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PubMed1980

Early pregnancy diagnosis in buffaloes from plasma progesterone concentration.

Blood samples were collected from 84 buffalo cows 21 days after fixed time artificial insemination following oestrus synchronisation and cloprostenol. Progesterone concentration in plasma was determined by radioimmunoassay. The animals were examined for pregnancy by rectal palpation 60 to 90 days after insemination. Forty-two animals were predicted pregnant on the basis of progesterone concentration (more than 1.0 ng per ml), and 28 (66.7 per cent) of them were subsequently confirmed pregnant by rectal palpation. Thirty-five animals were predicted non-pregnant (progesterone less than 0.7 ng per ml), in 34 (97.1 per cent) this proved to be so. Of the total number, seven (8.3 per cent) were classified as doubtful because their progesterone concentrations were within the range 0.7 to 1.0 ng per ml: two of them were confirmed pregnant and the other five non-pregnant. Out of 31 animals diagnosed pregnant by rectal palpation, 28 (90.3 per cent) had been correctly detected by assay at 21 days. Thirty-four (64.2 per cent) of the 53 animals found non-pregnant had been correctly detected by assay. It was concluded that the determination of plasma progesterone concentration 21 days after insemination was an accurate method of predicting non-pregnancy in buffaloes.

Animals↗
PubMedDate not supplied

Diagnostic value of signs and symptoms associated with peripheral arterial occlusive disease seen in general practice: a multivariable approach.

OBJECTIVES: To assess the diagnostic values of single and combined data from the history, physical examination, and medical record with regard to peripheral arterial occlusive disease (PAOD) in patients with leg complaints; to construct a multivariable model for the clinical diagnosis of PAOD by primary care physicians. SETTING: 18 general practice centers in The Netherlands. DESIGN: Cross-sectional comparison of signs, symptoms, and data from the medical record with the independently assessed ankle-brachial systolic pressure index (ABPI; cutoff point < 0.90); analysis: bivariate, multiple logistic regression (MLR). POPULATION: 2,455 individuals with leg complaints, aged 40.7-78.4 years; ABPI < 0.90 present in 9.2% of legs (11.7% of individuals). OUTCOME MEASURES: Clinical variables: sensitivity, specificity, positive and negative predictive values (PV+, PV-), diagnostic odds ratio (OR); models: likelihood ratio test, area under the receiver operating characteristic curve (AUC). RESULTS: Bivariate analysis: highest sensitivity: age more than 60 years (77.3%); highest specificity: wounds or sores on toes and foot (99.7%); highest PV+: typical intermittent claudication (IC) (45.0%) (abnormal foot pulses 41.3%); highest PV-: strong pulses of both foot arteries (97.7%). MRL: the best-performing model (AUC 0.89) consisted of ten clinical variables: gender (OR 1.5), age more than 60 (OR 2.2); IC (OR 3.5); palpation of the skin temperature of the feet (OR 2.5), palpation of both foot pulses [OR 16.4 (abnormal) and 7.0 (doubtful)], auscultation of the femoral artery (OR 3.5); previous diagnosis of IHD (OR 1.7) or diabetes (OR 1.6), history of smoking (OR 2.1), and elevated blood pressure (OR 1.5). The range of predicted probabilities was 0.4-98%. The Hosmer-Lemeshow goodness-of-fit test indicated good overall fit (p = 52). CONCLUSIONS: Palpation of both foot pulses is the key procedure for the clinical diagnosis of PAOD. Traditional clinical evaluation enables the general practitioner to exclude the diagnosis of PAOD in many individuals with a high degree of certainly, to establish the diagnosis in a small group of patients, and to define a limited group of patients where supplementary noninvasive testing is appropriate. The MLR model can be used as a diagnostic checklist and as a reference for the physician's clinical hypothesis.

Adult↗
PubMedDate not supplied

The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients.

A study to determine the sensitivity, specificity, and positive and negative predictive values of several clinical diagnostic tests of subcutaneous Achilles tendon rupture was performed during a 13-year period. There were 174 patients with clinical diagnosis of unilateral complete subcutaneous Achilles tendon tear and 28 patients with unilateral suspected but no actual Achilles tendon tear. The following tests were used: palpation, calf squeeze, Matles, Copeland, and O'Brien. Palpation of the gap was the least sensitive clinical test with the patient awake (0.73), increasing to 0.81 when the test was performed under anesthesia; the Copeland and O'Brien tests showed a sensitivity of 0.8. Both the calf squeeze and Matles tests were significantly more sensitive than the other tests (0.96 and 0.88, respectively; 0.022 < P < 0.05). All tests showed a high positive predictive value, with no statistically significant difference between the various tests. In the 28 patients with no evidence of a subcutaneous Achilles tendon tear on imaging, the tests showed a high capability to detect that the Achilles tendon was intact (gap palpation specificity, 0.89; calf squeeze test specificity, 0.93; Matles test specificity, 0.85). Whichever tests were performed, at least two of them were positive for a subcutaneous tear of the Achilles tendon in all patients in this study.

Achilles Tendon↗
PubMed2005

Combined Utilisation of Rapid Assessment Procedures for Loiasis (RAPLOA) and Onchocerciasis (REA) in Rain forest Villages of Cameroon.

BACKGROUND: Individuals with high microfilarial loads of Loa loa are at increased risk of neurologic serious adverse (SAE) events following ivermectin treatment against onchocerciasis. RAPLOA (Rapid Assessment Procedure for loiasis), a newly developed rapid assessment procedure for loiasis that relates the prevalence of key clinical manifestation of loiasis (history of eye worm) to the level of endemicity of the infection (prevalence of high intensity), is a very useful tool to identify areas at potential risk of L. loa post ivermectin treatment encephalopathy. In a perspective of treatment decision making in areas of co-endemicity of loiasis/onchocerciasis, it would be advantageous (both in time and cost savings) for national onchocerciasis control programmes to use RAPLOA and the Rapid epidemiologic assessment for onchocerciasis (REA), in combination in given surveys. Since each of the two rapid assessment tools have their own specificities, the workability of combining the two methods needed to be tested. METHODS: We worked in 10 communities of a forest area presumed co-endemic for loiasis and onchocerciasis in the North-West Province of Cameroon where the mass-treatment with ivermectin had not been carried out. A four-step approach was used and comprised: (i) generating data on the prevalence and intensity of loiasis and onchocerciasis in an area where such information is scarce; (ii) testing the relationship between the L. loa microfilaraemia prevalence and the RAPLOA prevalence, (iii) testing the relationship between the O. volvulus microfiladermia prevalence and the REA prevalence, (iv) testing the workability of combining RAPLOA/REA by study teams in which a single individual can perform the interview for RAPLOA and the nodule palpation for REA. RESULTS: The microfilaraemia prevalence of loiasis in communities ranged from 3.6% to 14.3%. 6 (0.61%) individuals had L. loa microfilarial loads above 8000 mf/ml but none of them attained 30,000 mf/ml, the threshold value above which the risk of developing neurologic SAE after ivermectin treatment is very high. None of the communities surveyed had RAPLOA prevalence above 40%. All the communities had microfiladermia prevalence above 60%. The microfiladermia results could be confirmed by the rapid epidemiologic method (nodule palpation), with all the 10 communities having REA prevalence above 20%. For the first time, this study has demonstrated that the two rapid assessment procedures for loiasis and onchocerciasis can be carried out simultaneously by a survey team, in which a single individual can administer the questionnaire for RAPLOA and perform the nodule palpation for REA. CONCLUSION: This study has: (i) Revealed that the Momo valley of the North West province of Cameroon is hyperendemic for onchocerciasis, but is of lower level of endemicity for L. loa. (ii) Confirmed the previous relationships established between RAPLOA and the L. loa microfilaraemia prevalence in one hand and between the REA and the O. volvulus microfiladermia prevalence in another hand (iii) Shown that RAPLOA and REA could be used simultaneously for the evaluation of loiasis and onchocerciasis endemicity in areas targeted by the African Programme for onchocerciasis Control for community-directed treatment with ivermectin (CDTI).

Journal Article↗
PubMed1983

The influence of percutaneous fine needle aspiration on serum thyroglobulin.

To determine whether percutaneous needle aspiration of the thyroid affects tests of thyroid function, in particular thyroglobulin (TG), serum TG, T4, free T4 index, T3, and TSH were measured before and after percutaneous needle aspiration biopsy of the thyroid in 25 subjects. Seven control subjects were tested before and after vigorous external manual palpation of the thyroid. Serial measurements were made additionally in 3 subjects undergoing thyroid surgery to assess how quickly serum TG increases after injury. The results were analyzed, and statistically significant differences between paired results were defined if the differences were greater than the maximum interassay variation in 11 consecutive assays. Eleven out of 25 patients had statistically significant elevations of serum TG after aspiration. None of the seven who underwent external manual palpation of the thyroid gland had elevation of serum TG. With three exceptions, there were no significant changes in serum T4, free T4 index, T3, and TSH in either group. Marked elevations in serum TG occurred within 2 min after open manual palpation, diathermy, and excision. The results were analyzed and correlated with factors that might lead to release of TG from the thyroid during needle aspiration. No positive correlation was observed with the apparent degree of trauma, the size of nodule, the TG content, volume or character of aspirate, or the time elapsed from aspiration to withdrawal of the blood sample. Correlation of serum TG elevation with final diagnosis did not show a significant trend; however, the existence of a possible relationship needs further studies. We conclude that serum for TG measurement should be obtained before percutaneous thyroid aspiration biopsy.

Adolescent↗
PubMed1986

Benign pancreatic insulinoma: preoperative and intraoperative sonographic localization.

Twenty-nine patients with surgically proved benign pancreatic insulinoma were studied by preoperative or intraoperative sonography. Twenty-five patients had solitary pancreatic tumors; four had multiple tumors. Six of the patients with solitary insulinomas and one of the patients with multiple insulinomas had undergone previous unsuccessful exploration. Preoperative sonography was performed in 24 patients with solitary insulinomas, and 15 (63%) were localized. Intraoperative sonography was performed in 22 patients with solitary insulinomas, and 19 (86%) were visualized without having been previously located by palpation. Four of these visible solitary tumors (18%) were not detected by palpation at surgery. All the solitary insulinomas were detected with the combination of palpation and intraoperative sonography. In each of the six patients with solitary insulinoma who had undergone previous surgery, the tumor was visible with intraoperative sonography, which also demonstrated nonpalpable insulinomas in two of the four patients with multiple tumors. Preoperative real-time sonography is a sensitive, noninvasive, inexpensive method for localization of insulinoma. Intraoperative high-frequency sonography is a highly sensitive method for the detection of insulinoma. Intraoperative sonography is also valuable to determine the relationship of the insulinoma to pancreatic and bile ducts and thereby facilitate safe enucleation.

Adenoma, Islet Cell↗
PubMed2005

Three-dimensional ultrasound imaging of breast cancer by a real-time intraoperative navigation system.

BACKGROUND: In order to achieve a good cosmetic result without increasing the risk of ipsilateral breast cancer recurrence after breast conserving surgery, it is very important to minimize the resection volume of the breast without compromising the negativity of the surgical margin. For this purpose, it is necessary to obtain precise information on tumor extension. We therefore developed a three-dimensional (3-D) ultrasound navigation system for breast cancer surgery, which can be performed in the operating room just before surgery. METHODS: We obtained 3-D breast tumor images by the 3-D ultrasound navigation system in 40 patients with primary breast cancer (stage 0-II) who underwent mastectomy or breast conserving surgery. The tumor size was measured in a coronal view of the 3-D tumor image and compared with the tumor size obtained from a pathological map of the tumor extension. RESULTS: We obtained 3-D tumor images in 38 patients (success rate=95%). The tumor size in the images showed a very strong correlation with the pathological tumor size (r=0.898). The difference in tumor size between the 3-D images and pathology was less than 1 cm in 29 tumors (76.3%) and less than 2 cm in 36 (94.7%). On the other hand, the difference in tumor size between palpation and pathology was less than 1 cm in 19 out of 38 tumors (50.0%) and less than 2 cm in 29 tumors (76.3%). The absolute difference between the 3-D images and pathology was significantly less than that between palpation and pathology (p=0.0197). CONCLUSIONS: Our 3-D ultrasound navigation system is useful in visualizing breast tumor extension and is more accurate than palpation. The system is expected to be helpful in deciding on the appropriate surgical margin in breast cancer surgery, resulting in a better cosmetic outcome without increasing the risk of surgical margin positivity.

Adult↗
PubMed1996

Assessment of exercise-induced minor muscle lesions: the accuracy of Cyriax's diagnosis by selective tension paradigm.

The Cyriax selective tension assessment paradigm is commonly used by clinicians for the diagnosis of soft tissue lesions; however, studies have not demonstrated that it is a valid method. The purpose of this study was to examine the construct validity of the active motion, passive motion, resisted movement, and palpation components of the Cyriax selective tension diagnosis paradigm in subjects with an exercise-induced minor hamstring muscle lesion. Nine female subjects with a mean age of 23.6 years (SD = 4.7) and a mass of 57.3 kg (SD = 10.7) performed two sets of 20 maximal eccentric isokinetic knee flexor contractions designed to induce a minor muscle lesion of the hamstrings. Active range of motion, passive range of motion, knee extension end-feel pain relative to resistance sequence, knee flexor isometric strength, pain perception during knee flexor resisted movement testing, and palpation pain of the hamstrings were assessed at 0, 5, 2, 12, 24, 48, and 72 hours postexercise and compared with Cyriax's hypothesized selective tension paradigm results. Consistent with Cyriax's paradigm, passive range of motion remained unchanged, and perceived pain of the hamstrings increased with resistance testing at 12, 24, 48, and 72 hours postexercise when compared with baseline. In addition, palpation pain of the hamstrings was significantly elevated at 48 and 72 hours after exercise (p < 0.05). In contrast of Cyriax's paradigm, active range of motion was significantly reduced over time (p < 0.05), with the least amount of motion compared to baseline (85%) occurring at 48 hours postexercise. Further, resisted movement testing found significant knee flexor isometric strength reductions over time (p < 0.05), with the greatest reductions (33%) occurring at 48 hours postexercise. According to Cyriax, when a minor muscle lesion is tested, it should be strong and painful; however, none of the postexercise time frames exhibited results that were strong and painful. This study suggests that the validity of using Cyriax's selective tension testing for the diagnosis of exercise-induced minor muscle lesions is questionable.

Adult↗
PubMed1992

Pregnancy rates in beef cattle after administering a GnRH agonist 11 to 14 days after insemination.

The objective of our study was to determine the dose-pregnancy rate response of a GnRH agonist injected once during the luteal phase in virgin heifers (four locations) and suckled beef cows (two locations) during the spring of 1989. The same treatments in virgin heifers were used at one location in the fall of 1989. Heifers and cows were inseminated at a synchronized estrus and then assigned randomly to each of three doses (0, 100, or 200 micrograms) of fertirelin acetate administered in 4 ml of saline in a double-blind study after being blocked by inseminator and service sire. Injections were given (i.m.) once on d 11, 12, 13, or 14 after estrus. Pregnancy rates were determined by palpation of the uterus per rectum and(or) by actual calving dates. Overall pregnancy rates for heifers across five locations were 86/201 (43%), 100/197 (51%), and 100/203 (49%) for the 0, 100, and 200 micrograms doses of fertirelin acetate, respectively. Pregnancy rates for heifers at two locations based on calving data were 28/48 (50%), 31/47 (66%), and 34/52 (65%) for the three doses. Both the 100- and 200-micrograms doses increased (P less than .05) pregnancy rates in heifers based on palpation results, whereas only the 200-micrograms dose tended to increase (P = .10) pregnancy rates based on calving results. Pregnancy rates based on palpation for suckled beef cows at two locations were 36/51 (71%), 30/43 (70%), and 34/51 (67%), and the corresponding pregnancy rates based on calving results were 30/41 (73%), 32/36 (89%), and 31/38 (82%) for the 0, 100, and 200 micrograms doses, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Pregnancy rates of beef heifers bred either on puberal or third estrus.

The objective of this study was to determine if pregnancy rates (PR) differed between beef heifers bred to fertile bulls on either their puberal (E1, n = 89) or third (E3, n = 67) estrus. Heifers were obtained from two lactations (Manhattan, L1; and Miles City, L2), and the experiment was conducted at Miles City. Heifers were assigned randomly within location to either E1 or E3. Heifers were fed to gain .56 kg.head-1 X d-1 and observed twice daily for estrus. After exhibiting first estrus (puberty) and breeding, each heifer in E1 was palpated rectally on d 6, 9 and 12 +/- 1 d (estrus = d 0) for the presence of a corpus luteum, and a venous blood sample was collected for assay of progesterone by radioimmunoassay. Heifers in E3 were palpated and bled on the same schedule as heifers in E1 after first estrus and after being bred to a fertile bull at third estrus. Pregnancy rates were determined by rectal palpation at approximately 38 d post-breeding. Location of origin did not affect (P greater than .10) weight at puberty or weight at breeding; however, heifers from L1 were younger (P less than .05) than heifers from L2 at puberty and breeding. Pregnancy rates were 57 and 78% for heifers in E1 and E3, respectively (P less than .05). Weight at breeding did not influence (P greater than .10) pregnancy rates. The probability of heifers in E1 becoming pregnant increased (P less than .05) with increasing age, while age was not a factor (P greater than .10) for heifers in E3. These results indicated that fertility of puberal estrus in beef heifers is lower than third estrus. Higher fertility of third estrus may be related to maturational changes associated with cycling activity.

Animals↗
PubMedDate not supplied

Optimization of hyperthermia with CT scanning.

In a prospective study CT scanning was used to evaluate the precision of thermometry catheter placement in tumours in the head and neck or on the chest wall in 30 consecutive patients prior to hyperthermia treatment. Patients had variable-sized tumours from several primary sites. Thermometry catheter placement was guided by palpation with or without a prior CT scan. Catheter placement was confirmed by CT. All lesions were less than 8 x 8 x 6 cm (L x W x D) in size. A mean of 4.2 +/- 0.2 (+/- 1 SEM, range 2-7) closed-end polyurethane catheters were inserted orthogonally by the same experienced radiation oncologist. Horizontal thermometry catheters were intended to traverse the centre and base of the tumour mass, and a vertical catheter was often inserted to intersect a horizontal catheter. After catheter placement, wire cables with 1 cm spacings were inserted into the catheters and positions determined using orthogonal films and CT scans. The success of catheter placement was judged on the following criteria: (1) catheter distribution factor (CDF = proportion of tumour CT slices transected by at least one catheter); (2) catheter hit ratio (CHR = average number of catheters in tumour per CT slice); (3) catheter miss factor (CMF = average number of catheters out of tumour per CT slice); (4) catheter placement index, CPI = [(CHR)(CDF)]-CMF; and (5) distance of nearest catheter from the visually estimated centre of tumour in the most central tumour CT scan. In the first seven lesions with 3-6 cm depth catheter insertion was guided by palpation only. In the next 23 lesions catheter insertion was guided by a prior CT scan. In the latter group, 15 lesions had depth 3-6 cm while eight lesions had depth < or = 3 cm. Catheter placement by palpation only, without the benefit of CT scan, was much less accurate in terms of the nearest catheter to the centre of the tumour (p = .001), the proportion of CT slices with catheter in tumour (CDF, p = 0.04) and the probability of a catheter being outside the tumour (CMF, p = 0.01). The catheter placement index (CPI) was a good measure of the accuracy and adequacy of catheter placement in large tumours (p = 0.04). Displacement of normal tissue structures by tumour precluded accurate catheter placement and led to a low CPI. It was difficult to accurately instrument lesions < or = 3 cm depth even with the benefit of a prior CT scan.(ABSTRACT TRUNCATED AT 400 WORDS)

Catheterization↗
PubMed2001

Stage of cycle, incidence, and timing of ovulation, and pregnancy rates in dairy cattle after three timed breeding protocols.

In experiment 1, 705 cows were assigned to three treatments: 1) the Ovsynch protocol (a GnRH injection given 7 d before and another 48 h after one PGF2alpha injection); 2) PGF2alpha + Ovsynch (one PGF2alpha injection given 12 d (d -22) before initiating Ovsynch (d -10); and 3) 2xPG12 (two PGF2alpha injections 12 d apart; d -15 and -3, followed 48 h later by a GnRH injection. All cows were inseminated (d 0) 16 to 20 h after the GnRH injection on d -1. Cyclic status was estimated by serum progesterone. More cows were in early diestrus at d -10 for PGF2alpha + Ovsynch (36%) and 2 x PG12 (29%) versus Ovsynch (19%). Multiparous cows receiving PGF2alpha + Ovsynch had greater pregnancy rates via ultrasonography at d 28 after AI (42%) than contemporaries after Ovsynch (28%) or 2xPG12 (27%) but did not differ significantly at palpation 10 to 30 d later (28, 19, and 17%, respectively). Pregnancy of first-parity cows was similar across treatments at 28 d (41%) or at palpation (33%). Pregnancy rates for 128 anestrous cows were lower, regardless of treatment. Overall embryo survival from d 28 until palpation was 72% but was only 44% in 2xPG12 cows that were anestrus through d -10. Experiment 2 included the three treatments above plus controls (one GnRH injection 7 d before PGF2alpha and AI after estrus). Preovulatory follicles were 6 to 11% larger near estrus in controls than on d -1 in cows receiving GnRH. More controls ovulated by 32 h after onset of estrus than were treated cows by 32 h after GnRH, but percentages (79 to 94%) were similar by 40 h. In multiparous cows, PGF2alpha before Ovsynch increased pregnancy rates, whereas the 2xPG12 protocol produced similar pregnancy rates as Ovsynch across parities. Ovulation was effectively induced by 40 h after GnRH.

Animals↗
PubMed1985

Effect of supplemental beta-carotene on incidence and responsiveness of ovarian cysts to hormone treatment.

Sixty-two multiparous and 35 primiparous Holstein cows were assigned randomly at 10 days postpartum to receive a ration with or without 300 mg beta-carotene/cow per day. Multiparous and primiparous cows were grouped separately and group-fed complete rations once daily. Incidence of ovarian cysts (26% by rectal palpation) was not affected by beta-carotene fed. Multiparous cows had greater incidence (39%) of ovarian cysts than primiparous cows (11%). Fifty-seven percent of cysts were classified follicular by rectal palpation. Progesterone concentration of milk also was used for diagnosis of type of cyst. Cows with ovarian cysts and with progesterone concentrations in milk less than 1 ng/ml were classified follicular, and those having concentration greater than 1 ng/ml were classified luteal. As determined by milk progesterone, rectal palpation was more accurate for diagnosis of luteal cysts than for diagnosis of follicular cysts. Progesterone concentrations of milk for animals with luteal and follicular cysts were 10.66 +/- 1.29 and .37 +/- .07 ng/ml. beta-Carotene did not affect response or days to respond to treatment with human chorionic gonadotropin or gonadotropin-releasing hormone. Supplemental beta-carotene was not beneficial for reducing incidence of ovarian cysts in cows receiving an adequate supply of beta-carotene in their diet.

Animals↗
PubMed1990

Economic evaluation of pregnancy diagnosis in dairy cattle: a decision analysis approach.

Cost-benefit evaluations of several pregnancy diagnosis schemes were performed. The strategy using on-farm milk progesterone test on d 19 after service, followed by treatment of nonpregnant cows with prostaglandin, was the most profitable returning $10.50 per cow above the cost of the intervention. An increase in efficiency of detection of estrus of greater than 20% among cows diagnosed nonpregnant and an error rate in pregnancy diagnosis of less than or equal to 3% were needed to ensure profitability. Pregnancy diagnosis by uterine palpation per rectum on d 35 after service, combined with the use of pressure-sensitive mounting devices on nonpregnant cows was the second most profitable strategy and returned $5.10 per cow. An increase in efficiency of detection of estrus of greater than or equal to 20% was required to ensure profitability. Embryonic mortality was also critical and an increase from a baseline value of 10% to 12%, as a result of early uterine palpation, made this scheme unprofitable ($-4.80 per cow). Pregnancy diagnosis by uterine palpation per rectum at 50 or 65 d was less profitable, with a return of $2.50 and $.10 per cow, respectively.

Animals↗
PubMed2002

Thyroid neoplasia following irradiation in adolescent and young adult survivors of childhood cancer.

OBJECTIVES: To describe a cohort of survivors of childhood malignancy at risk of developing thyroid abnormality, and propose guidelines for management of such patients. DESIGN: Retrospective case series. SETTING: Late-effects oncology clinic at a large children's hospital in Sydney. SUBJECTS: 142 patients who had received irradiation to the thyroid from the 1970s onwards, who attended the late-effects clinic from May 1989 to December 1998. INTERVENTIONS: Thyroid palpation by an endocrinologist or surgeon, serum thyroid-stimulating hormone assay and thyroid ultrasound examination were performed on all subjects and, depending on findings, some subjects proceeded to fine-needle biopsy or surgery (total thyroidectomy). A few patients required adjuvant (131)I administration. OUTCOME MEASURES: Radiation dose received; results of thyroid palpation; thyroid function tests; ultrasound findings; diagnosis of the abnormalities; and outcomes of surgical interventions. RESULTS: 49 subjects (24 of 65 patients who received scatter irradiation to the thyroid and 25 of 78 patients who received direct irradiation) had thyroid surgery. Of these, 12 in the scatter and six in the direct irradiation group were found to have thyroid malignancy. Fifty subjects with abnormal ultrasound results remain under surveillance. Having a palpable thyroid was predictive of malignancy, but age at original diagnosis, sex, current age, time since irradiation, radiation dose, nodule type and nodal involvement were not. CONCLUSION: There is a significant risk of cancer in thyroid glands exposed to radiation as part of therapy for childhood cancer. This risk is greater for patients who received scatter (versus direct) irradiation. Nodular change is usually not apparent for many years, so lifelong surveillance is necessary. Palpation alone is not sufficient to detect thyroid cancer and thyroid ultrasound examination is recommended.

Adolescent↗
PubMed1997

Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging.

BACKGROUND: The introduction of highly sensitive imaging techniques has made it possible to detect many non-palpable nodules, or "incidentalomas," in the thyroid. Discovery of these lesions raises concerns about their malignancy, but the optimal strategy for managing these lesions has not been clearly established. PURPOSE: To review evidence about incidentalomas, including prevalence and risk for malignancy, and to provide recommendations for their evaluation and treatment. DATA SOURCES: Literature searches for relevant articles published in the past 15 years in major English-language medical journals, review of selected articles published before this period, and reviews of bibliographies in text-books. STUDY SELECTION: Three studies on autopsy findings, 11 studies on ultrasonographic findings, and other reports on nonpalpable thyroid nodules were included. DATA EXTRACTION: Data on the prevalence of nodules on autopsy and in ultrasonographic series, palpation compared with ultrasonography, the risk for malignancy in nodules found in irradiated glands, the natural history of thyroid nodules, and the prevalence of occult cancer were collated and reviewed. DATA SYNTHESIS: Prevalence of thyroid incidentalomas estimated from autopsy studies ranges from 30% to 60%. Studies comparing clinical palpation with thyroid imaging show a prevalence of 13% to 50%. Prospective studies of randomly selected patients have reported a prevalence of 19% to 67%. The risk for malignancy in asymptomatic nodules found in nonirradiated glands is 0.45% to 13% (mean +/- SD, 3.9% +/- 4.1%). CONCLUSIONS: High-resolution ultrasonography is sensitive and capable of detecting many small, nonpalpable thyroid nodules. Most of these lesions are benign. For most patients with nonpalpable nodules that are incidentally detected by thyroid imaging, simple follow-up neck palpation is sufficient.

Autopsy↗
PubMed1999

[Influence of body posture in the prevalence of craniomandibular dysfunction].

BACKGROUND: Postural alterations of the shoulders, dorsal spine and hips could have an influence on the development of craniomandibular dysfunctions. AIM: To study the influence of body posture on the prevalence of craniomandibular dysfunction. SUBJECTS AND METHODS: One hundred thirty six dental students and 41 patients assisting to the temporomandibular joints (TMJ) clinic at the Freie Universität at Berlin, were studied. Masticator, cervical muscles, temporomandibular joints and occlusions were clinically examined. The position of shoulders and hips was measured with the use of an acromiopelvimeter. RESULTS: No relationship was found between postural alterations of the hips and shoulders, articular noises and sensibility or pain while palpating the temporomandibular joints. Among students, a relationship between postural alterations of the shoulders and the sensibility or pain while palpating the TMJ, was observed. When all muscles were considered, a significant relationship between asymmetric shoulders or hips and muscular pain while palpating was observed among students. CONCLUSIONS: Some symptoms, especially muscular sensibility is more pronounced in people with hip and shoulder asymmetries. This relation is more pronounced in dental students than in patients.

Adult↗
PubMed2001

Tactile responses in the granule cell layer of cerebellar folium crus IIa of freely behaving rats.

We recorded activity from the granule cell layer (GCL) of cerebellar folium Crus IIa as freely moving rats engaged in a variety of natural behaviors, including grooming, eating, and free tactile exploration. Multiunit responses in the 1000-4500 Hz range were found to be strongly correlated with tactile stimulation of lip and whisker (perioral) regions. These responses occurred regardless of whether the stimulus was externally or self-generated and during both active and passive touch. In contrast, perioral movements that did not tactually stimulate this region of the face (e.g., chewing) produced no detectable increases in GCL activity. In addition, GCL responses were not correlated with movement extremes. When rats used their lips actively for palpation and exploration, the tactile responses in the GCL were not detectably modulated by ongoing jaw movements. However, active palpation and exploratory behaviors did result in the largest and most continuous bursts of GCL activity: responses were on average 10% larger and 50% longer during palpation and exploration than during grooming or passive stimulation. Although activity levels differed between behaviors, the position and spatial extent of the peripheral receptive field was similar over all behaviors that resulted in tactile input. Overall, our data suggest that the 1000-4500 Hz multiunit responses in the Crus IIa GCL of awake rats are correlated with tactile input rather than with movement or any movement parameter and that these responses are likely to be of particular importance during the acquisition of sensory information by perioral structures.

Action Potentials↗