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PubMed2000

Ultrasonography of spontaneous lesions of the genital system of three rams, and their influence on semen quality.

Three young Suffolk ram lambs had lesions which rendered them reproductively unsound. One had a unilateral scrotal hernia, detected by palpation, and two had sperm granulomas which were detected by trans-scrotal ultrasonography at 18 to 20 weeks of age, before they could be detected by palpation. Changes in the lesions were monitored ultrasonographically at two-week intervals with a 7.5 MHz linear array transducer. On the day of each examination, semen was collected from the rams with sperm granulomas by using an artificial vagina, and their libido was assessed. Semen could rarely be collected from the third ram. Comparisons were made with similar data obtained from two normal rams. When the rams were 20 to 21 months of age, they were vasectomised on the normal side, so that the influence of the lesions on semen composition and libido could be assessed, and semen was collected and evaluated until they were euthanised at approximately 24 months of age, when the genital system was examined for gross lesions. The sperm granulomas changed in size (one of them increased in size by about 30 times) and echotexture over the 19-month period of the study, whereas the scrotal hernia, which contained omental fat, remained fairly constant. The libido of the two rams with sperm granulomas was comparable with the two normal controls. The total mean (sem) number of sperm in the ejaculates were 1.11 (0.10) x 10(9) and 2.03 (0.17) x 10(9) sperm/ml in the affected rams and 4.11 x 10(9) sperm/ml in the normal rams over the same period; the differences were significant (P<0.05). After unilateral vasectomy, the ejaculates from these two rams contained small numbers of dead spermatozoa, mostly with degenerate heads. Postmortem examination confirmed the gross lesions identified ultrasonographically.

Animals↗
PubMed2002

Aquapuncture therapy of repeat breeding in dairy cattle.

Repeat breeders cause great economic loss in dairy herds. This study determined the efficacy of simple aquapuncture therapy (acupuncture combined with injection) to treat repeat breeders in two dairy herds (one in Hsinchu County and the other in Tainan County). Both herds had used gonadotropin-releasing hormone (GnRH) beforehand to treat the symptom but the success rate was poor--about 30%. Therefore, cows that failed to respond to GnRH were given the aquapuncture treatment. A total of 18 animals (two heifers and 16 cows) that had failed to conceive to 3-9 services were treated by aquapuncture, in which 10 ml and 5 ml of 50% glucose solution were injected at Baihui (Hundred Meetings, the depression in the center of the lumbosacral space) and Shenpeng (Kidney Shelf, the depression in the space between the lumbar vertebral transverse processes 5-6) acupoints, respectively with a 21G, 1.5-inch hypodermic needle. Both acupoints belong to the traditional acupuncture points of bovine and equine systems. Most animals showed heat within 14 days after aquapuncture and were inseminated artificially. Serum progesterone concentrations and rectal palpation were used for pregnancy diagnosis. The pregnancy rate after the treatment was 14/18 (77.7%) and 12/18 (66.6%) based on progesterone concentration and rectal palpation respectively, suggesting acupuncture as a simple and effective method to treat repeat breeders in dairy herds. However, the final result obtained from actual delivery of fetus in the experimental animals was only 8/18 (44.4%).

Acupuncture Points↗
PubMed2004

Invasive cancers detected after breast cancer screening yielded a negative result: relationship of mammographic density to tumor prognostic factors.

PURPOSE: To evaluate common breast tumor prognostic characteristics, including estrogen receptor (ER) status, grade, size, and method of detection, in relationship to mammographic density. MATERIALS AND METHODS: The study involved 121 women who had negative results at both screening mammography and breast physical examination within 17 months before a diagnosis of breast cancer. Mammographic density was classified according to Breast Imaging Reporting and Data System patterns 1 through 4 (where 1 indicates a fatty breast and 4 indicates a dense breast). Axillary nodal status and tumor histologic ER status, histologic grade, size, stage, and method of detection (mammography alone, palpation alone, or both palpation and mammography) were analyzed by density category and tested for statistically significant differences across categories by using analysis of variance. RESULTS: Statistically significant differences (P <.05) by density category were found for the following variables: ER positivity (15 of 15 tumors in category 1 breasts, 32 of 41 tumors in category 2 breasts, 37 of 49 tumors in category 3 breasts, and eight of 16 tumors in category 4 breasts were ER positive), occurrence of grade 1 tumors (eight, 11, 19, and four tumors in category 1, category 2, category 3, and category 4 breasts, respectively, were grade 1), mean tumor size (11.3, 13.0, 14.7, and 19.7 mm for category 1, category 2, category 3, and category 4 breasts, respectively), detection with mammography alone (13, 31, 36, and four tumors in category 1, category 2, category 3, and category 4 breasts, respectively, were detected with mammography alone), and occurrence of stage I tumors (10, 25, 28, and five tumors in category 1, category 2, category 3, and category 4 breasts, respectively, were stage I). CONCLUSION: In women with negative results at clinical and mammographic screening within 17 months before breast tumor detection, subsequently diagnosed cancers tend to be ER negative, of higher grade, and larger in size in those with dense tissue patterns than in those with fat patterns.

Adult↗
PubMed1989

Manual compression device for fluoroscopy.

A device for manual compression and palpation during supine fluoroscopy has been designed. It enables effective use of the physiologic grasping and lever force potentials of the hand and wrist. The device permits optimal fluoroscopic palpation and compression techniques and prevents direct exposure to the lead-gloved hand.

Fluoroscopy↗
PubMed1992

Thyroid nodules associated with Hashimoto thyroiditis: assessment with US.

Sonographic findings in 109 thyroid nodules in 104 patients with Hashimoto thyroiditis were retrospectively analyzed. Sixty patients underwent ultrasound (US)--guided fine-needle aspiration (FNA) biopsy (65 nodules, 24 palpable, 27 surgically confirmed), 14 of whom also underwent palpation-guided FNA (14 nodules, all palpable, all surgically confirmed). Forty-four patients (44 nodules, 25 palpable) underwent diagnostic US followed up with surgery. US-guided FNA helped differentiate between benign (n = 11) and malignant (n = 16) diseases (sensitivity, 100%). Two papillary carcinomas were falsely diagnosed as Hashimoto thyroiditis with palpation-guided FNA. Eight malignancies were not palpable, and correct diagnosis was obtained with US-guided FNA. Hyperechoic nodules were usually benign, and isoechoic nodules had a low frequency (13%) of malignancy. Most carcinomas were found in hypoechoic masses, and almost all lymphomas were found in markedly hypoechoic masses. Lymphoma was indistinguishable from pseudotumor in Hashimoto thyroiditis or adenomatous hyperplasia at US. US-guided FNA is helpful in making the histologic diagnosis in thyroid nodules associated with Hashimoto thyroiditis. US-guided FNA is clinically beneficial because it can help select patients who need surgery, avoiding unnecessary surgery for patients with nonneoplastic disorders.

Adenoma↗
PubMedDate not supplied

Anterior abdominal wall hernias: findings in barium studies.

Findings of anterior abdominal wall hernias at computed tomography and magnetic resonance imaging are well documented; however, little information is available about the depiction and characterization of such hernias in barium studies, primarily in small-bowel follow-through examinations. Such examinations are performed frequently, and radiologists should be familiar with the hernia features that may be observed. Anterior abdominal wall hernias are best recognized in profile on lateral spot images from a small-bowel follow-through study when one or more loops of bowel extend beyond the fascial planes of the anterior abdominal wall, with luminal narrowing at the entry or exit site of the hernia or at both sites. In some patients, the hernia also can be recognized indirectly on a frontal view because of the displacement and, often, extrinsic compression or deformity of herniated bowel loops. In such cases, additional views should be obtained with the patient in the lateral position to confirm the presence of the hernia with direct visualization of the herniated loops in profile. The reducibility of bowel from an anterior abdominal wall hernia also can be assessed with manual palpation of the abdominal wall while the patient is in the lateral position. Manual palpation performed during fluoroscopy helps determine whether the bowel loops can be returned to the proper location or are fixed in the hernia, an important observation because of the higher risk of obstruction or strangulation when the bowel is incarcerated. Fluoroscopy therefore is a useful technique for the detection and characterization of anterior abdominal wall hernias in barium studies.

Barium Sulfate↗
PubMedDate not supplied

The new imaging-based classification for describing the location of lymph nodes in the neck with particular regard to cervical lymph nodes in relation to cancer of the larynx.

For over five decades, the principle landmarks used in cervical nodal classification were clinical and defined either by palpation or found at the operative table. However during the past two decades, sectional imaging has consistently improved its quality and resolution and it has been shown that imaging can identify deep structures and adenopathy not amenable to palpation. Such disease can alter planned operative or radiation fields. In the April 1999 issue of the Archives of Otolaryngology-Head Neck Surgery, for the first time an imaging-based classification was published that gave precise anatomic landmarks for use in classifying metastatic cervical adenopathy. This classification was developed in consultation with head and neck surgeons so that the nodal levels classified by this imaging-based system would correspond closely with the nodal levels determined by utilizing the most commonly employed clinically-based classifications. This article describes this imaging-based classification and demonstrates its use with axial diagrams.

Head and Neck Neoplasms↗
PubMedDate not supplied

Diagnostic procedures for detection of lymph node metastases in cancer of the larynx.

Squamous cell carcinoma is the most common malignant neoplasm of the larynx. One of the most important influences on prognosis is the presence of metastases to the cervical lymph nodes. Accurate determination of lymph node involvement is therefore a prerequisite for individualized therapy in patients with squamous cell carcinoma of the larynx. Clinical palpation of the neck is not very accurate and the role of imaging techniques such as ultrasound, ultrasound-guided fine needle aspiration cytology, color Doppler ultrasound, computed tomography, magnetic resonance imaging and positron emission tomography is being applied in order to improve upon the results of clinical investigation alone. According to our investigations and review of the literature, the accuracy of computed tomography scanning (84.9%) and magnetic resonance imaging (85%) was superior to palpation (69.7%) and ultrasound (72.7%). Ultrasound-guided fine needle aspiration cytology showed an accuracy of 89% and was in the same range with positron emission tomography (90.5%).

Biopsy, Needle↗
PubMed2005

Reduction of temporomandibular joint pain after treatment with a combination of methotrexate and infliximab is associated with changes in synovial fluid and plasma cytokines in rheumatoid arthritis.

The aims were to investigate the effect of intravenous infusions of the tumor necrosis factor-alpha (TNF-alpha) antibody infliximab on symptoms and signs of temporomandibular joint (TMJ) involvement in relation to effects on synovial fluid and plasma proinflammatory TNF-alpha, interleukin-1beta (IL-1beta) and interleukin-6 as well as antiinflam matory soluble TNF receptor II (TNF-sRII), interleukin-1 receptor antagonist (IL-1ra), soluble IL-1 receptor II (IL-1sRII) and interleukin-10 (IL-10) in patients with active rheumatoid arthritis (RA). Nineteen patients with TMJ involvement taking methotrexate were included in the study. TMJ and general joint pain intensity as well as pain on mandibular movements, tenderness to digital palpation, pressure pain threshold and maximum mouth-opening capacity were assessed in a clinical examination. The effect of infliximab was assessed after 2 and 14 or 22 weeks. TMJ synovial fluid and venous blood were collected for cytokine analysis at all occasions while determination of erythrocyte sedimentation rate and C-reactive protein were performed at baseline and at long-term follow-up only. Reduction of TMJ pain was associated with raised levels of synovial fluid TNF-sRII and IL-1sRII as well as raised plasma levels of IL-1ra and IL-10. Decreased erythrocyte sedimentation rate was associated with decreased tenderness to digital palpation. Reduced general joint pain intensity was associated with reduced plasma levels of IL-6 and C-reactive protein. In conclusion, systemic treatment with a combination of infliximab and methotrexate reduces TMJ pain in RA in association with an increase in anti-inflammatory cytokines and receptors in synovial fluid and plasma.

Antibodies, Monoclonal↗
PubMed1993

[Evaluation of tumor extension in invasive cancer of the uterine cervix. Diagnostic evaluation of cervix cancer].

Cancer of the uterine cervix accounts for approximately 30% of deaths from malignancies in gynecology and this rate has remained unchanged for more than 40 years. The most important prognostic factor is the extent of the disease at the beginning of treatment. There is, however, a discrepancy of some 50% between clinical and postoperative staging. The aim of this study was to evaluate different diagnostic investigations leading to the preoperative classification (FIGO) of 261 patients with cervical cancer. Data of presurgical clinical and radiological examinations were compared with postoperative histopathological findings. Rectovaginal palpation and computerized tomography (CAT) both showed a positive predictive value of 60%. The performance of CAT and lymphography in the diagnosis of lymph node metastasis was poor with positive predictive values of 36.3 and 20%, respectively. In the absence of parametrial infiltration on palpation, cystoscopy and rectoscopy are superfluous since they are always normal. Urography, because of the possibility to show the topographic anatomy of the urinary tract, was justified in all cases. The value of surgical staging and more recent techniques such as sonography and magnetic resonance is discussed.

Adult↗
PubMed1995

Penile ossification and acquired penile deviation.

We report on 3 patients with penile deviation during erection caused by ossification in the corpora cavernosa. In each case hard plaques could be palpated. These indurations were removed through a dorsal longitudinal incision. Histologically, solid bone was demonstrable. Two patients were able to resume normal sexual intercourse, but one became impotent following postoperative cavernitis. Penile ossification is rare in man, and its etiology is unknown. It bears no relationship to the os penis normally present in many other mammals. Diagnosis is best made by palpation and X-ray examination. The treatment of choice for symptomatic ossification is surgical excision.

Adult↗
PubMed1987

Experimental masticatory muscle pain.

Ten female subjects with no history of temporomandibular disorders performed five exercises designed to induce masticatory muscle pain. Three of the exercises were replications of Christensen's tooth-clenching (1970) and tooth-grinding (1971) studies and Scott and Lundeen's mandibular protrusion (1980) study. The other two exercises were designed to induce specific unilateral masticatory muscle pain. The amount of muscle pain as well as the time of onset and the duration were assessed by a clinical palpation exam and a pain questionnaire. These five pain-inducing methods did not consistently produce masticatory muscle pain in non-pain subjects. However, certain individuals appeared to be very susceptible to developing pain during or after most of the exercises. These susceptible individuals demonstrated a bilateral muscle pain pattern after the unilaterally stressful exercises. None of the five exercises produced a statistically significant amount of site-specific masticatory muscle pain as determined by either the palpation examination or the pain questionnaire, even when the exercise was intended to produce such specificity. The fact that some subjects did develop masticatory muscle pain is indicative that muscle exercise and fatigue may lead to TMD-like symptoms.

Adolescent↗
PubMedDate not supplied

Prevention of axillary nerve injury in anterior shoulder reconstructions: use of a subscapularis muscle-splitting technique and a review of the literature.

BACKGROUND: Previous authors have suggested that the axillary nerve should be explored or palpated during all anterior shoulder stabilization procedures. OBJECTIVE: The goal of this study was to document the axillary nerve injury rate in a cohort of patients who had undergone anterior shoulder stabilization without axillary nerve dissection. HYPOTHESIS: Use of a subscapularis muscle-splitting approach by using a retractor along the scapular neck does not result in significant risk of injury to the axillary nerve, and exploration of the axillary nerve is not necessary using this approach. STUDY DESIGN: Prospective cohort study. METHODS: One hundred and twenty-eight anterior stabilizations were performed with a subscapularis muscle-splitting approach that has been previously described. In all cases a retractor was placed along the inferior scapular neck to protect the axillary nerve. The axillary nerve was not exposed or palpated in any case. All patients were evaluated on the 1st postoperative day and again within 10 days for symptoms of axillary nerve palsy, including sensory loss and return of muscle function. One patient (0.8%) had paresthesia in an axillary nerve distribution; recovery occurred without the need for electromyography or other interventions. There were no clinically detected cases of axillary nerve motor dysfunction. CONCLUSIONS: Routine exposure of the axillary nerve is not necessary during anterior stabilization procedures using a subscapularis muscle-splitting approach if proper precautions are taken to protect the nerve. Other techniques of anterior stabilization may require exposure of the axillary nerve.

Axilla↗
PubMed2006

Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings.

BACKGROUND: Hamstring muscle strain is one of the most common injuries in sports. Still, knowledge is limited about the progression of clinical and magnetic resonance imaging characteristics and their association with recovery time in athletes. HYPOTHESIS: Knowing the anatomical location and extent of an acute first-time hamstring strain in athletes is critical for the prognosis of recovery time. STUDY DESIGN: Case series (prognosis); Level of evidence, 2. METHODS: Eighteen elite sprinters with acute first-time hamstring strains were prospectively included in the study. All subjects were examined, clinically and with magnetic resonance imaging, on 4 occasions after injury: at day 2 to 4, 10, 21, and 42. The clinical follow-up period was 2 years. RESULTS: All sprinters were injured during competitive sprinting, and the primary injuries were all located in the long head of the biceps femoris muscle. There was an association between the time to return to pre-injury level (median, 16; range, 6-50 weeks) and the extent of the injury, as indicated by the magnetic resonance imaging parameters. Involvement of the proximal free tendon, as estimated by MRI, and proximity to the ischial tuberosity, as estimated both by palpation and magnetic resonance imaging, were associated with longer time to return to pre-injury level. CONCLUSION: Careful palpation during the first 3 weeks after injury and magnetic resonance imaging investigation performed during the first 6 weeks after injury provide valuable information that can be used to predict the time to return to pre-injury level of performance in elite sprinting.

Adolescent↗
PubMed2006

Anamnestic index severity and signs and symptoms of TMD.

The aim of this study was to determine the frequency and to characterize the symptoms and clinical signs of temporomandibular disorders (TMD) related to each severity category of Fonseca's anamnestic index in a sample of Brazilian young adults (mean age 21.61+/-1.91 years, 87% females and 13% males), by the application of an anamnestic index proposed by Fonseca (1992) and by clinical examination considering mandibular range of motion and tenderness to palpation of stomatognathic system structures. A significant number of participants were classified with mild TMD (43.2%) and moderate TMD (34.8%). Pain frequency during mastication, temporomandibular joint (TMJ) pain, and TMJ sounds were shown to be good predictors of TMD severity. Neck pain, headache, difficulty during mouth opening and lateral deviation, and tenderness to palpation of masticatory sites and during protrusion accompanied the TMD severity but failed to demonstrate differences between moderate and severe groups, showing a poor ability to determine TMD severity progression. This study suggests that not only the frequency of signs and symptoms of TMD should be determined, but also symptom severity and its relationship to the presence of clinical signs in order to discriminate patients with real treatment needs in nonpatient samples.

Adolescent↗
PubMed2002

Measurement of spleen volume by ultrasound scanning in patients with thrombocytosis: a prospective study.

Spleen size was assessed in 73 patients with thrombocytosis and in 15 healthy subjects, comparing palpation with ultrasonography (US) measurement of longitudinal diameter and volume. Intraobserver and interobserver variability for volume on US, checked in 12 patients, was very low. Correlation between spleen volume measured by US and that measured by computed tomography was excellent. Splenomegaly was detected by palpation in 25% of patients, by US assessment of longitudinal diameter in 33%, and by US assessment of volume in 52%. After diagnostic work-up, 54 patients had a diagnosis of essential thrombocythemia (ET), 4 of idiopathic myelofibrosis (IMF), and 15 of secondary thrombocytosis (ST). Spleen volume in patients with ST was in the normal range (138 +/- 47 mL) and was significantly lower than that in patients with ET or IMF (370 +/- 210 mL; P <.001). Thus, US-measured volume was the most sensitive method for identifying nonpalpable splenomegaly in patients with primary myeloproliferative diseases, and it may help in distinguishing these diseases from reactive disorders.

Adolescent↗
PubMed2005

Frequent detection of worm movements in onchocercal nodules by ultrasonography.

BACKGROUND: Ultrasonography (USG) is known to be a suitable tool for diagnosis in lymphatic filariasis as the adult filarial nematode Wuchereria bancrofti in scrotal lymphatic vessels of infected men can be detected by the characteristic pattern of movement, the Filaria Dance Sign. In onchocerciasis, moving adult worms have not yet been demonstrated by USG. In addition the verification of drug effects on living adult Onchocerca volvulus filariae in trials is hampered by the lack of tools for longitudinal observation of alterations induced by potentially macrofilaricidal drugs in vivo. The present study was carried out to determine the frequency of detection of moving adult filariae of O. volvulus by USG. METHODS: In an endemic region for onchocerciasis in Ghana, 61 patients infected with onchocerciasis were recruited by palpation and onchocercomas examined by USG using an ultrasound system equipped with a 7.5 - 10 MHz linear transducer. Onchocercomas were recorded on videotape and evaluated with regard to location, number and size, as well as to movements of adult filariae. RESULTS: In the 61 patients 303 onchocercomas were found by palpation and 401 onchocercomas were detected by USG. In 18 out of 61 patients (29.5%), altogether 22 nodules with moving adult O. volvulus filariae were detected and are presented in animated ultrasound images as mp-4 videos. CONCLUSION: Ultrasonographical examinations of onchocercomas where living adult filariae can be displayed may serve as a new tool for the longitudinal observation in vivo of patients with onchocerciasis undergoing treatment and as an adjunct to histological evaluation.

Journal Article↗
PubMed2005

Single subject pharmacological-MRI (phMRI) study: modulation of brain activity of psoriatic arthritis pain by cyclooxygenase-2 inhibitor.

We use fMRI to examine brain activity for pain elicited by palpating joints in a single patient suffering from psoriatic arthritis. Changes in these responses are documented when the patient ingested a single dose of a selective cyclooxygenase-2 inhibitor (COX-2i). We show that mechanical stimulation of the painful joints exhibited a cortical activity pattern similar to that reported for acute pain, with activity primarily localized to the thalamus, insular, primary and secondary somatosensory cortices and the mid anterior cingulum. COX-2i resulted in significant decreased in reported pain intensity and in brain activity after 1 hour of administration. The anterior insula and SII correlated with pain intensity, however no central activation site for the drug was detected. We demonstrate the similarity of the activation pattern for palpating painful joints to brain activity in normal subjects in response to thermal painful stimuli, by performing a spatial conjunction analysis between these maps, where overlap is observed in the insula, thalamus, secondary somatosensory cortex, and anterior cingulate. The results demonstrate that one can study effects of pharmacological manipulations in a single subject where the brain activity for a clinical condition is delineated and its modulation by COX-2i demonstrated. This approach may have diagnostic and prognostic utility.

Adult↗