Removing rectal foreign bodies: is the ventouse gender specific?

To the Editor: Anthropomorphic studies of the penis have largely centred on comparisons of length and girth and have not always grasped the substance of a more important companion feature, namely direction. The "john Thomas" (JT) sign refers to the position of the penis in relation to unilateral disease on routine x-ray, with a positive sign being implied when inclined to the side of the disorder (eg, a fractured hip). Although readily recognised, it has attracted little scholarly attention, being confined to darkroom banter or to impressing humourless medical students. While some degree of prudishness may have been responsible for curbing potential applications of the JT sign in the past, we believe that the position of the penis now needs to be set straight. We identified 65 consecutive male patients with a fractured right hip and 65 with a fractured left hip. The penile position was graded as positive (illustrated in the Figure), negative or equivocal (part of the glans below the symphysis). The penile bent was similarly defined in a further 65 patients in whom fracture was suspected but not identified. The JT sign was positive (ie, the penis inclined toward the fracture) in 70% of patients with hip fracture (91/130), negative in 11% (14/130) and equivocal in 19% (25/130). Consequently, the sensitivity (70%; 95% CI, 62%-78%) and specificity (67%; 95% CI, 60%-75%) for the JT sign are low. The genital disposition did not correlate with length of stay (r =0.14). Demonstration of the JT sign before x-ray may be as useful as demonstrating leg shortening and external rotation synonymous but in no way diagnostic. And, if all patients with suspected hip fractures are routinely x-rayed, the prognostic significance of the pointer is minimised. Nonetheless, while the clinical utility of the JT sign may be limited, it appears to be real and reproducible. Thirty-one per cent of patients (20/65) presenting with a hip injury without fracture inclined to the injured side. If at least half of x-rays for hip fracture confirm the diagnosis, the predictive value of a positive JT sign is over 69%. Similar eponymous signs, such as Homan's,