodevelopmental disorders included autism, Down’s syndrome, ADHD, Cerebral palsy, learning disability and medical problems, plus significant behavioural difficulties. Initial SDQ indicated substantial risk of clinical significance 19/72(26%). Two children were suicidal and self harm concerns in four. Referrals were made to social services for CIN or CP concerns (12/72) (17%). Conclusion Extreme obesity in children is systemic and multifactorial, often associated with concerning psychosocial problems in families. Paediatricians who care for children who are extremely obese should enquire about mental health, parenting, development and psychosocial factors, and make appropriate referrals. Childhood obesity often indicates family distress and unmet need including important child mental health difficulties.

„Mysterium” w euchologii hiszpańsko‑mozarabskiej: od epistemologii liturgicznej do eklezjalnej praxis

Jedną z charakterystycznych cech hiszpańskiej euchologii jest jej akcent położony na misterium poznawane, przekazywane i partycypowane w rycie przez wiarę. Ten trójpodział wyznacza rytm refleksji nad pojęciem tajemnicy w rycie hiszpańsko-mozarabskim, który został przedstawiony w niniejszym artykule. Dlatego przede wszystkim zostało ukazane, że liturgia mozarabska jest ukierunkowana ad consideranda divinis Mysteriis sacramenta. To słowne połączenie terminów mysterium oraz sacramentum jest charakterystyczne dla tego rytu i ustanawia właściwe współrzędne hermeneutyczne dla epistemologii liturgicznej. Te dwa pojęcia nie są jeszcze synonimami, a bardziej wskazują na dwa różne aspekty: zewnętrzny (znak) oraz wewnętrzny (rzeczywistość zbawcza mediatyzowana w rycie). Liturgiczna actio otwiera przestrzeń i czas, aby w widzialnych znakach uczestnik liturgii odkrywał niewidzialną rzeczywistość. Po drugie, dla mozarabów misterium nie wyraża jedynie prawdy o niepoznawalności Boga, lecz wskazuje na Jego trynitarne odsłonięcie, objawienie. Wreszcie, euchologia hiszpańska jest naznaczona troską o adekwatne świętowanie mysteriis solemnitatis, co można tłumaczyć jako łaskę sakramentalną oraz o zachowania odore fragrantia mysterium. Życie chrześcijańskie jawi się w tej perspektywie jako przeżywanie tajemnic, które Bóg zechciał dzielić z człowiekiem. Wprowadza to eklezjalny paradygmat mądrości, który obejmuje liturgię rozumianą jako arcanum Christi.

Serum chemistry reference values for the common genet (Genetta genetta): variations associated with Leishmania infantum infection

Background: The role of wildlife in the epidemiology of leishmaniosis in under debate, and determining whether infection with Leishmania infantum causes illness in wild carnivores is important to determine its potential role as a reservoir.Objectives: To provide for the first time serum biochemistry reference values for the common genet (Genetta genetta), and to determine variations associated with L. infantum infection.Methods: Twenty-five serum biochemistry parameters were determined in 22 wild-caught genets. Blood samples were analyzed for L. infantum DNA by means of real-time polymerase chain reaction (PCR).Results: Two female genets were positive for L. infantum DNA but did not show any external clinical sign upon physical examination. Among other variations in the biochemistry values of these genets, one presented a higher concentration of gamma-globulins and cholesterol, whereas the other genet presented increased creatinine, bilirubin, and chloride levels when compared to uninfected females. Sex-related differences in some parameters were also reported.Conclusion: Infection with L. infantum may sometimes be accompanied by abnormal serum biochemistry in wild carnivores.Clinical importance: Clinical disease may occur in L. infantum-infected wild carnivores. This has implications in the epidemiology of leishmaniosis. In addition, the data provided here would also be useful as reference values for researchers or rehabilitators working with the common genet.

Poster 241 Differential Regenerative Capacities of Human Blood-Vessel-Derived Stem Cell Subsets in Injured Skeletal Muscle

Disclosures: J. Luz, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: There is sparse data on the utility of physical examination maneuvers described for rotator cuff tear, and the diagnosis in patients presenting with shoulder pain is challenging. Therefore, we determined the diagnostic accuracy of “special tests,” described for the diagnosis of rotator cuff tears. Design: Our prospective cohort study complies with the Standards for Reporting of Diagnostic Accuracy (STARD) guidelines. Setting: Outpatient physiatry and orthopedic clinics. Participants: Between 02/2011 and 12/2012, we recruited 214 eligible participants over 45 years of age with shoulder pain. Interventions: Physicians trained in our research protocol performed a standardized physical examination including 15 special tests. Patients also underwent shoulder MRI that was read by two shoulder experts blinded to clinical findings. Main Outcome Measures: Rotator cuff tear, diagnosed based on MRI and the clinical impression of a shoulder/sports medicine attending. Results or Clinical Course: Of 214 recruits, 80 satisfied our stringent criteria for rotator cuff tear. The lift-off test had 100% sensitivity (95% CI1⁄421-100), 93% specificity (95% CI1⁄4 87-97) and likelihood ratio (LRþ) 14.7 for the detection of subscapularis tears. The belly-press test had 100% sensitivity (34-100), 86% specificity (78-91), and LRþ 7.1 for the detection of subscapularis tears. Jobe’s test had 61% specificity (52-69), 86% sensitivity (7693), and LRþ 2.2 for the detection of supraspinatus tears. Full can test had 82% specificity (74-88), 71% sensitivity (59-81) and LRþ 3.9 for the detection of supraspinatus tears. External rotation lag sign had 97% specificity (93-99), 23% sensitivity (11-40), and LRþ of 9.0 for the detection of infraspinatus tears. Hornblower sign had 96% specificity (91-99), 28% sensitivity (15-46), and LRþ 7.8 for the detection of infraspinatus tears. Neer sign was a poor test for the detection of tears with 57% specificity (48-66), 50% sensitivity (15-85), and LRþ 1.2. Conclusions: Our data show that lift-off and belly-press tests had the highest diagnostic accuracy for subscapularis tear. External rotation lag sign, Jobe’s test, and full can test can considerably improve post-test probability for diagnosis of infraspinatus and supraspinatus tears. Clinicians can use the data to inform their diagnostic accuracy when assessing patients with shoulder pain.

Duchowość osób konsekrowanych w świetle adhortacji Jana Pawła II Vita consecrata

Refleksja uwzględnia problematykę zawartą w temacie, skupiając się na jego trzech zasadniczych składowych: koncepcji duchowości życia konsekrowanego, jego tożsamości, z której wynika styl życia i działania powołanych w myśl zasady: „agere sequitur esse”, oraz na jej reprezentacyjnych cechach sprowadzonych za przykładem struktury adhortacji Vita consecrata do trzech: konsekracja, komunia i misja. Duchowość traktujemy jako przejaw ducha ucznia Chrystusa wezwanego szczególnym powołaniem do radykalnego pójścia za Nim drogą zakonnej konsekracji. Ponieważ jest to także zewnętrzny przejaw ducha, istotna jest tożsamość osoby, która powinna egzystować w sposób „godny powołania”, a przez to dawać świadectwo zbawczej obecności Boga w dzisiejszym świecie w sposób niemal bezwiedny. Trzy cechy charakterystyczne duchowości osoby konsekrowanej określają jednocześnie jej tożsamość: osoba oddana przez śluby rad ewangelicznych Bogu; osoba komunii z Bogiem i braćmi oraz prorok-świadek wielkich dzieł Bożych, które realizują się w słabym człowieku. Całość wieńczy krótka synteza, która może stanowić jedynie pewną wskazówkę na temat tej złożonej rzeczywistości i zaproszenie do budowania tej syntezy na płaszczyźnie egzystencjalnej przez poszczególne osoby konsekrowane i ich wspólnoty.

The diagnostic value of the combination of patient characteristics, history, and clinical shoulder tests for the diagnosis of rotator cuff tear.

BackgroundIt is unknown which combination of patient information and clinical tests might be optimal for the diagnosis of rotator cuff tears. This study aimed to determine the diagnostic value of nine individual clinical tests for evaluating rotator cuff tear and to develop a prediction model for diagnosing rotator cuff tear.MethodsThis prospective cohort study included 169 patients with shoulder complaints. Patients who reported a previous shoulder dislocation were excluded from the analysis (N = 69). One experienced clinician conducted 25 clinical tests of which 9 are specifically designed to diagnose rotator cuff pathology (empty can, Neer, Hawkins-Kenney, drop arm, lift-off test, painful arc, external rotation lag sign, drop sign, infraspinatus muscle strength test). The final diagnosis, based on magnetic resonance arthrography (MRA), was determined by consensus between the clinician and a radiologist, who were blinded to patient information. A prediction model was developed by logistic regression analysis.Results and discussionIn this cohort, 38 patients were diagnosed with rotator cuff tears. The individual overall accuracy of the rotator cuff clinical tests was 61%–75%. After backward selection, the model determined that the most important predictors of rotator cuff tears were higher age and a positive Neer test. This internally validated prediction model had good discriminative ability (area under the receiver operating characteristic curve (AUC) = 0.73).ConclusionOur results showed that individual clinical shoulder tests had moderate diagnostic value for diagnosing rotator cuff tear. Our prediction model showed improved diagnostic value. However, the prediction value is still relatively low, supporting a low threshold for additional diagnostic tests for the diagnosis of rotator cuff tears.Level of evidenceStudy of diagnostic test: level I.

Drawing Threaded Programs with AutoCAD Secondary Development

AutoCAD is a drawing software is widely used in various industries. AutoLISP language embedded in AutoCAD software is one of many AutoCAD development tools and used very widely in the world. In this paper, AutoLISP will be used to develop a new program for drawing thread. We will draw a variety of internal and external thread and add center sign rapidly and accurately. New source program will be provided and is very meaningful and useful to the user.

The most influential scientists in the development of the medical informatics (3): peter leo reichertz.

Peter Leo Reichertz (1930 - 1987) was a physician and uni-versity professor in the fi eld of medical computer science.He studied physics, mathematics and medicine at the dif-ferent universities throughout the Europe, in universities of Gottingen, Koln, Geneva, Munich and Bonn. During that period he persuaded PhD and directed himself toward in-ternal medicine. His main scientifi c activity in this period was in the fi eld of cardiology.The experiences in practice and the emerging possibili-ties of data processing have convinced him of the importance of computer science in medicine and made him a pioneer of medical computer science. His path led him in time from 1966 to 1969 to USA at the University of Texas and the University of Missouri. There Reichertz Peter led the radiological com-puter research was responsible in a project to create a medical information system in the hospital worked and was director of a general university computer center.In 1969 he returned to Germany and took over the Depart-ment of Medical computer science at the Medical School of Hannover, which he designed from the ground up. From that Hannover was one of the centers of medical computer sci-ence, nationally and internationally.Peter Reichertz ambition was to reject the medical com-puter science closely to the core computer science and to create an understanding of the problems and possibilities of each other’s discipline and bring a discussion. The means to do so were joint meetings with the Society for computer science and GMDS to an Advanced Course in Medical Informatics. The external sign is that of him initiated certifi cate ‘Medical Informatics’, which is awarded jointly by the GMDS and GI. From 1975 to 1988 he was also a lecturer at the Technical University of Braunschweig.He was 1976/1977 President of the GMDS, co-founder of the IMIA (International Med-ical Informatics Association) and EFMI (European Federa-tion for Medical Informatics), as its fi rst president. His work on the international level, the term ‘Medical Informatics’ and its contents signifi cantly aff ected.In his honour, Peter L. Reichertz Instituts fur Med-izinische Informatik was formed in 2007. It was founded by the Technical University Carolo-Wilhelmina on two locations, in Braunschweig and Hannover. Founding goal was the formation of a regional cluster of excellence.Interesting facts!• He spoke English as his second mother tongue, French and Japanese.• He held a pilot licence for passenger transport.• He initiated the use of term „ medical informatics“.

A Non-Invasive Population Study of Moose in Northern Yellowstone National Park

North American moose (Alces alces) populations are declining across much of their southern distribution from the Canadian Maritimes to the Rocky Mountain range of the Shiras moose subspecies (Alces alces shirasi). Shiras moose population declines have been documented in Montana and Wyoming with reduced productivity reported from Utah and Colorado. These declines are due to a combination of factors including the natural succession, loss, and degradation of habitat; predation by wolves and bears; disease caused by infection from artery worm; and parasitism by moose ticks. The effects of heat stress may also contribute to chronic malnutrition and a reduction in female fertility. Significant reductions in Montana and Wyoming moose populations adjacent to Yellowstone National Park (YNP) are indicative of regional moose population declines and suggest that moose numbers may be decreasing in YNP as well. In the northern portion of YNP, also known as the Northern Range (NR), significant loss of riparian willow browse due to overgrazing by elk for decades and by bison more recently, the reduction of mature and old-growth conifer forests from the fires of 1988 and from disease more recently have reduced both winter habitat quality and quantity for moose. Several moose with cropped ears, an external sign of the disease Elaeophorosis, or artery worm, have been observed over the past few years on the NR suggesting that the disease may also be present in YNP. Northern Range estimates of moose have decreased from almost 400 in 1970 to possibly fewer than 100 today. Despite evidence suggesting moose decline in YNP, no current population data exists. Knowledge of population demographics serves as a critical baseline for evaluating and understanding factors leading to population declines. However, because moose are solitary, prefer densely vegetated habitats, and are present at low densities, collecting population data is challenging. Traditional methods of studying moose that require capture, radio-collaring, and aerial surveys are costly, sometimes produce unreliable results, can be harmful to the study animal, and are discouraged in some jurisdictions such as national parks. Non-invasive sampling, the collection of data without having to capture, handle, or in any manner physically restrain study animals, has proven to be a valuable tool for acquiring accurate population data from free-ranging ungulates when using traditional methods is neither feasible nor practical. In December 2013, we initiated a three-year non-invasive moose population study in YNP with the main objective to estimate population demographics of NR moose. For three consecutive winters we will be systematically collecting fecal pellets from the extent of NR moose wintering habitat. We are extracting DNA from epithelial cells on the pellet surface and through genetic testing will be able to identify individual moose and their genders. Female pellet samples will be analyzed for pregnancy hormone concentrations to make inferences on pregnancy rates. Because fecal pellet size is directly related to moose size, and therefore to moose age, we will use various pellet measurements to differentiate between age classes. These data will be used in capture-recapture modeling to estimate population abundance and vital rates.

The influence of temperature on embryonic developmental arrest in marine and freshwater turtles

Temporary arrest of embryonic development can occur both pre- and post-oviposition in turtles. Pre-ovipositional arrest is an obligate part of the life cycle and occurs universally in turtle embryos, commencing while eggs are in the oviduct and persisting until after oviposition. Pre-ovipositional arrest allows turtle mothers the flexibility to choose an optimum time to nest and provides embryos some capacity to respond to varying environmental conditions immediately after eggs are laid. Following oviposition, turtle embryos are known to be significantly affected by incubation conditions and specifically, temperature has a profound influence on developmental rate and success of embryos. We conducted a comparative investigation of how temperature influences (1) the duration of pre-ovipositional arrest after eggs are laid, (2) the number of embryos that fail to recommence development and (3) hatching success, using eggs of the green sea turtle (Chelonia mydas), and three species of freshwater turtle; the western oblong turtle (Chelodina oblonga), the eastern longneck turtle (Chelodina longicollis), and the Murray River turtle (Emydura macquarii). We incubated arrested eggs of each species at three different temperatures (low, medium, high) and monitored embryonic development immediately after oviposition and throughout incubation. Interspecific variation was evident in the effects that temperature had on pre-ovipositional arrest, subsequent embryonic development and hatching success. A major finding of this study was that, with the exception of E. macquarii, there was no significant difference in the time to white spot development (the first external visible sign of embryological development following arrest) between temperature treatments, suggesting that the resumption of development and the breaking of pre-ovipositional arrest after eggs are laid are independent of temperature. Furthermore, although the number of C. mydas eggs to successfully recommence development after oviposition was consistently high (~97–100%) across the three temperature treatments, a significant proportion of C. oblonga and E. macquarii eggs failed to resume development. In both the low and high temperature treatments the rate of C. oblonga embryo mortality was 95% and 60%, respectively, and for E. macquarii it was 53% and 24% respectively. These findings bring us a step closer to understanding why failure to recommence development after oviposition causes high rates of early stage embryo mortality and decreased hatching success in turtles.

Reverse shoulder arthroplasty combined with latissimus dorsi transfer using the bone-chip technique

Reverse shoulder arthroplasty (RSA) can restore active elevation in rotator-cuff-deficient shoulders. However, RSA cannot restore active external rotation. The combination of latissimus dorsi transfer with RSA has been reported to restore both active elevation and external rotation. We hypothesised that in the combined procedure, harvesting the latissimus dorsi with a small piece of bone, leads to good tendon integrity, low rupture rates and good clinical outcome. Between 2004 and 2010, 13 patients (13 shoulders) were treated with RSA in combination with latissimus dorsi transfer in a modified manner. The mean follow-up was 65.4months, and the mean age at index surgery was 71.1years. All patients had external rotation lag sign and positive hornblower's sign, as well as radiological signs of cuff-tear arthropathy (Hamada 3, 4 or 5) and fatty infiltration grade 3 according to Goutallier et al. on magnetic resonance imaging (MRI). The outcome measures included the Constant Murley Score, University of California-Los Angeles (UCLA) shoulder score, Simple Shoulder Test (SST), visual analogue scale (VAS) and the Activities of Daily Living Requiring External Rotation (ADLER) score. Tendon integrity was evaluated with dynamic ultrasound. All patients were asked at final follow-up to rate their satisfaction as excellent, good, satisfied or dissatisfied. The overall mean Constant-Murley Shoulder Outcome Score (CMS) improved from 20.4 to 64.3 points (p < 0.001). Mean VAS pain score decreased from 6.8 to 1.1 (p < 0.001)., mean UCLA score improved from 7.9 to 26.4 (p < 0.001), mean SST score improved from 2.3 to 7.9 (p < 0.001) and mean postoperative ADLER score was 26 points. The average degree of abduction improved from 45° to 129° (p < 0.001), the average degree of anterior flexion improved from 55° to 138° (p < 0.001) and the average degree of external rotation improved from -16° to 21° (p < 0.001). Eight patients rated their results as very satisfied, three as satisfied and two as dissatisfied. This modified technique, which avoids cutting the pectoralis major tendon and involves harvesting the tendon together with a small piece of bone, leads to good or even better functional results compared with the results reported in the literature, and also has high patient satisfaction and low failure rates.

Cardiac laceration without any external chest injury in an otherwise healthy myocardium – A case series

The heart is relatively well protected within the thoracic cavity from all the sides. Thus it is rather uncommon to find a cardiac laceration in cases of blunt trauma to the chest and that too when there is no evident injury to the chest wall. Several cases with history of death following blunt trauma were autopsied by us in recent months. Out of them, 3 cases that did not exhibit any external chest injury revealed hemopericardium following rupture of a cardiac chamber. The volume and suddenness of appearance of the hemopericardium were sufficient to cause tamponade. These case reports underline the importance of a systematic and complete autopsy in all cases of blunt trauma deaths even though they may be having no external injury. They also highlight that myocardial injury must be ruled out in every living patient presenting with blunt chest trauma even in the absence of an external sign.

Clinical outcome of reverse total shoulder arthroplasty combined with latissimus dorsi transfer for the treatment of chronic combined pseudoparesis of elevation and external rotation of the shoulder

Reverse total shoulder arthroplasty (RTSA) allows correction of pseudoparesis of elevation caused by irreparable rotator cuff tear but does not address loss of active external rotation. Latissimus dorsi transfer (LDT) is an established procedure for correction of pseudoparesis of external rotation. Forty-one shoulders of 40 consecutive patients, who were a mean age of 70 years old (range 47-85 years), underwent RTSA combined with LDT for irreparable rotator cuff failure with severe shoulder dysfunction. Nine orthopedic complications occurred in 7 of the 41 shoulders. Four shoulders were lost to follow-up, and 5 were excluded from the functional analysis. The mean follow-up of the eligible 32 shoulders with the prosthesis still in place was 53 months (range, 24-105 months). The age-related Constant score increased significantly from a preoperative mean of 45% (range, 16%-80%) to 89% (range, 25%-100%). The mean subjective shoulder value increased from 33% (range, 0%-70%) to 75% (range, 30%-100%). Active external rotation significantly improved from a mean of 4° (range, -30° to 40°) to 27° (range, -10° to 70°). A preoperative external rotation lag sign could be corrected in 25 of the 32 shoulders. For the 16 shoulders with at least 5 years of follow-up, the Constant scores were 47% (range, 16%-80%) preoperatively, 92% (range, 51%-100%) at 2 years, and 94% (range, 57%-100%) at the latest follow-up, and the respective subjective shoulder values were 32% (range, 0%-70%), 73% (range, 30%-100%), and 80% (range, 60%-100%). If treated with RTSA combined with LDT, patients with pseudoparesis of elevation and pseudoparesis of external rotation can expect an excellent clinical outcome for a period beyond 5 years, provided that complications that require removal of the prosthesis can be prevented.

Effectiveness of fluoxetine to control fur-chewing behaviour in the chinchilla (Chinchilla lanigera)

Due to its complexity and the relative lack of scientific reports, fur-chewing may be considered as one of the most challenging behavioural problems common to captive chinchillas. The development of this behaviour in commercial farms and the increasing popularity of this species as a pet have increased the public demands for a treatment. The objective of this work was to evaluate the effectiveness of fluoxetine to control the development of chinchillas’ fur-chewing behaviour, using an oral dose of 10mg/kg/day for a 90 days treatment period. For the measurement of the fur-chewing affected area and its variation during treatment as external sign of whether or not the behaviour was controlled, digital pictures were taken at 0, 45, 75 and 90 days of treatment and after drug withdrawal at 140 days. Results indicated that the greatest difference in percentages of body area affected by the behaviour in control vs. treated animals was observed after 75 days of treatment. However, this was not due to a decrease in the amount of body area affected by fur-chewing in treated animals, but conversely to an increase in the symptoms observed in control animals, that showed a ~10% increase in the fur-chewing affected body area than at the beginning of the experiments. Only ~46% of the fluoxetine treated animals showed a significant reduction in the body area affected by fur-chewing. In summary, the use of fluoxetine in fur-chewing chinchillas showed limited success, mostly reducing the progression of the behaviour.

Neanderthal language? Just-so stories take center stage

GENERAL COMMENTARY article Front. Psychol., 24 September 2013Sec. Language Sciences https://doi.org/10.3389/fpsyg.2013.00671

Fertile Ground

Fertile Ground

The validity of 9 physical tests for full-thickness rotator cuff tears after primary anterior shoulder dislocation in ED patients

PurposeThis study was undertaken to validate the diagnostic values of 9 different physical tests in emergency department patients with primary anterior shoulder dislocation (PASD) to select the best screening test for full-thickness rotator cuff tear (FTRCT) after PASD. MethodsA prospective analysis of 49 consecutive patients with x-ray-confirmed PASD was performed. All patients were followed at an average of 6.9 days (ranged from 4 to 10 days) in the emergency department. On the day of follow-up, 9 physical tests (namely, Jobe test, external rotation lag sign test, infraspinatus muscle strength test, dropping test, drop test, liftoff test, internal rotation lag sign test, belly-press test, and belly-off test) followed by shoulder ultrasound scan were performed to detect FTRCT. ResultsThe prevalence of FTRCT after PASD is 37% (95% confidence interval [CI], 24%-52%). Fourteen percent of the patients with PASD were complicated with isolated supraspinatus tendon tear, whereas 22% were complicated with supraspinatus tendon tear combined with subscapularis and/or infraspinatus tendon tear. Jobe test has the highest sensitivity among the 9 physical tests being evaluated. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for positive test, and likelihood ratio for negative test of Jobe test as a screening test for FTRCT after PASD are 89% (95% CI, 64%-98%), 55% (95% CI, 36%-72%), 53% (95% CI, 35%-71%), 89% (95% CI, 65%-98%), 1.97 (95% CI, 1.29-2.99), and 0.20 (95% CI, 0.05-0.79), respectively. ConclusionsThe prevalence of FTRCT after PASD is 37% (95% CI, 24%-52%). Jobe test has the highest sensitivity (89% CI, 64%-98%) among the tests.

Two-port vs. three-port laparoscopic appendicectomy: A bridge to least invasive surgery

INTRODUCTION:The conventional three-port technique for laparoscopic appendicectomy has proven its worth in the management of appendicular pathologies. From a cosmetic viewpoint, the umbilical and suprapubic port-sites are hidden by natural camouflages, the right Iliac fossa (RIF) port is the only visible external sign of surgery. The two-port technique avoids even this marker of abdominal invasion. In this study, we describe the technique of two-port laparoscopic appendicectomy (TPA) and compare it with conventional laparoscopic appendicectomy (CLA).MATERIALS AND METHODS:All patients studied underwent operation for acute appendicitis during a 6-month period. Data were collected prospectively for the TPA and retrospectively for the CLA. The TPA was performed with one 10 mm umbilical working port and one 5 mm suprapubic camera port. A hypodermic needle was introduced in the RIF to retract the appendix. The appendicular artery was controlled with diathermy or ultrasonic shears. The base was ligated with a loop knotted extracorporeally. CLA was performed via the conventional 10 mm umbilical, 5 mm suprapubic and 5 mm RIF ports. The appendicular stump was ligated with an endoloop or an intracorporeal knot.RESULTS:A total of 146 patients underwent surgery over the 6-month period for appendicitis. Out of 62 cases attempted, the TPA was successful in 51 cases, with conversion to the three-port technique in 11. The operative time, complication rates, return to work were comparable between the two groups. Patients who had TPA had a shorter postoperative stay.CONCLUSION:This is an initial experience with TPA. There is little difference in the operative time, postoperative stay and complications rates between this technique and the conventional three-port one. There is hence little to be lost and a likely benefit to be gained by performing the TPA although a randomised study is necessary.

Symptoms and Time to Medical Care in Children With Accidental Extremity Fractures

Delay in seeking medical care is one criterion used to identify victims of abuse. However, typical symptoms of accidental fractures in young children and the time between injury and the seeking of medical care have not been reported. We describe patient and injury characteristics that influence the time from injury to medical care. Parental interviews were conducted for children <6 years old with accidental extremity fractures. Demographic characteristics, signs and symptoms of the injury, and fracture location and severity were described and examined for their association with a delay (>8 hours) in seeking medical care. Among 206 children, 69% had upper extremity fractures. The median time to the first medical evaluation was 1 hour, but 21% were seen at >8 hours after injury. Although 91% of children cried after the injury, only 83% were irritable for >30 minutes. Parents observed no external sign of injury in 15% of children, and 12% used the injured extremity normally. However, all parents noted at least 1 sign or symptom. Minority children (odds ratio [OR]: 2.54 [95% confidence interval [CI]: 1.18-5.47), those with lower extremity injuries (OR: 2.23 [95% CI: 1.01-4.90]), those without external signs of injury (OR: 3.40 [95% CI: 1.36-8.51]), and those with continued extremity use (OR: 3.26 [95% CI: 1.22-8.76]) were more likely to delay seeking medical care. Although some children did not manifest all expected responses, no child with an accidental fracture was asymptomatic. Delay in seeking medical care was associated with more subtle signs of injury; however, delays identified in minority patients are unexplained.