Singleportal test
Ross P. Johnston, James B. Armstrong , Chee Chiang Mei. Finite-element investigation of cold-formed steel portal frames in fire.
Doctors to Test Single Portal For Insurance Information
The fast and steady development of arthroscopy techniques in the last couple of decades led to a drastic increase of arthroscopic rotator cuff repairs over the open procedure. Supraspinatus tears are the most common of all, but the subscapularis tendon tear is a more common injury than expected. Most of the time it presents as a partial tear or is associated with a subsequent rotator cuff tendon injury, especially the supraspinatus.
Nowadays, the standard procedure to repair the subscapularis tendon is performed arthroscopically, even though a real superior result over the open repair it is yet to be reported. Ideally less operative time, less scarring, and postoperative pain would be the expected benefits, but no study has compared the long-term outcome of these 2 procedures yet.
To maximize possible improvements, we would like to present an arthroscopic technique: a subscapularis tendon repair performed with the aid of an angled suture passer and using a single anterior working portal. It is still unclear if arthroscopy has a superior role in clinical outcome and tendon healing in the case of a subscapularis tendon tear compared with the open procedure.
The diagnosis of a subscapularis tendon rupture consists of a detailed history, comprehensive physical examination, and complementary imaging studies. A typical patient with subscapularis tendon rupture reports pain and swelling in the anterior part of the shoulder after a possible recent fall on an outstretched arm with possible anterior shoulder dislocation. There may be an associated lesion of other muscles in the rotator cuff.
Patients will complain of decreased range of motion ROM and weakness with internal rotation of the arm that will be assessed during the physical examination. Inspection of both upper extremities is done during the physical examination, followed by palpation of the region of interest and evaluation of the ROM. Ultrasound and magnetic resonance imaging are also helpful to confirm the diagnosis before possible surgical intervention.
The patient is placed supine on a beach-chair positioner, whereas an interscalene nerve block is placed in the upper extremity and general anesthesia is induced. An intraoperative examination should be performed under anesthesia to confirm our preoperative impression. The patient is then placed in the beach-chair position with a well-padded head cushion.
The operative site is then sterilely prepped, draped, and a McConnell arm holder is used. A marking pen is used to highlight the anatomical landmarks of the shoulder. The posterior portal is made in the soft spot of the shoulder with an incision performed using a No. The glenohumeral joint is then entered using a blunt trocar with scope and sheath. A spinal needle is used to needle-localize the anterior portal under arthroscopic visualization. The anterior portal used is the classic anterior medial portal, made lateral to the coracoid process and anterior to the acromioclavicular joint.
An 8-mm vertical incision is made followed by a switching stick, and then an 8. After standard diagnostic evaluation of the anatomic structures of the glenohumeral joint, attention is turned to the stabilization procedure.
The patient presented here had a full-thickness tear of the superior portion of the subscapularis tendon Fig 1. While viewing from the posterior portal, the footprint of the tendon must be cleaned off from debris and remodeled with an arthroscopic shaver to place the anchor. All the images from arthroscopy are performed in a right shoulder and viewed from the posterior portal.
The tendon presents with a full-thickness tear marked by an arrow. In the background, the left-angled ReelPass is about to take a healthy bite of the tendon. The ReelPass has 10 yards of polydioxanone PDS monofilament that is abundantly uncoiled into the joint.
The ReelPass is then withdrawn from the portal and the loose end of the PDS is retrieved from the same anterior portal with a ring grasper. The FiberTape is then passed in a manner to create a racking hitch stitch. Specifically, the PDS monofilament is tied to the center of the tape; it is then pulled half way through the labrum so that the center of the tape creates a loop.
The free ends of the FiberTape are passed through the looped end outside the shoulder Fig 3 and tightly cinched down to create a racking hitch stitch. Right shoulder arthroscopy, viewing from the posterior portal.
A A healthy bite of the tendon marked with a square is taken with the angled-suture passer inserted from the anterior portal. The PDS monofilament is abundantly uncoiled in the glenohumeral joint to be retrieved from the same anterior portal with the help of a ring grasper. B The center of the SutureTape, tied to the PDS monofilament, is being shuttled through the tendon and retrieved from the anterior portal to create a racking hitch stitch. PDS, polydioxanone. Picture from outside the right shoulder showing the racking hitch stitch circled.
The 2 limbs of the SutureTape fed through the looped end, and are about to be pulled and tension the stitch. Arthroscopic picture of a right shoulder viewing from the posterior portal showing the 2 FiberTape used for the subscapularis tendon repair before the anchor placement and the final reduction. After the application of the sutures, a pilot hole is drilled on the lesser tuberosity Video 1 , medial to the bicipital groove, where the anchor will be placed.
In this case, the repair warranted only 2 sutures, so the next step is to load both FiberTapes on a single 4. Each limb of the sutures is tensioned individually to ensure an appropriate reduction. The SwiveLock is malleted into the aperture of the hole and then screwed in to reduce the tendon down Fig 5.
When the SwiveLock is fully seated, all the sutures are cut with an arthroscopic suture cutter. Arthroscopy image of a right shoulder from the posterior portal. A Both sutures are loaded on the same 4. The adequate reduction of the subscapularis tendon is achieved by tensioning each suture limb independently from outside the shoulder. Next the SwiveLock is dunked into a pilot hole previously punched on the humeral head.
B The SwiveLock is being screwed in to secure a stable repair. The result of the repair is probed at the end of the procedure to evaluate the repair and stability of the sutures Fig 6. Final result of the subscapularis tendon repair using single row sutures and an angled suture passer in a right shoulder scope viewing from the posterior portal.
The portal incisions are closed in a standard fashion and covered by an abundant dressing. Active elevation of the arm to lift an object is to be avoided during this time period.
From weeks 2 to 6, the objective is to restore passive ROM and the sling is discontinued at the end of week 6. No difference in terms of outcome has been reported so far from the few articles the literature has provided on the difference between open and arthroscopic subscapularis tendon tear. Minor scarring, reduced operative time, and postoperative pain could be the biggest improvements following this procedure. In addition, there may potentially be a reduced learning curve for this kind of technique: knotless and therefore less passages are required to secure the sutures and stabilize the lesion.
Less operative time also gives the possibility of treating associated injuries that usually come with the subscapularis tear, before fluids distend the joint and limit the visibility especially in the subacromial space.
Given that a reduction in each of these aspects is associated with quicker return to work, further studies to confirm these results would be helpful in recommending arthroscopic over open repair. In case of muscle retraction, muscle atrophy, or fatty infiltration, mostly due to a late repair, a double row repair would be more suitable, because it has the advantage to recreate a larger footprint.
The timing of a repair plays a fundamental role in the prognosis, probably as fundamental as the size of the tear, and both can possibly lead to re-rupture in the future. A late repair can present with muscle atrophy or retraction or fatty infiltration leading to a more complex, long, and possibly less successful procedure. It is better to secure sutures separately, before the anchor placement, in case multiple FiberTapes are passed for the repair to avoid entangled sutures.
In case multiple sutures are entangled, they can oppose the tensioning and reduction process when the SwiveLock is set in place, thus leading to a poorly reduced tendon and high chances failure of the tendon repair. Finally, SutureTape is wider than normal FiberWire, and this option provides a stronger fixation and improved cut-through resistance with injured tissues. The authors report the following potential conflicts of interest or sources of funding: J.
The entire procedure is filmed from the posterior portal of a right shoulder, with the patient placed in a beach-chair position, whereas the tools are introduced in the glenohumeral joint from the single anterior working portal. After the diagnostic arthroscopy, the attention moves to the repair. The ReelPass is introduced through the anterior portal, and a bite of the superior border of the subscapularis tendon is successfully taken. The polydioxanone monofilament is abundantly uncoiled in the joint and then withdrawn from the same anterior portal with the aid of a ring grasper.
The middle of a FiberTape is secured to the polydioxanone with a simple knot to create a loop. The FiberTape suture is reeled in through the tendon and again withdrawn from the anterior portal. A racking hitch stitch is made by feeding the 2 limbs of the FiberTape through the loop, by hand outside the shoulder, and then cinched down. The same procedure is repeated once more to create a more stable repair. On the top part of the lesser tuberosity, a pilot hole is punched to accommodate a single 4.
The SwiveLock is malleted down to the aperture of the hole and then screwed in to reduce the tendon down. In the last part, it is possible to notice that the SwiveLock is secured in the hole and a probe is testing the tight repair. National Center for Biotechnology Information , U. Journal List Arthrosc Tech v. Arthrosc Tech. Published online May Nicholas Elena , M. Woodall , D. Mac Hale , B. McGahan , M. Pathare , M. Shin , M. Chen , M. Author information Article notes Copyright and License information Disclaimer.
Nicholas Elena: moc. Received Jan 25; Accepted Feb Published by Elsevier. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Video 1 The entire procedure is filmed from the posterior portal of a right shoulder, with the patient placed in a beach-chair position, whereas the tools are introduced in the glenohumeral joint from the single anterior working portal. ICMJE author disclosure forms. Abstract The fast and steady development of arthroscopy techniques in the last couple of decades led to a drastic increase of arthroscopic rotator cuff repairs over the open procedure.
Tools for Software Developers and Test Engineers Tom Arnold, Dominic it's a simple concept but very powerful in allowing you to create a single portal for. The new version of the Single Portal for Interactive Public Services has been launched and is running in test mode under the link queeniesnailsandspa.co.nz The new version of.
The fast and steady development of arthroscopy techniques in the last couple of decades led to a drastic increase of arthroscopic rotator cuff repairs over the open procedure. Supraspinatus tears are the most common of all, but the subscapularis tendon tear is a more common injury than expected. Most of the time it presents as a partial tear or is associated with a subsequent rotator cuff tendon injury, especially the supraspinatus. Nowadays, the standard procedure to repair the subscapularis tendon is performed arthroscopically, even though a real superior result over the open repair it is yet to be reported.
The new version of the Single Portal for Interactive Public Services has been launched and is running in test mode under the link my2. The new version of the Single portal is developed taking into account implementation of the full electronic public services grouped in offices — the citizen and the businessman, an opportunity online payment of electronic public services is created.
Laura Metaal staat voor kwaliteit, flexibiliteit en leverbetrouwbaarheid. Wij zijn ons daarnaast bewust van onze verantwoordelijkheid naar onze medewerkers, klanten, leveranciers, relaties en onze samenleving.
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A portal component providing testing code must implement the ITestable interface and implement the getTestName method. You can code several test case methods in a single portal component. All test methods must stick to the following pattern where XXX can be any string supported by Java :. IPortalComponentRequest request,. The method expects two parameters:.
Single Foreign Trade Portal now open for testing by private companies
In November, physicians in Ohio and New Jersey will begin to test a single, online portal through which they can access health insurance eligibility and benefits information for most of their privately insured patients. Physicians and their staffs in those states will have access to data on copayments, deductibles, in-network and out-of-network coverage, and the status of claims from multiple plans in one place. They will also be able to submit referrals, pre-authorization requests, and claims under a test project spearheaded nationally by America's Health Insurance Plans and the Blue Cross and Blue Shield Association. The changes are significant, Ms. Ignagni said, and are akin to what the banks did when they first allowed consumers to withdraw money from any ATM worldwide. The initiative is expected to decrease hassles for physicians and significantly reduce costs for both physicians and health plans. Ignagni estimated that the entire health system could see savings of hundreds of billions of dollars once these administrative simplification tools are available around the country, based on estimates of savings automating administrative tasks and implementing consistent business practices. The insurers' announcement comes as Congress debates comprehensive health reform, including tighter regulation of the insurance industry. Ignagni said AHIP has been exploring projects to simplify insurance administration over the last year and has kept the Obama administration and congressional leaders apprised of their progress. Some simplifications are already part of health reform proposals circulating in Congress, she said.
