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PubMedDate not supplied

Influence of gender on allograft rejection in a rat heart transplant model.

BACKGROUND: Clinical studies have reported increased rejection in female heart transplant recipients. Conflicting data exist as to whether rejection is increased with male donors or female donors in these female recipients. METHODS: We investigated in this study allograft rejection in four sets of gender combinations with and without immunosuppression with the use of a heterotopic rat heart transplant model: male donor heart to female recipient, female donor heart to female recipient, male donor to male recipient, and female donor to male recipient. To examine the possible effect of androgens as an immunosuppressant, we orchiectomized a group of male recipient rats before transplantation. The rats that were not immunosuppressed were evaluated for length of graft survival (palpation). In the immunosuppressed rats (cyclosporine, 10 mg/kg x 7 days) in each gender combination half of the grafts were evaluated for length of survival (palpation) and half for cellular rejection grade at day 14 (microscopy). RESULTS: When rats that underwent transplantation were not immunosuppressed, no difference in graft survival time was found among the four sets of gender combinations. With immunosuppression, median graft survival time was 23 days in female recipients versus 32 days in male recipients (p < 0.05). Mean cellular rejection grade at day 14 was 2.95 +/- 0.7 in female recipients and 0.8 +/- 0.4 in male recipients (p < 0.01). No significant difference was found in graft survival time or cellular rejection grade with respect to donor gender. The graft survival times and cellular rejection grades of the male rats undergoing orchiectomy were not different from those of normal male recipients (p = NS). Cyclosporine levels on day 7 in both male and female recipients were high, female levels (1039 +/- 411 ng/ml) were less than male levels (2029 +/- 379 ng/ml) (p < 0.01). CONCLUSIONS: Female recipients of heterotopic rat heart transplants had shorter graft survival time and increased cellular rejection as compared with male recipients. Donor gender had no influence on graft survival or cellular rejection grade. Orchiectomy had no influence on graft survival time or grade of rejection. Results of this model suggest that female recipients may require increased immunosuppression and rejection surveillance, regardless of donor gender.

Animals↗
PubMed1995

Experimental spinal fusion with recombinant human bone morphogenetic protein-2.

STUDY DESIGN: Lumbar intertransverse process arthrodesis using recombinant human bone morphogenetic protein-2 was performed in a previously established rabbit model for posterolateral spinal fusion and compared with fusions achieved using autogenous bone graft. OBJECTIVES: To qualitatively compare different recombinant human bone morphogenetic protein-2 dosages and carriers and to determine the efficacy of recombinant human bone morphogenetic protein-2 as a bone graft substitute to produce lumbar intertransverse process fusion in a validated rabbit model for posterolateral spinal fusion. SUMMARY OF BACKGROUND DATA: Autogenous bone was considered the most successful bone graft material used for spinal arthrodesis. Problems with its use may occur in 25-30% of patients and prompted the search for and investigation of bone graft substitutes and osteoinductive growth factors, such as bone morphogenetic proteins. Recombinant human bone morphogenetic protein-2 was used successfully in orthotopic sites to generate bone in animal mandibular and long bone defect models. METHODS: Posterolateral intertransverse process arthrodeses were performed at L5-L6 in 56 rabbits using recombinant human bone morphogenetic protein-2 or autogenous bone graft. Rabbits were killed either 5 weeks later to qualitatively compare fusions achieved using different recombinant human bone morphogenetic protein-2 dosages and carriers or 4 weeks later to compare the efficacy of recombinant human bone morphogenetic protein-2 in achieving spinal fusion compared with using autogenous bone graft. Inspection, manual palpation, radiography, histology, and biomechanic testing were used to assess the fusion. RESULTS: All rabbits implanted with recombinant human bone morphogenetic protein-2 achieved solid spinal fusion by manual palpation and were fused radiographically, whereas only 42% of the autograft control fusions were solid. More mature fusions with greater trabecular bone formation were shown radiographically and histologically in rabbits implanted with the high-dose recombinant human bone morphogenetic protein-2 than with the low-dose recombinant human bone morphogenetic protein-2. Fusions achieved using recombinant human bone morphogenetic protein-2 delivered in the collagen carrier were more remodeled and homogeneous compared with using recombinant human bone morphogenetic protein-2 delivered in autograft +/- collagen carrier. Fusions achieved with recombinant human bone morphogenetic protein-2 were biomechanically stronger and stiffer than fusions achieved using autogenous bone graft. CONCLUSIONS: Recombinant human bone morphogenetic protein-2 successfully and reliably achieved lumbar intertransverse process fusion in a validated rabbit model for posterolateral spinal fusion. Radiographically and histologically, greater and more rapid bone formation, consolidation, and remodeling were shown with recombinant human bone morphogenetic protein-2 compared with autogenous bone graft. Fusions achieved with recombinant human bone morphogenetic protein-2 were biomechanically stronger and stiffer than autograft fusions.

Animals↗
PubMed1994

[Urologic applications of intralaparoscopic echography].

The impossibility to palpate organs and tissues is probably the most important drawback of the laparoscopic approach: laparoscopic sonography represent the only real alternative to manual palpation. The laparoscopic approach in the field of urology was initially limited to the identification of the undescended testes in paediatric urology and to the laparoscopic ligation of varicocele. More recently, it took into account the pelvic lymphadenectomy for staging prostatic and bladder cancer. The upper urinary tract and the retroperitoneum were approached more recently. In a preliminary phase the indications for laparoscopic nephrectomy were limited to benign diseases, such as atrophic kidney in patients with renal hypertension, and scarred pyelonephritic kidney. At present some preliminary experiences are reported about nephrectomy performed for carcinoma of the urether or of the upper collecting system and for renal masses of unknown origin. Another indication for a laparoscopic approach to the kidney is represented by symptomatic renal cysts. These cysts have been usually treated with percutaneous aspiration and/or sclerosis, but a high rate of recurrence is reported. Laparoscopy may be used to approach renal cysts with the advantage that most of the cystic wall could be excised, reducing the change of recurrence. Another possible indication for laparoscopy and laparoscopic sonography is the retroperitoneal lymphadenectomy in testes cancer with staging or therapeutic purposes. Nowadays preliminary experiences in laparoscopic adrenalectomy have been reported in a limited series of cases. In this report the Authors present their initial experience using a 7.5 MHz rigid probe having 400 crystal which can be inserted into a 10 mm trocar.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Primary thyroid lymphoma: evaluation with US, CT, and MRI.

OBJECTIVE: Our goal was to determine the most effective radiologic workup in diagnosing and staging primary thyroid lymphomas and the value of knowing the extent of tumors for prognostic purposes. MATERIALS AND METHODS: Magnetic resonance imaging, CT, US, and fine-needle aspiration (FNA) biopsy (palpation- or US-guided) findings were retrospectively reviewed in 14 patients with primary thyroid lymphomas (5 palpable, 9 nonpalpable). Survival was correlated with the presence or absence of extrathyroidal spread of lymphoma. RESULTS: Thyroid lymphomas were detected in all patients with US and 12 (86%) each with CT and MRI. Histopathologic diagnosis was obtained with FNA in 11 patients (79%) and with surgical procedures in 3. Magnetic resonance imaging correctly diagnosed tumor involvement of the lymph nodes (four of four patients), muscle (five of five), esophagus (one of one), internal jugular vein (one of one), and carotid artery (one of one). Muscle invasion was missed with CT in one patient. Ultrasound was not accurate for diagnosing tumor invasion of the esophagus, carotid artery, and lymph nodes. The survival of patients without extrathyroidal spread was significantly (p < 0.05) better than that of patients (n = 5) with extrathyroidal spread. CONCLUSION: Palpable thyroid masses should undergo palpation-guided FNA for diagnosis and nonpalpable masses US-guided FNA. Tumor extent and staging should be determined with MRI, which will contribute to initiating appropriate therapy and prediction of prognosis.

Adult↗
PubMed1994

Prostate cancer. From the general practitioner's point of view.

The study was supported by the County of Halland and the Department of Public Health of the County. The information about prostate cancer in the community of Kungsbacka was obtained from the Regional Cancer Registry of the Oncological Center, Lund, Sweden. In the community of Kungsbacka, Sweden, with about 48,000 inhabitants, a study was made comprising all subjects with prostate cancer during a five-year period. The incidence was 36 per 100,000 inhabitants per year. Most patients first visited a general practitioner. The most common symptoms which brought the patient to the doctor were urinary urgency, nycturia, starting problems, poor stream of the urinary flow, terminal dribbling and urinary retention. The prostatic gland had as judged from digital palpation a pathological shape or consistency or both in 95% of the cases. Means of patient's delay and doctor's delay were very long, 17.5 and 14.6 months, respectively. The mortality during the study period was 100% in patients in whom the cancer had spread extracapsularly. General practitioners have an important role in the diagnostic process. It is important to increase public knowledge about the symptoms of prostate cancer in order to obtain a shorter patient's delay, and to palpate the prostate whenever symptoms appear from the prostate region, in order to diagnose the prostate cancer at an earlier stage.

Aged↗
PubMedDate not supplied

[Echography of the thyroid gland in the diagnosis of endemic goiter].

Screening of 1520 children living in the Khvalynsk district of the Saratov region, including assessment of urinary excretion of iodine and ultrasonic examinations of the thyroid in children and adults, revealed endemic goiter in the region. Special attention was paid to echographic examination of the thyroid; this method was used in examinations of 161 children aged 2 to 14 with thyroid enlargement of the I-III degree. 103 (64.0%) of there children had enlarged thyroid, in some children with diffusely enlarged thyroid of the I-II degree ultrasonic examination showed no enlargement, and in some children the gland was found even reduced in size. The greatest discrepancy between the data of palpation and ultrasonography was observed in first-degree thyroid enlargement, the least so in second-degree enlargement; in third-degree enlargement there was no such a discrepancy. Assessment of thyroid structure revealed various disorders of the organ in 29 of the 161 examined children, these disorders present both in enlarged glands and in those of normal or reduced size. Nodes that could not be palpated were detected in 2 children. Ultrasonic examinations of 56 adults aged 20 to 60 revealed changed structure of the thyroid in 35, with nodes of various sizes and localization detected in 15 of these.

Adolescent↗
PubMed1994

A prospective evaluation of the signs and symptoms of preterm labor.

OBJECTIVE: To describe the time relation between symptoms, contractions, and the clinical diagnosis of preterm labor. METHODS: We analyzed the records from 57 women who were enrolled in a previously reported trial of home uterine monitoring and who developed preterm labor while using the monitor. In a post hoc descriptive study of signs and symptoms during the 7 days preceding a diagnosis of preterm labor, we reviewed uterine contraction records and study records of the responses to a standard list of questions about potential symptoms of preterm labor. RESULTS: Monitored contraction frequency increased on the day of preterm labor diagnosis, from an average of fewer than three per hour to five per hour, but was not increased on any of the days before the day of diagnosis. Neither symptoms nor contraction monitoring strips indicated any significant changes more than 24 hours before the clinical diagnosis was made. Self-palpated and monitored contractions were the most common symptoms of preterm labor. CONCLUSION: A clinical diagnosis of preterm labor is preceded by an increase in self-palpated and monitored contractions and other symptoms for less than 24 hours.

Adult↗
PubMed1993

[Evaluation of ultrasonography in the diagnosis of thyroid nodules].

Purpose of the paper: Specify the merits of ultrasonography in thyroid pathology. Outline ultrasonographic orienting criteria to identify the nature of thyroid nodules. Analysis of the paper: Thyroid ultrasonography allows detecting nodules that cannot be detected clinically or with radionuclide scanning. 20% of sonographic nodules cannot be palpated; 33% of sonographic nodules are not visible on radionuclide scans. Ultrasonography often shows multiple nodules where palpation and/or radionuclide scanning detect only one. When there are clinical signs of hyperthyroidism and uncertain biological findings, ultrasonography can relate a low-uptake nodule with an adenoma becoming autonomous, if the nodule appears to be hypodense. It allows monitoring the volume of nodules under freination therapy. Benign nodules may be liquid (15.7% of all cases); solid and isoechogenic (27.6%); solid and hyperechogenic (10.1%); solid and hypoechogenic (18.1%, including 88.5% toxic adenomas) or compound (26.4%). Comparison of the 2 series of nodules reveals the predominance of liquid and iso/hyperechogenic solid appearances for benign nodules (63.8%, excluding toxic adenomas). For cancers, the frequency of hypodense solid or compound nodules is 92.2%. Combining radionuclide scanning and ultrasonography allows further restricting the group of suspicious nodules, which have a low uptake and are hypodense or compound.

France↗
PubMedDate not supplied

[Methods for detection of changes in muscle tonus].

Muscular spasm is a frequent symptom which is difficult to record precisely. On the basis of literature on the subject and of own studies, we undertook to describe various methods of examination which could be used to demonstrate such changes. Up to now, palpation is still the most important and most exact method for the experienced examiner. In this way local as well as extended muscular spasms can be made evident. The disadvantage however is the lack of objective proof. The easy-to-use Tissue-Compliance-Meter of Fischer, which measures the consistency of soft tissue, documents the intraindividual difference rather than the interindividual difference. This is due to the individually variable thickness of the subcutaneous fatty tissue. However, on the whole there is a good correlation to the findings of palpation. The pendulous-test and badismography allow especially the conclusion with regard to unilateral changes of tonus in the gluteal and upper leg muscles. This method also very well suits the intraindividual comparison, but less so the interindividual one. The continuous electromyogram is able to show the enhanced activity in spasmotic muscles also during sleep. The evaluation of enhanced muscle activity remains uncertain when using plain electromyogram. Recording of muscle tissue oxygen pressure is of little use to evaluate muscle spasm. Nonetheless, it provides interesting insights into pathogenetic questions. Thermography, measuring the blood circulation at the skin surface, is especially suited for perceiving intraindividual differences in case of muscle spasm. Nuclear magnetic resonance spectroscopy allows for noninvasive pH measurements in the muscle and therewith renders certain data concerning the degree of tension of this tissue. It is not yet suited for routine examination. The value of positron emission tomography for registering muscle spasm remains uncertain. Hopefully, this method, which documents the muscle energy metabolism, will enable us to more clearly evaluate muscle spasm than previous methods have done. Light and electron microscopic studies have provided contradictory results concerning histological changes in muscle biopsy in case of muscle spasm.

Adenosine Diphosphate↗
PubMed1994

Clinical imaging of head and neck cancer with technetium-99m-labeled monoclonal antibody E48 IgG or F(ab')2.

METHODS: In 32 patients who were suspected of having a neck lymph node metastasis from a histologically proven squamous-cell carcinoma of the head and neck (HNSCC), the diagnostic value of 99mTc-labeled (750 MBq) monoclonal antibody (1-2 mg) E48 IgG (n = 17) and its F(ab')2 fragment (n = 15) was evaluated and compared. Preoperative findings on lymph node status obtained by radioimmunoscintigraphy (RIS), computerized tomography (CT), magnetic resonance imaging (MRI) 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 to the histopathological outcome of the neck dissection specimen. RESULTS: All 31 tumors at the primary site were visualized. RIS was correct in 201 of 221 levels (accuracy 91%) and in 38 of 47 sides (accuracy 81%). Fifteen levels and seven sides with limited tumor load were scored false-negative and five levels and two sides were scored false-positive. Sensitivity and specificity of RIS were similar to those of palpation, CT and MRI. The diagnostic value of RIS with E48 F(ab')2 or E48 IgG appeared to be similar. CONCLUSIONS: The present study shows that RIS with either E48 F(ab')2 or E48 IgG is as valuable as the other imaging techniques. The selective accumulation of radioactivity in tumor tissues, in combination with the known intrinsic radiosensitivity of HNSCC, justifies the development of radioimmunoconjugates for radioimmunotherapy.

Aged↗
PubMed1994

Persistence of local twitch response with loss of conduction to and from the spinal cord.

A local twitch response (LTR) is a brisk contraction of a taut band of skeletal muscle fibers elicited by snapping palpation of a trigger point (TrP) in that band. The LTR is a clinically valuable objective sign that confirms the presence of a myofascial TrP. A transient burst of electromyographic (EMG) activity can be recorded from taut band fibers when an LTR is elicited by snapping palpation of TrP. A previous study of the human extensor digitorum muscle during ischemia suggested that both central and local pathways can be involved in the propagation of LTRs. In this study, EMG activity of LTRs in the third finger extensor muscle were recorded bilaterally in a patient with a unilateral brachial plexus lesion. This patient had complete loss of nerve conduction involving the posterior cord of the right brachial plexus as confirmed by EMG and nerve conduction studies and by neurological examination at 6 months after injury. EMG activity (measured as discharge duration and maximal amplitude) on the paralyzed side was significantly reduced (p < 0.01) as compared with the unaffected side, but had not disappeared. Three more studies were done at 7, 8, and 17 months after injury when the motor and sensory functions were recovered progressively. The EMG activity of LTRs recovered on the paralyzed side in parallel with the motor and sensory recovery. These findings indicate that the transmission of LTR depends mainly on the central nervous system with a possible minor degree of local transmission.

Action Potentials↗
PubMed1993

Treatment of facial muscles affected by Bell's palsy with high-voltage electrical muscle stimulation.

OBJECTIVE: This report discusses high-voltage electrical muscle stimulation and chiropractic manipulation used to treat two patients who suffered from Bell's palsy. CLINICAL FEATURES: Case A: A 15-yr-old with left sided facial palsy was seen 2 days after the onset of symptoms. Upon observation, the left upper and lower eyelids were drooping and the left eye had excessive tearing. Motion palpation indicated multiple fixations in the cervical spine. Laboratory studies showed a microcytic anemia. A clinical diagnosis of Bell's palsy (House-Brackmann Grade V) and microcytic anemia was made. Case B: A 17-yr-old with left sided facial palsy was seen 8 days after onset of symptoms. Upon observation, the patient showed left sided facial paralysis and an inability to close the left eye completely. Motion palpation indicated multiple fixations in the cervical spine. A clinical diagnosis of Bell's palsy (House-Brackmann Grade V) was made. INTERVENTION AND OUTCOME: Both patients were treated with high-voltage pulsed galvanic current at 80 peaks/sec with a 7-inch hand-held held probe for 10 min each visit. In addition, the cervical spine fixations were mobilized using chiropractic manipulation. Case A was resolved after 6 wk of treatment and case B was resolved after 3 wk of treatment. CONCLUSION: Both patients benefited from these procedures with complete resolution of symptoms. The techniques outlined should be used at an early stage to accelerate progress toward normal facial muscle function.

Adolescent↗
PubMed1993

Biomechanical analysis of an induced joint dysfunction (subluxation-mimic) in the thoracic spine of rabbits.

OBJECTIVE: The purpose of the present experiment was to evaluate functional biomechanics of the lesioned area in rabbits subjected to surgically placed vertebral lesions which may mimic a subluxation. It was hypothesized that wedging a bar between three adjacent vertebrae would lead to visual and palpatory alterations and also to a decrease in range of motion (ROM) at the affected segments. DESIGN: A controlled laboratory experiment was performed to measure directly ROM and to evaluate the functional and anatomic relationships of vertebrally lesioned rabbits. SUBJECTS: Twelve healthy adult New Zealand rabbits of either sex, weighing 3-5 kg, were maintained in the PCC animal facilities under normal husbandry conditions. Six operated controls and six experimentally lesioned rabbits were available for analysis. INTERVENTIONS: Rabbits were anesthetized and a vertebral lesion surgically placed at various locations along the thoracic spine. A stainless steel bar was implanted to produce a putative partial fixation and misalignment of three adjacent segments. The middle spinous process was forced contralaterally and slightly rotated relative to the adjacent two. At intervals ranging from a few weeks to several months postsurgery, the animals were evaluated for spinal ROM and also by visual and palpatory means for spinal misalignment. MAIN OUTCOME MEASURE: X rays, using rubber foam molds to standardize positioning, were taken pre- and postsurgery to measure ROM. Statistical analysis was made to compare ROM between the lesioned and adjacent areas of experimental and control animals. RESULTS: All but one of the experimental animals, but none of the controls, showed some reduced ROM on palpation at autopsy. Radiographic measures, however, showed that the ROM in the experimental animals as a group was not significantly reduced compared to control values, nor was there a significant ROM decrease compared to nonlesioned motor units within the experimental group. In some individual animals, however, there was a significant decrease in spinal ROM. CONCLUSIONS: This study failed to demonstrate any effect of the vertebral lesion on spinal ROM as measured radiographically, although by palpation the lesioned area did appear to be partially fixated in most animals. This surprising result may perhaps be explained by the large variability in measurements, the small number of subjects used or by inadequacies of X-ray positioning. Further work on biomechanical effects of vertebral lesions is clearly required.

Animals↗
PubMed1993

Analysis and prevention of recurrent goiter.

The current study was done to analyze our experience with recurrent goiter. Prevention must be stressed because reoperations of the thyroid gland present technical difficulties and are associated with an increased risk of hypoparathyroidism and permanent hoarseness. Nodular recurrences occurred in 36 of 1,456 patients (2.5 percent) who underwent thyroidectomy between 1968 and 1983. All patients had the initial operation at Jean Bernard Hospital, Poitiers, France, and had follow-up evaluation from five to 20 years. Multinodular goiter accounted for 70 percent of the recurrences. Sixty percent of the recurrences were in patients with multinodular goiters. Recurrent goiter was usually first detected about eight years after thyroidectomy. Thirty patients with recurrence had reoperations. Two patients had paralysis of the vocal cord and one patient had permanent hypoparathyroidism. Recurrent goiter may occur because of the development of new nodules (true recurrence) or because of the growth of "residual" or persistent macroscopic or microscopic nodules left at the previous thyroid operation. Intraoperative digital palpation of the entire thyroid gland is essential for detecting residual macroscopic thyroid nodules, and all enlarged nodules should be removed. Thyroid-stimulating hormone (TSH) suppressive therapy is recommended by some authorities to prevent "true" recurrences, although its efficacy is debated. Since recurrence is uncommon in the current series, perhaps TSH suppressive therapy should only be used in high-risk patients. In the current experience, only the multinodular character of the nodules in euthyroid patients has a significant correlation with subsequent development of recurrent goiter (p < 0.01), and one must consider patients with multinodular goiter at risk for recurrence. Once TSH treatment is begun, it will logically be continued for life. Total thyroidectomy has been recommended by some endocrine surgeons for treating patients with multinodular goiter. We prefer subtotal thyroidectomy and reserve total thyroidectomy for patients when no normal thyroid tissue can be preserved because only 2.5 percent of the patients in the current study had recurrent goiter. Prevention of residual nodules is probably best assured by systematic palpation during operation of the two thyroid lobes. This considerably lessens the risk of recurrence. Since nodular recurrences occurred in only 2.5 percent of the patients in the current study, although multinodular goiter must be considered at risk for recurrence, we do not recommend systematic total thyroidectomy in multinodular goiter.

Adolescent↗
PubMed1977

The value of liver scan in the follow-up study of patients with adenocarcinoma of the colon and rectum.

Seventy consecutive patients with adenocarcinoma of the colon and rectum had a liver scan followed by surgical exploration of the liver. Preoperatively, blood chemistry studies were done in addition to palpation of the abdomen. Surgical findings were correlated to results of the liver scans, function tests and palpation of the liver. The overall concordance of liver scans with surgical findings was 78 per cent. Thirty per cent had false-positive results and 15 per cent, false-negative results. The correlation of the liver scan with surgical findings was improved with increasing extent of metastases. When less than 25 per cent of the liver was replaced by tumor, there was a random correlation of scan to surgical findings. By combining liver scans and liver function tests, metastases could be predicted with increased reliability only in patients who had severe metastatic disease of the liver. It is strongly recommended that patients with liver scans suggestive of metastatic disease and with most liver function tests within normal limits undergo exploration to establish the diagnosis. Exploratory laparotomy seems to be the only way to avoid chemotherapeutic treatment of patients with false-positive scans and still allow detection and treatment of metastases to the liver to occur at earlier stages.

Adenocarcinoma↗
PubMed1996

[The combined diagnosis of male breast lesions: a review of a series of 748 consecutive cases].

The authors reviewed a series of 748 consecutive male patients referred for breast screening; their average age was 50.5 years. A malignant lesion was detected in 20 patients (18 infiltrating ductal carcinomas, 1 intraductal carcinoma and 1 myxosarcoma). Of 18 infiltrating carcinomas, 17 were found in patients over 60 years of age; pT classes were pT1c in 13 patients, pT2 in 2, pT4b in 1, pT4d in 1 and pTx in one patient. Biopsy demonstrated 92 benign lesions (74 gynecomastia cases and 18 other lesions), whereas 636 lesions were considered benign at direct or cancer registry follow-up. Sensitivity was 85% for palpation, 88.8% for mammography, 93.7% for cytology and 100% for US. Specificity was 95.3%, 94%, 95.6% and 97.9%, respectively. Combined palpation and mammography had 100% sensitivity. Sixty-five of 92 benign lesions were submitted to biopsy, even in the absence of suspicion, for psychological/cosmetic reasons. Negative cytology spared unnecessary biopsy in 9 cases, which were fairly suspicious at other exams. To conclude, we confirm the role of this multimodality clinical-instrumental diagnostic approach, with a special emphasis on the role of US. Cytology was as useful to avoid unnecessary open biopsy in men as it is in women. Male breast cancer has the same semiology as female breast cancer, though with a prevalence of opacities with blurred outline and in the absence of scirrhous-stellate patterns. The diagnostic protocol we used to diagnose breast cancer in women seems to be fully indicated also in men.

Adolescent↗
PubMedDate not supplied

Leprosy neuropathy: correlation of clinical and electrophysiological tests.

This report describes the neurological and electrophysiological examination of 35 subjects with leprosy (average duration of symptoms 3.4 years, average time since diagnosis 7.5 months). Clinical examination in the distribution of non-dominant median and ulnar nerves was performed with the following clinical methods: touch sensation with 0.05 gm. Monofilament nylon, thermal sensation with a thermal sensitivity testing device, voluntary muscle testing and nerve palpation. At least one abnormality was found in 22 ulnar and 13 median nerves (63% and 37%, respectively). Nerve palpation was the most frequent clinical abnormality, while the other methods had similar frequencies of abnormality. Electrophysiological studies were performed on the ipsilateral side of the leprosy subjects and on 32 age-matched normal subjects. Electrophysiological responses from the leprosy subjects were evaluated by criteria established from normal subject data. Abnormal or absent responses were found in 21/35 ulnar sensory, 12/35 ulnar motor, 9/35 median sensory and 6/35 median motor responses among the leprosy subjects. The most important electrodiagnostic findings were: (i) low sensory amplitudes and (ii) drops in amplitude and NCV over the across-elbow segment of the ulnar nerve. Both clinical and nerve conduction abnormalities were positively associated with duration of leprosy symptoms. The four clinical methods were compared for concordance with nerve conduction data by cross-tabulation. The two sensory measures, monofilaments and the thermal sensitivity device, had the highest concordances. Usefulness of clinical tests for nerve damage in leprosy may vary depending on whether the purpose is for diagnosis, patient education or clinical follow-up.

Adult↗
PubMedDate not supplied

Short-term responsiveness of manual thoracic end-play assessment to spinal manipulation: a randomized controlled trial of construct validity.

OBJECTIVE: To evaluate the short-term responsiveness of rotatory thoracic end-play assessment to spinal manipulation and, thereby, motion palpation construct validity. DESIGN: Prospective, single-blind, randomized, controlled trial (randomized blocks design). SETTING: Laboratory, Center for Technique Research. PARTICIPANTS: Sixty first-year chiropractic college student volunteers; seventy-three possible candidates were screened. INTERVENTIONS: The treatment group received manual high-velocity, low-amplitude rotatory manipulation. The control group received no intervention to minimize nonspecific effects of sham treatment. MAIN OUTCOME MEASURES: End-play response, defined as the change from restricted to normal end play immediately after intervention. Responsiveness, defined as the percentage of the end-play response attributable to spinal manipulation: relative response attributable to the maneuver, RRAM = (treatment group response--control group response)/treatment group response. RESULTS: Ten percent of the tests were positive for restriction of end play in left or right rotation from T3-T4 to T12-L1; the average rate was 2.1 restrictions per subject (SD = 1.4). End-play response was 60% in the treatment group, in contrast to the 37% response in the control group (z = 1.86, p = .04). More than a third of the response in the treatment group was attributable to spinal manipulation (RRAM = 39%). For one examiner, RRAM = 51%. Mild symptomatology did not affect responsiveness. CONCLUSIONS: The data suggest a moderate short-term responsiveness of rotatory thoracic end-play restriction to spinal manipulation, hence it has utility as a posttreatment evaluative test. This study was the first to use an external standard (manipulation) to demonstrate that segmental end-play restriction changes, hence end-play restriction itself, are detectable in human subjects with manual palpation by chiropractors. Further research is required to determine the generalizability of the study findings.

Adult↗