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By D. Farmon. University of Health Sciences College of Osteopathic Medicine.

Funnel chest is also relatively frequently associated with a scoliosis (15%–20% [5 generic evista 60mg fast delivery, 8]) discount 60 mg evista otc. Radiographic findings A lateral x-ray of the rib cage will clearly show the depres- sion of the sternum (⊡ Fig cheap 60mg evista fast delivery. The depth of the depres- sion can also be correlated with the depth of the thorax discount evista 60mg without a prescription. Additional imaging procedures (CT) are only required preparatory to surgery discount evista 60mg with amex. Recently we have been evaluating a treatment with a kind of suction bell applied to the chest daily for 30–60 min. If cardiovascular function is not diminished, the ourselves have operated on 30 patients to date and have psychological distress can constitute a relative indication not experienced any serious complications. Now that a satisfactory surgical technique is available in the form of the Nuss technique (see below), 3. It is impor- tant, however, that the corresponding decision is taken Definition not by the parents or the doctor, but solely by the patient, Deformity of the thorax with keel-shaped protrusion of and only after, or towards the end of, puberty. Etiology, pathogenesis Previously employed surgical techniques involving Keeled chest, like funnel chest, occurs as a result of a correction performed directly on the deformity itself predisposition and is not an actual hereditary condition. Silicone implantation was also associated with certain Secondary forms occur in complications (e. In this thoracoscopic technique, two Occurrence small lateral incisions are made to allow insertion of a Keeled chest is rarer than funnel chest, although precise curved bar that exerts outward pressure on the sternum. The bar is left in situ for 2–3 years, after which time it can Clinical features then be removed. We perform this operation jointly with Keeled chest involves a symmetrical or asymmetrical pediatric (thoracic) surgeons because of the possible risk protrusion of the sternum (⊡ Fig. Three patients required revision sur- asymmetrical, causing the whole sternum to be slightly gery, in one case because of a pneumothorax, and in the tilted. A depression of the thorax is also occasionally pres- other two because of displacement of the bar. This indentation then authors have also reported low complication rates. Terms involving comparisons with animals (»Chicken breast«) can prove especially hurtful Keeled chest is never associated with a functional re- Findings of imaging techniques, striction as the heart and lungs are always able to develop radiographic findings sufficiently. The condition is therefore a purely cosmetic The extent of the keeled chest can also be measured objec- problem. Just as with funnel chest, however, keeled chest tively by raster stereography ( Chapter 3. This fact underlines the importance of the role played conservative treatment with a brace, by posture in the development of Scheuermann’s disease. Whether the mechanical deformation of the thorax is also responsible for the development of Scheuermann’s disease The conservative treatment with a brace is much more remains doubtful. Although we know from our experience promising for keeled chest than for funnel chest since, with vertebral fractures that a fracture of the sternum on in the former condition, pressure can be exerted from the same side results in considerable instability and exac- outside to produce a genuine corrective effect. Good erbation of the kyphosis, keeled chest does not involve any results have been reported in the literature and we significant reduction in strength, which means that this have been able to confirm this in our own experience. However, the brace is not always accepted by the patient and the treatment should be implemented primarily in! Try to avoid using expressions such as »pigeon younger children, as it will no longer have much effect chest« or »chicken breast« when talking to patients by the time of adolescence. I try to persuade parents of children with the animal world and applied to humans, these a pronounced keeled chest of the advantages of brace terms have very negative connotations. The clinical pictures are A split sternum and premature sternal synostosis always discussed in detail in chapters 4. Flat thorax is a very specific problem in which the thorax should Occurrence always be considered in connection with the spine. We While the reports in the literature concerning frequency see flat thorax primarily in association with idiopathic show substantial differences, one thing is certain: both adolescent scoliosis, but also in connection with lumbar the prevalence and the severity of scoliosis are largely Scheuermann’s disease (⊡ Fig.

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It is a good idea to choose three or four journals in which you are most interested and rank them in order of prestige and competitiveness buy evista 60mg free shipping. This may help you to decide whether you want to send your paper to a highly regarded journal where you may be rejected but which will bring inestimable prestige if accepted discount evista 60mg visa. Alternatively cheap 60 mg evista amex, you may want to send your paper to a journal where you stand a good chance of being accepted or to a journal where acceptance is most likely evista 60 mg on-line. One thing is certain – you will never be published in a prestigious journal if you never submit your work there generic evista 60mg with visa. In this, the journal you choose will need to be well suited to your research findings, and the topic of your paper will need to fall within the scope of the journal. For example, the results of a large randomised controlled trial of an innovative and effective treatment for breast cancer may be best submitted to the New England Journal of Medicine. However, details of a newly identified gene may be best submitted to Nature Genetics, and an epidemiological study to assess the prevalence of a childhood illness may be best submitted to the Archives of Diseases in Childhood. The concept that negative results are harder to place than positive results is supported by documented publication bias. Classic examples of this are the delayed publication of negative results from randomised controlled trials16 and for studies that have reported non-significant health effects of passive smoking. However, regardless of the journal, your writing must always be easy to understand by both the external reviewers and the audience that you expect to reach. If your message is important, then delivering it in an entirely effective way will help to disseminate your results to the research and medical community where they really matter. On the other hand, if you don’t have an important question, good data with which to answer it, and a clear message for your audience, you should think twice about starting to write the paper. You should try to reach a consensus with your coauthors about preferred journals when you are first ready to start writing your paper. This will help you to decide on the style and the format in which you will write and, in turn, save you from the frustration and time that it takes to change your paper and the format of your citations from one journal to another. Since different journals require you to present your text and/or analyses in different formats, the earlier you make the decision about the journal the sooner you can begin formatting your paper in the correct style. Some journals resist figures and prefer tables, some journals resist the use of percentages and prefer you to give both the numerators and denominators in the tables, and some journals have a limit on the number of tables, figures, or citations that they will accept. Some journals request that you check your spelling using the Oxford English Dictionary, others specify the Macquarie Dictionary or Webster’s Dictionary. It is best to know about the quirks of your journal of first choice so that you can adopt their format early in the piece. To expedite the publication of your work, try to be realistic and choose the right journal first time. However, if your paper is rejected and you decide to submit it to a second journal, then keep in mind that some journals request that you also send the previous reviewers’ comments plus your responses. The editor will want to be assured that you have addressed and/or amended any problems that have already been identified. There are no published statistics about journal shopping 20 Getting started practices, but an editor will obviously not be interested in a paper that has been rejected from other journals on the basis of fundamental problems with study design. Remember that if you do submit to another journal, reading the instructions to authors and modifying the manuscript accordingly will improve your chances of publication. This may also save you time because many journals will automatically return papers that do not meet their standards. A study by researchers at Stanford University suggested that prestige, whether the journal usually publishes papers on a particular topic, and reader profiles are important factors that influence decisions about where to send a manuscript. In the end, your decision on where to send your paper will be based on many factors and, in deciding, you will need to respect the advice of your colleagues and coauthors. Uniform requirements The Uniform Requirements are instructions to authors on how to prepare manuscripts, not to editors on publication style. International Committee of Medical Journal editors (www3) All draft papers should be prepared in a format that is consistent with the “Uniform requirements for manuscripts submitted to biomedical journals”. The group naturally became known as the Vancouver group and the standard format is still referred to as Vancouver format. The first uniform requirements for manuscripts and recommendations for formatting references were published in 1979, and an updated version can now be accessed via the world wide web (www3).

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For comment 7 generic evista 60mg with mastercard, the decision has been left to the editor because the authors considered the figure to be essential to the message of the paper 60mg evista otc. Occasionally buy evista 60mg low cost, you find that the reviewer has made disparaging or less than polite comments purchase evista 60mg visa. Remember that two wrongs do not make a right and that responding with disparaging or impolite comments will not impress the editor cheap evista 60 mg on line. Occasionally reviewers may suggest that you include more work, seemingly forgetting that they are reviewing this paper and not the next one. This will take a prudent response, perhaps on advice from more senior researchers. Handling rejection As for disappointing them I should not so much mind; but I can’t abide to disappoint myself. Oliver Goldsmith (1728–1774) Letters of rejection may arrive much more quickly than letters of acceptance because some journals may reject up to 50% of papers before they are sent out for external review. If your paper is rejected without being sent out for review, you could expect to hear back from the journal within a month. If your paper falls into this category, it is probably considered to be insufficiently original, to be of minor interest to the journal’s readership, or to be scientifically flawed, too long, or incomprehensible. Editors strive to treat their external reviewers with respect and therefore do not send them papers that are perceived to be of poor quality. Whether or not your paper has been sent out for external review, the letter you receive will be very polite if the editor 130 Review and editorial processes decides to reject it. You will need to decide whether the paper needs some major attention or whether you misjudged the appropriateness of the journal. Once a paper is formally rejected, you are free to submit it to another journal either without changes or with a complete rewrite. We have now considered this very carefully at an editorial level and I am afraid that we have decided not to accept the paper for publication. I know that you addressed the comments made by the reviewers by making some modifications to the paper. However, our decision not to publish was on the basis that we did not feel that the information was new or would be of great interest to our readership. Thank you for your communication that you sent for publication in our correspondence column. With well over 2000 letters submitted every year, we sometimes have to make difficult editorial decisions. On the basis of the recommendations of the reviewers and the Editorial Office, it was not accepted. Both reviewers raised concerns regarding the study design, analysis, and interpretation of the data. We hope that you can use their comments to improve your manuscript for submission to another journal. The further reports of the referees are enclosed and we hope that you will find them helpful. When evaluating whether a manuscript can be accepted for publication, the Editorial Office must consider several aspects such as scientific value, interest to readers, and space in the journal. Unfortunately, based on these factors and despite its scientific quality, your paper cannot be accepted for publication. We have now received the reviewers’ reports on your manuscript and enclose these for your information. However, if you would like to revise your manuscript to address the reviewers’ comments, we will resubmit it for review and will be happy to give it further consideration, although we cannot promise publication. Solving these sorts of problems usually involves some serious rewriting and may involve further data analyses. If the comments relate to style and presentation, you would be wise to spend some time fixing these up before you reformat your paper for a new journal and resubmit it. However, after three consecutive rejections, it is perhaps prudent to completely reassess your whole approach. Stephen King12 Once you have returned a revised paper to the journal, the editorial committee will consider the new version and your replies to the external reviewers’ comments. At the BMJ, papers that are thought to merit publication at this stage are passed on to a very appropriately named “hanging committee”. This committee is named after the committee at the Royal Academy in London that decides which pictures to hang in the summer exhibition each year. The hanging committee, which is made up of practising clinicians, statisticians, and medically qualified editors, makes the final decision about publication and may often ask for further revisions.

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