Gastroduodenal hemorrhage: difficulties in recognition of lesions at operation by palpation and inspection.
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Detection of thyroid nodules by physical examination and high-resolution ultrasonography was compared using small groups of blinded, experienced physician examiners working with a sample of 2441 persons from Estonia, most of whom were Chernobyl nuclear reactor clean-up workers. A random subsample of 113 (5%) persons was subjected to triple control examinations with both physical examination and high-resolution ultrasonography. Positive high-resolution ultrasonographic findings were considerably more reproducible among different observers than were positive physical examination findings. Agreement between methods was poor. Nodules were found in 169 (6.9%) subjects by physical examination and in 249 (10.2%) subjects by high-resolution ultrasonography. Physical examination found only 53 (21%) of the 249 nodules found by high-resolution ultrasonography. High-resolution ultrasonography did not confirm the existence of 115 (68%) of the 169 nodules found by physical examination. Only 6.4% of nodules less than 0.5 cm in diameter, as based on high-resolution ultrasonographic results, were detected by physical examination. Physical examination detection improved with increasing nodule size but was still only 48.2% for nodules larger than 2 cm. Physical examination was relatively effective in detecting nodules in the isthmus of the thyroid gland but much less so for nodules in the upper pole of the gland. Clinical evaluation and epidemiologic studies of nodular thyroid disease stand to benefit from the greater sensitivity and specificity of ultrasonographic examinations.
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In dairy goats there is less evidence for relationships between udder form traits, results of physical udder examinations and mastitis indicators in the milk than in dairy cows. In 413 goats (predominantly Weisse Deutsche Edelziege and Bunte Deutsche Edelziege) from five herds (free from C.A.E.) repeated investigations of 2537 udder halves and fore milk samples were carried out in order to compare udder traits with findings in the milk. Less than 20% positive bacteriological findings and a low incidence of clinical mastitis testified a good clinical udder health status of the herds. Small teat-floor distances, loose hanging of the udders and bottle-shaped teats, findings which tended to become more frequent as lactation and lactation numbers progressed, indurative alterations of the mammary tissues and the teats tended to be connected with higher milk cell counts (> 1 million/microliter), more polymorphonuclear milk cells (> 40%), higher electrical milk conductivity (> 6.8 mS/cm) and lower milk lactose content (< 4.6%). A similar effect had a bad state of foot trimming. It is proposed to include the studied udder traits into herd health programs and breeding schemes for goats.
OBJECTIVE: To evaluate the overall incidence of prostate cancer in patients with symptoms of prostatism, no suspicious DRE and PSA > 10 ng/ml. MATERIAL AND METHOD: 397 eligible patients based on the above criteria, mean age 69.3 +/- 7.7 years and mean PSA level of 21.3 +/- 29.3 ng/ml, underwent ultrasound-guided transrectal biopsy of the peripheral and central areas. Patients with no cancer in the biopsy and surgery indication underwent prostate surgery. Incidence of cancer in the transitional area was evaluated in these patients. RESULTS: Biopsy was found to be positive for cancer in 15.4% patients. Patients with prostate cancer had PSA concentrations (p = 0.06) and PSAD (p < 0.0001) lower than cancer-free patients. Thirteen (21%) of these patients underwent radical prostatectomy; an extracapsular tumour was found in 46% of the surgical specimens. Of the 336 patients with benign histology in the biopsy, 94 (28%) underwent prostate surgery. Cancer in the transitional zone was found in 15% cases (5 T1a and 8 T1b), with significant differences between PSA (0.03) and PSAD (0.04) concentrations between patients with BPH or T1b tumour in the surgical specimen but not among patients with BPH and T1a cancer. CONCLUSIONS: Approximately 30% of these patients had prostate cancer, half of them found in the transitional area. PSA and PSAD did not show enough diagnostic strength to identify these patients. Most patients with cancer had clinically significant tumours. Therefore, we believe that prior to deciding the course of therapy these patients should undergo another series of biopsies including the transitional area, mainly in those with long-term life expectancy.
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The primary respiratory mechanism (PRM) as manifested by the cranial rhythmic impulse (CRI), a fundamental concept to cranial osteopathy, and the Traube-Hering-Mayer (THM) oscillation bear a striking resemblance to one another. Because of this, the authors developed a protocol to simultaneously measure both phenomena. Statistical comparisons demonstrated that the CRI is palpably concomitant with the low-frequency fluctuations of the THM oscillation as measured with the Transonic Systems BLF 21 Perfusion Monitor laser-Doppler flowmeter. This opens new potential explanations for the basic theoretical concepts of the physiologic mechanism of the PRM/CRI and cranial therapy. Comparison of the PRM/CRI with current understanding of the physiology of the THM oscillation is therefore warranted. Additionally, the recognition that these phenomena can be simultaneously monitored and recorded creates a new opportunity for further research into what is distinctive about the science and practice of osteopathic medicine.
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The paper presents the case of bilateral simultaneous breast amputation due to different histological classification cancer. The right breast tumor was non-palpable.