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[Intraoperative evaluation of tricuspid valve annuloplasty with transesophageal echocardiography].

The present study shows a new application of transesophageal echocardiography (TEE) to optimize tricuspid valve annuloplasty. Eighteen patients with tricuspid regurgitation (TR) underwent De Vega tricuspid annuloplasty. After cardiopulmonary bypass the tension on the suture was adjusted until the surgeon could not feel any regurgitant jet by intraatrial palpation; subsequently, the tension was further adjusted on the basis of TEE. The post-pump residual tricuspid regurgitation was assessed by semiquantitative grading of tricuspid regurgitation (0 to 4+), area of regurgitant jet and percentage of right atrial area subtended by jet area. The data obtained by intraatrial palpation were compared with the data obtained by TEE. A significant reduction of residual tricuspid regurgitation was shown by TEE when compared to intraatrial palpation. After a follow-up period of 2 weeks, no significant changes in the grade of TR were observed. The results showed that the use of TEE was able to optimize the De Vega's tricuspid annuloplasty.

Adult↗

[Effect of three years obligatory iodine prophylaxis on the incidence of goiter in school children fron the seaside region of Poland].

UNLABELLED: In 1993 a mild iodine deficiency in the seaside region of Poland was revealed. In 1997 a mandatory iodine prophylaxis was introduced. The aim of the study was to determine the prevalence of goiter in schoolchildren aged 12-15 years from the seaside area after 3 years of obligatory iodine prophylaxis. The study comprised 628 children (291 boys and 337 girls). Thyroid size was estimated by palpation and by ultrasonography. Analysis of iodine excretion (Uroiod-Test Merck) was performed in 147 children. The goiter was found in 9% of children by palpation. The mean thyroid volume in 12 years old group was 9.3 +/- 5.1 ml, in 13 years old group 10.6 +/- 4.2 ml, 14 years old group 11.7 +/- 3.9 ml, 15 years 13.8 +/- 4.3 ml. The thyroid volume in girls was larger than that in boys. Thyroid volume above 97th percentile was assessed by ultrasound in 16% children (all of them from rural area). No goiter was found by palpation or ultrasound in children living in Gdańsk Thyroid volume is closely correlated with iodine excretion, age and height. Urinary iodine excretion above 100 micrograms/l was stated in 68% children. CONCLUSIONS: Model of obligatory iodised salt prophylaxis is highly effective and is able to increase urinary iodine excretion and decrease of goiter prevalence. Ultrasound is especially recommended for the evaluation of thyroid volume in children from previously mild iodine deficiency areas.

Adolescent↗

Assessing peripheral arteries in South African black women with type 2 diabetes mellitus.

OBJECTIVES: To determine the value of ankle and toe blood pressure indices and pedal pulse palpation in the assessment of peripheral arterial disease in subjects with type 2 diabetes mellitus (DM). DESIGN: Cross-sectional study. SUBJECTS: A convenience sample of 85 female subjects with type 2 DM underwent a series of peripheral vascular assessments at the diabetes clinic of a community hospital. OUTCOME MEASURES: Palpation of the pedal pulses, Doppler-derived ankle brachial systolic blood pressure indices, photo plethysmographic-derived toe brachial systolic blood pressure indices and antero-posterior radiographs of both feet. RESULTS: Mean values were 1.15 (standard deviation (SD): 0.17) and 0.76 (SD: 0.17) for ankle brachial index (ABI) and toe brachial index (TBI) respectively. The differences between the two indices increased from 0.36 (95% confidence interval (CI): 0.32-0.41) to 0.58 (95% CI: 0.46-0.70) depending on whether ABI was less or greater than 1.3. The correlation coefficient for left versus right foot was 0.62 and 0.71 for ABI and TBI respectively. The relationship between ABI and TBI is non-linear with a cut point close to 1.3. Both ABI and TBI were significantly lower in subjects who had both pedal pulses absent on palpation. CONCLUSIONS: The relationship between ABI and TBI is linear below an ABI of 1.3. but with a wide 95% prediction interval. If both pedal pulses are absent the ABI is significantly diminished compared with when both pulses are present, even though not necessarily below 0.9.

Aged↗

Radioimmunoscintigraphy of head and neck cancer using 99mTc-labeled monoclonal antibody E48 F(ab')2.

The diagnostic value of 99mTc-labeled monoclonal antibody E48 F(ab')2 (750 MBq, 1 mg) was evaluated in 10 patients with a histologically proven squamous cell carcinoma of the head and neck and with clinical evidence of cervical lymph node involvement. Preoperative findings on lymph node status obtained by radioimmunoscintigraphy (RIS), computerized tomography, magnetic resonance imaging, and palpation were defined per side (left and/or right side of the neck) as well as per lymph node level (I through V) and compared with the histopathological outcome of the neck dissection specimen. In 10 patients, all 8 known tumors at the primary site were detected by RIS. Furthermore, RIS was correct in 13 of 13 tumor involved neck sides and in 17 of 20 tumor involved lymph node levels. False-negative observations comprised 3 levels containing tumor deposits smaller than 1 cm in diameter, 2 of which were not detected by any other diagnostic modality. Palpation, computerized tomography, and magnetic resonance imaging were correct in, respectively, 13, 15, and 15 of the 20 tumor involved levels. There were 2 false-positive observations with monoclonal antibody E48 and 3 with palpation. No false-positive detections occurred with computerized tomography or magnetic resonance imaging. In two of the patients, RIS provided clinically important information which was not provided by any other diagnostic method. In one patient, recurrence of laryngeal carcinoma was established at the primary site after previous radiotherapy. In another patient, bilateral instead of unilateral lymph node involvement became apparent. These preliminary data indicate that radioimmunoscintigraphy with monoclonal antibody E48 may be helpful in the diagnosis of metastatic and recurrent head and neck cancer.

Adolescent↗

[Evaluation of the thyroid size among school children aged 6-13 with the normal iodine excretion in the urine and the usability of referential values still applied].

BACKGROUND: The evaluation criteria of the enlarged thyroid gland becomes a key problem when analyzing the prevalence of goiter in the population of school children. The review of the literature and own experience indicate lack of a consensus concerning this problem among researchers. Similarly, in the report of WHO in the year 2001 concerning the problem of iodine deficit and goiter endemia, experts did not present universal referential values of the thyroid size in ultrasonography for children population aged 6-15 years living in the regions of proper iodine supply in the diet, thus suggesting the necessity of working out regional norms. OBJECTIVES: The aim of the study was to evaluate the prevalence of goiter in children aged 6-13 years from schools chosen randomly in Białystok with proper iodine supplementation in the study population and to estimate the usability of referential values applied in the assessment of the thyroid size. MATERIAL AND METHODS: In the year 2002, the examination was carried out in 4 elementary schools chosen randomly from Białystok. A total of 480 children aged 6-13 years were included in the study. All children were examined physically with palpation assessment of the thyroid size and had USG of the thyroid. The concentration of iodine was measured in the morning urine. The blood samples were collected to determine hTSH concentration. RESULTS: In palpation, with regard to WHO criteria of the year 2001, the prevalence of goiter was 6.8% in the study population. Applying WHO criteria of 1994 in palpation assessment of goiter increased this percentage up to 18.2%. When using WHO criteria for body surface of 1997 to evaluate goiter by USG, its percentage equaled 7%, whereas taking into consideration referential values for child's age doubled its percentage up to 13.5%. The percentage of goiter increased up to 45.5%, when referential values introduced by Gutekunst et al. were applied. CONCLUSIONS: When evaluating the thyroid size in ultrasonographic diagnostics of goiter in children aged 6-13 years, it seems more purposeful to apply referential values of the thyroid size regarding the body surface and sex (manifesting a child's actual physical development) than to use the norms concerning the calendar age. The prevalence of goiter amounting 7% in the population of school children in spite of adequate iodine prophylaxis suggests other than iodine deficit, factors causing goiter in this population.

Adolescent↗

[Screening for cancer of the prostate using prostate-specific antigen].

Systematic screening for prostate cancer was carried out in 600 men over 50 years of age by the industrial medicine departments of four big companies in the Paris region. The exploratory methods included prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) assays, rectal palpation and two-dimensional transrectal ultrasonography. Biopsy of the prostate was performed either when the PSA level was above 5 ng/ml or when rectal palpation gave suspicious results, or when ultrasonography showed abnormal images. A total of 93 biopsies were performed, and 18 cases of cancer were detected. Eleven of these 18 patients underwent radical prostatectomy. The PSA assay, with an accepted limit of 5 ng/ml, detected 17 out of 18 cancers but was not very specific. The PAP assay had low sensitivity (only 5 positive results). Combined PAP assay and rectal palpation provided high sensitivity and good specificity. Transrectal ultrasonography was helpful only to determine the site of biopsy and the distribution of the lesions.

Acid Phosphatase↗

[The value of venous endoscopy in sclerosing therapy].

The sclerosing treatment of varices of the legs is based on palpation. Endoscopic palpation can be useful in the treatment of insufficiency of the territory of the external saphenous vein. A penetrating ulcer on the posterior surface of the thigh, with an intramuscular pathway linking the deep femoral vein with the external saphenous arch can lead to venous reflux in addition to that in the external saphenous arch. If this penetrating ulcer is overlooked, post-surgical recurrence may result within a brief period. However, a penetrating ulcer of this type cannot be detected by palpation and therefore cannot be treated by conventional sclerosis. Venous endoscopy offers a solution by permitting per-operative catheterization of the ulcer from the saphenous arch and the injection of sclerosing agents at the site of the reflux. Venous endoscopy of the saphenous arch can be of value if it makes it possible to avoid the repeated injection of rising doses. The use of chemical glues and fibrotic compounds has been discontinued due to the risk of damaging the deep veins. The future lies in a mechanical process, laser, electrocauterization or ligature.

Endoscopy↗

Sonographic staging of cancer of the mobile tongue.

In order to determine the value of sonography (US), in staging cancer of the mobile tongue, 57 patients were studied prospectively. Real-time sector scanners (5 and 7.5 MHz) were used with a submental approach. The findings by US were compared with those obtained by inspection and palpation and in 13 operated patients with the surgical results. US failed to visualize the tumor in 3 of the 57 patients (5%); in 30 patients (53%), the tumor was considered to be of nearly the same size by US and by palpation, but in 17 cases (30%), to be larger by US than by palpation, and in the remaining 7 cases (12%), to be smaller by US. Extension across the midline (8/8), and depth of tumor penetration, or extension to adjacent structures (5/5) were more correctly evaluated by US. We conclude that US is useful for staging work-up of tumors of the mobile tongue.

Adult↗

[Diseases of the extremities of swine in relationship to the floor condition with special reference to bursitis].

In 2 pig farms, 102 sows kept in single ranging on plain concrete floor, 168 sows kept in single ranging on cast-iron grates and 27 fattening pigs kept in group penning on concrete slatted floors were repeatedly examined for the incidence of auxiliary synovial bursae (ASB). The clinical examination was completed by radiological, patho-anatomical and histological examinations of the rear legs. In sows, ASB were found on two prominences of the bones: on the latero-plantar area of the calcaneum and the fourth tarsal bone as well as on the plantar tarsal sesamoid bone. ASB on the rear legs were found in 41.2% of the sows kept on plain concrete floor and in 59.5% of the sows kept on cast-iron grates. The ASB of the sows kept on cast-iron grates were larger than those of the sows kept on plain concrete floor. In 49% of the sows kept on plain concrete floor the skin covering the ASB was reddened, in 45% of the sows kept on cast-iron grates it was covered with scab. Injury and necrosis of the skin as well as injury of the ASB themselves were found only in animals kept on cast-iron grates and made up 5% of the cases. In 30% of the cases, palpation of the ASB induced defensive movement. The palpation of ball-shaped, soft bursae more often caused defensive movement than did the palpation of flat-shaped, hard bursae. The occurrence of ASB was combined with kyphosis of the spine, false posture of the rear legs, dystasia, hyperextension of the fetlock, arthrosis of the ankle joint, and anomalies of the claws. In fattening pigs, the ASB were localized at the lateroplantar area of the calcaneum and the fourth tarsal bone as well as at the posterior surface of the calcaneum. At the end of the fattening period, ASB were detected in 26 out of 27 fattening pigs. All of the 48 ASB that were examined histologically showed signs of inflammation. In 30 cases the inflammation was chronic, in 18 cases it turned out to be florid. The results indicate that ASB cause pain during the developing phase and also in the chronic stage.

Animals↗

Craniomandibular disorders in adolescents. A longitudinal study in an urban Swedish population.

The prevalence of craniomandibular disorders was studied in 285 17-year-old adolescents with the aid of a questionnaire and a functional examination of the masticatory system including evaluation of TMJs, masticatory muscles, mandibular mobility, and occlusion. The adolescents were followed up longitudinally two more subsequent years. Totally 27 subjects dropped out, leaving 258 for the longitudinal intraindividual comparisons. At the age of 17 a fifth of the subjects reported some symptoms involving the masticatory system, of which most were mild, according to the anamnestic index (Ai) used. Oral parafunctions were commonly reported of which nail-biting dominated. Grinding and clenching of teeth were reported by 8% and 11% respectively. Signs of mandibular dysfunction were found in 56% of the adolescents and were mostly mild according to the dysfunction index (Di) used. Girls more often had signs of mandibular dysfunction than boys. Morphologic malocclusion was recorded in 35%, unilateral contact in RP in 77%, lateral shift between RP and IP greater than or equal to 0.5 mm in 19% and mediotrusion interferences in 30% among the 17-year-olds. No significant difference between sexes was found. Of the sample 62% had either some sign or symptom of dysfunction and there was a positive relationship between the dysfunction indices used. Neither morphologic nor functional malocclusions were related to the Ai. TMJ sounds were related to palpation tenderness in the lateral pterygoid muscle and impaired mobility of the mandible. The number of masticatory muscles tender to palpation was related to reports of fatigue in the jaw, TMJ tenderness, and mediotrusion interferences. Recurrent headache was reported by about 18% of the girls and by almost 6% of the boys. Fatigue in the jaws and difficulties in chewing were commoner in those with frequent and more intensive headache. Tenderness to palpation of the masticatory muscles and impaired mandibular mobility were significantly commoner findings among those with recurrent headaches and those with more intense headache. Tooth-grinding and clenching were related to frequency but not to intensity of headache. Reports of TMJ sounds increased with age for girls who also more frequently reported recurrent headaches than boys. The prevalence of symptoms of mandibular dysfunction was about 20% each year, but there was no general increase of frequency and severity of symptoms during the observation period in spite of an incidence of 8%. The prevalence was, according to the Ai, significantly higher for 18- and 19-year-old girls than for boys. Most symptoms were mild and fluctuated longitudinally.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

[Evaluation of preoperative bladder tumor staging].

Twenty-eight out of 90 patients with bladder tumor seen from 1979 to 1982 were examined by CT, pelvic angiography, cystography and bimanual digital palpation for staging diagnosis preoperatively. Twenty-two patients underwent total cystectomy, and the other 6 patients underwent partial cystectomy. Preoperative staging (T) and postoperative histopathological staging (pT) were compared to define the diagnostic accuracy. The accuracy rate with CT was 20.0%, that with pelvic angiography, 29.4%, that with cystography 33.3%, and that with bimanual digital palpation 47.1%. Digital palpation had a better diagnostic accuracy rather than other examinations.

Aged↗

Double-blind comparison of ketoprofen and placebo in the treatment of sprains and strains.

Sixty patients (42 men and 18 women between the ages of 18 and 37 years) with grade 2 or grade 3 sprains or elongations participated in a seven-day double-blind study. By random determination, they were treated with either 100 mg of ketoprofen or placebo TID. Pain evaluation, vital signs, concomitant medication, and side effects were determined on days 1,3, and 7. Compared with placebo, ketoprofen produced statistically significant reductions (P less than 0.05) in investigator-rated pain at rest (day 3), on palpation (days 1, 3, and 7), on motion (days 1 and 3), and on the subject-rated analog scale (days 1 and 3). It also achieved a greater relief of pain (days 1 and 3) and greater overall efficacy, as expressed by the statistically significant improvements in the total pain scores on motion and on palpation, on the total pain relief score, on the total pain analog score, and on the sum of pain intensity differences for pain at rest, on palpation, and on motion. Tolerance to the seven-day ketoprofen treatment was excellent. Results from the study indicate that ketoprofen is efficacious in relieving pain following sprains and strains.

Acetaminophen↗

Triple osteotomy of the pelvis and trochanteric osteotomy as a treatment for hip dysplasia in the immature dog: the surgical technique and results of 77 consecutive operations.

Triple osteotomy of the pelvis with transplantation of the greater trochanter was performed in 41 immature dogs (77 hips) with hip dysplasia. Before surgery, all hips were moderately to severely subluxated and unstable on palpation. The juxta-acetabular location of the ilial, ischial, and pubic osteotomies allowed repositioning of the acetabulum over the femoral head even when subluxation was severe. The acetabular fragment was rotated 70 degrees to 90 degrees in all hips. After surgery, craniodorsal coverage of the femoral head was increased and each hip was stable on palpation. Bilateral procedures were performed 4 to 7 weeks apart. The functional status of the limb was assessed and physical examination and radiography were performed in 71% (55) of the hips 1.0 to 5.5 years (mean, 2.7 years) after surgery. Functional ability was considered satisfactory in 93% (51) of the limbs, though few dogs had a normal gait. On palpation, all hips were stable and all but one were evaluated as nonpainful. In most instances, contact between the femoral neck and the repositioned acetabular rim resulted in a variable amount of crepitus and restriction of motion when the hip was abducted and rotated externally and internally. Eighty-two percent (45) of the hips had little or no evidence of degenerative joint disease. A satisfactory functional, physical, and radiographic result was obtained in 73% (40) of the hips.

Acetabulum↗

Studies on nodules and adult Onchocerca volvulus during a nodulectomy trial in hyperendemic villages in Liberia and Upper Volta. I. Palpable and impalpable onchocercomata.

In hyperendemic onchocerciasis areas of West Africa nodulectomy trials were performed. 163 nodule carriers from four villages in the Liberian rain-forest and 52 nodule carriers from a savanna village in Upper Volta were operated on. During the surveys in the villages in Liberia and Upper Volta, an average of three and five nodules respectively per patient were palpated. Before each operation a further palpation was done and two more nodules per patient from both countries were found. The nodulectomies revealed 75% more nodules in the Liberian patients and 53% more in the patients from Upper Volta than were palpated immediately before. Half of these additional subcutaneous nodules extirpated in Liberians were superficially located, the other half deeper and impalpable through the skin. In the patients from Upper Volta two thirds of the additional nodules were seated in the depth of the subcutis. In both countries an average of three deep subcutaneous nodules per patient were found and this was equivalent to 20% of all extirpated onchocercomata. Most of these deep subcutaneous nodules were at those sites where most of the superficial nodules were located.

Adipose Tissue↗

Ovarian response, pregnancy rate, and incidence of multiple fetuses in mares treated with an equine pituitary extract.

The ability of a pituitary extract to induce ovulation and the effect of multiple ovulations on pregnancy rate and incidence of multiple fetuses were studied in seasonally anovulatory mares. The extract induced ovulation in 95% of mares having a greater than or equal to 25 mm follicle at the onset of treatment and in 64% the ovulations were multiple. The extract was less effective when the largest initial follicle was less than 25 mm. Approximately 50% of the treated mares that ovulated did not become pregnant or enter prolonged dioestrus before returning to an anovulatory condition. In treated mares with one ovulation the pregnancy rate (33%) was lower than in controls (60%) and was further reduced in mares with greater than 2 ovulations. There was a pronounced discrepancy between the number of palpated conceptuses and number of palpated ovulations. Only one conceptus and one fetus was found on Days 28 and 50, respectively, in every pregnant mare (11 treated, 1 control) in which multiple ovulations were palpated.

Animals↗

Induction of abortion in feedlot heifers with a combination of cloprostenol and dexamethasone.

A field trial was conducted to assess the efficacy of a combined prostaglandin F(2)alpha analogue (cloprostenol) and dexamethasone treatment as an abortifacient in feedlot heifers. Heifers were grouped according to stage of gestation as follows: Group I, one to four months, n = 37: group II, four to six months, n = 40: group III, six to eight months, n = 40: group IV, one to eight months, n = 29. Heifers in groups I, II and III received a simultaneous intramuscular injection of 500 mug cloprostenol and 25 mg dexamethasone at the time of rectal palpation for pregnancy diagnosis. Heifers in group IV were subjected to rectal palpation for pregnancy diagnosis but received no treatments. Heifers were observed daily for two weeks for abortion and rectal palpations were done 50 days after treatment to determine reproductive status. HEIFERS ABORTING AFTER TREATMENT WERE AS FOLLOWS: Group I, 37/37; group II, 37/40, group III, 37/40; group IV, 0/29. In each of groups II and III there was one pregnancy and two cases of fetal mummification. The numbers of abortions in groups I, II and III were significantly different from that in group IV (P</=0.01). Weight gains were satisfactory and there was no illness associated with treatment. Results indicate that a combination of prostaglandin F(2)alpha analogue and dexamethasone will induce abortion at all stages of pregnancy in feedlot heifers.

Abortion, Induced↗

[Blood pressure during pediatric anesthesia. Four methods of peroperative indirect measurement. Comparison (author's transl)].

During general anesthesia blood pressure levels have been recorded for 35 children (10 aged 1-12 months, 15 aged 12-24 months, 10 more than 24 months). Four different methods of indirect measurement were used: pulse palpation, flush technique, ausculatory determination by mean of a conventional sphygmomanometer, Doppler ultrasonic technique by mean of arteriosonde. The pulse palpation is the easiest method at any age, during pediatric anesthesia but does not give values of diastolic blood pressure. The flush technique quite convenient for infants less than 24 months gives values lying midway between systolic and diastolic blood pressure. Ausculatory determination in operating room is difficult especially with small infants less than 12 months. During anesthesia longer than thirty minutes, monitoring blood pressure by Doppler ultrasound sphygmomanometer can be fairly available. Even in case of difficulties to detect clear signals of systolic and diastolic blood pressure the sphygmomanometer can be used to obtain blod pressure determination by flush technique or pulse palpation.

Age Factors↗

Reliability of clinical findings in temporomandibular disorders.

The aim of the present investigation was to study the interexaminer reliability of orthopedic tests and palpation techniques routinely used in the clinical diagnosis of disorders of the masticatory system. The tests were performed by a dentist and a physiotherapist, who both used the tests routinely when examining patients with temporomandibular disorders. Seventy-nine patients participated in this study. In the analysis, percentage agreement, intraclass correlation, and Cohen's kappa were used. The interexaminer reliability of the tests measuring maximal active mouth opening and registration of clicking during active mouth opening was high. The interexaminer reliability was fair for the tests measuring the intensity of pain during active movements and moderate for tests recording joint sounds (kappa = 0.47 to 0.59). There was high interobserver agreement on several items of the traction and translation tests, although the kappa values were low. The interexaminer reliability of the multitest scores for compression was substantial for joint sounds (kappa = 0.66) and fair for pain (kappa = 0.40). The interexaminer reliability of the multitest scores for muscle palpation and joint palpation was moderate (kappa = 0.51) and fair (kappa = 0.33), respectively. It can be concluded that most variables determined during active movements can be measured with satisfactory reliability, whereas variables for other tests are not measured with the same reliability on the basis of the kappa scores. The main symptoms of temporomandibular disorders can be evaluated reliably with multitest scores. It is recommended that clinicians calibrate their techniques regularly to improve the reliability of results in daily practice.

Adolescent↗