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PubMed2002

Clinical observations of pharmaceutical, physical, and visual evidence of presumed extraocular myositis and tendonitis.

PURPOSE: This study examines data from pharmaceutical, physical, and visual tests that support the possible diagnosis of presumed extraocular myositis and tendonitis (PEM-T). METHOD: The presence of ocular pain derived from inflamed extraocular musculature and tendons in 60 subjects with PEM-T was detected by palpating their globes near the eye muscle insertions. The pain sensations were subjectively rated and recorded. Because the sensation of pain elicited by such palpation was most-often unilateral, the study compares the affected sidewith pain to the side tha exhibited vision disturbance during the Turville Infinity Binocular Balance (TIB) test. Lastly, an anti-inflammatory ophthalmic pharmaceutical was used to see if the pain could be resolved. Saline was used as a control. The subjects evaluated their pain after 1 and 10 minutes of the saline drop. The remaining subjects who still had pain after the saline drops were given one of two topical steroids: a hydrophilic or a lipaphilic derivative of prednisolone. Again, the subjects rated and recorded their pain after 1, 10, and 60 minutes. RESULTS: Of 60 subjects who had headaches and associated painful areas on their globes, 5B observed the monocular blur effect (MBE) on the same side as these palpable sore spots. Of the 60 subjects with such sore areas, 10 individuals were relieved with a saline drop. Of the remaining 50 subjects, 25 received a drop of lipophilic, prednisolone acetate and 25 received a drop of hydrophilic, prednisolone sodium phosphate. Of the 50 subjects from these two groups, 39 had a significant reduction of their palpable pain sensations; the data indicate there was little difference in response between the two formulations of prednisolone. CONCLUSION: The corroboration of results from pharmaceutical, physical, and visual tests supports the diagnosis of PEM-T.

Adult↗
PubMed2002

[The Dutch College of General Practitioners' practice guidelines, "Examination of the neonate": response from the perspective of pediatrics].

The practice guideline on routine neonatal examination of the Dutch College of General Practitioners describes the examination of the newborn directly after birth, whether at home or in the hospital. It is proposed that examination be limited to inspection, without auscultation and palpation. If conducted strictly according to the guidelines given, this may be sufficient. However, auscultation of the heart is the most reliable way to determine the heart rate. Including auscultation and palpation in the routine examination after birth would contribute to the experience of general practitioners with these techniques in babies. This is of importance, since general practitioners are the first to be consulted in case of any health problems in this patient category. Previously, it was recommended that the general practitioner visit mother and child on the third, fourth or fifth day after delivery and examine the baby. In the new standard, this second examination is considered to be redundant, based on data in the literature. However, it remains the duty of the general practitioner to inform the parents about (non-specific) early signs of disease in newborns. Furthermore, the threshold for consultation of the general practitioner should be low for the early diagnosis and management of serious conditions, such as septicaemia or congenital heart disease.

Family Practice↗
PubMed2002

[Insulinoma of the pancreas--difficulties with imaging].

We present a case of 29-year old man in whom despite the lack of finding tumor in USG and CT surgical intervention was performed and insulinoma of the pancreas was excised. Insulinoma was diagnosed on the basis of clinical picture (Whipple's triade) that was reassured by positive fast test. The fast was terminated at 11 and half hours because of neuroglycopenic symptoms with serum glucose and insulin levels 2.0 mmol/l (36 mg/dl) and 11.07 microU/ml respectively, which established the diagnosis. Laparotomy was performed, during which the tumor was palpated and seen in ultrasonography in the head of pancreas. The tumor of 12 mm diameter was excised. Histopathological examination revealed benign insulinoma. After surgery the symptoms alleviated completely. The patient with proper glucose levels was discharged in good health. The case supports high usefulness of intraoperative ultrasonography and surgeon's palpation.

Adult↗
PubMed1976

Microscopic features and transient contraction of palpable bands in canine muscle.

Ten pairs of biopsies were excised from gracilis and semitendinosus muscles of 4 mongrel dogs. These were compared with the histological findings reported in painful spots and muscle hardenings of human muscles. Test biopsies sampled a palpable band. Paired control biopsies sampled a portion of the same muscle where it showed no palpable hardening. Processed sections were randomized and read blind. Sections stained with aqueous toluidine blue showed no convincing metachromasia. Sections stained with trichrome showed no proliferation of endomysial connective tissue. Test sections stained with hematoxylin and eosin showed no proliferation of nuclei and no increase in the number of central nuclei in muscle fibers compared to control sections. No convincing histological difference was found. During surgery under Nembutal anesthesia, rubbing palpation of the exposed muscle elicited a transient contraction of a bundle of muscle fibers several milli-meters in diameter. This corresponded in time and position to the palpable band in the dog muscle. The band-like hardness palpated in these canine muscles appears to be caused by a circumscribed transient muscular contraction rather than histologically demonstrable structural changes.

Animals↗
PubMed2003

Direction and side used to determine the extent of sensory block after subarachnoid anesthesia do not influence the level of the block.

Methods of sensory testing in neuraxial anesthesia may supposedly account for different results in reporting the extent of the block. To determine whether the caudad to cephalad versus the cephalad to caudad direction as well as the side of testing, left versus right, may affect the assessment of sensory block after subarachnoid anesthesia, two groups of patients undergoing transurethral surgery were studied. One group, 44 patients were tested for the influence of direction of block determination and another group 50 patients for the influence of side. Subarachnoid anesthesia was performed with 100 mg of 5% hyperbaric lidocaine using a 25 Whitacre needle with its opening consistently pointing cranially and the patient in the sitting position. To assess the sensory block four lines were drawn bilaterally along the posterior, middle, and anterior axillary lines and a line 5 cm medial to the anterior axillary line. A pressure palpator was moved along each of the four lines and patients were asked to answer if they detected a stimulus, with "yes/no". In the 44 patients assessment of sensory block was performed from caudad to cephalad direction on one side and viceversa on the other. In the other 50 patients the extent of the block was compared between the right and left side. In 44 patients, the level of sensory block determined 20, 25 and 30 minutes after the subarachnoid anesthesia in a cephalad to caudad direction was found at the T11 dermatome at each time point and did not differ when compared to the levels determined following the caudad to cephalad direction. In the second study in a different group of 50 patients, the level of sensory block 20, 25 and 30 minutes after the subarachnoid injection was found at the T11 dermatome on the right side at each time point and did not differ from the level determined on the left side. We conclude that the level of sensory block after subarachnoid anesthesia with lidocaine is independent of the direction of testing and the side the assessment is performed using the pressure palpator.

Aged↗
PubMed2003

[Surgical treatment of acute embolism of the upper extremity].

OBJECTIVE: To study the methods of surgical treatment and the prognosis of acute embolism of the upper extremity. METHODS: Balloon catheter embolectomy through the brachial artery was performed in 18 patients with acute embolism of the upper extremity. RESULTS: Both the pulse of the radial and ulnar artery could be palpated in 8 patients, either the pulse of the radial or ulner artery could be palpated in 9 patients. The temperature of the upper extremity was increased in the patient whose embolectomy was performed in the 6th day after onset of the illness. Three patients died postoperatively. CONCLUSIONS: Embolectomy through the brachial artery is an effective method to treat acute embolism of the upper extremity. Elderly and heart and pulmonary diseases are the high risk factors for postoperative death.

Acute Disease↗
PubMed2003

Iodine deficiency disorders in the Saratov province in Russia.

OBJECTIVE: The work deals with epidemiology of iodine deficiency (ID) in the Saratov province in Russia, with clinical data and thyroid autoimmunity disorders in schoolchildren living in a moderate ID area. STUDY DESIGN: The Saratov province is situated in the Volga Region. The epidemiological study was made according to WHO/UNICEF/ICCIDD recommendations (1994). METHODS: 2040 children aged 6-12 in 21 schools from 14 districts of the province were examined (palpation and ultrasound). Ioduria was measured in 654 children. The results of screening for congenital hypothyroidism in 95657 neonates were analysed. The clinical study included hormonal (tT3, tT4, TSH) and immunological (Abs TPO, Abs Tg) assays in 246 children. RESULTS: In the Saratov province of Russia moderate ID has been proved (ioduria median 38.2 microg/l, endemic goiter incidence in children 35.8% by palpation and 25.8% by ultrasound, hyperTSHemia incidence in neonates' blood 37.4%). Ioduria median correlates with the data of other ID epidemiological criteria in different ways, it being most high with hyperTSHemia. Thyroid nodules were detected in 2.0% goitrous children. Hypothyroidism was found in 31.1% of the goitrous children. Thyroid antibodies were determined in 10.8% of the children. The incidence of antibodies increases with age and goiter size. High prevalence of associated chronic pathology in goitrous children was observed. CONCLUSION: According to WHO/UNICEF/ICCIDD criteria, moderate ID in Saratov province has been found. Iodine deficiency disorders in children area cluster of pathological states, endemic goiter being one of the clinical symptoms. High prevalence of goiter, hypothyroidism, associated chronic pathology in children have been detected.

Autoantibodies↗
PubMed2003

[Dynamic changes in synovitis activity after intra-articular administration of xefocam in patients with rheumatoid arthritis (according to clinical and device examinations)].

AIM: To assess efficacy of intraarticular administration of lornoxicam (xefocam) in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: Xefocam was injected into the knee joints of 58 patients with RA once a week for 3 weeks in a dose 8 mg. The treatment efficacy was evaluated by changes in the severity of arthralgias, pain in the joints at palpation, circumference of the knee joints at the level of the upper edge of the patella, ultrasound and thermography of the knee joints. RESULTS: Xefocam relieved arthralgia (in 44 patients at least by 30%), pain in the joints at palpation and joint circumference. Ultrasound investigation registered a significant thinning of the synovial membrane and amount of exudates. CONCLUSION: If local steroid therapy is not definitely indicated, intraarticular administration of xefocam can be effectively used for suppression of moderate inflammation in the joints in RA patients.

Adult↗
PubMed2003

Spleen enlargement following recombinant human granulocyte colony-stimulating factor administration for peripheral blood stem cell mobilization.

BACKGROUND AND OBJECTIVES: Recombinant human granulocyte colony-stimulating factor (rhG-CSF) is widely used to mobilize peripheral blood stem cells (PBSC) for autologous or allogeneic transplants. Such treatment may cause spleen enlargement; exceptionally, spontaneous spleen rupture has been reported. We investigated changes in spleen size during stem cell mobilization. DESIGN AND METHODS: We evaluated spleen size, comparing palpation with ultrasound (US)-evaluated longitudinal diameter and volume, in 13 healthy donors and 22 patients with a hematological malignancy who were undergoing PBSC mobilization with rhG-CSF-including regimens. RESULTS: Intraobserver and interobserver variability of US-calculated spleen volume was very low; the correlation between the volume calculated by US and that measured by 3-dimensional computed tomography was excellent. During mobilization, spleen enlargement was detected by palpation in 17% of subjects, by US-measured longitudinal diameter in 60%, and by US-calculated volume in 91%. The median increase in spleen volume was 300 mL (range, 54-820; p<0.001) in healthy donors and 135 mL (range, 0-413; p=0.004) in the group of patients; the enlargement correlated with white blood cell count elevation (p=0.016) but not with circulating CD34+ cells. One month after the last administration of rhG-CSF, the median decrease was 160 mL (range, 35-800) in healthy donors and 58 mL (range, 0-310) in patients. INTERPRETATION AND CONCLUSIONS: When evaluated by sensitive methods, rhG-CSF caused spleen enlargement in almost all individuals treated. US-calculated volume proved to be an excellent method, much better than longitudinal diameter, for detecting non-palpable splenomegaly induced by rhG-CSF.

Adolescent↗
PubMed1999

Intraoperative ultrasound for hepatic neoplasm during surgery.

OBJECTIVE: The purpose of this study was to determine the impact of intraoperative ultrasound (IOUS) on the management of patients with neoplasms of the liver. METHODS: Forty-nine patients operated on for liver or other pathologic processes were examined intraoperatively with 5.0 MHz special ultrasound transducers during surgical exploration of the abdomen. Subjects were evaluated because of known or suspected disease of the liver. Preoperative imaging studies included percutaneous ultrasound (n = 49), magnetic resonance imaging (n = 11), and computed tomography (n = 34). Intraoperative evaluation on all patients included inspection, bimanual palpation, and ultrasonography. Comparison between preoperative imagings and IOUS were analysed. RESULTS: Sensitivity for detection of hepatic neoplasms showed in intraoperative ultrasound, percutaneous ultrasound, magnetic resonance imaging and computed tomography as 100% (23/23), 74% (17/23), 74% (14/19) and 75% (6/8). Specificity showed 100% (26/26), 100% (26/26), 93% (14/15) and 67 (2/3). In seven patients (14%), the neoplasms were not found by inspection, bimanual palpation, and identified only by IOUS. CONCLUSIONS: Intraoperative ultrasound is the most sensitive and specific method for detection and surgery of liver neoplasms, especially the occult neoplasms and small size lesion (< 2 cm).

Carcinoma, Hepatocellular↗
PubMed1992

Evaluation of masticatory function before and after treatment in patients with craniomandibular disorders.

The masticatory function was evaluated in 12 patients with signs and symptoms of craniomandibular disorders of mainly muscular origin. Palpation of the masticatory muscles and measurements of occlusal force endurance, on a submaximal level with visual feedback, and of masticatory efficiency were performed before and after treatment. Significant changes occurred between the two measurements. Of a total of 10 masticatory muscles, 8 were sensitive to palpation before treatment and 2 after treatment. Occlusal force endurance increased from 92.5 seconds before treatment to 132 seconds after treatment, and masticatory efficiency increased from 54% to 65%, respectively. It is concluded that the masticatory muscle function of these patients is compromised and that treatment had a positive effect on the masticatory function.

Adult↗
PubMedDate not supplied

Intraoperative ultrasound of hepatic tumors.

Intraoperative ultrasound (IOUS) scanning of liver masses was compared with those of preoperative computed tomography (CT) and intraoperative palpation. Between March 1989 and May 1991, 24 patients underwent 25 IOUS procedures during laparotomy. Intraoperative ultrasound provided more information than the other modalities in 10 patients (40%) and affected operative management in eight patients (32%). It was concluded that IOUS, when used in conjunction with CT and palpation, is an important technique in the surgical management of patients with hepatic neoplasms.

Adult↗
PubMed1992

Cholelith causing duodenal obstruction in a horse.

A 10-year-old Appaloosa stallion was referred for evaluation of colic. At admission, the heart rate, capillary refill time, respiratory rate, and rectal temperature were high. Fifteen liters of reflux was obtained by nasogastric intubation. Palpation of an abdominal mass per rectum elicited signs of pain. At exploratory laparotomy, a mass was palpated in the ascending portion of the duodenum. The small intestine ruptured at the site of obstruction during manipulation. The horse was euthanatized. A large cholelith was the cause of the duodenal obstruction. At necropsy, multiple choleliths of various sizes were found in the pancreatic and common bile ducts and in the stomach.

Animals↗
PubMed1999

Subtotal colectomy and ileocolonic anastomosis in a Vietnamese pot-bellied pig with idiopathic megacolon.

A 7-month-old sexually intact female Vietnamese pot-bellied pig was evaluated because of constipation. On abdominal palpation, a hard tubular structure was palpated in the middle of the abdomen. Abdominal radiography revealed loops of intestine that were markedly distended with ingesta, consistent with obstructive intestinal disease. On exploratory celiotomy, a massively distended cecum and spiral colon were found. A subtotal colectomy, with a side-to-side ileocolonic anastomosis, was performed. The cause of the megacolon was not discovered. The pig did well following surgery and eventually defecated normally following an initial period of diarrhea. To our knowledge, this is the first report of therapeutic removal of a substantial portion of the large intestine in swine. Our decisions concerning the pig of this report were based largely on our knowledge of megacolon in cats. The outcome for this pig indicates that subtotal colectomy along with removal of the cecum and ileocecal valve can be used to successfully treat idiopathic megacolon in Vietnamese pot-bellied pigs.

Anastomosis, Surgical↗
PubMed1992

[Iodine status and incidence of thyropathies in the Czech population].

Based on clinical experience on the rising incidence of some thyropathies in our population, the authors examined a random sample of the Prague population. They assessed and evaluated iodinuria, the sonographic finding of the thyroid gland, the palpation finding of the thyroid and a clinical examination which comprised a detailed case-history (a questionnaire checked during the examination) and a clinical and anthropometric examination. The results indicate that iodinuria (which reflects the iodine intake) reaches the recommended optimum (above 150 micrograms iodine/l) only in 11.4% of boys, 14% men, 6.3% girls and 5.4% women. A quite inadequate intake (less than 50 g iodine/l) was recorded in 13.2% boys, 15.2% men, 17% girls and 33.1% women. When evaluating the thyroid volume, an enlarged volume is found in 20.4-58.3% and on evaluation by palpation pathological changes are found in a considerable proportion of the examined population. The findings suggest that the iodine supply of the Prague population is inadequate and the incidence of abnormal findings on the thyroid gland is high. It will be necessary to verify these findings in other random population samples from other localities. If the adverse position will be confirmed, this will call for an urgent solution, i.e. a better iodine supply of the population.

Adolescent↗
PubMedDate not supplied

[The periampullary carcinoma. Clinical and therapeutic alternatives].

BACKGROUND AND STUDY AIMS: An analysis of the diagnosis difficulties in periampullary carcinoma (PAC) is done, the consequences being the possible therapeutically insufficiencies. PATIENTS AND METHODS: During 10 years (1990-1998) 54 patients have been operated on for a PAC. Sex ratio: 34 males (63%)/20 females (37%). The pick of frequency was in the decade 61-70 years (20 patients) with extremes ages between 20 and 80 years. The main symptom was the cholestatic progressive jaundice with or without neoplasic pain (39 patients--72%). The intermittent jaundice was present only to 7 patients (13%) and the clinical forms without jaundice were manifested to other 8 (15%); superaded colangitic syndrome was present to 17 patients (31%). Other concomitances manifestations of the neoplasic disease were record to 23 cases (43%). Historical evolution of the illness until the cholestatic jaundice appearance was under 2 month to 23 cases, between 2 and 4 months to 24 patients and not sure determined to other 8. The biological preoperative investigations confirmed the clinically evident biliary retention syndrome in 85% of the cases and not yet clinically visible to other 15% of the cases. The ultrasonography was the most conclusive method from the imaging examinations because it have suggested the diagnostic of PAC to 43.5% from the patients submitted to this exploration. Computed tomography was diagnosis relevant only for the in site-regional invasion of the tumors or for the nodes or systemic metastases. Endoscopy and the endobiopsy proved to be valuable especially associated with ERCP (our experience regarding ERCP is not conclusive yet). Therefore the real preoperative diagnostic was established to 11 patients (20%), and for the rest of the cases there have been another presumptive preoperative diagnosis: cancer of the pancreatic head (11 patients), retentive jaundice without determined origin (24 patients), others (8 patients). Intraoperative exploration detected the periampullary tumor through palpation in 30 (55%) cases, through palpation and exploratory duodenectomy in 8 (15%) cases and/or by accessory signs (hydropic gallbladder, dilatation of the main biliary duct etc.). Organic metastases or duodenal stenosis was present in nine cases (6 with nodes metastases). The practiced surgery was: Whipple operations (in one--the majority--or two steps)--35 cases (65%); palliative surgery for biliary drainage 16 (30%) cases; others 3 (6%) cases. The postoperative staging of pT parameter (in situ or ex situ dimensional determined) reveled: pT1-12 patients; pT2--9 patients; pT3--14 patients; pT4--19 patients. Histopathological examinations confirmed the diagnostic of periampullary adenocarcinoma (32 patients) or carcinoma (3 patients) for the 35 patients with resectional operations. The determination of the tissular origin of the periampullary tumor was initially possible only in 11 (31%) operative specimens. A secondary study with many repeated sections in the wax included blocks specified the histogenesis of the tumors to other 10 patients, therefore for a total of 21 cases. We think that this histogenetically diagnosis aspect is important only for some predictive appreciations regarding the outcome of the operated patients and not for the elected therapeutically surgical method. RESULTS: The globally perioperative mortality was 8 (15%) patients. Three from this deceased were a consequence of palliative surgery applied to patients with advanced stages of neoplasic disease. The medium outcome for patients submitted to Whipple operation--in course of evaluation--is between 32 and 41 months to the patients which we can followed. For the patients with palliative operations the same distant survival is between 12 and 24 months.

Adenocarcinoma↗
PubMed1992

[Echography in the study of lipomas of superficial soft tissues].

High-resolution sonography (US) was used to evaluate 47 superficial soft tissue lipomas. Forty-one lesions were found in subcutaneous tissues and 6 in superficial muscles. The lipomas were classified by location, shape, echotexture, homogeneity and US beam attenuation values. Moreover, 21 lipomas underwent histology and histologic patterns were correlated with echogenicity. Most lesions were elongated and their greatest diameter was parallel to the skin. Eighty-four percent exhibited well-defined margins. Twenty-six percent of the lipomas were hypoechoic, 24% were isoechoic, 34% hyperechoic and 16% exhibited a mixed pattern. In 27% of cases, a hypoechoic capsule was present. Superficial soft tissue lipomas exhibit unsteady echotexture: most of them are hyperechoic. The correlation between echotexture and histology showed that no typical and steady patterns can be identified, since lipomas vary from a histologic point of view. The clinical diagnosis of superficial lipomas is based on clinical history and the palpation of a well-defined, mobile and soft superficial mass. When palpation is not diagnostic, US can be used to rule out a cyst. An elongated isoechoic or hyperechoic mass in the subcutaneous tissue should suggest a lipoma, whereas a hypoechoic mass is associated with a broader range of differential diagnoses, including malignant tumors. However, malignant masses are not likely to have an elongated or flattened shape. Even though tissue characterization is less specific with US than with CT and MRI, the former method is quick, easy and less expensive and, thanks to high-frequency transducers, is also well-suited to diagnose soft tissue lipomas.

Adolescent↗
PubMedDate not supplied

[Pain in venous thrombosis of the leg].

According to D. Reinharez, pain and edema are the commonest presenting symptoms in phlebology. Pain is one of the most classical symptoms of an ordinary deep venous thrombosis, a valuable feature when present, in the form of deep tension, heaviness, swelling and a feeling of dead weight. It is often absent or slight. It may consist merely of a dull cramp, or of an "undefinable" (C. Bourde) odd, heavy leg. It generally affects the calf but may involve the sole of the foot, the heel, the thigh, the groin or even the true pelvis. This feeling, although "imprecise and variable" (P. Wallois, P. Griton) is highly suggestive. It increases on standing and walking in the form of unilateral uncomfortable tension, heaviness or painful swelling, which maybe a source of worry or even anxiety to the patient. Tenderness on palpation of venous tracts and their stretching is more suggestive. In the opinion of M. Duruble, Neuhof's sign (feeling of tender fullness of the calf) is more reliable than Homans' sign (pain in the calf caused by passive dorsiflexion of the foot, with the lower limb in extension) which essentially stretches only the posterior tibial venous system. The value of Sigg's sign (pain in the popliteal fossa on passive extension of the knee) is controversial. Far more rare is phlegmasia coerulea dolens or Grégoire's blue leg, complicating phlegmasia alba dolens or of sudden onset, with initial very severe or even "intolerable" pain (J.J. Pinot) in Scarpa's triangle, rapidly spreading to the limb. In varicose phlebitis (M. Perrin) or superficial thrombophlebitis or varico-phlebitis (A.A. Ramelet) or superficial venitis (J.P. Henriet), pain most often consists of moderate burning tension overlying the thrombosed vein(s), increased by palpation and mobilisation. Sometimes severe initially, it is exacerbated by the slightest touch. In total, pain, regardless of its characteristics, its site and/or its severity, is one of the most constant clinical features of venous thrombosis. It is a warning sign for the clinician and should lead to emergency request for non-invasive investigations (Doppler-Echo) which will enable confirmation or elimination of the diagnosis.

Humans↗