T he diagnosis of chronic lesions of the rotator cuff is challenging. We have developed a new index to improve the sonographic diagnosis of chronic tears of the cuff.In a pilot study, we examined 50 asymptomatic healthy volunteers by ultrasound to establish the diameter of the rotator cuff in relation to the tendon of the long head of biceps. Subsequently, the index was calculated in 64 patients who had had shoulder pain for more than three months caused by clinically diagnosed lesions of the rotator cuff. The compensatory hypertrophy of the biceps tendon was quantified sonographically in relation to the diameter of the cuff.Comparison with the contralateral shoulder revealed a significantly higher biceps rotator-cuff ratio (p < 0.05) for patients with torn rotator cuffs. A ratio greater than 0.8 was considered pathological (index positive); the mean ratio in the control group was 0.43. The sensitivity of a positive index was 97.8%, the specificity 63.2%, the positive predictive value 86.3%, and the negative predictive value 92.4% in comparison with surgical findings.Use of the index improves sensitivity in the diagnosis of chronic tears of the cuff by ultrasound. [Br] 1999;81-B:675-8. J Bone Joint Surg Received 1 December 1997; Accepted after revision 6 February 1998The diagnosis of tears of the rotator cuff by ultrasound is still uncertain. Some descriptions, such as inhomogeneity, sonographically-detectable effusions into the tendon sheath of the long head of biceps of patients with tears of the rotator cuff and other soft-tissue abnormalities. A partial tear of the rotator cuff may present with no more than nocturnal pain or a minor functional loss. Even with modern diagnostic facilities such as MRI, difficulties of definition are seen after scar formation and the compensatory hypertrophy of muscles of the shoulder girdle.Arthrography has been used in the diagnosis of acute, complete ruptures of the rotator cuff, 4 but it is an invasive procedure with a high rate of delayed morbidity 4,5 and it is expensive. Conventional radiological findings include a narrowing of the acromiohumeral interval, decalcification of the greater tuberosity or a reversal of the normal convexity of the inferior surface of the acromion. These appearances are not specifically diagnostic of tears of the rotator cuff. 6Patients and MethodsIn a pilot study we examined 50 asymptomatic healthy volunteers (25 women and 25 men) by ultrasound to establish standard values for the diameter of the rotator cuff in relation to the long tendon of biceps. The mean age of the group was 32 years (19 to 52) and 46 (91.6%) were righthanded. A commercially available real-time 7.5MHz linear scanner (Siemens) was used. The sonographic protocol was standardised by scanning the infraspinatus, supraspinatus and biceps tendon in longitudinal and transverse planes. The supraspinatus tendon was identified using the biceps tendon as a landmark. No abnormalities of the biceps tendon were seen. It was measured sonographically in relation to the diameter of the rot...
The diagnosis of chronic lesions of the rotator cuff is challenging. We have developed a new index to improve the sonographic diagnosis of chronic tears of the cuff. In a pilot study, we examined 50 asymptomatic healthy volunteers by ultrasound to establish the diameter of the rotator cuff in relation to the tendon of the long head of biceps. Subsequently, the index was calculated in 64 patients who had had shoulder pain for more than three months caused by clinically diagnosed lesions of the rotator cuff. The compensatory hypertrophy of the biceps tendon was quantified sonographically in relation to the diameter of the cuff. Comparison with the contralateral shoulder revealed a significantly higher biceps rotator-cuff ratio (p < 0.05) for patients with torn rotator cuffs. A ratio greater than 0.8 was considered pathological (index positive); the mean ratio in the control group was 0.43. The sensitivity of a positive index was 97.8%, the specificity 63.2%, the positive predictive value 86.3%, and the negative predictive value 92.4% in comparison with surgical findings. Use of the index improves sensitivity in the diagnosis of chronic tears of the cuff by ultrasound.
Of all the oriental spices, black pepper was the most important until the eighteenth century. The historiography of the pepper trade is characterized by a strong focus on Europe in terms of both its economic significance in the ancient and medieval periods and the struggle for its control in the early modern period. This article, by contrast, seeks to situate the pepper trade firmly in its Asian contexts. It examines the Indian Ocean pepper trade from three perspectives. First, it places the trade in its supply-side context by focusing on the Malabar coast as the primary source of pepper. Second, it examines the relative importance of the different branches of Malabar's pepper trade and highlights the central role played by Muslim mercantile networks. Third, it considers the reconfiguration of these pepper networks in the sixteenth century in the face of aggressive competition from the Portuguese. In their sum, these arguments advocate the need for rethought balances of trade and a reweighted scholarly focus on the pepper trade in its global dimensions.
Using ultrasound topometry, the posture of children with sufficient and insufficient posture can be differentiated by measuring, the angles of kyphosis and lordosis. This quantification could be used for objective monitoring of the posture.
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