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PubMed1997

Percutaneous vascular access guided by color duplex sonography.

Color duplex sonography (CDS) is primarily applied as a diagnostic procedure. It has not yet established itself as an aid in punctures or other interventions. The aim of this study was to evaluate the value of CDS in arterial and venous vascular punctures. One hundred and sixty-five CDS-assisted vascular punctures were performed in a prospective study after three unsuccessful palpation-guided vasopunctures or in the absence of a palpable pulse. All CDS-assisted punctures were successful. The duration of each attempted puncture showed no statistically significant difference compared with the palpation-guided puncture technique. In the cases with three unsuccessful palpation-guided vascular punctures, the CDS-assisted technique was successful after 1.66 attempts on the average. It is concluded that CDS-assisted vascular puncture is a fast and safe alternative for puncturing a pulseless vessel or for puncturing under difficult conditions.

Adult↗
PubMed2004

Unexpected gallbladder cancer during laparoscopic cholecystectomy.

BACKGROUND/PURPOSE: In the present study, we investigated the effectiveness of surgeons in determining incidental gallbladder pathologies at laparoscopic cholecystectomy (LC). METHODS: This study included 548 patients with gallstones who underwent LC between May 1, 2001 and October 15, 2003. The surgeon made an incision on the gallbladder wall for inspection, and palpated the mucosa after removing the gallbladder from the abdominal cavity to look for unsuspected pathologies. If an abnormal mucosa was observed or palpated, it was marked with a silk suture and then histopathologic examination was performed. RESULTS: Fifty of 548 LC specimens were found to be suspi-cious by the surgeon. Histopathological examination of frozen sections revealed incidental pathologies in 15 of these specimens. Strikingly, 5 of these specimens were considered to have gallbladder cancer (GBC). The other incidental pathologies were consistent with adenomyomatosis, xanthogranulomatous cholecystitis, and fibroepithelial and hyperplastic polyps. Four of the other 498 specimens revealed incidental pathologies at definitive histopathological examination, and all of them were consistent with gastric metaplasia. The sensitivity and specificity of the procedure was 78.9% and 93%, respectively. CONCLUSIONS: A simple prosedure; that is, incision and inspection, and palpation of the gallbladder, seems to be useful for the diagnosis of incidental gallbladder pathologies.

Adult↗
PubMed2007

Development of a content-valid standardized orthopedic assessment tool (SOAT).

INTRODUCTION: Content validation of an instrument that measures student performance in OSCE-type practical examinations is a critical step in a tool's overall validity and reliability [Hopkins (1998), Educational and Psychological Measurement and Evaluation (8th ed.). Toronto: Allyn & Bacon]. PURPOSE: The purpose of the paper is to outline the process employed to create a content-valid Standardized Orthopedic Assessment Tool (SOAT). Orthopedic assessment skills are employed by athletic therapists, physiotherapists and physicians. All follow very similar diagnostic algorithms and that system was used to develop the original SOAT [Cyriax (1982). Textbook of Orthopaedic Medicine, (vol. 1) Bailliere Tindall]. METHODS: To validate the tool, the study followed procedures outlined by Violato, Salami, and Muiznieks (2002), Journal of Manipulative Physiological Therapeutics, 25, 111-115, and Butterwick, Paskevich, Vallevand and Lafave (2006), Journal of Allied Health: a modified Ebel procedure. An expert group of athletic therapists from across Canada were chosen to create the content valid tool. Representation from all accredited athletic therapy programs in Canada was sought. Experts participated in three stages of content validation: Stage one consisted of individuals grading tasks on difficulty (hard, medium, easy) and importance (essential, important, not important) for 8 body regions (cervical spine, lumbar spine, shoulder, elbow, wrist/hand/thumb, hip, knee and lower leg/foot/ankle) and three diagnoses for each body region (24 total). If 80% consensus was not achieved in the first stage, then in stage two, face to face discussion is meant to clarify positions and achieved consensus, if possible. RESULTS: The history component, the observation component, scanning exams, clearing joints above and below the lesion site and active range of motion, passive range of motion and isometric resisted testing all yielded 80% consensus in the first two stages of development. A third stage was added to this process because a new model of measurement was conceptualized during the second stage due to a lack of consensus on two orthopedic assessment categories: special testing and palpation. The new model consisted of a ;;clinical reasoning" metric that tied each section of an orthopedic assessment (history; observation; scanning and clearing; examination, special testing; palpation; conclusion) together and would permit the expert rater to evaluate the student performance based on the student's rationale for tests chosen rather than the traditionally rigid checklists. At least 80% consensus was achieved with the new ;;clinical reasoning" metric and the originally contentious special testing and palpation categories. CONCLUSIONS: The new SOAT that underwent content validation may be a hybrid between the traditional OSCE-type checklists and global scales that provide a more realistic and thus more valid depiction of orthopedic assessment clinical competence. Now that content validation has been established, the next steps include inter-rater reliability testing.

Algorithms↗
PubMed1988

Piroxicam and naproxen in acute sports injuries.

The efficacy of piroxicam versus placebo was studied in a double-blind, randomized trial of 74 patients with traumatic injury of muscle, periosteum, bursa, or ankle joint. The piroxicam dosage was 40 mg once daily for two days and then 20 mg daily for an additional five days. Efficacy parameters were assessed at entry and at three, seven, and 14 days. At the Day 3 visit, there was a statistically significant improvement in the piroxicam group for pain at rest, pain on movement, pain on palpation, reduced muscle force, and general limitation of function. At the Day 7 visit, the difference was still significant for pain on palpation and reduced muscle force. Mean time required for full relief of symptoms was 7.5 days in the piroxicam group and 10.2 days in the placebo group. The anti-inflammatory effects of piroxicam and naproxen were then compared in 254 patients experiencing the same types of injuries mentioned above. The dosage of piroxicam was the same as in the comparison with placebo, whereas naproxen was given 500 mg twice daily; treatment in both groups lasted for five days. There was no difference in most parameters for pain, swelling, and function. There was a significant difference in favor of piroxicam for tenderness on palpation and time to complete relief of symptoms.

Acute Disease↗
PubMed1979

Mandibular asymmetry and its relation to pain dysfunction.

Fifty-three subjects were examined for mandibular asymmetry using measurements from submental-vertex and frontal cephalograms. All subjects displayed malocclusions and were examined for sensitivity of the muscles of mastication to palpation. The amount of pretreatment pain to muscle palpation was then correlated to the degree of asymmetry found. No statistically significant correlation was shown between mandibular asymmetry and muscle sensitivity. The following conclusions were drawn from this study: 1. There was no correlation between the amount of mandibular morphologic asymmetry and the amount of facial pain elicited from muscle palpation. 2. In the sample used, asymmetry seemed to be the rule rather than the exception. 3. The clinician needs to be aware of asymmetry in all three planes of space in order to plan his occlusal treatment in advance and prepare patients for possible compromise. 4. Class II molar and canine relationships may be more difficult to correct on the patient's right side than on his left, provided there is no compensation from glenoid fossa position or the maxillary dentition.

Adolescent↗
PubMed1985

Effects of an analog of PGF2(alpha) (ONO-1052) on cows with luteinized ovarian cysts following treatment with GnRH analog (fertirelin acetate).

Effects of PGF2(alpha) analog (ONO-1052) on cows with luteinized cysts following treatment with GnRH analog (fertirelin) in inducing estrus and shortening an interval from treatment to conception were investigated in a field trial. Seventy-five cows with follicular cysts diagnosed by rectal palpation were treated intramuscularly (i.m.) with 400 mug fertirelin (an analog of GnRH). Luteinization of follicular cysts were tentatively judged by rectal palpation. Forty-one cows were considered to have luteinized cysts and were either treated i.m. with ONO-1052 (28 cows) or left untreated as controls (13 cows). Thirty-four other cows were considered to have not responded to fertirelin and retreated with 10,000 MU hCG (19 cows) or fertirelin (five cows). This tentative judgment of luteinization of the cysts by rectal palpation after treatment was later confirmed by determining serum progesterone concentration before and 10 to 14 days after treatment. Only in the cows with luteinized cysts which were confirmed by serum progesterone analysis; increased from a pretreatment level below 1.0 ng/ml to a value of 1.0 ng/ml or higher 10 to 14 days after treatment, effects of ONO-1052 combined with fertirelin were investigated. Of the 18 cows with luteinized cysts thus confirmed following fertirelin injection and treated with ONO-1052, 15 (83.3 %) cows came into estrus within 26 +/- 14 (mean +/- SD) days after the first treatment; eight cows within three to five days and four cows within 22 to 28 days, and 14 cows (77.8 %) conceived within 100 days (42 +/- 26 days). On the other hand, the five control cows with luteinized cysts that were not treated with ONO-1052 required significantly longer to exhibit normal estrus (54 +/- 13 days; P<0.05) and to conceive (54 +/- 13 days). These results indicate that ONO-1052 combined with fertirelin may be useful to shorten the interval from treatment to normal estrus and to conception in cows with follicular cysts.

Journal Article↗
PubMed1988

Influence of Synchro-Mate-B and breed composition on estrous response and pregnancy rate in spring- and fall-bred Brahman crossbred beef cows.

Estrous response, pregnancy rate, and the relationship between palpable corpora lutea (CL) and plasma progesterone concentrations were studied during the spring (n = 149) and fall (n = 146) breeding seasons using postpartum, crossbred beef cows consisting of 0-Brahman, 1 4 - Brahman , or 1 2 Brahman breeding. At the start of each breeding season, a jugular blood sample was collected for progesterone analysis; each cow was palpated for the presence of a CL and randomly alloted within breed to a non-treated control or Synchro-Mate-B (SMB) treatment. Fewer (P<0.01) fall than spring bred cows exhibited estrus within the first 21 d of breeding. Within 48 h of implant removal, 84 and 64% (spring and fall, respectively) of synchronized cows exhibited estrus. In both seasons, more SMB than control cows became pregnant by 7 d of breeding. Percentage of Brahman breeding did not influence estrous response or pregnancy rate. On the basis of 292 evaluations, palpation per rectum correctly assessed ovarian status 74% of the time. These data indicate that although season can influence response. SMB can be used effectively to synchronize Brahman crossbred cows. In addition, it was found that there is a close relationship between palpation per rectum and plasma concentrations of progesterone.

Journal Article↗
PubMed1988

Conception rates in repeat-breeders and dairy cattle with unobserved estrus after prostaglandin F(2) alpha and gonadotropin-releasing hormone.

In Experiment 1, cows with a history of at least two previous unsuccessful inseminations were allocated to four groups. At the repeated estrus (third or greater service), some of the cows were inseminated according to the a.m.-p.m. rule (Controls, n = 83), or received i.m. 100 mug gonadotropin-releasing hormone (GnRH, n = 32) within 30 sec after insemination. Ovaries of the remaining cows to be treated were palpated during the anticipated ensuing luteal phase to determine the presence of a corpus luteum. Cows found to have luteal tissue received i.m. 25 mg prostaglandin F(2)-alpha (PGF(2)-alpha) and were inseminated after detected estrus or at 72 and 96 h after PGF(2)-alpha in the absence of estrus. Cows given PGF(2)-alpha either received no further treatment (PGF(2)-alpha, n = 40) or were given i.m. 100 mug GnRH (PGF(2)-alpha + GnRH, n = 29) after insemination or at 72 h after PGF(2)-alpha in the absence of estrus. Conception rate of control cows (39%) was similar to that of cows given PGF(2)-alpha (40%) or PGF(2)-alpha + GnRH (43%), but it tended to be lower (P = 0.13) than that of cows given only GnRH at insemination (54%). In Experiment 2, cows with unobserved estrus and diagnosed not pregnant (palpation) were palpated to detect a corpus luteum. Cows with luteal tissue received i.m. PGF(2)-alpha (n = 52) or PGF(2)-alpha + GnRH (n = 45) and were inseminated as described above. Conception rates were similar (39% vs 33%, respectively). In Experiment 3, cows in a large commercial dairy with (n = 93) or without (n = 420) previous reproductive problems were given i.m. 100 mug GnRH after insemination (n = 169) or were left untreated (n = 344) at repeat services (third and fourth services). Treatment with GnRH improved (P < 0.05) conception in normal (47% vs 36%) and abnormal (25% vs 12%) repeat-breeding cows. Treatment with PGF(2)-alpha alone or in conjunction with GnRH failed to further improve conception rates and only delayed intervals to rebreeding when administered during the luteal phase after the repeated estrus. The use of GnRH failed to reduce intervals from treatment to insemination or improve conception in cows with unobserved estrus compared to treatment with PGF(2)-alpha alone.

Journal Article↗
PubMed1989

Effect of Actinomyces pyogenes and gram-negative anaerobic bacteria on the development of bovine pyometra.

Fifteen lactating Holstein cows were used in a trial designed to evaluate the effectiveness of intrauterine inoculation (challenge) of Actinomyces pyogenes (A) alone or in combination with Fusobacterium necrophorum (F) and Bacteroides melaninogenicus (B) to induce pyometra. Cows were assigned to one of five groups: A (n = 3), AB (n = 3), AF (n = 3), ABF (n = 3) or C (control, broth medium alone; n = 3). All cows exhibited estrus 12 or 13 d prior to challenge (Day 0=first day of challenge). During the prechallenge period, the reproductive tract of each cow was palpated per rectum and uterine fluid aspirates for culture and uterine biopsies were also obtained. All cows received an intravenous injection of 5,000 IU of human chorionic gonadotropin (hCG; Day 5) and an intrauterine infusion of 40 ml of 0.7% iodine solution (Day 1). Cows were then inoculated on Days 0, 1 and 2 of the experiment. Sequential palpations of the reproductive tracts, samples of uterine fluid for culture and uterine biopsies were performed for a total of 30 d after the first inoculation. A cow was diagnosed as having pyometra when purulent uterine fluid and a corpus luteum were detected by palpation per rectum. The number of cows that developed pyometra in Group A was 2 of 3, in Group AB 3 of 3, in Group AF 3 of 3, in Group ABF 3 of 3 and in Group C 0 of 3. Cows with pyometra did not exhibit estrus. In 7 of 11 cows, pyometra persisted for more than 21 d. In cows that developed pyometra, the same species of bacteria infused into the uterus were usually recovered one or more times during the postchallenge period. When clinical pyometra was diagnosed, histologic endometritis was invariably present. Histologic endometritis and concurrent isolation of A . pyogenes alone or A . pyogenes with gram-negative anaerobic bacteria occurred in 91.7% of samples during the postchallenge period. Regardless of bacterial treatment, gram-negative anaerobic bacteria were frequently isolated with A . pyogenes during this period.

Journal Article↗
PubMed1994

Correlation of in vivo testicle and seminal vesicle size with post mortem dimensions in bulls.

This study was conducted to quantify the relationships between in vivo measurements of testicular and seminal vesicle size and post mortem size of these organs in 30 Santa Gertrudis bulls. The in vivo measurements of testicles were obtained by transrectal ultrasonography and palpation per rectum, while scrotal circumference was measured by scrotal tape. Linear post mortem dimensions were obtained by direct measurements of the excised organs. Volume was assessed by water displacement while the testicles were weighed. Seminal vesicle length, determined by palpation, had the highest correlation with post mortem measurements (r = 0.70; P = 0.0001). Accurate estimation of the thickness of the vesicles (1.47 vs 1.55 cm for in vivo and post mortem, respectively) was performed by ultrasonograph. Of all seminal vesicle linear measurements, width had the highest correlations with volume measured by water displacement (r = 0.67; P = 0.0001 and r = 0.38; P = 0.04 for post mortem and in vivo, respectively). Testicular diameter was accurately measured by ultrasonography (5.54 vs 4.58 cm in vivo and post mortem, respectively) and was highly correlated (range r = 0.84 to 0.89; P = 0.0001) with post mortem measurements of testicular volume, weight and circumference. The correlation between scrotal circumference and diameter of the testicle was 0.75 (P = 0.0001). The correlations of testicular diameter measured by ultrasound with the post mortem measurements of testicular weight and circumference were similar to the correlations between scrotal circumference and those 2 post mortem measurements. We conclude that palpation of vesicle length is highly correlated with volume of the seminal vesicle in situ. Individual linear measurements do not seem to be an accurate predictor of the relativ size of the seminal vesicle. Furthermore, ultrasonography does not seem to be a more accurate measure of testicular size than scrotal circumference for evaluation of breeding soundness.

Journal Article↗
PubMed1996

Ejaculatory pattern of llamas during copulation.

The objective of this study was to use transrectal digital palpation of urethral pulses to define the ejaculatory pattern of llamas during copulation. Five male llamas were palpated during 5 to 6 copulations each with receptive female llamas (n = 28 copulations). The time from first exposure of a male to a female until mounting was 0.7 +/- 1.1 min (mean +/- SD), time to the first intromission was 1.7 +/- 1.4 min, and time from initial mount to final dismount (copulation duration) was 21.7 +/- 7.8 min. A total of 121.9 +/- 61.0 urethral pulses per copulation (5.6 +/- 1.7 pulses/min) was palpated. During the first 3.9 +/- 3.7 min of copulation, urethral pulses (11.0 +/- 10.1 urethral pulses at 3.5 +/- 2.5 pulses/min) occurred randomly and were not associated with whole-body strains. After the first 4 min of copulation, urethral pulses occurred in a pattern of clusters of frequent urethral pulses associated with whole-body strains, alternating with intercluster intervals of infrequent urethral pulses without whole-body strains. Individual clusters were characterized by 4.3 +/- 2.7 urethral pulses at 16.7 +/- 4.5 pulses/min during strains, and intercluster intervals were characterized by 1.7 +/- 2.3 urethral pulses at 2.2 +/- 1.8 pulses/min. Each cluster of urethral pulses during a strain was preceded by 2.3 +/- 1.8 repositions of the male's hindlegs and by 38.1 +/- 20.8 pelvic thrusts. There were 18.5 +/- 10.6 clusters of urethral pulses accompanied by strains per copulation at 0.9 +/- 0.3 clusters/min. The 18 to 19 clusters of urethral pulses appeared to be individual ejaculations. Therefore, we hypothesize that llamas ejaculated 18 to 19 times during their 22-min copulations.

Journal Article↗
PubMed1989

Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain.

Four studies are presented testing the validity and reliability of pressure pain thresholds (PPTs) and of examination parameters believed to be important in the clinical assessment of sites commonly used for such measures in patient samples. Forty-five patients with a myogenous temporomandibular disorder were examined clinically prior to PPT measures. Criteria for history and examination included functional aspects of the pain, tissue quality of the pain site, and the type of pain elicited from palpation. Control sites within the same muscle and in the contralateral muscle were also examined. PPTs were measured as an index of tenderness using a strain gauge algometer at these sites. The data from the 5 male subjects were excluded from subsequent analyses due to the higher PPT in the males and to their unequal distribution among the various factorial conditions. The first study demonstrated strong validity in PPT measures between patients (using pain sites replicating the patients' pain) and matched controls (n = 11). The PPT was not significantly different between the primary pain site (referred pain and non-referred pain collapsed) and the no-pain control site in the same muscle (n = 16). The PPT was significantly lower at the pain site compared to the no-pain control site in the contralateral muscle (n = 13). The second study indicated adequate reliability in patient samples of the PPT measures. In the third study, the PPT was significantly lower at sites producing referred pain on palpation compared to sites producing localized pain on palpation. The PPT findings from the control sites were inconsistent on this factor. The fourth study presented preliminary evidence that palpable bands and nodular areas in muscle were most commonly associated with muscle regions that produce pain; such muscle findings were not specific, however, for regions that produce pain. Further, the intraexaminer reliability in reassessing these pain sites qualitatively was only fair. Referred pain had a poor association with the pain pattern and physical findings, which may suggest a need to reevaluate part of the theory regarding referred muscle pain. The reliability of PPT measures was better overall than the reliability of the signs and site-specific symptoms, suggesting that pressure pain thresholds may be an important tool in clinical studies of pain. PPT measures demonstrate a high within-subject variability in pain patient subjects as well as non-pain subjects.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

Pressure pain thresholds and thermal nociceptive thresholds in chronic tension-type headache.

The nociceptive thresholds to mechanical and thermal stimuli in patients with chronic tension-type headache were compared. Palpation of pericranial tenderness was performed in 50 patients and a total tenderness score (TTS) was calculated. Palpation was repeated, and pressure pain thresholds (PPTs) were determined with a pressure algometer in the temporal and occipital regions. In 32 of the patients, pain thresholds for heat and cold and limens for detection of non-painful temperature changes were determined in the hands and the temporal regions. Twenty-four healthy volunteers served as controls. Scores obtained by manual palpation (TTS) at the first and second visit were positively correlated. A negative correlation between headache severity and PPT was found in the temporal region. A positive correlation between PPT in the temporal and occipital region was found, and PPT and TTS were negatively correlated. Thermal pain thresholds were consistently less extreme in patients compared to controls, and patients reporting severe headache on the examination day were those most sensitive to thermal pain. No difference was found between patients and controls with respect to detection of temperature changes. A correlation was found between PPT and the corresponding cold pain thresholds, but no correlation could be demonstrated between TTS and thermal pain thresholds. In conclusion, headache patients had decreased pain perception thresholds. Chronic tension-type headache might be a result of dysmodulation of nociceptive impulses, but it is likely that sensitized nociceptors also play a role.

Adult↗
PubMed2006

Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques.

OBJECTIVE: Tracheal necrosis, stenosis, and rupture may result from overinflated endotracheal tube cuffs (ETTcs). We sought to determine the ability of faculty emergency medicine (EM) physicians to safely inflate ETTc as well as to estimate pressure of previously inflated ETTc. METHODS: Using a previously tested tracheal simulation model, we assessed EM physician inflation of ETTc pilot balloons. Participants also palpated the pilot balloon of 9 ETTc inflated to pressures ranging from extremely low to extremely high in a random order and reported their estimate of pressure. RESULTS: We sampled 41 faculty EM physicians from 5 EM residency programs. Using palpation, participants were only 22% sensitive detecting overinflated ETTc. The average ETTc pressure produced by inflation was more than 93 cm H(2)O (normal, 15-25 cm H(2)O). CONCLUSIONS: Participants were unable to inflate ETTc to safe pressures or estimate pressure of ETTc by palpation. Clinicians should consider using devices to facilitate safe inflation and accurate measurement of ETTc pressure.

Clinical Competence↗
PubMed2006

Indirect ultrasound measurement of humeral torsion in adolescent baseball players and non-athletic adults: reliability and significance.

Accurate clinical interpretation of shoulder rotation range requires knowledge of the contribution of humeral torsion. This study compares the reliability of indirectly measuring humeral torsion using ultrasound visualisation with direct palpation and compares the degree of humeral torsion in a non-throwing adult population with a population of elite adolescent baseballers. The reliability of a novel method of indirectly measuring humeral torsion using palpation and ultrasound was established prior to using the ultrasound method to determine the amount of humeral torsion in both humeri of a group of 16 non-throwing subjects and 36 elite adolescent baseball players. Excellent inter-tester reliability was found for the ultrasound method of measuring humeral torsion in each arm (ICC 2,1: 0.98 and 0.94) but poor reliability for the direct palpation method (ICC 2,1: 0.51 and 0.49). Using the ultrasound method, side-to-side differences in humeral torsion ranged from 0 to 13 degrees for the non-throwing group and 0 to 29 degrees for the baseball players. This side-to-side difference was significant in the baseball players (p<0.001) but not significant in the non-throwing group (p=0.43). Whilst side-to-side differences in humeral torsion were noted between all subjects irrespective of arm dominance, only throwers demonstrated consistently greater humeral retrotorsion in their throwing arm. A reliable clinical tool for estimating humeral torsion, such as that employed in this study, will allow for a more valid prescription of interventions for the treatment of shoulder dysfunction.

Adolescent↗
PubMed2000

Transxiphoid video-assisted pulmonary metastasectomy: relevance of helical computed tomography occult lesions.

BACKGROUND: The new transxiphoid video-assisted approach allows manual palpation of both lungs, thus permitting better evaluation of helical computed tomography (CT) in detection of pulmonary metastases. METHODS: From December 1995 to May 1999, 22 patients underwent a transxiphoid video-assisted pulmonary metastasectomy. Manual palpation of both lungs was possible in 18 patients, whereas only 13 had radiologic evidence of unilateral disease. Primaries were colon-rectum (n = 8), kidney (n = 3), uterus (n = 2), larynx (n = 2), limb osteosarcoma (n = 2), and one each of breast, skin melanoma, prostate, fibrosarcoma, and ovary. RESULTS: No perioperative death occurred. Fifty-eight lesions, 49 metastatic, were resected, whereas only 46 had been predicted by helical CT scan. Twelve occult lesions were discovered, eight of which were malignant. Overall sensitivity for proved metastases was 83.7% (41 of 49) and 75.8% (22 of 29) for those less than or equal to 5 mm. Mean follow-up was 15.27 months. Only 2 patients had pulmonary relapse at 6 and 12 months. CONCLUSIONS: Despite helical CT, occult metastases may still be identified in almost one-third of the patients. The transxiphoid approach allows routine bilateral palpation and safe resection, and overcomes this critical limitation of video-assisted metastasectomy.

Disease-Free Survival↗
PubMed1981

Per rectal ultrasound in the investigation of prostatic disease.

Primary prostatic disease is usually assessed by digital palpation of the prostate. This method lacks objectivity and has been shown to be inaccurate, especially in the staging of primary prostatic cancer. This paper describes the investigation of 200 subjects using per rectal ultrasound. Of 70 patients with histological evidence of carcinoma of the prostate, 96% were correctly diagnosed ultrasonically and 87% correctly diagnosed by digital palpation. Of the 37 patients with ultrasonic evidence of a capsular breach, only 65% were diagnosed as such by digital palpation. A study of 10 cadaver specimens confirmed the accuracy of per rectal ultrasound as a technique for staging primary prostatic cancer . The ultrasonic appearances of the prostate, seminal vesicles and bladder base are described. Per rectal ultrasound is acceptable to patients, and its use is recommended in all cases where accurate assessment of primary prostatic cancer is required.

Adult↗
PubMed2002

Effect of gastrointestinal nematode and liver fluke infections on weight gain and reproductive performance of beef heifers.

Spring born, crossbred beef heifers (n=372) were utilized over four years to measure reductions in body weights, reproductive performance and calf weights caused by gastrointestinal nematodes (primarily Ostertagia ostertagi) and the bovine liver fluke (Fasciola hepatica) and to differentiate losses attributable to each type of parasitism. Each year, weaned heifers were allotted to one of the four treatment regimens: Group 1, untreated controls; Group 2, treated for nematodes; Group 3, treated for liver fluke; and Group 4, treated for both nematodes and liver fluke. Nematodes were controlled with subcutaneous injections of either ivermectin (Ivomec, Merial) or doramectin (Dectomax, Pfizer), both at the recommended dose of 200 ug/kg bodyweight. Clorsulon (Curatrem, Merial) drench was given at the recommended rate of 7 mg/kg bodyweight to control flukes. Treatments and fecal collections were initiated at allotment each year and were repeated at 28-84-day intervals until palpation for pregnancy diagnosis. Open heifers were removed from the study at this time. Treatment dates were based on expected length of treatment efficacy, the stage of growth of the heifers and the seasonal risk of infection by the parasites. Pregnant females were pooled and received their assigned treatments prior to their calving and breeding seasons and remained together until their calves were weaned. Heifers treated for nematode infections were heavier and had higher condition scores (P<0.01) than untreated control heifers at initiation of breeding, and maintained that difference through pregnancy diagnosis. Liver fluke infection did not affect heifer gains or condition scores prior to palpation (P<0.01). At palpation, heifers treated for both forms of parasitism had the highest condition scores and weight gains (P<0.01), and also higher pregnancy rates than control heifers and heifers treated for nematodes only (P<0.01). Pregnancy rates for heifers treated for flukes only were not significantly different from those treated for both nematodes and flukes. Heifers treated for nematodes weaned heavier calves than those not treated for nematodes (P<0.05).

Animals↗