Management of Hydramnion in a Holstein Friesian Cow Affected with Prepubic Tendon Rupture

The examination of patients suffering from an acute abdomen routinely comprises both clinical and rectal examinations, and is ever more frequently accompanied by an ultrasonographic abdominal examination. The aim of the study was to compare the findings as defined through rectal examination with the results of the ultrasonographic examination for different forms of colic. In a retrospective study, the patient records of the Large Animal Clinic of the University of Leipzig from 2012 and 2013 were analysed, and those of horses suffering from colic were included. Diagnoses made through rectal and ultrasonographic examination were grouped and compared with the diagnoses made during colic surgery or pathologic examination, which served as the gold standard. Horses that underwent conservative treatment had a definitive diagnosis assigned only in cases where a pathognostic rectal finding defined the diagnosis. Based on these data, sensitivity, specificity and positive and negative predictive values were calculated for both techniques. Ultrasonography was more sensitive than rectal examination in cases of small intestinal occlusion (97.1% vs. 50.7%), torsion of the large colon in the long axis (63.2% vs. 26.3%) and dislocation of the large colon into the nephrosplenic space (90.9% vs. 72.7%). Rectal examination was more sensitive than ultrasonographic examination in cases of other types of dislocation of the large colon (96.5% vs. 8.8%) and of constipations of the large colon (93.6% vs. 29.8%). In cases of severe diseases, including small intestinal occlusions and torsions of the large colon, ultrasonography helps to better identify and more precisely diagnose conditions that in most cases require abdominal surgery than rectal examination. Therefore, under hospital conditions, it is highly advisable to include ultrasonography in the routine examination of the equine acute abdomen. However, this technique does not replace the traditional rectal examination, which is superior in the diagnosis of dislocations and constipations of the large colon as well as diseases of the caecum.

There is still lack of consensus regarding the most effective follow-up for stage I and II melanoma patients although some consensus conferences have provided guidelines stating that clinical examination should be the standard. Our aim was to study the value of adding ultrasound lymph node examination (7.5 MHz) to the routine clinical examination recommended by French guidelines in melanoma follow-up. A cohort of melanoma patients was enrolled between 1 July 1995 and 1 July 2000 in a follow-up protocol including clinical examination performed four times a year for thick melanomas (Breslow index > or = 1.5 mm) and twice a year for thin melanomas (Breslow index < 1.5 mm) according to French guidelines, and ultrasound lymph node examination performed every 6 months for thick melanomas and every year for thin melanomas. Follow-up was continued up to 1 July 2003. When clinical or ultrasound examination indicated signs of node recurrence, surgical biopsy of the involved node was performed. When ultrasound examination was only suspicious, another ultrasound examination was performed within the following 3 months. The results of both clinical and ultrasound examinations were compared with histopathology examination when node biopsy was performed. Ultrasound follow-up was performed for 373 patients (213 females and 160 males). Mean age at diagnosis of melanoma was 59 years (range 14-90, SD 15). In total, 1909 ultrasound examinations combined with clinical examination were analysed. Node biopsy was performed in 65 patients and demonstrated melanoma metastases in 54. Sensitivity of clinical examination and ultrasound examination was 71.4%[95% confidence interval (CI) 55.4-84.3] and 92.9 (95% CI 80.5-98.5), respectively, P = 0.02. Specificity of clinical examination and ultrasound examination was 99.6% (95% CI 99.2-99.8) and 97.8% (95% CI 97.0-98.4), respectively. Despite this apparent superiority of ultrasound examination over palpation, only 7.2% of the patients really benefited from ultrasound examination (earlier lymph node metastasis detection or avoidance of unnecessary surgery), while 5.9% had some deleterious effect from ultrasound examination (unnecessary stress caused by repetition of ultrasound examination for benign lymph nodes, useless removal of benign lymph node). This study confirms the greater sensitivity of ultrasound examination to clinical examination in the diagnosis of node metastases from cutaneous melanoma. However, the place of ultrasound in routine follow-up is at least questionable as only a very small proportion of patients (1.3%) really benefited from adding ultrasound examination to clinical examination.

To evaluate the value of clinical and ultrasound (US) examinations performed in the gynaecology emergency departement in women with acute pelvic pain. To assess the performance of clinical and US examination for diagnosing pathologies requiring immediate surgical management. Retrospective study of patients who underwent laparoscopy following emergency consultation for acute pelvic pain at the gynaecology emergency unit of a teaching hospital from January 2004 to December 31st 2006. Patients in whom physical and pelvic ultrasound examinations were performed were included and results were collected. Laparoscopy was considered justified if the final diagnosis was: hemoperotoneum > 300 ml, ruptured ectopic pregnancy, or active bleeding, or with a cardiac activity, pelvis inflammatory disease complicated of pelviperitonitis or pyosalpinx or tubo-ovarian abcess, adnexal torsion, appendicitis or occlusion. The sensitivities (Se), specificities (Spe), positive and negative likelihood ratio (LHR) were calculated for clinical and US examinations respectively. 231 patients had a laparoscopy following gynaecologic emergency consultation. In 136 cases, this emergency surgical treatment was needed. The Se, Spe, LHR+ and LHR− were 87.5%, 32.6%, 1.30 and 0.38 and 95.6%, 25.3%, 1.28 and 0.17 for clinical and US examinations alone respectively. When both clinical and US examinations were abnormal, there were 83.8%, 50.5%, 1.69 and 0.32 for Se, Spe, LLR+ and LLR− respectively. When only one of them was considered abnormal, there were 99.3%, 7.4%, 1.07 and 0.10 for Se, Spe, LLR+ and LLR− respectively. US examination may be used to select those patients who do not need an emergency surgical treatment and has better performance than clinical examination for that purpose. Clinical examination is not enough accurate to choose the best therapeutic decision.

BackgroundJIA is the commonest rheumatologic disease of childhood with a quoted prevalence of 1:1000. Assessment of children with JIA includes:Clinical, laboratory and more recently US evaluation of joints. Rapid attainment...

It has been reported that clinical evaluation consistently underestimates the severity of hidradenitis suppurativa (HS). To determine the usefulness of ultrasound as a diagnostic tool in HS compared with clinical examination and to assess the subsequent modification of disease management. Cross-sectional multicentre study. Severity classification and therapeutic approach according to clinical vs. ultrasound examination were compared. Of 143 HS patients were included. Clinical examination scored 38, 70 and 35 patients as Hurley stage I, II and III, respectively; with ultrasound examination, 21, 80 and 42 patients were staged with Hurley stage I, II and III disease, respectively (P<0.01). In patients with stage I classification as determined by clinical examination, 44.7% changed to a more severe stage. Clinical examination indicated that 44.1%, 54.5% and 1.4% of patients would maintain, increase or decrease treatment, respectively. For ultrasound examination, these percentages were 31.5%, 67.1% and 1.4% (P<0.01). Concordance between clinical and ultrasound intra-rater examination was 22.8% (P<0.01); intra-rater and inter-rater (radiologist) ultrasound agreement was 94.9% and 81.7%, respectively (P<0.01). The inability to detect lesions that measure ≤0.1mm or with only epidermal location. Ultrasound can modify the clinical staging and therapeutic management in HS by detecting subclinical disease.

BackgroundFor early detection of developmental dysplasia of the hip (DDH), neonatal hip screening using clinical examination and/or ultrasound has been recommended. Although there have been many studies on the reliability of both screening techniques, there is still controversy in the screening strategies; clinical vs. selective or universal ultrasound screening. To determine the screening strategy, we assessed the agreement among the methods; clinical examination by an experienced pediatric orthopedic surgeon, sonographic morphology, and sonographic stability.MethodsFrom January 2004 to June 2009, a single experienced pediatric orthopedic surgeon performed clinical hip screenings for 2,686 infants in the neonatal unit and 43 infants who were referred due to impressions of hip dysplasia before 3 months of age. Among them, 156 clinically unstable or high-risk babies selectively received bilateral hip ultrasound examinations performed by the same surgeon using the modified Graf method. The results were analyzed statistically to detect any correlations between the clinical and sonographic findings.ResultsAlthough a single experienced orthopedic surgeon conducted all examinations, we detected only a limited relationship between the results of clinical and ultrasound examinations. Ninety-three percent of the clinically subluxatable hips were normal or immature based on static ultrasound examination, and 74% of dislocating hips and 67% of limited abduction hips presented with the morphology below Graf IIa. A total of 80% of clinically subluxatable, 42% of dislocating and 67% of limited abduction hips appeared stable or exhibited minor instability on dynamic ultrasound examination. About 7% of clinically normal hips were abnormal upon ultrasound examination; 5% showed major instability and 3% showed dysplasia above Graf IIc. Clinical stability had small coefficients between ultrasound examinations; 0.39 for sonographic stability and 0.37 for sonographic morphology. Between sonographic stability and morphology, although 71% of hips with major instability showed normal or immature morphology according to static ultrasound examination, the coefficient was as high as 0.64.ConclusionsDiscrepancies between clinical and ultrasound examinations were present even if almost all of the exams were performed by a single experienced pediatric orthopedic surgeon. In relation to screening for DDH, it is recommended that both sonographic morphology and stability be checked in addition to clinical examination.

A screening study with transrectal ultrasound (US) and digital rectal examination to diagnose early prostate cancer was performed to calculate diagnostic costs. The total costs of screening 784 men were $130,400 with transrectal US and $41,080 with digital rectal examination. Per diagnosed cancer, the costs were $6,520 for transrectal US and $4,108 for digital rectal examination, a difference of 37%. The costs per early diagnosed cancer (stage A or B) were $7,671 and $5,869 for transrectal US and digital rectal examination, respectively--a difference of 23%. The costs per early cancer that would have been advanced if diagnosed without screening were $22,177 for transrectal US and $28,528 for digital rectal examination--a difference of 22% in favor of transrectal US. Equations for these relative costs were generated for transrectal US and digital rectal examination. Costs are related to changes in prevalences and to changes in the stages of prostate cancer when diagnosed without screening.

Intussusception is defined as the invagination of a portion of bowel into the lumen of the adjacent segment of bowel [15]. Intussusception, one of the causes of intestinal obstruction, is not a common gastrointestinal condition in cattle [12,15,16] and is usually seen in calves less than two months old [5]. The cause of an intussusception is often unknown but any condition that alters intestinal motility has been implicated [1,5]. It is suggested that intussusception can represent a diagnostic challenge in cattle medicine. History, clinical and clinicopathologic examinations are important in the diagnosis of intussusception [5,14]. Although ultrasonography has been commonly used as a diagnostic tool to detect internal diseases of large animals, there is limited ultrasonographic data demonstrating intussusceptions in cattle [4,7,3]. This case report describes a small intestinal intussusception in a cow and the transrectal ultrasonographic view of the lesion. In November 2005, a four-year-old, non-pregnant Simmental cow, with a history of anorexia, colic and a lack of defaecation was submitted to the clinic after two days without treatment. Values for rectal temperature, pulse and respiratory rate were 38.2°C, 100 beats/minute and 20 breaths/minute, respectively. Ruminal contractions were markedly reduced (two contractions every five minutes). The cow showed mild abdominal pain. Auscultation with percussion over the right flank was negative and abdominal distention was not evident. Rectal examination revealed the presence of a firm mass on the left of the median line and cranial to the pelvis. There was no faecal material in rectum. No distended loops of small intestine were palpable on rectal examination. The firm mass was examined using an 8-MHz rectal transducer (100 Falco, Pie Medical). The transducer was placed in a rectal palpation sleeve containing transducer coupling gel and inserted per rectum. The longitudinal ultrasound view of the firm mass revealed several echogenic parallel densities with a hypoechogenic central core representing the intestinal lumen of the intussusception (Figure ​(Figure1).1). Ultrasonographic examination of the right flank failed to reveal dilated loops of small intestine. Figure 1 The ultrasonographic appearance of the intussusception. This sonogram was obtained transrectally with an 8-MHz rectal transducer. Mildly echogenic densities represent bowel walls (arrows). Hypoechogenic areas among the echogenic linear densities probably ... The cow was slightly dehydrated. Haematocrit value, total serum protein and fibrinogen concentrations were 36% (reference range 24-46%), 7 g/dl (reference range 6.7-7.5 g/dl), and 600 mg/dl (reference range 100-600 mg/dl), respectively. Clinical pathology revealed that there was a mild hyperglycemia (5.1645 mmol/L; reference range 2.4975-4.1625 mmol/L), hypocalcaemia (1.675 mmol/L; reference range 2.425-3.1 mmol/L) and a slight hypochloraemia (93 mmol/L; reference range 97-111 mmol/L). Serum urea, creatinine, potassium and sodium concentrations were all within the normal range. Based on the history and the results of physical, ultrasonographic and biochemical examination, a tentative diagnosis of intussusception was made and the cow was submitted for surgery. Surgery was performed by a right flank laparotomy with the cow in a standing position, under local infiltration analgesia using 2% lidocaine hydrochloride (Vilcain; Vilsan, Ankara, Turkey). The intussusception was found. However, it could not be reduced by manual traction. An end-to-end anastomosis was performed following the jejunoileal resection. Postoperative therapy included 0.9% sodium chloride (10 L iv, daily) (Eczacibasi-Baxter, Istanbul, Turkey) for two days and penicillin (Strepto-Veticilline; Eczacibasi-Baxter, Istanbul, Turkey) for five days. The cow became appetent one day post surgery and made steady improvement over the following ten days. The resected bowel segment (Figure ​(Figure2)2) was placed in formalin for subsequent histopathological examination. Histopathological examination confirmed that the intussusceptum was distal jejunum and that the intussucipiens was ileum. Figure 2 The view of the resected bowel segment. Different types of intussusception have been recognised in cattle such as enteric, ileoileal, ileocecocolic, cecocolic and colocolic. Among these types, the enteric type of intussusception which occurs with invagination of one segment of the small intestine into another (usually distal jejunum or the ileum), is the most common form in cattle [17,5]. Enteric intussusception was diagnosed in this case. Although the majority of intussusceptions are idiopathic, intussusception may result from enteritis, intestinal parasitism, abrupt dietary changes, drug-induced changes in intestinal motility, mural or luminal intestinal lesions and foreign bodies [8,17,18,11,10,5]. The prevalence of enteric intussusception in cattle has been attributed to the length and mobility of the jejunal mesenteric attachments, especially the distal third [15]. Based on history, clinical examination findings on laparotomy and pathological findings, the cause of intussusception couldn't be determined in this case. Classic signs of intussusception are, initially, either chronic low grade pain or acute signs of abdominal pain, followed by progressive inappetence, abdominal distention, a reduction in faecal volume and lethargy [13]. The cow showed slight signs of colic, anorexia, lack of defaecation and lethargy but no abdominal distention. In the diagnosis of small intestinal obstruction, rectal palpation is considered valuable. Although intussusception is palpable in only a minority of affected adult cattle (23%), distended loops of small intestine are palpable per rectum in 50% of cases with intussusception [5]. In this case, while the intussusception was diagnosed on the rectal examination, neither rectal palpation nor ultrasonographic examination of the right flank revealed distended loops of small intestine. The transabdominal ultrasonographic pattern of an intussusception in cross-section has been described as 'bowel within bowel', a 'bull's eye' lesion, 'target pattern' or as a multiple layered, 'onion ring-type' mass with varying echogenities [2,3]. In longitudinal section, the typical lumen-within-a-lumen can be clearly identified and has been described as a 'sandwich' configuration [3]. Abdominal ultrasonography was attempted using a 3.5 MHz curved array with a maximal penetration depth of 17 cm, but the lesion could not be imaged probably because of the depth of the lesion. Transrectal ultrasonography has also been employed to diagnose intussusceptions in equine medicine. The transrectal ultrasonographic pattern associated with the intussusception varies in respect to transducer placement. It has been suggested that while the target-like configuration is obtained on a transverse section of intussusception, longitudinal ultrasound views of the intussusception reveals several echogenic parallel densities and a hypoechogenic core [7]. In the present case, there were several echogenic parallel densities with a hypoechogenic central core representing the intestinal lumen of the intussusception. Moreover, hypoechogenic densities were evident in parallel with hyperechogenic areas. The transrectal ultasonographic findings of the case are similar to those described by Edens et al. [7]. The hyperechogenic densities indicate the bowel walls. Hypoechogenic parallel linear densities interspersed among hyperechogenic areas probably correspond to oedema. Lack of faecal output, signs of abdominal pain, the palpation of a firm mass on rectal examination and especially the transrectal ultrasonographic pattern of the lesion led to the suspect diagnosis of intussusception requiring immediate exploratory laparotomy. Small intestinal intussusceptions are surgically repaired by means of resection and end-to-end anastomosis in both cattle and horses [2,5,6,9], because end-to-end anastomosis causes less chance of stricture formation and leakage [5]. This technique was preferred in this cow and no complications were observed. In conclusion, transrectal ultrasonography can be a valuable diagnostic tool in cattle that have a palpable mass on rectal examination.

Accuracy of Digital Rectal Examination and Transrectal Ultrasonography in Localizing Prostate Cancer

Ultrasound is increasingly being used to complement the clinical examination in assessing neonatal hip instability. The clinical examination, although highly sensitive in detecting hip instability, can lead to considerable overtreatment. To compare anterior dynamic ultrasound and clinical examination in the assessment of neonatal hip instability and regarding treatment rates. 536 newborn infants (out of a population of 18,031) were selected, on the basis of a combination of risk factors, clinical signs of hip instability or ambiguous clinical findings, to undergo an anterior dynamic ultrasound examination of the hip, by a method developed by our group. This examination, performed by one out of seven experienced examiners, was compared with the standard clinical hip examination conducted by one of four pediatric orthopedic surgeons. The clinical examination was carried out both prior to and within a few hours after the ultrasound examination. The clinical examination diagnosed 81.7% of the hips as normal, 14.5% as unstable, and 3.8% as dislocatable or dislocated. With the dynamic ultrasound method, the corresponding figures were 87.8%, 10.4%, and 1.8%, respectively. Use of the criteria of the clinical examination resulted in treatment of 147 infants. Using the dynamic ultrasound examination as a criterion meant that 87 infants would receive treatment. The calculated treatment rate was 0.85% when based on the clinical stress test and 0.49% when based on the dynamic ultrasound. The dynamic ultrasound results reduced the treatment rate by over 40% when used as a basis for the decision regarding treatment.

Background: During infancy, among developmental abnormalities of the hip joint, a broad-spectrum anomaly is developmental dysplasia of the hip (DDH). To examine this abnormality, no standardized screening protocol is available. Clinical examination is most frequently followed, and in doubtful cases, ultrasound (US) examination is used to confirm the diagnosis. Aims: The present study aims to compare the sensitivity and specificity of clinical to US examination in neonatal hip screening to detect DDH. Materials and Methods: This is a 1-year hospital-based cross-sectional study. Newborns who were referred to the Department of Orthopaedics with suspected DDH and examined by both clinical examination and US examination were included in the study. The Chi-square test and Fisher’s t-test were used for statistical analysis. Results: Out of the 75 babies, referred two-thirds were girls. The mean age of the babies was 6.25 ± 3.50 days. The breech presentation was the common risk factor (85.33%) for DDH, and LSCS was the standard mode of delivery. Clinical diagnosis of DDH was positive among babies, more on the left side than the right side. Eight babies (10.67%) were diagnosed to have DDH based on Graf’s test using USG. Among them, 4 (50%) babies had a clinical diagnosis of DDH. The sensitivity of the clinical trial with USG as reference standard was 50% Conclusion: Due to the lower sensitivity of clinical examination, USG screening should be done to detect DDH.

Clinical, laboratory and ultrasonographic findings in Egyptian buffalo (Bubalus bubalis) with caecal and colonic dilatation

Aim:In this study, the results of clinical, ultrasonographic, and laparotomy examinations of a five-year-old dairy cow with right abomasal displacement and traumatic reticuloperitonitis are presented. Materials and Methods: A five-year-old Holstein cow who had recently given birth was brought to the veterinary teaching hospital with a history of depression, anorexia, constipation, arched backs, and bloat. Based on the history and the results of the clinical and ultrasonographic examination, a tentative diagnosis of TRP and RDA was made, and the cow was submitted for surgery. Results: An ultrasonographic examination revealed hyperechogenic fibrin deposits and anechogenic fluid pockets between the reticulum and the anterior dorsal blind sac of the rumen. It was discovered that the displaced abomasum is hypoechogenic, has fluid ingesta ventrally, and has a gas cap more dorsally. The reticulum's submerged and free foreign bodies were removed, and an abomasopexy procedure was performed. She became appetent the following day after the surgery and made steady improvements over the following days. Conclusion: It was concluded that ultrasonography along with a clinical examination, is a useful adjunct tool for assessing the concurrent observed abomasal displacement and traumatic reticuloperitonitis.

At the Universitäts-Frauenklinik Köln (Cologne) 515 patients with gynecological symptoms underwent 597 clinical and ultrasound examinations; 224 patients had a subsequent laparotomy which offered means of checking the clinical and ultrasound findings. There was full agreement between ultrasound and clinical examination in 80%, partial agreement in 9%, and no agreement in 11%. Ultrasound provided information not gained by clinical means in 12%. In those patients subjected to operation clinical examination provided correct and complete diagnoses in 70% of patients, partially correct diagnoses in 19%, and wrong diagnoses in 11%. Ultrasound, however, provided correct diagnoses in 78%, partially correct diagnoses in 14%, and wrong diagnoses in only 8%. The results of ultrasound and clinical findings tallied in 51%, in 38% the ultrasonogram provided more precise information than palpation, and in 11% the clinical findings were more revealing than ultrasound examination. Additional valuable information was provided by 13% of ultrasonograms. Ultrasonography was not a precise predictor of malignancy.

Objectives: The aim of this study is to understand whether or not, and to what extent, clinical examination (CE) of joint involvement in rheumatoid arthritis depends on clinical experience and whether or not, despite clinical experience, ultrasound examination provides more accurate results than CE. Methods: 51 rheumatologists with different professional experience measured in years since MD graduation. All clinicians studied the same patient and they evaluated the wrists and indicated the presence/absence of swelling and its extent (mild, moderate, severe). Three experienced sonographers blinded to clinical findings each performed ultrasound (US) examination of the patient's wrists. Results: US analysis showed that the patient’s right wrist had moderate joint effusion, whereas the left wrist had mild joint effusion; similar results were obtained with power Doppler imaging of both wrists. Only about 50% of the clinicians involved recognized joint effusion in both wrists. The CE findings were independent of clinical experience. The results of CE were coherent with US evaluation only in a percentage of 23%. Conclusions: This study underscores again the superiority of US in the assessment of inflammatory processes and the inaccuracy of CE, even if performed by rheumatologists with extensive professional experience.