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At least 1,783 records · Page 99Linked to original sources
PubMed1998

[Role of spiral computerized tomography in the staging of pancreatic carcinoma].

INTRODUCTION: Few pancreatic carcinomas (5-22%) are resectable at the time of diagnosis because this lesion is seldom diagnosed in an early stage. Unresectability is mainly due to the presence of metastases to the liver, peritoneum and lymph nodes and to tumor spread especially to the portal mesenteric trunk where it can invade, compress, reduce, or occlude the vessels. We investigated the diagnostic yield of multiplanar and 3D spiral CT in the assessment of pancreatic carcinoma resectability. MATERIAL AND METHODS: Twenty-seven patients with histologically confirmed pancreatic head cancer were submitted to spiral CT and color Doppler US in the Surgical Clinic I of the Bologna University. The examination results were correlated with the intraoperative findings of careful inspection and palpation and of US studies of the pancreatic mass and adjacent structures. The tumors were classified in relation to some CT parameters: tumor size (T), infiltration of the stomach (S) and/or duodenum, lymph nodes (N) or distant (M) metastases, involvement of vascular structures (V), particularly of portal or superior mesenteric vein, or superior mesenteric artery. Five grades of vascular involvement were considered. The results of these techniques were correlated with intraoperative findings from careful inspection and palpation and with US studies of the pancreatic mass and adjacent structures. RESULTS: Spiral CT revealed vascular involvement in 19 of 27 cases (70.4%): involvement of portal and superior mesenteric vein was found in 14 (73.6%), superior mesenteric vein was involved in 2 (10.6%), the portal vein in one (2%) and, finally the portal, superior mesenteric vein and superior mesenteric artery in 2 cases (10.6%). The spiral CT results were confirmed intraoperatively in 26 of 27 cases (96.3%); spiral CT did not reveal hepatic metastasis only in one case. Spiral CT with multiplanar reconstructions had very high specificity and sensitivity (100%) in the assessment of vascular involvement, while color Doppler US had the same specificity but lower sensitivity (84.2%). Spiral CT was less sensitive (80%) in the detection of liver metastases. CONCLUSIONS: We believe that spiral CT is currently the best technique for pancreatic carcinoma staging, providing useful information for correct surgical planning.

Adult↗
PubMed1998

Use of ultrasound-guided fine needle aspiration biopsy in the management of thyroid disease.

Fine-needle aspiration biopsy (FNAB) of thyroid nodules has resulted in fewer patients needing thyroidectomy. Nondiagnostic FNAB specimens may require surgery for diagnosis. Ultrasound can help decrease nondiagnostic biopsies by visualizing lesions and guiding biopsy needles. Between 1996 and 1997, 76 patients had ultrasound-guided needle biopsies of thyroid nodules. Sixteen patients had clearly palpable nodules, whereas 19 were described as difficult to palpate. There were 32 patients who presented with either prominent thyroids or enlarged lobes. Six patients presented only with nonspecific symptoms, and 3 had nodules discovered incidentally on imaging studies. Biopsies were diagnostic in 73 of 76 (96%) patients. This varied with the size of the nodule, with the rate of nondiagnostic biopsies being 13 per cent in lesions <1.0 cm and 3 per cent in lesions >2.0 cm. Fifteen patients had surgery based on the FNAB, with a surgical yield of malignancy of 47 per cent. Ultrasound-guided FNAB is extremely useful in evaluating thyroid lesions that are difficult to palpate or nonpalpable, as well as the remainder of the gland and surrounding structures. The use of ultrasound guidance in performing FNAB results in a low rate of nondiagnostic biopsies, which may decrease the number of unnecessary thyroidectomies performed to rule out malignancy.

Biopsy, Needle↗
PubMed1998

Longitudinal cohort analysis of lethal prostate cancer progression in transgenic mice.

PURPOSE: Human prostate cancer is variably lethal, shows heterogeneous progression, and exhibits a spectrum of histopathology. Traditional rodent models of prostate cancer lack these characteristics. An alternative, autochthonous model of prostate cancer consists of transgenic mice which develop prostate cancer due to prostatic expression of SV40 T antigen. Lethal progression of such cancers in individual mice has not been previously characterized. Studies were undertaken to characterize the longitudinal progression of prostate cancers in these transgenic mice. METHODS: A prospective longitudinal cohort study was undertaken to characterize prostate cancer volume, progression, lethality, and histological heterogeneity in a transgenic mouse model of prostatic adenocarcinoma. Fifty-one transgenic mice were followed prospectively to determine the age at onset of palpable tumor and age at cancer-related death. Tumor volume was followed longitudinally by magnetic resonance imaging (MRI) in a subset of these mice and lethal cancers were evaluated by histopathology. RESULTS: Primary tumors became palpable at 10-38 weeks of age. Palpable tumors always preceded lethal progression. Cancer death followed 2-9 weeks later, and age at cancer death varied from 24 to 39 weeks of age. The histopathological changes were heterogeneous. Primary tumors were detectable by MRI before they became detectable by palpation. MRI showed that, analogous to human prostate cancers, volume of early stage primary tumors did not necessarily predict age at cancer death. CONCLUSION: Prostate cancer in transgenic mice mimics heterogeneic tumor progression in human prostate cancer, providing a uniquely relevant pre-clinical model. Tumor detection by MRI and palpation are valid surrogate measures of tumor progression in this model.

Animals↗
PubMed1998

Prevalence of fibromyalgia in children: a clinical study of Mexican children.

OBJECTIVE: To determine the prevalence of fibromyalgia (FM) in schoolchildren according to the 2 stage classification process proposed by the 1990 American College of Rheumatology (ACR) Multicenter Criteria Committee on Fibromyalgia. METHODS: Stage 1: we administered a pain questionnaire to a sample of 548 schoolchildren (264 boys, 284 girls; mean age 11.9 yrs, range 9-15). Stage 2: two rheumatologists examined all children with diffuse pain. Using thumb palpation, they examined 18 fibromyalgia tender points and 3 pairs of controls points followed by dolorimetry. Additionally, a random sample of 79 children with no pain were selected as controls, following the same procedures (thumb palpation and dolorimetry). The Wilcoxon test was used to compare the distribution of tenderness thresholds between FM and non-FM groups. Kappa statistics for multiple raters was used to assess interobserver agreement. RESULTS: Seven children, all girls, fulfilled the ACR diagnostic criteria for FM. Thus, the prevalence of FM in this group of schoolchildren reached only 1.2%. The girls with FM had a mean of 14 tender points, whereas controls (n = 79) had 2.4. Pain thresholds were 3.4 kg in children with FM and 5.1 kg in controls (p = 0.004). CONCLUSION: The prevalence of FM in our study was 5-fold lower than a previous report. This variance may be due to (1) racial and sociocultural differences between populations; and (2) differences in methodological approach. The difficulties of making accurate estimates of FM across different studies are highlighted.

Adolescent↗
PubMed1998

A clinico-anatomic study of the auricular branch of the vagus nerve and Arnold's ear-cough reflex.

The results of a clinico-anatomic study of the auricular branch of the vagus nerve (ABVN) and Arnold's ear-cough reflex are presented. The frequency of the ear-cough reflex was found to be 2.3% (12 out of 514 patients). It was bilateral in 3 cases (0.6%). The reflex was elicited by palpation of the postero-inferior wall of the external acoustic meatus (EAM) in 11 patients, and by palpation of the antero-inferior wall in one patient (0.2%). The reflex was frequently noticed to occur after a short latent period. The course of the ABVN inside the jugular foramen (JF), and distribution of the terminal branches of the ABVN in the external acoustic meatus were determined in 8 male cadavers (16 sides). In addition, the length of the mastoid canaliculus (MC) and the relationships of the ABVN with the facial nerve and stylomastoid foramen (SMF) were studied in both cadavers and 25 dry skulls (50 sides). High-resolution computed tomography (HRCT) scanning was also performed in all cadavers prior to microdissections. The ABVN emerged from the superior ganglion of the vagus nerve in all the cadavers. It ran between the internal jugular vein (IJV) and the bony wall of the jugular foramen. The ABVN was encased in a partial bony canal during its course from the jugular foramen to mastoid canaliculus in 18% of all specimens. The average length of the mastoid canaliculus was 5.6 mm (4.2-6.5), and it ran transversely towards the tympanomastoid suture 4.5 mm (4-5.1) above the stylomastoid foramen. The mastoid canaliculus was well demonstrated in all the HRCT scans.

Adult↗
PubMed1998

[Treatment of gynecologic inflammations in Frantiskových Lázních Health Spa].

In 36 patients treated on account of chronic inflammations of the genitals a check-up examination was made 5 to 6 months after termination of spa treatment. Attention was paid to the gynaecological palpation finding, the mental state of the patients and their sex life. It was found that the palpation finding improved markedly or became normal (p < 0.0001). The values of Zung's self-assessment anxiety scale SAS were significantly more favourable (p < 0.001). Almost 40% of the examined women (14 probands) reported improvement of sex life. Treatment of chronic gynaecological inflammations in Frantiskovy Láznĕ is thus effective and helps affected women.

Adult↗
PubMed1998

[The internist and ovarian cancer].

For the purpose of evaluating the role and participation of the internist in the diagnosis of Epithelial Ovarian Cancer (EOC), 81 medical records belonging to patients with EOC, were analyzed. The mean age of the patients was 63.5 years old (SD 12.33). Of these patients 21% were asked about their personal and familiar oncology history during their first office visit. Thirteen patients (16%) were asymptomatic in the first consultation. The more frequent symptoms were pain and abdominal distention. During this first examination, 46 patients (56.8%) presented some evident physical sign, and EOC was suspected in 35 patients (P = 0.00000004): the most frequent sign was an abdominopelvic mass in 34 patients (74%). Forty-six patients with EOC (56.8%) consulted an internist and twenty-four patients (29.6%) a gynecologist at first evaluation, without significant differences in diagnostic suspicion. Internists did not perform an abdomino-pelvic palpation. Gynecologists performed the abdomino-pelvic palpation in 74 patients, and 58 (78.4%) were found to be abnormal. The mean age of patients examined by internists was 68.2 years old, that is ten years older than the patients examined by gynecologists (P = 0.0007) and 70% were in Stages III and IV (P = 0.02). Gynecologists examined 9 asymptomatic patients (P = 0.0003) and 42% in Stages III and IV. The more frequent reasons for consultation to internists were abdominal pain (23 patients) and distention (17 patients). On the other hand metrorrhagia (9 patients) was the most common reason to consult a gynecologist. In conclusion, internists were frequent receptors of women with ovarian cancer at the first consultation. Their patients were older and with a more advanced disease stage. The interrogation concerning the oncology history was insufficient and the gastrointestinal symptoms were the most frequent cause for consulting an internist. The presence of some physical signs was associated with more diagnostic suspicion. The gynecologists examined more asymptomatic patients.

Family Practice↗
PubMed1976

[The value of ultrasonography in the diagnosis of female genital tract tumors (author's transl)].

In 199 patients with female genital tract tumors the preoperative diagnosis recorded by palpation and ultrasound examination with the A and B apparatus of Kretz were compared with the microscopic findings at laparotomy. The sonographic description of the findings was accurate in 60% of the cases, largely correct in 33% of the cases and mostly erroneous in 7% of the cases. By palpation a correct diagnosis was made in 38% of the cases, largely correct diagnosis was established in 45% of the cases and a mostly erroneous diagnosis was made in 17% of the cases. With tumors up to 4 cm. in diameter, both methods were of approximately equal value. A prognosis as to the likely histology was not possible with the ultrasound technique. A prediction as to malignancy was possible in many cases. Only 4% of the homogenous tumors were malignant whereas 27% of the inhomogenous tumors were malignant tumors.

Diagnostic Errors↗
PubMed1976

Acute dacryocystic retention.

Acute dacryocystic retention is a disease of adults under 50 years old due to a noninfective foreign body blocking the nasolacrimal duct. It is characterized by the sudden onset of severe unilateral facial pain without significant localized swelling or erythema. Palpation of the involved lacrimal sac reveals slight induration and marked tenderness. Percutaneous aspiration of lacrimal sac contents, followed by probing of the nasolacrimal duct, is usually curative.

Acute Disease↗
PubMed2002

The impact of hormone replacement therapy on the detection and stage of breast cancer.

HYPOTHESIS: Patients who receive hormone replacement therapy (HRT) and subsequently develop breast cancer are more likely to be diagnosed by palpation than mammography and have a higher stage of cancer at initial diagnosis. DESIGN: Retrospective case series. SETTING: University hospital. PATIENTS: Two hundred ninety-two patients with breast cancer who were postmenopausal. INTERVENTIONS: Clinical examination, mammography, and definitive therapy. MAIN OUTCOME MEASURES: Hormone replacement therapy use, mode of cancer detection, tumor size, nodal status, stage, and survival. RESULTS: Patients receiving HRT prior to diagnosis had significantly more incidences of mammographically detected tumors, ductal carcinoma in situ, T1 lesions, negative nodes, and better survival rates than nonusers. CONCLUSIONS: A history of HRT use had only beneficial and no discernible adverse effects on breast cancer detection and outcomes. These effects of HRT seem to be due to the development of less aggressive tumors rather than earlier detection.

Aged↗
PubMed1996

Usefulness of ultrasound-guided, fine-needle aspiration biopsy for palpable breast tumors.

OBJECTIVE: To investigate whether ultrasound (US) guidance improves the sensitivity of fine-needle aspiration biopsy (FNAB) in patients with palpable breast tumors. DESIGN: A retrospective study. SETTING: A university hospital. PATIENTS: A total of 107 patients with breast tumors (114 lesions) underwent US-guided FNAB and 138 patients (143 lesions) underwent FNAB guided by palpation (standard FNAB). MAIN OUTCOME MEASURES: The diagnoses obtained by FNAB were compared with the surgical findings and the diagnostic value of US-guided FNAB was evaluated. RESULTS: The sensitivity of US-guided FNAB was 89.3%, the specificity was 82.9%, and the accuracy was 86.9%. In contrast, the sensitivity of standard FNAB was 61.1%, the specificity was 73.3%, and the accuracy was 65.0%. For breast tumors 2.0 cm or less in diameter, the sensitivity and accuracy of US-guided FNAB were significantly higher than those of standard FNAB. CONCLUSION: Ultrasound-guided FNAB can improve the preoperative diagnosis of breast cancer, especially in patients with tumors that are 2 cm or less in diameter.

Biopsy, Needle↗
PubMed1998

Clinical assessment of pelvic floor dysfunction in multiple sclerosis: urodynamic and neurological correlates.

We present a study on the clinical assessment of pelvic floor dysfunction in 30 female patients with proven multiple sclerosis (MS). A scoring system for pelvic floor muscle testing by digital vaginal palpation is proposed. The concept of pelvic floor spasticity in MS is introduced. The relationship of our findings with the neurological findings and urodynamic data is presented. Pelvic floor spasticity correlates well with the presence of detrusor-external sphincter dyssynergia and with more severe spinal cord disease.

Female↗
PubMed1975

Carcinoma of the bladder T3NxMo treated by preoperative irradiation followed by cystectomy.

Eighty-nine patients with bladder cancer T3NxMo have been treated by preoperative external irradiation (4000 rads in 4 weeks) followed by cystectomy. Five-year survival is 50%. Of patients with T-reduction (T3 becomes P0, P1, or P2) the 5-year survival is 70%. Treatment mortality has been reduced to 3% during the last 2 years. T-reduction cannot be predicted by histologic grade. A second staging by palpation under general anesthesia ("T" 4000) is reliable when T-reduction is felt; however, fibrosis can simulate a persisting T3 mass.

Adult↗
PubMed1977

Progress in manual breast examination.

Manual breast examination, despite recent advances in mechanical screening devices, remains a primary diagnostic procedure for early detection of breast cancer. The potential effectiveness of breast self-examination for reducing mortality relies on the effectiveness of a technology for training women to detect small tumors through manual palpation. Research indicates that although the regular practice of breast self-examination can lead to the detection of small tumors, current training methods are inadequate to ensure proper performance and maintain regular practice. An alternative interdisciplinary research and training approach, involving medicine, biomaterials engineering, psychophysics, and experimental psychology, is suggested. A dynamic lifelike breast model with variable lumps would provide the basis for generating systematic data regarding the factors affecting detection of small lumps and lead to development and evaluation of efficient and effective methods to teach manual examination.

Breast↗
PubMed1980

Studies in variation associated with the measurement of solid tumors.

The existing system for solid tumor evaluation is criticized and revised criteria are proposed. The foundation for this analysis is a tumor stimulation experiment to determine the distribution associated with measurement of solid tumors. This tumor simulation experiment was conducted among 26 oncologists in order to assess the errors associated with the measurement of solid tumors by means of palpation. Tumor size, shape, and texture were included as study factors. Tumor texture did not appear to affect measurement outcome. Overall, the statistical law governing tumor area measurement is best described as a log-normal distribution. Under this assumption, the sufficient statistic for the evaluation of tumor response or progression is simply the ratio of the tumor areas at each evaluation. The data generalize to permit the construction of statistical power curves for the probability of declaring response or progression, based upon the theoretic tumor/area ratios. Response and progression criteria are related in logarithmic proportion, i.e., a 50% decrease for response corresponds to a 100% increase for progression. The use of more sensitive progression criteria (a 25% increase in solid tumor area), in light of the nature of tumor measurement error, can lead to premature rejection of any therapy that stabilizes or reduces disease. Furthermore, the use of specified cutoffs for progression and response introduce a significant error into clinical evaluations of solid tumors.

Biometry↗
PubMed1984

Mass screening for control of breast cancer.

The serious import of breast cancer lies in its potential for metastatic spread, which probably starts early in the course of the disease. Detection of the lesion when immunocompetence can control the metastases leads to long-term survival. This usually involves detection of unsuspected, preclinical disease. This is the important lesson learned from the large screening program of the Health Insurance Plan of New York, where they used palpation and mammography. The substantial reduction in mortality over a matched control group has continued in a 15-year follow-up. Improved mammography techniques at the Guttman Institute, a mass screening project in New York, New York, conducted in cooperation with the American Cancer Society and in the Breast Cancer Detection Demonstration Project, which used the Guttman Institute program as a prototype, have led to substantially improved yield from mammography in screening. Three important factors in mass screening are discussed: (1) benefits versus hazards in mammography, (2) correct age to start screening, and (3) costs of screening.

Adult↗
PubMed1984

Lucy Wortham James Lecture. Subclinical disease.

A number of patients with cancer later develop metastases in the draining lymphatics, which initially were clinically negative. These occult deposits represent subclinical disease in lymphatic areas accessible to palpation, like the neck, axillae, and groin. The concept applies also to the microscopic disease left in an area after a surgical procedure is known to have removed all gross cancer, yet some patients later develop a recurrence. The term "subclinical disease" refers only to disease in a specific anatomic area, based on clinical facts. Radiobiological parameters account for the fact that subclinical disease requires less irradiation to be eradicated than gross cancer. The concept has two main applications, elective irradiation of clinically negative peripheral lymphatics and locoregional irradiation combined with surgery, which are determined by site and disease. The concept of subclinical disease also has implications for chemotherapy, which bear a direct relationship between chemotherapy both with radiation therapy and surgery.

Axilla↗
PubMed1986

Increased proficiency of search in breast self-examination.

Two experiments were conducted to assess the relative thoroughness of three search patterns for breast self-examination (BSE). Experiment 1 compared the commonly taught concentric circles (CC) pattern to a new pattern composed of vertical strips (VS). Experiment 2 compared a radial spoke (RS) pattern to the VS pattern. Twenty-eight female subjects participated in each experiment. Each learned BSE and was post-tested using the two patterns under investigation; order of presentation was counterbalanced. BSE thoroughness was measured with the aid of a numbered grid projected on the subject's chest allowing an observer to mark each square of the grid palpated on a congruently gridded scoresheet. The percentage of the cone of the breast and of the totality of the breast tissue examined was calculated for each exam. Experiment 1 showed that the VS pattern engendered more thorough coverage of the total breast area (64.4% vs. 38.9%) and of the cone (64.1% vs. 48.7%). The results of Experiment 2 were similar: the VS pattern produced more thorough coverage of the total area (67.9% vs. 44.7%) and of the cone (70.3% vs. 57.2%). All differences were statistically reliable. Of 112 intrasubject comparisons involving the VS pattern, it produced more thorough coverage in all but nine. These results indicate that the VS pattern is the pattern of choice for maximally effective BSE.

Adolescent↗