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PubMed2000

[Ultrasound elastography of the prostate. A new technique for tumor detection].

AIM: Prostate tumours are often of harder consistency than the surrounding tissue. During digital rectal examination, this fact can be used not only to detect hypertrophy but also localized hardenings. The examination by digital palpation is inaccurate and, even in combination with PSA-value and a transrectal ultrasonic examination, the result is often not reliable. Ultrasound elastography enables us to measure and visualize the elastic properties of a tissue region and is a useful supplement to the examination by digital palpation. Ultrasound elastography is able to measure and visualize the elastic properties of a tissue region, therefore it is a useful supplement to commonly used diagnostic procedures. METHOD: We have developed a new system for elastographic prostate diagnosis which can be used during the transrectal ultrasonic examination. During the examination a sequence of ultrasonic images is acquired while the organ is slightly compressed by the ultrasound probe. Using numerical analysis of image pairs for the acquired sequence we calculate the tissue strain which represents the spatial elasticity distribution of a specific cross-section of the organ. This enables us to distinguish hard areas in the tissue. Image artifacts resulting from lateral motion components, i.e., orthogonal to the direction of the applied force, are compensated for by a special approach. RESULTS: We present results obtained from a typical elastography phantom and also the first in vivo images from patients who were undergoing radical prostatectomy. Our images prove that ultrasound elastography has the potential to detect malignant tissue areas, which are inconspicuous in the B-mode image. Our findings are confirmed by the corresponding histological specimens.

Elasticity↗
PubMed2001

[Dysphagia without clinically relevant pathological correlation: to exclude tumours of the floor of the mouth and the base of the tongue ultrasound diagnosis is mandatory].

In patients suffering from dysphagia, a tumour of the tongue and its base must be excluded. This is not always possible by means of endoscopy and palpation. In contrast it is possible to visualize deep-seated structures of this region by ultrasound. Unfortunately, this technique is rarely used, as shown in the cases demonstrated. We present five patients suffering from dysphagia for a long period of time (up to 30 years) where ultrasound was not performed and a tumour of the floor of the mouth and the base of the tongue was overlooked. Thus, adequate therapy was delayed, which proved to be especially relevant in three patients suffering from a malignoma. Three patients suffered from a malignant tumour of the base of the tongue. Up to two years passed between the beginning of dysphagia and the necessary surgical treatment. One of these patients even underwent psychological treatment for his symptoms. In two other patients a dermoid cyst and ectopic thyroid tissue were removed. In patients suffering from dysphagia with normal endoscopic findings and normal palpation of the neck ultrasound of the floor of the mouth and the base of the tongue is imperative. Tumours of this area can be detected early with high sensitivity and cost-effectiveness by ultrasound.

Adult↗
PubMed2002

Ambiguous genitalia in the newborn.

Ambiguous genitalia in the newborn need immediate and rational management. This complex situation requires a strategy of clinical, hormonal, genetic, molecular, and radiographic investigation to determine the etiology of the intersex state and orient the therapeutic approach. Physical examination is key to diagnosis. Careful palpation to locate gonads at the genital folds or in the inguinal region provides the first element for diagnostic orientation. If gonads are absent, a diagnosis of female pseudohermaphroditism seems advisable; if gonads are palpated, a diagnosis of male pseudohermaphroditism is more appropriate. Karyotyping is systematic while polymerase chain reaction (PCR) analysis of the SRY gene provides information about the presence of a Y chromosome within 1 day. Hormonal investigation should be based on clinical and genetic orientation. Substantially elevated plasma 17-OH progesterone will confirm the diagnosis of congenital adrenal hyperplasia due to deficiency in 21-hydroxylase. Testicular stimulation with human chorionic gonadotropin (hCG) will determine the functional value of testicular tissue. Exploration of the genitourinary axis is principally carried out by ultrasound and genitography. By the end of these investigations, the medical team should be able to give a precise diagnosis. Female pseudohermaphroditism may be due to excess fetal androgens (congenital adrenal hyperplasia), increased androgen production of maternal origin, or placental androgen excess. In male pseudohermaphroditism, if testosterone rises normally after hCG stimulation, androgen resistance is indicated. If it does not rise after this test, either testicular dysgenesis or disturbance in testosterone biosynthesis may be responsible. The assignment of sex for rearing must be guided by the etiology of the genital malformation, the anatomic condition, and family considerations. In cases of female pseudohermaphroditism, the newborn should always be declared to be of female sex at birth. In cases of male pseudohermaphroditism, great care should be taken in the declaration of male sex: the potential for reconstructive surgery and the pubertal "programmed" response of the external genitalia to endogenous and exogenous testosterone are determinant. Management of ambiguous genitalia in the newborn requires an entire multidisciplinary team in every step of the diagnostic procedure, the choice of sex assignment, and the treatment strategy.

Disorders of Sex Development↗
PubMed1996

[Ultrasound and mammography follow-up of findings after breast saving operation and adjuvant irradiation].

AIM: The aim of our controlled retrospective study was to assess the diagnostic value of sonography for detection and characterisation of changes compared to mammography and palpation. METHOD: In 80 patients sonographic and clinical follow-up examinations were performed every 3 to 6 months, mammography examinations were performed every 6 to 12 months during the first 2 years after breast-preserving therapy (BPT) and irradiation. Extension, echogenicity, and configuration of lesions in sonography, and semiquantitiative description of diffuse or circumscribed changes in mammography were the basis of comparative follow-up observation. RESULTS: Postoperative seromas and haematomas, initially presenting echo-free or as hypoechoic lesions, showed an increase in echogenicity within 18 months after irradiation. Fat necrosis occurred in 9.5% of patients, lymph cysts developed in 4%, granuloma in 3%, recurrence of neoplasma in 1.6%. The diffuse loss of transparency in mammography that was associated with radiation therapy, showed a peak 6-12 months after irradiation. CONCLUSION: Sonography and sonographic guided puncture are mandatory tools to characterise circumscribed unclear lesions after breast-conserving therapy and irradiation in specialised centers. We recommend a 6-month interval for combined sonography, palpation, and mammography within the first 2 years after BPT and irradiation, because shorter control intervals did not result in relevant diagnostic advantages.

Adult↗
PubMed1991

[Diagnostic problems in local recurrence after breast saving therapy of breast cancer].

From 1970 to 1987, 331 breast cancer patients of the Department of Gynaecology of the University of Erlangen were treated by conservative breast surgery. Adjuvant radiotherapy of the remaining breast was applied to only one-third of the patients. 30 patients (9.8%) had a local recurrence. This study analyses the 21 patients with local recurrence after breast conserving therapy, treated afterwards again in our hospital. 60% of the recurrences occurred within 2 years after the primary treatment. In 18 cases, the recurrences were located in the vicinity of the segmental resection area, in 3 cases the recurrences were diagnosed as new second primaries in the ipsilateral breast. 19 of the 21 recurrences were diagnosed by palpation, 2 cases were detected by mammography examination only. The palpable recurrences could only be shown in the mammography in 14 cases. We conclude, that for patients with breast conserving therapy, a mammographic examination need not be increased in frequency, but a quarterly examination by palpation should be extended over more than 2 years.

Adult↗
PubMed1998

[Duplication cyst of the stomach antrum as the cause of an acute gastric emptying disorder in an adult].

HISTORY AND CLINICAL FINDINGS: A 35-year old woman without previous history of gastrointestinal complaints developed increasing upper abdominal pain with nausea and postprandial vomiting over 2 days during which she had been unable to take any food. She had no fever; her general physical condition was slightly reduced. While her abdomen felt soft on palpation, she had epigastric pain on pressure but no resistance to palpation. INVESTIGATIONS: Blood picture and routine laboratory tests were unremarkable. Plain film of the abdomen demonstrated marked gastric retention. Abdominal ultrasound showed an invagination in the gastric antrum suggesting a layering phenomenon. Gastroscopy revealed a submucosal tumour-like lesion with central ulceration which obstructed gastric exit. TREATMENT AND COURSE: After conclusion of the diagnostic tests on the first hospital day partial gastric resection (Billroth I) was performed as, in the absence of any surrounding reaction, a leiomyoma had been suspected. The further course was without complication and she was discharged on the 13th hospital day. The surgical specimen revealed a duplication cyst of the gastric antrum. CONCLUSION: (Endo)sonography, computed tomography and endoscopy make it possible to diagnose duplication cyst, as long as it is included in the differential diagnosis of acute abdomen in an adult. Emergency resection of the cyst is indicated because of the acute nature of the symptoms. But even in less urgent cases or as an incidental finding it is the treatment of choice.

Abdomen, Acute↗
PubMed1989

[Detection and assessment of cervical lymph node metastases in head-neck tumors. A comparison of methods].

From 1984 to 1987, seventy-two patients with squamous cell carcinomas involving oropharynx, hypopharynx, larynx and cervical lymph nodes, who underwent surgery, were examined to determine the value of computed tomography (CT), magnetic resonance (MR), high-resolution real-time sonography (US) and palpation in preoperative staging of cervical nodal metastases. The clinical staging was compared with the microscopic findings in the neck specimens and with operative reports. For the identification and description of cervical lymph node metastases, US and CT are more valuable than MR and palpation. In comparison to CT, however, US has advantages in most cervical areas as a dynamic method with variable representation of interesting regions. False positive errors are related to confusion with inflammatory nodes in all examinations. Metastatic infiltration of surrounding tissue especially of neck vessels, are best recognised by means of US and MR. However, the high rates of sensitivity and low rates of specificity of all methods point to the possibility of a great number of false positive errors in demonstrating tissue infiltration.

Angiography↗
PubMed1991

[The value of different clinical and imaging procedures for the postoperative follow-up of extra-anatomical bypasses].

In order to judge the patency of extra-anatomical by-passes in the lower extremities, 24 patients with 29 by-passes were examined clinically (palpation of the by-pass pulse, Fontaine staging, Doppler index) and by imaging methods (i-v DSA, Duplex sonography, colour-coded Doppler sonography). The value of these methods was compared. Sonography was found to be the ideal method for follow-up. Palpation was unreliable, particularly for femoro-femoral by-passes. The Doppler index and the Fontaine method provided no information about the actual state of the bypass. Angiography is indicated only if further vascular reconstruction is planned.

Aged↗
PubMed1987

[Status of radiologic pelvimetry].

The diagnostic value of radiological pelvimetry is subject to controversial interpretation. This examination is being conducted at the Department of Gynaecology in Aarau (Frauenklinik Aarau) mainly in pregnant women in pelvic presentation or during the puerperium after Caesarean section. Based on 164 radiological pelvimetric measurements in breech presentation and 112 X-ray films after Caesarean section an attempt was made to assess the prospective value of this examination. Abnormal shapes of the pelvis and narrow pelvic dimensions were found about equally often. Analysis of the indications of the section yielded both in breech presentation and in the entire group of the patients examined post partum an almost equally high percentage of about 20% of indications for a disproportionate head-pelvis relationship. Radiologically, considerably narrowed pelvic dimensions were seen in 10% of the examined women. The most frequent finding was a funnel-shaped pelvis, whereas an assimilation pelvis was never seen. Every pathologically narrowed funnel-shaped pelvis and generally narrow pelvis was detected also by digital palpation. All cases of conjugata vera masses below 10 cm concerned generally narrow cases of pelvic dimensions and were thus detectable by digital palpation. We recommended to abstain from routine performance of radiometric pelvimetry. Lateral pelvic X-ray can be an additional help in difficulties in pregnant women with regard to determining the mode of birth in breech presentation and after Caesarean section in case there is an urgent suspicion of malproportionate head-pelvis ratios.

Cesarean Section↗
PubMed1982

[Diagnostic and therapeutic management of breast cysts].

In a study of 144 patients with cystic dysplasia of the breast diagnostic and therapeutic accuracy of palpation, mammography, aspiration cytology and pneumocystography was investigated. Only in 9.7% of the cases a surgical biopsy was necessary. In more than 90% of the cases biopsy was not performed; instead of this follow up with palpation, mammography and aspiration cytology up to 11 months was done. No breast cancer was overlooked, three of four proliferating dysplasias were detected. In 21% a local cystic recidive occurred which again was punctured. In contrary to surgical biopsy follow up of cystic dysplasias is not complicated by scars and their diagnostic problems. No complications were seen.

Biopsy↗
PubMed1982

[Suprapubic prostatic sonography for staging prostatic carcinoma].

Sixty-one patients with histologically confirmed carcinomas of the prostate were examined by suprapubic, transvesical prostatic sonography in order to stage local tumor spread. The results were compared with rectal palpation. Compared with rectal palpation, sonography led to tumor up-staging in 16% and down-staging in 7%. The results showed good agreement with findings at prostatectomy, autopsy and cystoscopy. Additionally, the sonographic up-staging/down-staging figures were compared with "tumor staging after prostatectomy, as compared with clinical staging" quoted in the literature. It is concluded that suprapubic prostatic sonography is reliable supplementary method of examination for local tumor staging and that it improves the classification of local tumor extent.

Adult↗
PubMed1992

[Goiter epidemiology in South Tirol].

To ascertain the prevalence of goitre among schoolchildren in South Tyrol (uncontrolled voluntary iodine salt prophylaxis), the size of the thyroid gland was determined by palpation and ultrasound in 1,013 of 1,224 children, aged 6 to 14 years (547 boys, 466 girls), selected by statistically criteria. At the same time, to assess thyroid function, total and free fractions of T3 and T4, and TSH were measured, while iodine supply was determined by measuring urinary iodine. Stage Ia goitre was diagnosed by palpation in 157 children, stage Ib in 18 and stage II in two (goitre prevalence of 1.97% according to WHO criteria). Mean thyroid volume as determined by ultrasound was 4.26 (0.8-23.4) ml. As expected, it increased with age and body surface area: it was 2.55 +/- 0.49 ml in 6-year olds, 3.83 +/- 0.42 ml in 10-year olds and 6.42 +/- 0.69 ml in 14-year olds. Iodine excretion (143.8 [4.1-984.8] micrograms iodine/g creatinine) indicated adequate iodine supply to the tested subjects. South Tyrol is thus, according to WHO criteria, no longer an endemic goitre area. The voluntary use of iodinated cooking salt and changed food habits have probably effected this change in goitre epidemiology.

Adolescent↗
PubMed2002

The biological concept of "internal derangement and osteoarthrosis": a diagnostic approach in patients with temporomandibular joint pain?

OBJECTIVES: We sought to investigate whether the finding of temporomandibular joint (TMJ)-related pain may be linked to magnetic resonance (MR) imaging findings of TMJ internal derangement and TMJ osteoarthrosis. STUDY DESIGN: The study consisted of 194 consecutive TMJ patients. Criteria for including a patient with a painful TMJ were as follow: report of orofacial pain in the TMJ, with the presence of unilateral or bilateral TMJ pain during palpation, function, and unassisted or assisted mandibular opening. Criteria for including a patient with a nonpainful TMJ were as follow: absence of a TMJ with pain during palpation, function, and unassisted or assisted mandibular opening. Application of the criteria resulted in a study group of 150 patients with unilateral TMJ pain, 10 with bilateral TMJ pain, and 34 without TMJ pain. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement or osteoarthrosis, or both. RESULTS: A comparison of the TMJ-related data showed a significant relationship between the clinical finding of TMJ pain and the MR imaging diagnoses of TMJ internal derangement (P =.002) and TMJ osteoarthrosis (P =.004). Significant increases in risk of pain occurred with "disk displacement without reduction and osteoarthrosis" (P =.000), "disk displacement without reduction and absence of osteoarthrosis" (P =.000), and "disk displacement with reduction and osteoarthrosis" (P =.036). CONCLUSIONS: The results suggest that TMJ-related pain is correlated with TMJ-related MR imaging diagnoses of internal derangement and osteoarthrosis. The data confirm the biological concept of "internal derangement and osteoarthrosis," yet re-emphasize that internal derangement and osteoarthrosis may not be regarded as the unique and dominant factors in the definition of TMJ pain.

Adolescent↗
PubMed2003

Relative odds of temporomandibular joint pain as a function of magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema.

OBJECTIVE: The purpose of this study was to evaluate whether common magnetic resonance (MR) imaging variables such as temporomandibular joint (TMJ) internal derangement, osteoarthrosis, effusion, and bone marrow edema are predictive of the presence of TMJ pain. STUDY DESIGN: The relationship between TMJ pain and TMJ internal derangement, osteoarthrosis, effusion, and bone marrow edema was analyzed in MR images of 338 TMJs in 169 patients with a clinical diagnosis of TMJ pain and dysfunction. Criteria for including a patient with TMJ pain were a report of orofacial pain referred to the TMJ, with the presence of unilateral or bilateral TMJ pain during palpation, function, or unassisted or assisted mandibular opening. The criteria for including a patient with no pain were the absence of TMJ pain during palpation, function, and unassisted or assisted mandibular opening. Application of the criteria resulted in a study group of 129 patients with unilateral TMJ pain, 18 with bilateral TMJ pain, and 22 without TMJ pain. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement, osteoarthrosis, effusion, and bone marrow edema. Logistic regression analysis was used to compute the odds ratios for internal derangement, osteoarthrosis, effusion, and bone marrow edema for nonpainful TMJs (n = 173) versus painful TMJs (n = 165). RESULTS: For pairwise comparison, the chi(2) test was used; the resultant data showed a significant relationship between the clinical findings of TMJ pain and the MR imaging diagnoses of internal derangement (P =.000), osteoarthrosis (P =.015), effusion (P =.002), and bone marrow edema (P =.016). Of the MR imaging variables considered simultaneously in multiple logistic regression analysis, osteoarthrosis (P =.405), effusion (P =.131), and bone marrow edema (P =.231) dropped out as nonsignificant in the diagnostic TMJ pain group in comparison with the TMJ no-pain group. Significant increases in risk of TMJ pain occurred with disk displacement without reduction in combination with osteoarthrosis and bone marrow edema (3.7:1 odds ratio; P =.000) and with disk displacement without reduction in combination with osteoarthrosis and effusion (2.8:1 odds ratio; P =.000). CONCLUSIONS: The results suggest that TMJ pain is related to internal derangement, osteoarthrosis, effusion, and bone marrow edema. However, the data reemphasize that these MR imaging variables may not be regarded as the unique and dominant factors in defining TMJ pain occurrence.

Adolescent↗
PubMed2003

Electrophysiologic evidence of impaired cross-modal recognition memory in 8-month-old infants of diabetic mothers.

OBJECTIVES: Previous studies have shown deficits in auditory and visual recognition memory in infants of diabetic mothers. The purpose of this study was to further investigate memory development in infants of diabetic mothers (IDMs) by evaluating cross-modal recognition memory followed by behavioral memory testing at 8 months of age. STUDY DESIGN: Cross-modal (tactile to vision) recognition memory was evaluated using event related potentials. Control and IDMs palpated an object without seeing it and were then tested on their ability to recognize that object visually. Infants were then tested behaviorally on their ability to recognize and discriminate faces. The Bayley Scales of Infant Development was administered at 12 months of age. RESULTS: Control infants showed typical event-related potential patterns indicative of intact cross-modal recognition memory, whereas the IDMs did not show any evidence of recognition of the palpated object. Neither group showed behavioral evidence of visual recognition memory. Both groups had Bayley scores in the normal range, although controls had slightly higher mental development index scores than IDMs. CONCLUSIONS: IDMs showed neurophysiologic evidence of persistent subtle impairments in hippocampally-based recognition memory, despite having normal one-year developmental scores.

Adult↗
PubMedDate not supplied

Arthroscopic subacromial decompression.

In this study, we analyzed the results of two series of patients treated for impingement syndrome by undergoing arthroscopic subacromial decompression (ASD). Patients had not responded to nonoperative treatment. Group 1 included 112 consecutive patients (average age, 41 years) with 96 (77%) patients available for 2-year follow-up. Group 2 (28 patients, 29 shoulders; average age, 43 years; range, 22 to 72) had ASD and the subacromial space digitally palpated to determine if adequate decompression was performed. Twenty-two (85%) of 26 shoulders were available for follow-up. At follow-up, pain, function, range of motion, strength, impingement signs, and patient satisfaction were assessed. In group 1, according to the Neer criteria, 48% of the patients were graded as satisfactory and 52% unsatisfactory. Workers' Compensation patients had a satisfactory rate of 32%, whereas non-Workers' Compensation patients had a satisfactory rate of 59%. Twenty patients had open acromioplasty after ASD. Inadequate decompression was noted in 14 of 20 failed patients. In group 2, 86% of the patients were graded as satisfactory according to the Neer criteria, with 14% unsatisfactory, which included the 2 failures. The 2 (9%) of 22 shoulders that failed the ASD went on to further surgical treatment. Average follow-up was 56 months (range, 13 to 78 months). The average American Shoulder and Elbow Society score at follow-up was 90.4. No difference between Workers' Compensation cases and the other cases was seen (P <.7). Finger palpation can help to improve outcomes by allowing the surgeon to assess the adequacy of decompression.

Acromion↗
PubMed2002

Effect on prostaglandin E2 and leukotriene B4 levels by local administration of glucocorticoid in human masseter muscle myalgia.

Our aim was to determine whether masseter muscle (M) and plasma (P) levels of prostaglandin E2 (PGE2) or leukotriene B4 (LTB4) are influenced by local glucocorticoid administration and whether such changes would be associated with corresponding changes in local pain or hyperalgesia. Eighteen patients with fibromyalgia and 15 with local masseter myalgia were examined immediately before and 2 weeks after intramuscular administration of glucocorticoid with regard to masseter muscle resting pain and tenderness to palpation, pressure pain threshold, maximum voluntary mouth opening (MVM), and pain on maximum voluntary mouth opening. The primary criteria for inclusion were presence of pain for a period of at least 3 months and tenderness to digital palpation in the masseter muscle region. At both visits microdialysis samples were obtained from the masseter muscle, and venous blood was collected for analysis of PGE2 and LTB4. Dialysate levels of M-PGE2 did not change significantly after glucocorticoid administration, but reduction of masseter resting pain and increase of MVM were associated with decrease of M-PGE2 in the patients with fibromyalgia. Dialysate levels of M-LTB4 increased in both groups. In the patients with local myalgia the plasma level of LTB4 also increased, and this increase was associated with a decrease of pain and masseter tenderness. In conclusion, this study shows that reduction of masseter level of PGE2 after intramuscular glucocorticoid administration is associated with a decrease of resting pain in patients with fibromyalgia. In addition, the masseter muscle level of LTB4 increases in patients with fibromyalgia and local myalgia.

Adult↗