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PubMed1991

Imaging. Follow-up of breast cancer reconstruction cases.

Imaging a breast that has had cancer and been reconstructed has inherent problems, mostly because the reconstruction and the implant may be obscuring recurrence. It should, therefore, be emphasized that such patients require frequent follow-up. Perhaps every 6 months they also need skillful palpation as well as mammography with proper techniques that image as much of breast tissue as possible with the implant displaced as much as possible.

Aftercare↗
PubMed1991

Nonimaging aspects of follow-up in breast cancer reconstruction.

Follow-up of patients with breast cancer is directed to the early detection of recurrent or metastatic disease and the detection of new primary breast cancer. The survival benefit of early detection is limited to some patients with local failure or new primary tumors. That imaging is not used in follow-up of patients who have had breast cancer reconstruction is related to possible interference with this putative benefit by the reconstructive procedure. Such follow-up is accomplished by the patient's own surveillance, clinical examination, and laboratory testing supplemented by imaging studies. Clinical follow-up trials of women who have undergone breast reconstructive surgery show no evidence that locally recurrent breast carcinoma is masked when compared with follow-up of women who did not undergo reconstructive procedures. Reshaping of the contralateral breast to match the reconstructed breast introduces the possibility of interference with palpation as well as mammographic distortion in some women. This is an uncommon practical problem except when complicated by fat necrosis.

Breast Neoplasms↗
PubMed1993

Cancer in the augmented breast. Diagnosis and prognosis.

BACKGROUND: The stage of breast cancer at diagnosis in women who have undergone augmentation mammoplasty has been examined with conflicting results. Additional evaluation of this population is needed. METHODS: A retrospective review of a large cancer center's breast cancer registry for a 116-month period was performed. Comparisons of patient age, method of detection, and pathologic stage of disease at presentation were performed for 33 patients with augmented breasts and 1735 patients with nonaugmented breasts who were treated. RESULTS: Twenty-four percent of the patients with augmented breasts and 42% of those with nonaugmented breasts had mammographically detected cancers (P = NS). The incidence of ductal carcinoma in situ in the two groups was similar (18% versus 15%). Sizes of the mammographically detected tumors in the two groups were comparable; however, palpable tumors in the augmented group were significantly smaller than were those in the nonaugmented group. Overall, a significant difference in axillary lymph node involvement was detected, with 19% of the augmented group and 41% of the nonaugmented group having positive lymph nodes. In patients with palpable tumors, axillary lymph node involvement also was significantly different, with 22% of the patients with augmented breasts and 58% of those with nonaugmented breasts having axillary lymph node metastases. In the mammographically detected tumors, there was no significant difference in axillary lymph node metastases between the patients with augmented (13%) and those with nonaugmented (15%) breasts. CONCLUSIONS: Early detection of breast cancer is possible in the patient who has undergone augumentation mammoplasty. Mammography was successful in detecting occult lesions, and palpation detected smaller tumors. In this cohort, there was no evidence to suggest that the patients with augmented breasts had more advanced disease at presentation.

Adult↗
PubMed1996

Diagnostic role of cytology in screen-detected breast cancer.

Fine-needle aspiration cytology (FNAC) of the breast was performed in 491 patients over a 3-year period. Some 365 examinations (74.3 percent) were performed by palpation and the remaining 126 (25.7 percent) by stereotaxis. Ninety-six patients were excluded because of inadequate follow-up. Using a standard method of reporting the results 247 smears were classified as C1 and C2, but based on clinical and radiological criteria excision biopsy was recommended and performed in 122 patients with these lesions. Twenty-two per cent of C2 lesions were found to be malignant after histological examination. Forty-two patients with C3 or C4 cytology were advised to have excision biopsy and 41 had surgery. In all but one case the lesion was found to be malignant histologically. Definitive surgery was performed on 106 patients with C5 cytology and the diagnosis of malignancy was confirmed histologically in 105 of them. FNAC is a useful diagnostic tool in breast screening but in view of the number of false-negative results, cytology alone is unreliable and, therefore, full triple assessment is recommended.

Adenocarcinoma↗
PubMed1993

Prophylaxis in ovarian cancer.

The only prophylaxis for ovarian cancer is oophorectomy, except in the very rare case when an ovarian cancer appears to arise from the mesothelial tissue of the abdominal cavity. It has been shown that women who have taken the oral contraceptive pill for 4 or 5 years decreases the incidence of ovarian cancer by approximately 40%. It is estimated that the oral contraceptive pill can prevent approximately 1500 ovarian cancers each year. The postmenopausal palpable ovary syndrome is simply the palpation of what is interpreted as a normal-sized ovary in the premenopausal woman represents an ovarian tumor in the postmenopausal woman. It addresses the size and consistency and has nothing to do with the small cysts reported by the sonographer. A patient who has two first-degree blood relatives or a mother, sister, or daughter who has developed ovarian cancer premenopausally is at high risk to develop ovarian cancer. Because ovarian cancer is the leading cause of death from gynecologic cancer, it is important to explore all options for prophylaxis in the prevention of ovarian cancer.

Adult↗
PubMed2001

Observer error in the assessment of nodal disease in head and neck cancer.

BACKGROUND: There is no previously published information on clinicians' abilities to accurately differentiate between different stages of node positive disease in head and neck cancer. METHODS: Forty-two surgeons examined standardized nodes in a model neck and estimated nodal size. Each recorded their confidence in their ability to perform the task using a visual analogue scale. Reference nodes of known size were provided for comparison during a second examination of each node. The study was repeated after 1 month. RESULTS: Accuracy was poor and was not dependent on experience or confidence. There was a tendency to underestimate the size of smaller nodes. Estimates were strongly influenced by volume independent of largest diameter (p <.001). Reference nodes aided accuracy (p =.031). Subjects were not consistent on repeated testing (p <.001). CONCLUSIONS: Both trainees and specialists are poor at accurately staging nodal disease using palpation alone.

Clinical Competence↗
PubMed1991

Sonographic assessment and grading of spleen size.

Ultrasonography was used to evaluate spleen size in patients with various clinical conditions including those of the liver, blood, collagen, or autoimmune disease. To express spleen size, a spleen index (SI), the product of the transverse diameter and its perpendicular diameter measured on the maximum cross-sectional image of the spleen, was used. SI correlated well with the volumes of resected spleens. Splenomegaly was present in high percentages of patients with liver, blood, collagen, and autoimmune disease, even though a majority of these spleens were not large enough to palpate. By grading the SI, characteristic distributions of SI were obtained for patients with different types of diseases. Obtaining and grading the SI by the use of ultrasound appears to be a significant supplemental aid for evaluating spleen size, especially in patients whose spleens are not palpable.

Adolescent↗
PubMed2006

Added value of ultrasound in screening the clinically negative axilla in breast cancer.

BACKGROUND: For staging purposes in breast cancer it is current practice to perform a sentinel node biopsy in a clinically negative axilla, followed by an axillary lymph node dissection if metastases are found in the sentinel node. To limit the number of surgical procedures it is therefore of importance to try and identify as much patients as possible who have axillary metastases. Clinical staging of the axillary nodes in breast cancer is mainly based on palpation, but ultrasound has been shown to be of additional value in detecting pathological nodes. METHODS: In this paper, we report our results of screening 131 breast cancer patients without palpable axillary nodes through ultrasound. RESULTS: Out of the 53 patients with axillary node involvement, 18 were identified as such by our radiologist, resulting in a detection score of 34%. DISCUSSION: This high rate is probably reached because of the limited number of radiologists performing this procedure, thereby rapidly increasing their experience.

Axilla↗
PubMed1977

Obesity obscuring breast cancer: a case report.

There is normally a layer of fat in the breast between the parenchyma of the breast and the skin. This is frequently thin and does not preclude the palpation of a tumor mass which involves the breast parenchyma. In patients suffering from obesity this fat pad becomes much thicker and obscures any underlying masses arising from the breast parenchyma. A case is reported in which a woman who was markedly obese lost a significant amount of weight and presented a bulge which was found to be carcinoma. This situation, in which fat obscures underlying breast lesion, has been observed in a number of patients. Attention is called to the limited value of physical examination of the breast in markedly obese patients. If any suspicion exists or if the patient is a candidate for cancer from a familial standpoint, mammograms are indicated.

Breast Neoplasms↗
PubMed1976

The disparity of the size of the liver as determined by physical examination and by hepatic gammascanning in 504 patients.

The liver extended a minimum of 5 cm inferior to the right costal margin in 51% of the 504 patients studied. In 53% of these patients, experienced, mature physicians declared that the liver was not palpable on physical examination. In 3% of the cases, a mass was palpated which was believed to be liver by the examining physician but was found to be extrahepatic upon scanning and laparotomy. The unreliability of physical examination in determining whether or not the liver extends inferior to the costal margin in many instances is demonstrated.

Humans↗
PubMed1994

Improved method for needle electromyography of the urethral sphincter in women.

Needle electromyography (EMG) of the urethral sphincter using the periurethral approach is a procedure which most women find painful and their discomfort can restrict the usefulness of the test. A new technique has been devised using a transvaginal approach. The patient lies in the left lateral position and using a Sims speculum the posterior vaginal wall is retracted. The urethral sphincter can be easily seen and palpated, assisting correct electrode placement. This new technique is much less uncomfortable and highly satisfactory EMG recordings are obtained.

Electromyography↗
PubMed2004

Clinical evaluation of pelvic floor muscle function in continent and incontinent women.

AIMS: The aim of the study was to investigate the reliability of a scoring system for the investigation of voluntary and reflex co-contractions of abdominal and pelvic floor muscles in lying, sitting, and standing positions in continent and incontinent women. METHODS: A visual inspection and digital (strength, tone, speed, and endurance) palpation scale was developed to measure the coordination of the lower abdominal and pelvic floor muscles. Inter-observer reliability of the scales was investigated in 40 continent and 40 incontinent women. Differences between the continent and incontinent group were analysed. RESULTS: Inter-observer reliability for the visual inspection scale showed kappa values between 0.91 and 1.00, for tone percentage of agreement ranged from 95 to 100% (superficial) and 95 to 98% (deep muscle). Weighted Kappa (K(w)) varied from 0.77 to 0.95 for strength and 0.75 to 0.98 for the inward movement of superficial and deep pelvic floor muscles. K(w) for coordination between the superficial and deep part of the pelvic floor muscles groups was from 0.87 to 0.88 and 0.97 to 1.00 for endurance and global speed of the pelvic floor contraction. The continent women exhibited significantly better coordination between the pelvic floor and lower abdominal muscles during coughing in all three positions. Also the superficial part of the inward movement, the feeling and the coordination of the pelvic floor muscles were significantly better in the continent group. CONCLUSIONS: Visual inspection and digital tests are easy and reliable methods by which insight can be gained into the multi-muscular activity and coordination of the pelvic floor and lower abdominal muscles in continent and incontinent women.

Abdominal Muscles↗
PubMed2006

Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging.

AIMS: Defects in the pubovisceral portion of the levator ani muscle are seen with MR imaging. This study aims to determine interrater reliability of physical examination in detecting these defects, and to validate findings from physical examination using comparisons with MR images. METHODS: Two examiners palpated the pubovisceral muscles of 29 women to assess for defects in this muscle. Each examiner was blinded to the others findings. MR scans were acquired on a further 24 women after structured clinical examination by one examiner. These images were read to determine pubovisceral muscle defects, blinded to patient identifiers. Agreement between raters and between MR imaging and clinical examination were calculated. RESULTS: The two examiners had positive agreement (presence of a defect) of 72.7% and negative agreement (absence of a defect) of 83.3%. The positive agreement between physical examination and MR imaging was 27.3% and the negative agreement 86.5%. CONCLUSION: The structured physical examination to detect defects in the pubovisceral portion of the levator ani muscle can be learned as shown by good interrater agreement. However, examination alone underestimates these defects compared with MR imaging.

Adult↗
PubMed2007

Levator ani trigger point injections: An underutilized treatment for chronic pelvic pain.

AIMS: We conducted this study to examine the role of trigger point injections in females with chronic pelvic pain (CPP) of at least 6 months duration and specific levator ani trigger points. METHODS: This prospective study included 18 consecutive female patients with CPP and specific palpable levator ani trigger points. Pain was evaluated before and after trigger point injection on a Visual Analog Scale (VAS). Patient global satisfaction (PGS) and cure rates (PGC) were also measured by a VAS on a scale of 0-100%. The trigger points were identified manually by intravaginal palpation of the levator ani bilaterally. A mixture of 10 cc of 0.25% bupivacaine, 10 cc of 2% lidocaine and 1 cc (40 mg) of triamcinolone was used for injection of 5 cc per trigger point. A 5.5'' Iowa trumpet pudendal needle guide was used for injection. All but one injection were performed in the office setting without sedation. Pelvic floor muscle exercises were taught for use after injection. Success was defined as a decrease in pain as measured by a VAS of 50% or more, as well as PGS and PGC scores of 60% or greater. There was a mean follow up of 3 months after trigger point injection. RESULTS: Thirteen of 18 women improved with the first trigger point injection resulting in a comprehensive success rate of 72%. Six (33%) of 18 women were completely pain free. CONCLUSION: In the management of CPP, a non-surgical office-based therapy such as trigger point injections can be effective in selected patients.

Adult↗
PubMed2006

Bishop score and ultrasound assessment of the cervix for prediction of time to onset of labor and time to delivery in prolonged pregnancy.

OBJECTIVES: To determine the ability of Bishop score and sonographic cervical length to predict time to spontaneous onset of labor and time to delivery in prolonged pregnancy. METHODS: Ninety-seven women underwent transvaginal ultrasound examination and palpation of the cervix at 291-296 days' gestation according to ultrasound fetometry at 12-20 weeks' gestation. Sonographic cervical length and Bishop score were recorded. Multivariate logistic regression analysis was used to determine which variables were independent predictors of the onset of labor/delivery < or = 24 h, < or = 48 h, and < or = 96 h. Receiver-operating characteristics (ROC) curves were drawn to assess diagnostic performance. RESULTS: In nulliparous women (n = 45), both Bishop score and sonographic cervical length predicted the onset of labor/delivery < or = 24 h and < or = 48 h (area under ROC curve for the onset of labor < or = 24 h 0.79 vs. 0.80, P = 0.94; for delivery < or = 24 h 0.81 vs. 0.85, P = 0.64; for the onset of labor < or = 48 h 0.73 vs. 0.74, P = 0.90; for delivery < or = 48 h 0.77 vs. 0.71, P = 0.50). Only Bishop score discriminated between nulliparous women who went into labor/delivered < or = 96 h or > 96 h. A logistic regression model including Bishop score and cervical length was superior to Bishop score alone in predicting delivery < or = 24 h (area under ROC curve 0.93 vs. 0.81, P = 0.03) and superior to Bishop score alone and cervical length alone in predicting the onset of labor < or = 24 h (area under ROC curve 0.90 vs. 0.79, P = 0.06; and 0.90 vs. 0.80, P = 0.06). In parous women (n = 52), Bishop score and sonographic cervical length predicted the onset of labor/delivery < or = 24 h (area under ROC curve for the onset of labor 0.75 vs. 0.69, P = 0.49; for delivery 0.74 vs. 0.70, P = 0.62), but only Bishop score discriminated between women who went into labor/delivered < or = 48 h and > 48 h. Three parous women had not gone into labor and six had not given birth at 96 h. In parous women logistic regression models including both Bishop score and cervical length did not substantially improve prediction of the time to onset of labor/delivery. CONCLUSIONS: In prolonged pregnancy Bishop score and sonographic cervical length have a similar ability to predict the time to the onset of labor and delivery. In nulliparous women the use of logistic regression models including Bishop score and cervical length is likely to offer better prediction of the onset of labor/delivery < or = 24 h than the use of the Bishop score alone.

Adolescent↗
PubMed1995

Determinants of breast cancer detection among Wisconsin (United States) women, 1988-90.

Early detection is advocated widely as the best method to reduce the high rate of breast cancer mortality in women. The purpose of this study was to describe the detection histories of women with breast cancer and to identify factors related to the method of detection. During the period 1988-90, 3,197 women with invasive breast cancer, identified through the Wisconsin (United States) tumor registry, were interviewed. The method of cancer detection (classified as self, screening mammography, or clinical breast examination [CBE]) was analyzed using polychotomous logistic regression. Fifty-five percent (1,754/3,197) of the women found their own cancers, while 35 percent (1,122/3,197) were detected by screening mammography. Compared with self-detection, the likelihood of non-localized disease was significantly lower for tumors detected by mammography (odds ratio [OR] = 0.3, 95 percent confidence interval [CI] = 0.2-0.4) and CBE (OR = 0.6, CI = 0.4-0.7). The likelihood of cancer being detected by screening mammography increased with increasing age, education, number of prior mammograms, family history, and body mass index (weight/height2) (BMI). Women in the highest BMI quintile were 2.3 times (CI = 1.7-3.0) more likely than women in the lowest BMI quintile to have their cancers diagnosed by mammography. This association most likely results from breast tumors being more difficult to palpate in heavier women.

Adult↗
PubMed1993

Diagnosis and treatment of the N0 neck in carcinomas of the upper aerodigestive tract: current status of diagnostic procedures.

Diagnostic procedures currently utilized for determining nodal status in patients with head and neck primary carcinomas are reviewed. Diagnostic procedures include clinical palpation, computed tomography, magnetic resonance imaging and ultrasound. Each technique is discussed on the basis of clinical experience at the Technical University of Munich.

Carcinoma, Squamous Cell↗
PubMed1985

Role of 201Tl in the management of cardiac transplantation.

Serial percutaneous endomyocardial biopsy is the standard for diagnosis of cardiac rejection; it is generally done on a weekly basis for the first month and then as indicated by ECG voltage; but, this method is invasive, can be done only in specialized centers, not available for the many patients who return home, requires 18-24 h before a result is obtained, delaying institution of therapy, and it is aggressive for the endomyocardium of the graft. A reliable, rapid, and noninvasive test for detection of cardiac rejection is still not available. The aim of this work was to determine whether 201Tl uptake was significantly correlated with the histological findings presenting in cardiac rejection. Auxiliary heart transplantation was carried out on 60 male rats. Graft viability was evaluated by direct palpation, ECG voltage, and 201Tl uptake during the study (from 4-6 h after transplantation to 1 month). Syngenic rats (without rejection) were used as a control group. Histological studies were done at the end of the isotope study in all animals. The statistical significance of all results was determined by means of Student's t-test. A very significant correlation between the severity of the histological findings of rejection and 201Tl uptake was found (P less than 0.001). Our results have demonstrated that 201Tl uptake detected rejection earlier than ECG voltage; moreover, 201Tl uptake was more sensitive in detecting a mild degree of rejection while ECG only detected a moderate degree. We believe that 201Tl uptake should be the screening method for the follow-up of cardiac transplantation; it offers to surgeons the opportunity to select patients for endomyocardial biopsy, with a higher accuracy than the other noninvasive methods.

Animals↗

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