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Purpose To present a new outcomes-based registry to collect data on outpatient endovascular interventions, a relatively new site of service without adequate historical data to assess best clinical practices. Quality data collection with subsequent outcomes analysis, benchmarking, and direct feedback is necessary to achieve optimal care. Materials and Methods The Outpatient Endovascular and Interventional Society (OEIS) established the OEIS National Registry in 2017 to collect data on safety, efficacy, and quality of care for outpatient endovascular interventions. Since then, it has grown to include a peripheral artery disease (PAD) module with plans to expand to include cardiac, venous, dialysis access, and other procedures in future modules. As a Qualified Clinical Data Registry approved by the Centers for Medicare and Medicaid Services, this application also supports new quality measure development under the Quality Payment Program. All physicians operating in an office-based laboratory or ambulatory surgery center can use the Registry to analyze de-identified data and benchmark performance against national averages. Major adverse events were defined as death, stroke, myocardial infarction, acute onset of limb ischemia, index bypass graft or treated segment thrombosis, and/or need for urgent/emergent vascular surgery. Results Since Registry inception in 2017, 251 participating physicians from 64 centers located in 18 states have participated. The current database includes 18,134 peripheral endovascular interventions performed in 12,403 PAD patients (mean age 72.3±10.2 years; 60.1% men) between January 2017 and January 2020. Cases were performed primarily in an office-based laboratory (85.1%) or ambulatory surgery center setting (10.4%). Most frequently observed procedure indications from 16,086 preprocedure form submissions included claudication (59%), minor tissue loss (16%), rest pain (9%), acute limb ischemia (5%), and maintenance of patency (3%). Planned diagnostic procedures made up 12.2% of cases entered, with the remainder indicated as interventional procedures (87.6%). The hospital transfer rate was 0.62%, with 88 urgent/emergent transfers and 24 elective transfers. The overall complication rate for the Registry was 1.87% (n=338), and the rate of major adverse events was 0.51% (n=92). Thirty-day mortality was 0.03% (n=6). Conclusion This report describes the current structure, methodology, and preliminary results of OEIS National Registry, an outcomes-based registry designed to collect quality performance data with subsequent outcome analysis, benchmarking, and direct feedback to aid clinicians in providing optimal care.

This article aims to present the outcomes of treating anterior mandibular fractures using Herbert's screw. A total of 10 patients were treated for fractures of anterior mandible by open reduction and internal fixation using the Herbert screw. The patients were collected starting from June 2016 to November 2017, at the Department of Craniomaxillofacial Surgery, Nasser Institute for Research and Treatment, Cairo, and Faculty of Dentistry, Ain Shams University, Cairo, Egypt. The follow-up plan was done to evaluate the postoperative clinical outcomes for malocclusion, neurosensory status, hardware failure, malunion/ nonunion, pain, and edema. There were no intraoperative or postoperative complications, except for one case where the Herbert screw was insufficient and needed additional 2.0-mm miniplate at the superior border. The postoperative orthopantomograms revealed satisfactory reduction and fixation of the fractures of all cases. The Herbert screw fixation of anterior mandibular fracture is a reliable technique but sensitive and surgeon dependent and needs further clinical investigation.

Targeted temperature management (TTM) is a recommended neuroprotective intervention for coma after out-of-hospital cardiac arrest (OHCA). However, controversies exist concerning the proper implementation and overall efficacy of post-CA TTM, particularly related to optimal timing and depth of TTM and cooling methods. A review of the literature finds that optimizing and individualizing TTM remains an open question requiring further clinical investigation. This paper will summarize the preclinical and clinical trial data to-date, current recommendations, and future directions of this therapy, including new cooling methods under investigation. For now, early induction, maintenance for at least 24 hours, and slow rewarming utilizing endovascular methods may be preferred. Moreover, timely and accurate neuro-prognostication is valuable for guiding ethical and cost-effective management of post-CA coma. Current evidence for early neuro-prognostication after TTM suggests that a combination of initial prediction models, biomarkers, neuroimaging, and electrophysiological methods is the optimal strategy in predicting neurological functional outcomes.

Parent–child interaction therapy (PCIT) is widely used by speech and language therapists to improve the interactions between children with delayed language development and their parents/carers. Despite favourable reports of the therapy from clinicians, little evidence of its effectiveness is available. We investigated the effects of PCIT as practised by clinicians within a clinical setting. Eighteen consecutive children referred for speech and language therapy because of their delayed language were entered in the study. A within-participants design was used, and the procedure was similar to that used clinically. Blind assessments were conducted twice before therapy to monitor change without therapy and once after completing PCIT. Significant changes in a parent rating scale, the children’s mean length of utterance and the ratio of time of child to parent speech were found after the therapy. No changes were detected prior to therapy. The similarity of the design to clinical practice and the use of several clinicians suggest that the findings can be generalized to other settings and clinicians. These findings are a first step in evaluating PCIT; we now need to show that parents can maintain their newly acquired skills in interaction, and that this benefits their children’s communication.

Searching for new materials for bone substitution, fixation, and reconstruction is a challenging task that attracts scientists and researchers of different fields of medicine. During the last few decades, much interest has been paid to polymeric materials, polyethylene in particular. The aim of this study is to present generalizations about our own experience in the employment of polyethylene miniplates for the surgical treatment of mandibular fractures. Ninety patients with 139 uni- and bilateral mandibular fractures in different locations were involved. Treatment modalities included open reduction and internal fixation with self-made polyethylene miniplates of straight, T-shaped, Y-shaped, and X-shaped configurations and titanium screws. In 88 (97.8%) cases of surgical treatment of mandibular fractures using polymer miniplates, good anatomical and functional results were achieved. Regardless of the necessity for improvement of some mechanical properties of polyethylene, the results obtained in our clinical investigation allow us to recommend polyethylene miniplates for routine practice.

Introduction A prospective clinical investigation was carried out in order to clarify whether Matrix-associated autologous chondrocyte implantation (MACI) results in clinical improvement at long-term follow-up. Hypothesis MACI will result in clinical improvement at long-term follow-up. Study Design Case series; level of evidence, 4. Methods Thirty-eight patients were treated with MACI. These patients were evaluated for up to a mean of 16 years (range 15-17 years) after the intervention. Three different scores (Lysholm-Gilquist score, International Cartilage Repair Society score, and Tegner score) formed the basis of this study. Overall, we were able to obtain valid preoperative and postoperative results from 18 (47%) of 38 patients. In 1 patient, both knees were treated. In 4 patients, an arthroplasty was implanted over the course of time; thus they were excluded from this case series. In conclusion, follow-up of 15 knees was performed in the recent series. Results In subjective rating, 12 out of 14 patients (86%) rated the function of their knee as much better or better than before the index procedure. All numerical outcome scores showed significant improvement compared to the preoperative value (preoperative/postoperative at 5 years/postoperative at 15 years): Lysholm score 59.6 (±24.6)/78.6 (±21.5)/82.7 (±11.3), International Knee Documentation Committee score 50.6 (±22.7)/64.7 (±21.6)/69.7 (±18.7), Tegner score 3.0 (±2.2)/3.6 (±1.5)/5.2 (±1.7). Conclusion The significantly improved results on 3 scores after 15 years suggest that MACI represents a suitable treatment of local cartilage defects in the knee.

Children with language difficulties often omit verbs and grammatical elements and fail to complete sentences. Bryan (1997) described ‘colourful semantics’, a therapy she used to treat a 5-year-old boy. The therapy uses colour coding to highlight the predicate argument structure of sentences. This study further tested the therapy’s effectiveness by assessing the progress of six 5- and 6-year-olds receiving it under clinical conditions. The children were assessed on the Renfrew Action Picture Test (RAPT), the Bus Story, the Test of the Reception of Grammar (TROG) and an informal verb assessment. They were assessed again after a 9-week baseline without therapy and then treated twice weekly for 8 weeks after which a final assessment was carried out. A clinician who did not know the children conducted the second and third assessments. RAPT information and grammar scores and the Bus Story information and mean sentence length scores all improved during therapy but not in the baseline. These results obtained under clinical conditions are encouraging and warrant a larger study of this approach.

Acute poisonings may require identification of the toxic agents. It is impossible for routine laboratories to provide a full spectrum of toxicological analyses, and clinicians should know the reliability of the clinical diagnoses of toxic agents. We performed a 1-year study of hospitalized acute poisonings to determine the agreement between the clinical assessment on admission and serum laboratory tests for eight common toxic agents. Blood samples were drawn in 665 (70%) of the 947 admissions. The total number of laboratory found agents (967) exceeded the clinically suspected (871) by 11%. The agreement between the clinical assessment and laboratory analyses was good for ethanol and paracetamol ( κ = 0.70 for both), whereas only moderate or fair for other agents ( κ 0.22–0.51). Sensitivities of the clinical assessments compared to the laboratory results were better for common than rare agents, and better for higher than lower serum concentrations. The four most common agents (ethanol, benzodiazepines, paracetamol, and opiates) had overall sensitivity of 82% for higher-than-median serum concentrations, whereas the other agents had sensitivities ranging from 14% to 71% for higher-than-median concentrations. The reliability of the clinical diagnoses varied to such an extent that agents, which are important to recognize for specific treatment, should be tested for.

The paradoxical hemodynamic response after surgical or catheter pericardial drainage for cardiac tamponade is an infrequent complication. This case report describes this occasional ominous consequence of surgical pericardial decompression and suggests possible physiological explanations of rapidly progressive heart failure and death.

Case summary A male neutered Ragdoll cat aged 11 years and 9 months presented with a 6 month history of weight loss and a 1 month history of lethargy and adipsia. A thorough clinical investigation confirmed a diagnosis of primary adipsia and hypernatraemia secondary to a non-secretory neuroendocrine pituitary macroadenoma. Relevance and novel information Primary adipsia is a very rare clinical entity. This report is the first to describe primary adipsia secondary to a non-secretory pituitary macroadenoma in the cat. The veterinary literature available in this field is very limited and this report adds a new differential diagnosis for cats presenting with primary hypodipsia.

Assessments of clinical skills of medical students rely increasingly on standardized patients demonstrating medical cases with faculty rating performance. The common finding of inconsistency of scores across cases is often referred to as case specificity. A multivariate generalizability model reveals that overall case specificity cannot explain inconsistency in this example. Results from the multivariate model suggest directions for enhancing the table of specifications, optimizing scoring, and improving case selection to reduce inconsistency in scores across cases.

Objective The Shprintzen-Goldberg syndrome is an extremely rare syndrome with a characteristic face. This is one of a group of disorders characterized by craniosynostosis and marfanoid features. The aim of this study was to present a new sporadic case of the syndrome and describe in detail the findings at the maxillofacial region.

The Kunkel laboratory provided a unique environment for dedicated young scientists to learn the art of clinical investigation.

Background: Evaluation of the effectiveness of therapy to improve sitting balance has been hampered by the limited number of sensitive objective clinical measures. We developed the Manchester Active Position Seat (MAPS) to provide a portable system to track change in the position of centre of force over time. Objectives: (1) To investigate whether there is correspondence between the measurement of position change by a forceplate and by MAPS. (2) To explore whether and how MAPS measures changes in position when seated healthy adults change posture. Design: A feasibility study. Methods: (1) An adult subject sat on MAPS placed on top of a forceplate. The x and y coordinates of the centre of pressure recorded from the forceplate and centre of force from MAPS during movement were compared graphically. (2) Four adults sat on MAPS using a standardized starting position and moving into six sets of six standardized target postures in a predetermined randomized order. The absolute shift in centre of force from the starting position was calculated. Results: (1) The pattern of change of position over time was similar for the forceplate and for MAPS although there was a measurement difference, which increased with distance from the centre. (2) The direction of change of position corresponded to the direction of movement to the target postures but the amount of change varied between subjects. Conclusions: MAPS shows promise as an objective clinical measure of sitting balance, but peripheral accuracy of measurement needs to be improved.

Background: Ethical conflicts in nursing have generally been studied in terms of temporal frequency and the degree of conflict. This study presents a new perspective for examining ethical conflict in terms of the degree of exposure to conflict and its typology. Objectives: The aim was to examine the level of exposure to ethical conflict for professional nurses in critical care units and to analyze the relation between this level and the types of ethical conflict and moral states. Research design: This was a descriptive correlational study. Central and dispersion, normality tests, and analysis of variance were carried out. Participants and research context: A total of 203 nurses were from two third-level teaching hospitals in Spain. Both centers are part of the University of Barcelona Health Network. Participants filled out the Ethical Conflict in Nursing Questionnaire–Critical Care Version. Ethical considerations: This investigation received the approval of the ethical committees for clinical investigation of the two participating hospitals. Participants were informed of the authorship and aims of the study. Findings: The index of exposure to ethical conflict was [Formula: see text]. The situations involving analgesic treatment and end-of-life care were shown to be frequent sources of conflict. The types of ethical conflict and moral states generally arranged themselves from lesser to greater levels of index of exposure to ethical conflict. Discussion: The moderate level of exposure to ethical conflict was consistent with other international studies. However, the situations related with family are infrequent, and this presents differences with previous research. The results suggest that there is a logical relationship between types of conflict and levels of exposure to ethical conflict. Conclusion: The types of ethical conflict and moral states were related with the levels of exposure to ethical conflict. The new perspective was shown to be useful for analyzing the phenomenon of ethical conflict in the nurse.

This article reviews the psychiatric complications of malaria. A case of malaria infection is described. The diagnoses, treatment, and neuropsychiatric complications of acute and chronic malaria infection are discussed. The treatment of malaria and its complications are summarized.

La fatigue est l'un des symptomes les plus repandus que rencontre le clinicien. Pourtant, la nature du symptome et ses implications sur les troubles du sommeil sont mal comprises Cette etude offre au clinicien une comprehension des difficultes inherentes a l'evaluation du patient fatigue. Le symptome de fatigue est souvent une expression de la somnolence et de la fatigue qu'entrainent les troubles du sommeil lies au rythme circadien. Les procedures comportementales et physiologiques sont decrites dans l'evaluation et le traitement de la somnolence et de la fatigue des troubles du sommeil primaires, et des troubles medicaux et psychiatriques lies au sommeil, Pour ameliorer le diagnostic et le traitement des patients fatigues ou somnolents, les residents en psychiatrie et en neurologie doivent etre exposes aux techniques comportementales et physiologiques de la medecine du sommeil, dans le cadre de leurs programs de formation postdoctorale.

Clinicians frequently describe incomplete adherence to stimulant medication as a limitation to the effectiveness of treating ADHD in adolescents. This study examined reported adherence among 44 adolescents prescribed medication for symptoms of attention deficit hyperactivity disorder (ADHD). Reports of medication adherence were obtained from adolescents and parents at two time points, approximately two months apart. Parent and adolescent reports indicated reasonable agreement, with parents and adolescents reporting high rates of adherence at both time points (medians ranged from 85 to 89% adherence). A small group of adolescents reported extremely low rates of adherence, but we were not able to distinguish this group from the remainder of the sample based on demographics. It is argued that the sample is generally representative of adolescents who are being prescribed medication for ADHD, and that the high adherence rates are valid. These findings imply that clinicians treating adolescents with ADHD should be cautious in assuming that medication adherence is an inevitable problem in this population.

The detail and scholarship of the two major psychiatric taxonomies, ICD-10 and DSM-IV, have made an invaluable contribution to classification in child and adolescent psychiatry. Nonetheless, persistent minority voices have challenged their applicability to clinical practice. We tentatively offer for discussion a new taxonomy which we believe complements existing paradigms and has more clinical relevance. It is multitheoretical and attempts to fill the gap that exists between the language of the helped and that of the helper. A series of vignettes is provided to illustrate the clinical application of the new taxonomy.

Objective: This study addresses several issues concerning patients' and therapists' perceptions of key therapy process variables. This includes examining whether patients and therapists differ in their perceptions of the therapeutic alliance and therapist technique, what the relation is between perceptions of the alliance and technique, and whether these perceptions are predictive of treatment outcome. Method: Patient and therapist perceptions of the therapy process were provided in a comparative trial of 2 forms of short-term individual dynamic psychotherapy. Patients (n = 144) were randomly assigned to each condition. Treatment outcome was assessed using a large, comprehensive battery of reliable measures. Results: The findings revealed several differences in the patients' and therapists' ratings of the alliance and technique in the 2 forms of therapy. Patient ratings of the alliance and technique were predictive of treatment outcome. Conclusion: The findings contribute to understanding the extent to which therapy participants share views of therapy processes and highlight the importance of the therapist's attending to the patient's perception of therapy.

Objectifs: Cet exposé de synthèse se propose de réunir, de confronter et de commenter les arguments cliniques et expérimentaux plaidant en faveur de l'hypothèse d'un déficit en théorie de l'esprit dans la schizophrénie. Méthode: Après la définition du terme « théorie de l'esprit », suit une revue qui se veut exhaustive de la documentation concernant l'hypothèse d'un déficit en théorie de l'esprit dans la schizophrénie. Les différents arguments cliniques ou expérimentaux sont présentés en huit chapitres, et suivis d'une synthèse de la question. Résultats: L'hypothèse d'un déficit en théorie de l'esprit dans la schizophrénie est convaincante, surtout au vu des expériences les plus récentes. Ce déficit cognitif permettrait d'expliquer la présence de certains signes schizophréniques comme le délire d'influence ou de référence, les troubles de l'adaptation sociale ou les signes de désorganisation dans le champ de la communication. Le rôle de l'ambiguïté des situations, du niveau intellectuel et du traitement est discuté. Conclusions: Le déficit en théorie de l'esprit est une voie de recherche récente dans le domaine de la schizophrénie, susceptible de répercussions cliniques. Les modèles explicatifs et les paradigmes expérimentaux doivent être perfectionnés pour pouvoir déterminer plus précisément le rôle d'un tel déficit dans la survenue des symptômes.

Objectif : Proceder a une analyse critique de la documentation concernant les facteurs de risque, et les symptomes et syndromes antecedents afin de determiner une strategie empirique de traitement et de prevention precoces des troubles de l'humeur graves. Methode : On a resume la documentation pertinente, en insistant sur l'apparition precoce (durant l'enfance et l'adolescence) des troubles de l'humeur. Resultats : Une interaction complexe des facteurs biologiques, psychosociaux et sociologiques contribue au developpement d'un trouble de l'humeur grave. Les facteurs de risque les plus influents et les plus fiables sont le fait d'avoir des antecedents familiaux de trouble de l'humeur (bipolaire et unipolaire) et d'etre de sexe feminin (unipolaire). Il y a continuite entre les troubles de l'humeur a l'adolescence et a l'âge adulte, et le sous-syndrome de perturbation de l'humeur chez les adolescents a une signification clinique et de sante publique. Toutefois, il faut une etude longitudinale plus approfondie pour etablir avec certitude le cours et l'importance predictive des troubles de l'humeur chez les tres jeunes enfants. Conclusions : Des preuves substantielles soutiennent l'efficacite de l'intervention et de la prevention precoces chez les enfants a risque de troubles de l'humeur (identifies comme ayant des membres de la famille affectes) et chez les adolescents manifestant des symptomes et syndromes significatifs des troubles de l'humeur (surtout s'ils sont associes a des antecedents familiaux). Cependant, le niveau actuel des connaissances concernant la signification etiologique et le mecanisme des facteurs de risque associes aux troubles de l'humeur ne peut soutenir de vastes strategies communautaires de prevention primaire chez des populations non ciblees.

This report outlines a unique case of pseudoseizures associated with doll phobia in a young adult. Early recognition and treatment directed at the aetiological factors led to the effective treatment of the pseudoseizures and doll phobia.

To introduce this series on Strategies for Innovation and Interdisciplinary Translational Research , I want briefly to frame some of the issues we will be exploring. To do that, it is helpful first to define some of the terms in our series' title, namely translational research, innovation and interdisciplinary research and to consider their connections. The term "translational research" is now being used to describe many things-both types of research as well as research processes.1According to an National Institutes for Health (NIH) Office for Translational Research (http://www.niehs.nih.gov/about/od/otr/), the definition of translational research differs even among NIH institutes. However, common to these definitions is the concept of using research to realize tangible benefits for individual and population health. This concept is clearly not new and is a basic underpinning of public support for biomedical research. Read most NIH grant applications, and you will find an outlining of how the proposed specific aims, even when basic and circumscribed, will help to realize better health. However, interest in demonstrating the "translational" nature and the connections of research to tangible beneficial goals has been reinvigorated by the explicit attention to "translational research" in the NIH roadmap initiatives and its priority for funding these types of projects.2 Often cited when describing translational research, particularly for clinical investigation, is a model put forth in a report from the Institute of Medicine's Clinical Research Roundtable on Challenges facing the Clinical Research Enterprise. 3It depicts the clinical research continuum progressing from "basic biomedical research" to "clinical science and knowledge" to "improved health" and identifies the potential barriers to progress along this continuum as "translational blocks." Impediments to activities involved in transforming basic laboratory research findings into clinical sciences and human subjects' applications (historically also termed development research-as in product development) are called the T1 …

Objective:To review the scientific literature on the imaging of autism with a view to understanding how imaging can contribute to future studies.Methods:Medline was searched, and bibliographies from retrieved articles were reviewed. Inclusion criteria were a diagnosis of autism according to Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, third edition or later, and a control group without autism.Results:The field suffers from a lack of replication studies and poor methodology in terms of not controlling for confounding variables. Enlarged brain size, particularly in the temporoparietal brain region, and decreased size of the posterior corpus callosum are the only findings that have been independently replicated.Conclusion:Future imaging studies should attempt to investigate more homogeneous subgroups of patients such as those with “the lesser variant of PDD” and high-functioning patients with PDD who do not have comorbid medical conditions. A different approach, examining the individual behaviours that constitute the PDD spectrum and exploring these separately along with other associated variables such as neuropsychological deficits, structural and functional brain abnormalities, and genetic information could help identify biological mechanisms that do not follow diagnostic boundaries.

In a study to compare the clinical diagnostic skills of academic general pediatricians and academic pediatric cardiologists in the evaluation of heart murmurs, a total of 128 patients (aged 1 month to 18 years) newly referred to a university pediatric cardiology clinic were evaluated by one of three general pediatricians and one of four pediatric cardiologists. The murmurs were clinically classified as innocent, pathologic, or possibly pathologic. The classification was revised after the review of electrocardiogram (EKG) and chest radiograph (CXR), if indicated. The definitive diagnosis was ascertained by echocardiography (94 normal, 34 abnormal). The general pediatricians identified as many pathologic heart murmurs as the pediatric cardiologists (27/34 vs. 29/34), with no difference in sensitivity, 79% vs. 85% (p=0.53). The similarity in sensitivity could be because the general pediatricians were more cautious in the classification of heart murmurs and had classified more innocent heart murmurs as pathologic than the pediatric cardiologists (13/39 vs. 3/23), 41% vs. 13% (p=0.02). The pediatric cardiologists correctly identified more innocent murmurs than general pediatricians (52/94 vs.72/94), with a better specificity, 55% vs. 76% (p=0.001); however, the accuracy of prediction of innocence was similar for both groups (52/59 vs. 72/77), 88% vs. 93% (p=0.36). The revision of diagnosis with review of EKG and CXR was more often misleading than helpful for either group. Academic general pediatricians would identify most of the pathologic murmurs and are no more likely than an academic pediatric cardiologist to misclassify a pathologic heart murmur as innocent. Clin Pediatr. 1999;38:511-518

A prospective study of algodystrophy after fracture of the distal radius was carried out to search for early diagnostic and prognostic criteria. One hundred consecutive patients were assessed by a radiographic score and by a semi-quantitative clinical score at 1, 6 and 12 weeks and 1 year after fracture. The reactive disorders observed could be classified in four groups, each with a different course. There was a close link between patient satisfaction at 1 year and the group to which the patient belonged. Algodystrophy was diagnosed in 26% of cases. Of these, 58% were active and left sequelae at 1 year. A clinical score greater than 7 at 6 weeks predicted 96% of these cases of active algodystrophy. Active algodystrophy was more likely after a severe initial injury and if there was pain at the distal radioulnar joint.

Technologic advancement has provided earlier detection and confirmation of aortic aneurysms, fewer physicians seemingly relying on their clinical skills to diagnose abdominal aortic aneurysms. Of 145 infrarenal aortic aneurysms, analysis disclosed that less than 30% were clinically discovered on admission. Fifty-six aortic aneurysms were discovered incidentally, most often during an annual physical examination in the course of evaluation for another problem. Aneurysms measuring less than 4.5 cm were rarely discovered on physical examination. The majority of both clinically discovered and inci dental aneurysms ranged between 5.5 and 6.0 cm. Ultrasound identified most aneurysms. The size of an aneurysm did not appear to have a role in determining whether it was discovered clinically.

A new electrogoniometer technique is described for the measurement of wrist movements, including circumduction, with the results being displayed as figures. Clinical validation has been performed and the system found to be highly accurate and reliable. Applications of the technique are illustrated. It is suggested this technique should in the future be used to assess wrist movement in clinical and research applications.

Adolf Grünbaum contends that he has discovered in Freud's writings a hitherto overlooked thesis (the Tally Argument), enunciated by Freud to underwrite his psychoanalytic method of clinical investigation. (The Foundations of Psycho analysis, 1984:127-72). He claims that until at least 1917, and possibly up to 1926, Freud invoked the unique efficacy of analytic therapy to vindicate the Freudian theory of personality, including the specific aetiologies of the psychoneuroses and the general theory of psychosexual development ( Foun dations : 140-1). In this article I shall argue (1) that the Tally Argument itself is defective, and (2) that Freud did not invoke it as Grünbaum claims. In short, I shall argue that Grünbaum's Tally Argument thesis is untenable and, as a corollary, that his depiction of Freud as a 'sophisticated scientific methodologist' is misconceived.

Many medical disorders present with psychiatric symptoms. Teasing out what is caused by the medical problem and what is underlying psychopathology can be a tremendous challenge. We report the case of a young man with no documented past psychiatric history that developed symptoms consistent with bipolar disorder with mood-congruent psychotic features as well as typhoid fever. In this report, we summarize the biological, psychological, and social underpinnings of this rare and interesting case.

Pure-tone audiograms of 501 patients with preoperative Meniere's disease were analyzed. Age of onset and incidence of bilaterality were studied. The most common audiogram was the peak-type (50.26%), next the falling-type (26.26%), and then the dip-type (9.24%). Although few papers mention this peak audiogram, we suggest it is a diagnostic feature of Meniere's disease. Average age of onset was 42.59 years; this did not differ from males to females. Prevalence in females exceeded that in males by about 4:3. The disease was bilateral in 31.13%. Generally, those with better hearing thresholds at the first examination had less tendency to develop bilaterality. Age of onset was not significantly correlated with bilaterality.

This paper reviews developments over the past decade in the clinical investigation and management of children with developmental phono logical disorders. It examines three aspects of this investigation: descrip tive assessment procedures, patterns of disorder, and treatment strategies. New approaches for clinical practice are described in all three areas.

We describe an unusual case of bilateral intraparenchymal parotid stones with unilateral parotitis in a 17-year-old boy. The patient went on to develop multiple parotid abscesses, which we treated with a superficial parotidectomy. To our knowledge, this is only the second report of intraparenchymal parotid stones in a pediatric patient.

We report a rare case of moderately differentiated neuroendocrine carcinoma of the larynx. We describe the clinical and pathologic findings relevant to this case, and we review the literature on the pathologic features of this malignancy. We also discuss treatment options.

The bicaudate and bifrontal indices have been used in prior computed tomographic studies to investigate atrophy of the caudate nuclei in patients with Huntington's chorea and cerebral atrophy. However, the relationship between these indices and caudate volume has not been documented previously. In this study, we used high-field magnetic resonance imaging (MRI) to determine the effects of normal aging on the bicaudate and bifrontal indices and to study the relationship between these indices and caudate volume. The subjects were 49 normal volunteers, aged 22 to 82 years, who were without any significant neurologic or psychiatric disorders. Age was positively correlated with bicaudate index ( r = .59; P < .0001) and bifrontal index ( r = .40; P < .0047). Age was negatively correlated with caudate nuclei volume ( r = -.47; P < .0005). Caudate volume was negatively correlated with bicaudate ( r = -.27; P < .06) and bifrontal ( r = -.31; P < .03) indices. These findings are consistent with prior reports of caudate nuclei degeneration with increasing age. Linear and volumetric caudate measurements with MRI may prove useful in the investigation of caudate nuclei function in the neuromotor decline with normal aging and in disorders such as Huntington's chorea.

The aim of this article is to show that the well-known Tinel sign is realiy a Hoffmann-Tinel sign. The translation of the two papers of Hoffmann, published in the same year that Tinel wrote his article (1915), is completed by a short biography of Paul Hoffmann.

Finger dynamography is a bedside technique for evaluation of the moving abilities and working space of the hand. Various operative procedures used for correcting the claw finger deformity restore the functional abilities to a varying extent. The palmaris longus transfer with insertion into A1–A2 pulley appears to be a better procedure than lateral band insertion, extensor diversion or extensor many-tail procedures. The use of palmaris longus as a motor seems to have advantages over flexor digitorum superficialis transfer where removal of FDS as a motor produces local deficits.

The movements of the MP and PIP joints occur together and enable the fingers to acquire different postures. A graphic record of these movements gives an idea of the working space of the fingers. Normally, the tracing forms the shape of a quadrangle with almost parallel sides. If muscle paralysis occurs or joints are diseased, the shape of the quadrangle—the “working space”—becomes distorted. Different patterns of distortion are seen with different finger problems. “Finger dynamography” is a simple bedside procedure requiring only a goniometer. If supplemented with additional data on pinch and grip strengths and sensibility, it gives a pictorial record which is easy to interpret and can be used for documentation.

The quantitative applications of echocardiography in clinical practice are well known. The measurements of cardiac chamber dimensions, wall thickness, and overall performance have been uniformly adopted. An important emerging ultrasound modality known as tissue characterization of the myocardium has evolved from experimental studies to clinical investigation. The ability to quantitate myocardial acoustic properties by the measurement of integrated backscatter (in decibels) provides direct assessment of myocardial structural characteristics and contractile performance, to complement conventional two-dimensional imaging of ventricular wall motion and wall thickening. Despite the considerable amount of work that has been done, there are several areas of research that need to be further investigated before widespread clinical use of these techniques is possible. Specifically, absolute values of myocardial backscatter are not yet obtainable with the current instrumentation; only the relative change in backscatter during the cardiac cycle (cyclic variation) has been defined and employed in clinical studies. This review summarizes the principles of tissue characterization and the results of several clinical studies, specifically those carried out in patients with coronary artery disease and cardiomyopathies.

The speech of 102 patients with complete unilateral and bilateral cleft lip and palate and 40 noncleft subjects was analysed using the NORAM (Nasal Oral Ratio Meter) instrument. The results obtained were compared with the perceptual judgments made by experienced listeners. A significant correlation was found between the NORAM values and the listener judgments. The NORAM instrument can thus be used as a complement to listener judgments in assessing hypernasality. A discussion of the acoustic and phonetic aspects of the differences between the instrumental and perceptual results is presented.