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PubMed1993

Pretreatment sonographic evaluation of inguinal lymph nodes in patients with vulvar malignancy.

The state of the inguinal nodes is a major prognostic factor in vulvar carcinoma. Because of new surgical trends with selective inguinal lymphadenectomy, the preoperative evaluation of inguinal lymph nodes is essential for adequate treatment of vulvar carcinoma. To evaluate the adequacy of clinical examination and high-frequency transducer sonography in detecting metastatic inguinal lymph nodes, we studied 25 patients with vulvar malignancy who underwent operation. Histopathologically proved lymph node metastases were found in 11 (22%) of 50 inguinal areas studied. All of the suspected metastases were in patients with stage III-IV disease. The inguinal lymph node metastases were found by sonography in nine (82%), by preoperative palpation in one (9%), and by operative palpation in six (55%) of 11 areas. The difference between sonography and palpation was statistically significant (P < 0.01). The sensitivity and specificity were 82% and 87% for sonography, 9% and 100% for preoperative palpation, and 55% and 90% for operative palpation.

Adult↗
PubMed1996

Role of high frequency ultrasonography in the evaluation of palpable breast masses in Chinese women: alternative to mammography?

We prospectively assessed the accuracy of high resolution breast ultrasonography in the diagnosis of palpable breast masses in comparison to clinical palpation and x-ray mammography. Four hundred and eight Chinese women with palpable breast lumps had clinical assessment followed by ultrasonography of the breast, mammography (for women over 35 years), and fine needle aspiration cytology. Excisional biopsy or surgery was performed for suggestive lesions. The clinical, mammographic and ultrasound diagnoses were compared with the final pathologic diagnosis. In the determination of whether a lesion was malignant, the sensitivity, specificity, and positive predictive values were 97%, 97%, and 85%, respectively, for ultrasonography; 92%, 94%, and 84%, respectively, for mammography; and 88%, 92%, and 67%, respectively, for clinical evaluation. The specificity for combined clinical palpation and ultrasonography was higher (99%) than that for combined clinical palpation and mammography (96%). Addition of ultrasonography to combined clinical palpation and mammography increased specificity. Mammography in addition to combined clinical palpation and ultrasonography did not significantly improve the sensitivity, specificity, or positive predictive value. This limited usefulness raises the question as to whether it should be eliminated in the workup of a palpable mass in the average Chinese patient. Its main advantage is the detection of extended foci of carcinoma in situ related to a palpable mass, which often is undetected by ultrasonography.

Adult↗
PubMed1999

[Diagnostic value of ultrasonography in cervical lymph node metastasis].

OBJECTIVE: To research the accuracy of ultrasonography in the diagnosis of cervical lymph node metastasis and the value of that of cervical lymph node occult metastasis. METHOD: Fifty-five patients(61 sides) operated by neck dissection were double-blindedly studied by preoperation palpation and ultrasonography comparing with postoperating pathological examination. RESULT: Fifty-two sides were confirmed to be pathology lymph node metastasis from 61 sides. 40 and 48 sides were checked out by palpation and ultrasonography, respectively. The sensitivity, specificity and accuracy of palpation and ultrasonography were 76.9% and 92.3% (P < 0.05), 77.8% and 88.9%(P > 0.05) and 77.0% and 91.8%(P < 0.05), respectively. Six sides were checked out by ultrasonography (occult metastasis) in 12 sides of palpation negative. CONCLUSION: The accuracy of ultrasonography was prior to that of palpation in examining cervical lymph node metastsis. Ultrasonography could check out about half occult metastasis and should be regarded as a routine examining items in diagnosing cervical lymph node metastasis.

Adult↗
PubMed2004

[Diagnosis of penile carcinoma].

UNLABELLED: Diagnosing penile cancer requires a consistent search for initial tumor lesion, determination of the condition of the regional lymph nodes, and a search for distant metastases. Compulsory examinations such as: Inspection, Palpation and Biopsy define the presence of a tumor process and its histological clarification. Additional examinations such as: Echography, Computer tomography, and Magnetic Resonance define the stage of the disease and the method of its treatment. OBJECTIVE: The objective of the present research is to present the diagnostic methods applied in the case of penile cancer at the Clinic of Urology, Medical University-Sofia. METHODS: The patients having penile cancer diagnosis who were treated at the Clinic of Urology, Medical University-Sofia for 13 years, from 1990 to 2002 were studied and 80 cases were found. The diagnostic methods used were examined, and the said methods were conditionally divided into two categories: compulsory and additional. RESULTS: The condition of the palpating inguinal lymph nodes is influenced by the removal of the initial tumor lesion through partial penile amputation and treatment with broad-spectrum antibiotics. The enlarged palpating lymph nodes undergo a process of reverse development in 50% of the cases. CONCLUSIONS: Application of diagnostic methods such as: inspection, palpation, biopsy, echography, computer axis tomography, and nuclear magnetic resonance ensure the diagnosis of the initial tumor lesion in the case of penile cancer. The condition of the palpating inguinal lymph nodes is determined through the above-cited diagnostic methods. The presence of Na metastases in the inguinal lymph nodes is proved through surgical biopsy.

Adult↗
PubMed2005

Risk factors for headache, including TMD signs and symptoms, and their impact on quality of life. Results of the Study of Health in Pomerania (SHIP).

OBJECTIVE: The aim of this investigation was to evaluate the role of various signs and symptoms of temporomandibular disorders (TMD), among other potential risk factors, in developing frequent headache in a population-based sample of the cross-sectional epidemiologic Study of Health in Pomerania (SHIP). The impact of headache and of myogenous and arthrogenous signs of TMD on the quality of life of this sample was evaluated. METHOD AND MATERIALS: Medical history and dental and sociodemographic parameters of 4,255 subjects were checked for correlations with frequent headache using a multivariate logistic regression model. The quality of life of the headache sufferers was evaluated with a questionnaire on mental and physical health. RESULTS: Of the sample, 9% reported suffering from frequent headache. Significant values for the odds ratios for the whole sample were found for pain on palpation of the masticatory muscles; the anamnestic question on masticatory muscle pain; ear noises; lateral palpation pain of the temporomandibular joints (TMJ); several sleep disorders; psychosomatic complaints; and risk for women. Palpation pain of the muscles showed a dose/response effect. Subjects with a higher education level had a significantly reduced risk for developing frequent headache. Anamnestic questions for pain in the TMJ area, TMJ clicking, smoking, alcohol abuse, contraceptives, income, and chronic diseases did not correlate significantly with frequent headache. Subjects who reported frequent headache exhibited a significant reduction of physical and mental health scores. Pain upon muscle palpation showed significantly reduced scores on both scales for both genders. CONCLUSION: Within the limitations of this study, in addition to sensitive TMJs, mainly palpation-sensitive masticatory muscles showed a significant relation to the occurrence of frequent headache. Because of the number of tested covariates originally included in the model, this relation seems essential.

Adult↗
PubMed2006

An absent pulse is not sensitive for the early detection of peripheral arterial disease.

BACKGROUND: This study's objective was to determine the test characteristics of pedal pulse palpation in the diagnosis of peripheral arterial disease (PAD) when compared to the more widely recommended screening tool, the ankle-brachial index (ABI). METHODS: We screened patients > 50 years of age for PAD within primary care clinics in Houston. PAD was diagnosed by an ABI of <0.9. At each visit, pedal pulse palpation was performed for each leg. Of the patients who screened positive for PAD by ABI, we determined the sensitivity, specificity, and positive predictive value of pulse palpation. RESULTS: We enrolled 403 patients with a mean age of 63.8 +/- .36 years. The prevalence of PAD was 16.6% (67 patients total). Of the 45 patients with disease involving their left leg, 37 (82.2%) had a palpable pulse. Of the 37 patients with disease involving their right leg, 25 (67.6%) had a palpable pulse. The sensitivity of a non-detectable pulse for the diagnosis of PAD was 17.8% and 32.4% for the left leg and the right leg, respectively. The specificity of pulse palpation for the detection of PAD was 98.7% and 97.8% for the left leg and the right leg, respectively. CONCLUSIONS: Pulse palpation is not sensitive for the detection of PAD compared to ABI. More than two thirds of the patients within our cohort with PAD of either the left or right leg had a detectable pulse.

Age Distribution↗
PubMed1985

The use of ultrasonography for pregnancy diagnosis in the bitch.

Twenty-three Greyhound bitches housed at 3 breeding kennels were examined for pregnancy via transabdominal palpation and ultrasonography. Pregnancy was timed from the calculated day of ovulation (day of ovulation = day when first pup was whelped--63), and from a single breeding date (day 0). Starting on day 10 after ovulation, 9 bitches were monitored every 3 days by ultrasonography only, to determine gestational vesicle sizes during gestation and the time when fetal movements and heartbeats could be first detected. The other 14 bitches were examined by ultrasonography and transabdominal palpation on the same day every week, starting on postovulation day 19, to compare the effectiveness of the 2 methods of pregnancy determination. Parturition was the final determinant of pregnancy status. The earliest correct diagnosis of pregnancy was at 18 days after ovulation, but fetal movements and heartbeat could not be identified until days 28 and 35, respectively. Estimation of fetal numbers by ultrasound or palpation was not reliable when there were more than four in the litter. Pregnancy and nonpregnancy were correctly determined by both methods in an increasingly greater number of bitches as gestation progressed, but ultrasonography was more accurate at all stages; on days 19 to 22, 26 to 30, 34 to 38, and greater than 40 after ovulation, correct diagnoses were made in 33%, 42%, 50%, and 75% of the bitches by palpation and in 42%, 67%, 75%, and 83% of the bitches by ultrasonography. The most common error was failure to detect pregnancy by palpation or ultrasonography in bitches with small litters and tense abdominal muscles.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1977

Pregnancy diagnosis in the guinea pig.

A method for diagnosing pregnancy in the guinea pig by manual palpation was developed. Using this technique, pregnancy was detected between the 15th and 30th day of gestation with 98% accuracy. The 2% error consisted of animals that were pregnant but diagnosed as nonpregnant. Common mistakes that led to diagnosing nonpregnant animals as pregnant were: (1) palpation of fecal pellets; (2) palpation of left kidney; and (3) palpation of the sartorius muscle. Common errors that led to diagnosing pregnant animals as nonpregnant were: (1) failure to search the entire abdomen; (2) too close apposition of thumb and forefingers while searching the abdomen; and (3) failure to deprive animals of feed before palpation.

Animals↗
PubMed1995

The reliability of examination for tenderness in patients with myofascial pain, chronic fibromyalgia and controls.

OBJECTIVE: To establish the reliability with which tenderness could be evaluated in patients with chronic myalgias, using dolorimetry and palpation. METHODS: Three blinded examiners using pressure dolorimetry and digital palpation compared 19 paired tender points and 8 paired control points in 4 matched groups of 6 patients with fibromyalgia (FM), myofascial pain, pain controls, and healthy controls. RESULTS: Good interrater and test-retest reliability were found for dolorimetry scores. There were significant differences in tenderness ratings by dolorimetry between the diagnostic groups, with the patients with FM and myofascial pain having the greatest tenderness, the normals having the least tenderness, and the pain controls having tenderness levels midway between the patients with FM or myofascial pain and the normals. In all patients, control points had higher pain thresholds than tender points. One-third of patients with localized pain complaints demonstrated a significant relationship between region of clinical pain complaint and measured tenderness thresholds by dolorimetry. In ratings of tenderness by digital palpation, there was very good intrarater reliability over 26 of 27 paired points, and good interrater reliability at 75% of the points. One-half of patients with localized pain complaints demonstrated a significant relationship between region of clinical pain complaint and number of tender points by palpation. CONCLUSION: Both dolorimetry and palpation are sufficiently reliable to discriminate control patients from patients with myofascial pain and FM, but may not discriminate patients with myofascial pain from those with FM. Neither method appears to correlate well with the location of the clinical pain complaint, regardless of diagnosis.

Adult↗
PubMed2006

The value of onsite adequacy assessment of thyroid fine-needle aspirations is a function of operator experience.

BACKGROUND: Cytotechnologists and pathologists often perform onsite evaluations of thyroid fine-needle aspirations (FNAs) to provide immediate feedback regarding whether adequate material has been obtained for cytologic diagnosis. The current study was designed to determine whether onsite adequacy assessment results in a significant decrease in nondiagnostic specimens between ultrasound (US)-guided FNAs of the thyroid and those performed by palpation alone. METHODS: A search was performed to identify in-house thyroid FNAs performed between January 1, 2000 and December 31, 2003 that were obtained under US guidance or by palpation only. It was then recorded whether an onsite adequacy assessment was performed. The submitting physician and final diagnosis also were recorded for each case. Contingency tables were constructed and evaluated using chi-square analysis. RESULTS: Of 1502 in-house thyroid FNAs included in the current study, 981 (65.3%) were performed under US guidance and 521 (34.7%) were performed with palpation alone. Onsite adequacy assessment of the aspirated material was performed in 323 cases (21.5%), whereas 1179 cases (78.5%) were performed without onsite evaluation. Of the 418 palpation-guided FNAs that were performed without adequacy assessment, 70 (16.7%) were reported to be nondiagnostic, whereas of the 103 palpation-guided FNAs with immediate evaluation, only 7 (6.8%) were determined to be inadequate for diagnosis. This difference was statistically significant (P < 0.025). Of 761 US-guided FNAs without immediate adequacy assessment, 54 (7.1%) were nondiagnostic, which was not statistically different from the nondiagnostic rate of 4.5% (10 of 220 cases) for US-guided FNAs with onsite evaluation. However, when these US-guided FNAs were divided further into 2 groups based on the experience of the radiologist performing the FNA, the nondiagnostic rate in the group of experienced radiologists was only 5.4% (or 32 of 592 US-guided FNAs), even though onsite evaluation was not performed. Among radiologists with less experience, adequacy assessment significantly reduced the nondiagnostic rate from 13.0% (22 of 169 FNAs without adequacy assessment) to 4.5% (10 of 220 FNAs with adequacy assessment) (P < 0.01). CONCLUSIONS: The results of the current study demonstrate that onsite adequacy assessment of thyroid FNAs significantly reduces the number of nondiagnostic aspirates. However, the benefit of onsite evaluation, at least for US-guided FNAs, depends on the experience of the radiologist. In the current study, experienced radiologists with a relatively low nondiagnostic rate did not benefit from onsite adequacy assessment. This finding confirms the importance of experience in the performance of FNA, but suggests that onsite adequacy assessment may assist the less experienced operator.

Biopsy, Fine-Needle↗
PubMed1980

Non-surgical embryo transfer in cattle.

Embryos collected surgically from donors superovulated with PMSG and synchronized with either prostaglandin F(2)alpha or progestagen impregnated sponges were transferred non-surgically to prostaglandin or progestagen synchronized recipients. One embryo was transferred to the uterine horn ipsilateral to the corpus luteum either through a flexible catheter introduced through a steel tube and passed to the uterine tip, or through a Cassou inseminating gun passed approximately 6 cm into the horn. Of 16 recipients receiving 5 or 6 day old embryos through the catheter (1976), 6 (38%) were palpated pregnant at 42 days and 4 (25%) subsequently calved. Of 16 recipients receiving 7 or 8 day old embryos through the straw and 16 through the catheter (1977), 10 (63%) and 3 (19%), respectively, were palpated pregnant (P<0.05) and 8 (50%) and 3 (19%), respectively, had normal embryos at slaughter 4 to 29 days after palpation (P reverse similar0.10 ). Forty 7 to 9 day old embryos were transferred through the straw in 1978. Eighteen (45%) of the recipients were palpated pregnant and 16 (40%) had normal embryos at slaughter 98 to 168 days after palpation. The success of the transfers in 1978 was affected by embryo quality [good vs poor embryos; 64% vs 22% recipients pregnant (P<0.01) and 59% vs 17% embryos surviving to slaughter (P<0.05)]. Also, in 1978, pregnancy rate was affected by the time taken to transfer the embryo with the highest rate achieved with the fastest transfers (P<0.10, b = -0.47). Injection of Indomethacin near the time of transfer, synchronization between donor and recipient onset of estrus and embryo age did not affect pregnancy rates. The pregnancy rate achieved after the transfer of good quality embryos by the straw technique was equal to that expected from surgical techniques.

Journal Article↗
PubMed2004

Paraspinal muscles and intervertebral dysfunction: part one.

BACKGROUND: One of the diagnostic characteristics of the manipulable spinal lesion--a musculoskeletal disturbance detected by manual palpation and corrected with manipulation--is said to be altered segmental tissue texture. Various manual therapy authors have speculated on the possible nature of this tissue change, with some authors hypothesizing that it represents deep segmental muscle overactivity. OBJECTIVES: To review the literature relating to the detection and nature of altered paraspinal tissue texture, proposed explanations for altered tissue texture, evidence for the plausibility of paraspinal muscle spasm, and evidence of muscle dysfunction associated with low back pain (LBP). DATA SOURCE: MEDLINE and CINAHL databases were searched using various combinations of the keywords paraspinal, muscle, palpation, EMG, spine, low back pain, pain, myofascial, hardness, manipulation, reliability, and somatic dysfunction, along with searching the bibliographies of selected articles and textbooks. DATA EXTRACTION: All relevant data were used. RESULTS: Little direct evidence exists for the nature of abnormal paraspinal tissue texture detected by palpation. Palpation for tenderness is more reliable than palpation for tissue texture change. Indirect evidence from animal studies and experimental muscle inflammation support the plausibility of protective paraspinal muscle contraction. Increased paraspinal electromyographic (EMG) activity observed in subjects with LBP appears to be a result of voluntary and nonvoluntary changes in motor control, modified by psychophysiological responses to perceived stress rather than a simple protective reflex. CONCLUSION: Although little direct evidence exists of the nature of clinically detected paraspinal tissue texture change, the concept of reactive muscle contraction appears plausible. Increased paraspinal EMG activity associated with LBP does not appear to be mediated by a simple protective reflex.

Electromyography↗
PubMedDate not supplied

The effects of doxorubicin (adriamycin) on spinal fusion: an experimental model of posterolateral lumbar spinal arthrodesis.

BACKGROUND CONTEXT: Malignant spinal lesions may require surgical excision and segmental stabilization. The decision to perform a concomitant fusion procedure is influenced in part by the need for adjunctive chemotherapy as well as the patient's anticipated survival. Although some evidence exists that suggests that chemotherapy may inhibit bony healing, no information exists regarding the effect of chemotherapy on spinal fusion healing. PURPOSE: To determine the effect of a frequently used chemotherapeutic agent, doxorubicin, on posterolateral spinal fusion rates. STUDY DESIGN/SETTING: Prospective animal model of posterolateral lumbar fusion. OUTCOME MEASURES: Determination of spinal fusion by manual palpation of excised spines. Plain radiographic evaluation of denuded spines to evaluate intertransverse bone formation. METHODS: Thirty-two New Zealand White rabbits underwent posterior intertransverse process fusion at L5-L6 with the use of iliac autograft bone. Rabbits randomly received either intravenous doxorubicin (2.5 mg/kg) by means of the central vein of the ear at the time of surgery (16 animals) or no treatment (16 animals; the control group). The animals were euthanized at 5 weeks, and the lumbar spines were excised. Spine fusion was assessed by manually palpating (by observers blinded to the treatment group) at the level of arthrodesis, and at the adjacent levels proximal and distal. This provided similar information to surgical fusion assessment by palpation in humans. Fusion was defined as the absence of palpable motion. Posteroanterior radiographs of the excised spines were graded in a blinded fashion using a five-point scoring system (0 to 4) devised to describe the amount of bone observed between the L5-L6 transverse processes. Power analysis conducted before initiation of the study indicated that an allocation of 16 animals to each group would permit detection of at least a 20% difference in fusion rates with statistical significance at p=.05. RESULTS: Eleven of the 16 spines (69%) in the control group and 6 of the 16 spines (38%) in the doxorubicin group fused. This difference was statistically significant (=.038). There was no significant correlation (p>.05) between the radiographic grade of bone formation (0 to 4) and fusion as determined by palpation. There were four wound infections in the control group and four in the doxorubicin group. However, solid fusions were palpated in three of these four spines in both the control and treatment groups. CONCLUSIONS: No significant differences in wound complications were noted with doxorubicin administration. A single dose of doxorubicin administered intravenously at the time of surgery appears to play a significant inhibitory role in the process of spinal fusion. If similar effects occur in humans, these data suggest that doxorubicin may be harmful to bone healing in a spine fusion if given during the perioperative period. Further investigation will be necessary to determine the effect of time to aid at determining whether doxorubicin administered several weeks pre- or postoperatively results in improved fusion rate, and whether bone morphogenetic proteins can overcome these inhibitory effects.

Animals↗
PubMed2005

Comparison of Healos/bone marrow to INFUSE(rhBMP-2/ACS) with a collagen-ceramic sponge bulking agent as graft substitutes for lumbar spine fusion.

STUDY DESIGN: A rabbit lumbar intertransverse process arthrodesis model was used to evaluate the efficacy of two different bone substitute materials: 1) collagen-hydroxyapatite sponge (Healos bone void filler) combined with heparinized bone marrow; and 2) recombinant human bone morphogenetic protein-2 delivered in a collagen sponge (INFUSE Bone Graft) wrapped around an additional collagen-ceramic sponge (Mastergraft Matrix) as a "bulking agent." OBJECTIVES: To compare the relative efficacy of two different bone graft substitutes to achieve posterolateral lumbar spine fusion in rabbits. SUMMARY OF BACKGROUND DATA: Autogenous bone graft is considered the gold standard graft material for spine fusion. Complications with its use, however, may occur in as many as 30% of patients. A variety of bone substitutes have been used for spine fusion, but there are few direct comparison experiments to determine the relative efficacy of any two alternatives. METHODS: Adult New Zealand white rabbits (n = 24) were divided into two groups and underwent bilateral posterolateral intertransverse process spine arthrodesis at L5-L6. The fusions were augmented by different bone substitute materials as follows: Group 1 (n = 12) received 3 mL of collagen-hydroxyapatite sponge (Healos bone void filler) (10 x 30 x 5 mm, two per side) with 3.0 mL of heparinized bone marrow on each side of the spine. (ratio 1:1); Group 2 (n = 12) received 1.5 mL of rhBMP-2 (0.43 mg/mL solution) on a Type 1 collagen sponge (INFUSE Bone Graft) wrapped around an additional 1.5 mL collagen-ceramic (15%HA/85%TCP) sponge (Mastergraft Matrix) as a bulking agent to provide 3 mL of graft on each side of the spine. Bone marrow was aspirated from posterior iliac crest, and 1 mL of bone marrow was sent to count number of nucleated cells. The rabbits were killed after 8 weeks; the spines were evaluated by manual palpation, radiographs (plain radiograph and CT scan), tensile mechanical testing, and nondecalcified histology. RESULTS: The bone marrow had average of total nucleated cell count 9 x 10 cells. All rabbits (100%) in Group 2 (INFUSE/Mastergraft Matrix) achieved solid spinal fusions by manual palpation and radiographs, whereas solid spinal fusion was not achieved by manual palpation and radiographs in any of the rabbits treated with Healos combined with heparinized bone marrow (Group 1). The plain radiograph and CT scans of Group 1 showed some minimal new bone formation near the transverse processes, but none of these rabbits formed a continuous fusion mass. In contrast, all of plain radiographs and CT scans in Group 2 showed continuous fusion mass and complete graft incorporation between transverse processes bilaterally. Biomechanically, the relative strength and relative stiffness values of L5-L6 (fusion segment) in Group 2 were statistically significant greater than L5-L6 in Group 1 (P < 0.001). Histologic sections confirmed the palpation and radiographic results. CONCLUSION: From the manual palpation, radiographic and biomechanical assessment of fusion, the results in this study showed that INFUSE (rhBMP-2/collagen sponge) consistently produced spine fusion when wrapped around a collagen-ceramic sponge bulking agent (Mastergraft Matrix). Meanwhile, Healos was ineffective as a bone graft material when combined with heparinized autogenous bone marrow.

Animals↗
PubMed2003

Use of ultrasound guidance in the insertion of radial artery catheters.

OBJECTIVE: To assess the role of a portable ultrasound device in the insertion of radial artery catheters. DESIGN: Prospective, randomized, comparative study. SETTING: Tertiary university hospital. PATIENTS: Elective surgery patients requiring arterial catheter insertion for intraoperative monitoring. INTERVENTIONS: A portable ultrasound device was used to visualize the radial artery at the wrist and to direct arterial catheter insertion. This new technique of arterial catheter insertion was compared with the classic palpation technique. MEASUREMENTS AND MAIN RESULTS: A total of 69 patients requiring an arterial catheter were randomized to either the ultrasound (34 patients) or palpation technique (35 patients). The time taken from skin puncture to successful arterial catheter insertion, the time taken per insertion attempt, the number of attempts required, and the number of cannulae used were recorded for each group. The arterial cannula was inserted on the first attempt in 21 (62%) cases using ultrasound vs. 12 (34%) cases by palpation (p =.03). Significantly fewer attempts were required for catheter insertion using ultrasound as compared with palpation (mean +/- sd, 1.6 +/- 1.0 vs. 3.1 +/- 2.4; p=.003); however, the time taken for each successful attempt was longer (26.1 +/- 2.0 vs. 17.3 +/- 1.6 secs, p=.001). A trend toward shorter overall time required for catheter insertion was found for the ultrasound group (55.5 +/- 63.8 vs. 111.5 +/- 121.5 secs, p=.17). There were four failures in the ultrasound group and one in the palpation group (not significant). CONCLUSIONS: Ultrasound is a useful adjunct to arterial catheter insertion and increases the rate of success at first attempt. The technique is easy to learn and may reduce the time taken to insert the catheter.

Aged↗
PubMed2004

Cost-effectiveness of a community-based screening programme for chronic atrial fibrillation in Japan.

OBJECTIVES: To examine the cost-effectiveness of a community-based screening programme for chronic atrial fibrillation (AF) in Japan. METHODS: Using a computer model of a Markov process, the cost-effectiveness of an annual ECG screening programme and an annual pulse palpation screening programme for arrhythmia were compared with no screening. A hypothetical Japanese population of 65 year old individuals was followed until 85 years of age. We assumed that individuals with irregular beats on palpation were worked up by ECG and that ECG was perfect in detecting AF, whereas palpation was not. It was also assumed that patients diagnosed with AF received anticoagulant therapy, that some AF patients developed ischaemic stroke, and that some on anticoagulant therapy developed intracranial or gastrointestinal haemorrhage. Costs, efficacy of anticoagulation, utility of health status, and clinical variables were estimated from the literature. Outcomes were expressed as US dollars per quality-adjusted life-year (QALY). RESULTS: Both annual ECG screening programme and annual palpation screening programme were more costly and at the same time more effective compared with no screening, with their incremental cost-effectiveness ratios approximately US$8000 per QALY in males and US$10,000 per QALY in females. Sensitivity analyses showed high sensitivity of cost-effectiveness ratios to the incidence of ischaemic stroke and anticoagulants prescription rate. Two annual screening programmes were similar in effectiveness and costs. CONCLUSION: To prevent ischaemic stroke associated with AF, both annual ECG screening and annual palpation screening were favourable in the context of conventional criteria for cost-effectiveness.

Aged↗
PubMed2005

Use of intraoperative epiaortic ultrasonography to delineate aortic atheroma.

OBJECTIVE: A cerebrovascular accident (CVA) is a devastating complication of coronary artery bypass grafting (CABG) and a major cause for morbidity and mortality. Aortic manipulation, cannulation, and clamping during CABG may lead to release of atheromatous material from the ascending aorta, which may cause a CVA. This study assessed the hypothesis that the use of intraoperative epiaortic ultrasonography (EAUS) would supplement imaging information with that derived from manual aortic palpation and influence the surgical decision-making approach accordingly. METHODS: After undergoing a mid-sternotomy for CABG, 105 patients underwent EAUS with an 8-MHz transducer ordinarily used for conventional transthoracic echocardiography. The surgical strategy was decided on at three stages: preoperatively, after manual aortic palpation, and following EAUS. RESULTS: The preoperative strategy had assigned 105 patients to the "touched aorta" group that was planned for either on-pump or off-pump CABG (OPCAB) with proximal anastomosis to the aorta. Pathologic lesions of the atheromatotic ascending aorta were evident in 40 patients (38%), with the lesions detected in 22 patients (21%) by both palpation and EAUS, and in 18 patients (17%) by EAUS alone. The planned surgical strategy was changed in 29 patients (28%): 25 patients (24%) were converted from on-pump CABG to OPCAB, and the EAUS influenced the choice of the aortic cannulation, cross-clamping, and proximal anastomosis site in 4 patients (4%). Among the changes in surgical decision making, changes in 11 patients (10%) were based on lesion detection by both manual palpation and EAUS; in 18 patients (17%), changes resulted from pathologic evidence provided by EAUS alone. CONCLUSIONS: This study showed EAUS to be more sensitive in detecting atherosclerotic lesions than manual intraoperative palpation of the ascending aorta. This investigation contributes new data on the effect of EAUS on intraoperative surgical approach in the era of OPCAB. The use of EAUS has emerged as an important tool in intraoperative decision making, and we recommend its use routinely in CABG procedures.

Aged↗
PubMed2006

Application of the breast imaging reporting and data system final assessment system in sonography of palpable breast lesions and reconsideration of the modified triple test.

OBJECTIVE: The purpose of our study was to evaluate the utility of the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) sonographic final assessment system and palpation-guided fine-needle aspiration (FNA) for evaluation of palpable breast lesions. METHODS: Our computerized database identified 160 palpable lesions of the breast in which follow-up palpation-guided FNA, targeted sonography, and pathologic confirmation were performed. We used BI-RADS sonographic data on all lesions. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of malignancy were calculated for sonography and palpation-guided FNA. Two-sample binomial proportion tests were used as the statistical analysis (P<.05). RESULTS: The FNA results were defined as benign, atypical cells, suspicious for malignancy, malignancy, and insufficiency. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 90.9%, 82.7%, 84.3%, 57.7%, and 97.2%, respectively, on sonography and 75.8% to 90.9%, 82.7% to 98.4%, 84.3% to 94.4%, 57.7% to 92.6%, and 93.9% to 97.2% on FNA. There was no statistically significant difference for sensitivity and negative predictive value between the two examinations. CONCLUSIONS: The diagnostic accuracy of sonography was similar to that of palpation-guided FNA for not missing the malignancy. Clinical application of FNA results can be difficult, especially when the result is insufficiency or atypical cells. Moreover, FNA is invasive and overlaps other procedures. Therefore, we conclude that sonography can replace palpation-guided FNA for diagnosis of palpable lesions of the breast when the BI-RADS sonographic final assessment system is used appropriately.

Adolescent↗