Accuracy Of Clinical Examination Research Articles

Accuracy of clinical examination and magnetic resonance in assessment of chondral lesion of knee joint by arthroscopy

Introduction: The knee joint has a unique anatomical structure in the human body. The localization between the two longest bones in the human body – femur, and tibia – makes it prone to injuries, trauma, and other pathologies. Clinical examination of the joint is still the primary method in evaluating the condition of the patient's knee. The study aims to determine the diagnostic accuracy of clinical examination and magnetic resonance (MR) in assessing chondral lesions of knee joint using arthroscopy as a reference standard.Patients and methods: The examination was conducted on 94 patients (58 males and 36 females) with knee injuries. Clinical examination indicated a primary chondral lesion of knee cartilage in eight patients (five men and three women), with an average age of 45.75. Besides the clinical examination, the diagnostics were performed using MR imaging by Siemens of 0.5 Tesla, and arthroscopy was performed using Storz arthroscope.Results: Our research has generated the following values of clinical and MR results for chondral lesions: Sensitivity (Se) = 12.5%, Specificity (Sp): could not be calculated, Positive Predictive Value (PPV) = 100%, Negative Predictive Value (NPV) = 0% and Accuracy (ACC) = 12.5%. The accuracy of clinical and intraoperative results for chondral lesion was: Se =100%, Sp: could not be calculated, PPV = 100%, NPV: could not be calculated, and ACC = 100%. MR imaging and arthroscopy findings of chondral lesion showed: Se = 100%, Sp = 0%, PPV = 12.5%, NPV: could not be calculated and ACC = 12.5%. In comparing the clinical sign and MRand intraoperative result, Positive Predictive Value for patients with chondral lesion was maximal (100%), while comparing MR with the intraoperative result, Positive Predictive Value was 12.5%. In comparison between clinical sign and intraoperative results, the accuracy for patients with chondral lesion was 100%, while comparing the clinical sign with MR result and MR with the intraoperative result, the accuracy was 12.5%.Conclusion: Our examinations have shown that MR examination is not currently as valid for diagnosing injury of chondral cartilage of knee as the medical community or patients have anticipated it.

A Prospective Observational Study to Determine the Correlation of Clinical, Ultrasonography, and Pathological Examination of Cervical Lymph Nodal Staging in Oral Squamous Cell Carcinoma.

Oral cancer is one of the most common cancers in our population. These cancers are drained by the nodes located in the cervical region which are easily accessible for clinical examination. However, these cervical nodes may also be enlarged due to various other nonmalignant causes. Hence, accuracy of clinical examination and ultrasound screening for cervical lymph nodes is invaluable. The aims of this study are (1) to correlate the clinical, radiological, and pathological results of cervical lymph nodes in patients with oral malignancy and (2) to calculate the accuracy of clinical and radiological methods in detecting malignant cervical lymph nodes. A prospective observational study was undertaken from January 2016 to December 2016 amounting to a total of 76 patients. All patients diagnosed with squamous cell carcinoma of the oral cavity and having a palpable neck node(s), who were planned for surgery were included. Clinical examination, ultrasonographic (USG) screening of the neck, and the final histopathology reports were noted. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for radiological screening by ultrasound were 90.5%, 90.9%, 79.2%, and 96.2%, respectively, and that for clinical examination were 61.9%, 69.1%, 43.3%, and 82.6%, respectively. Area under the curve (AUC) for ultrasound screening was 0.907, and the AUC for clinical examination was 0.655. Ultrasonography is a reliable, cost-effective imaging method in the assessment of malignant cervical nodes in patients with oral cancer, which is to be used along with clinical palpation for improving the accuracy of clinical staging and surgical planning preoperatively.

Evaluation of Metastatic Lymph Nodes in Oral Squamous Cell Carcinoma: A Comparative Study of Clinical, FNAC, Ultra Sonography and Computed Tomography with Post Operative Histopathology.

All the head and neck tumours, more than 90% are squamous cell carcinomas (SCC). The presence of metastatic cervical lymph nodes histologically positive for SCC provides one of the simplest and most important prognostic factor in patients with head and neck cancer. In this study, all patients were examined clinically for, location, number, size, shape, consistency and fixation of cervical neck nodes to the underlying structure, and the same was carried out by FNAC, USG and CT. Findings of these modalities and histopathological results were compared for the overall metastases of lymph nodes in the neck. The accuracy of clinical examination was 87.77% and sensitivity only 41.66%. FNAC has the greatest specificity, 98.71% and least sensitivity, 33.33%. The accuracy of FNAC was 90%. The positive predictive value and negative predictive value of FNAC were 80.0% and 90.58% respectively. USG revealed 50% of sensitivity. Specificity of USG was 93.58% and accuracy 87.77%. CT scan have the highest sensitivity among all other tests, 66.66%.The negative predictive value for CT scan was also the highest, 94.59%. Specificity and accuracy of CT scan was 89.74% and 86.66% respectively. This study concludes that USG with FNAC is the most accurate in evaluating metastatic lymph nodes in oral squamous cell carcinoma patients along with other investigations like CT scan for staging of the oral squamous cell carcinoma.

Clinical Findings Versus Imaging Studies in the Diagnosis of Infantile Hypertrophic Pyloric Stenosis

Background : Infantile hypertrophic pyloric stenosis is the commonest surgical cause of vomiting in early infancy and can be diagnosed clinically or by imaging studies. OBJECTIVES : To assess the accuracy of clinical examination as compared with ultrasound and upper gastrointestinal contrast imaging in the diagnosis of infantile hypertrophic pyloric stenosis. PATIENTS AND METHODS : A prospective study of 30 patients referred to the pediatric surgical department in pediatric teaching hospital in Erbil with a possible diagnosis of IHPS in the period from June 2006 to January 2009. RESULTS : The male to female ratio was 3.28:1 .The mean age at onset was 29.5 days. The mean age at presentation was 48 days. Projectile vomiting was present in all infants (100%). Pyloric mass was palpable in 21 infants (70%). Visible peristaltic waves were noted in 12 infants (40%). 27 patients (90%) had gastric aspirate of more than 10cc. Ultrasound examination was confirmatory in 29 patients (96.6%). Barium study was positive in 27 cases (90%) and different signs were noted with various percentages. All patients underwent Ramstedt`s operation through right upper transverse incision. The average hospital stay was 3.5 days. The long term results in all the 30 cases were excellent. CONCLUSION : A palpable pyloric mass with suggestive history is a sufficient indication for proceeding to surgical treatment without confirming diagnostic imaging studies. However, when physical findings alone are inconclusive, an upper gastrointestinal series or an abdominal ultrasound examination should be done because of their high sensitivity in identifying the underlying problems. DOI: 10.7176/JHMN/76-04 Publication date: June 30th 2020

A comprehensive review of the normal, abnormal, and post-operative MRI appearance of the proximal biceps brachii.

The biceps brachii myotendinous unit, particularly the long head of the biceps tendon and its labral attachment, is a common cause of shoulder and arm pain. Its complex anatomy and normal variations can present a challenge when interpreting MR images. The purpose of this manuscript is to review the proximal biceps anatomy, variants, pathology, and post-operative appearance as seen on MRI. Recent data regarding the accuracy of clinical examination and MRI will be summarized.

Fetal weight estimation at term \u2013 ultrasound versus clinical examination with Leopold\u2019s manoeuvres: a prospective blinded observational study

BackgroundFetal weight estimation is of key importance in the decision-making process for obstetric planning and management. The literature is inconsistent on the accuracy of measurements with either ultrasound or clinical examination, known as Leopold’s manoeuvres, shortly before term. Maternal BMI is a confounding factor because it is associated with both the fetal weight and the accuracy of fetal weight estimation. The aim of our study was to compare the accuracy of fetal weight estimation performed with ultrasound and with clinical examination with respect to BMI.MethodsIn this prospective blinded observational study we investigated the accuracy of clinical examination as compared to ultrasound measurement in fetal weight estimation, taking the actual birth weight as the gold standard.In a cohort of all consecutive patients who presented in our department from January 2016 to May 2017 to register for delivery at ≥37 weeks, examination was done by ultrasound and Leopold’s manoeuvres to estimate fetal weight. All examiners (midwives and physicians) had about the same level of professional experience.The primary aim was to compare overall absolute error, overall absolute percent error, absolute percent error > 10% and absolute percent error > 20% for weight estimation by ultrasound and by means of Leopold’s manoeuvres versus the actual birth weight as the given gold standard, namely separately for normal weight and for overweight pregnant women.ResultsFive hundred forty-three patients were included in the data analysis. The accuracy of fetal weight estimation was significantly better with ultrasound than with Leopold’s manoeuvres in all absolute error calculations made in overweight pregnant women. For all error calculations performed in normal weight pregnant women, no statistically significant difference was seen in the accuracy of fetal weight estimation between ultrasound and Leopold’s manoeuvres.ConclusionsData from our prospective blinded observational study show a significantly better accuracy of ultrasound for fetal weight estimation in overweight pregnant women only as compared to Leopold’s manoeuvres with a significant difference in absolute error. We did not observe significantly better accuracy of ultrasound as compared to Leopold’s manoeuvres in normal weight women. Further research is needed to analyse the situation in normal weight women.

Clinico- pathological correlation of pattern of cervical lymph node metastases in oral cavity cancers

Introduction: The Oral Squamous cell carcinoma spreads by lymphatics. Hence it is the important prognostic factor in oral carcinoma. The involvement of lymph nodes guides in the treatment of oral carcinoma and neck dissection. By knowing the level of involvement of oral carcinoma, the staging can be done and the type of neck dissection can be planned accordingly and decrease the morbidity of the radical neck dissection.Aim: To determine the clinico pathological correlation of pattern of cervical lymph nodes metastases in oral cavity cancers. Methodology: It is a prospective study of histologically proven oral carcinoma of 50 patients. Data for the study collected from the patients coming to the General Surgery OPD at SS Institute of Medical sciences and Research Centre, Davangere, over a period of two years from October 2016 to August 2018. Inclusion Criteria included are patients with clinical suspicion of oral cancer with positive/negative lymph nodes, previously untreated oral cancers, histologically proven oral carcinoma cases. Exclusion Criteria are patients not willing to give informed consent, patients who are unfit for general anaesthesia, prior treatment of other head and neck cancers by surgery, chemotherapy and radiotherapy, previous surgery in the neck, presence of distant metastasis. Clinical neck examination done along with other necessary radiological investigations. The neck examination is compared with histological examination. The analysis done by Sensitivity, Specificity and Accuracy of the neck examination.Results: In our study, Pathologically level II (56.3%) was the most commonly involved lymph node station in patients with oral cancer. Most of the patients presented in an advanced stage clinically. Stage IV was the commonest with 20(40%) patients. The Sensitivity and Specificity of the clinical neck examination were 76.9% and 61.8% respectively in patients with oral cancer. The accuracy of clinical examination is 78%. In our study, tumour stage had a positive correlation (r=0.987) with the pathological nodal status, that was significant (p=

Correlation of Clinical Examination, MRI and Arthroscopy Findings in Menisco-Cruciate Injuries of the Knee: A Prospective Diagnostic Study

Background The aim of this study was to examine the correlation of the clinical examination, MRI and arthroscopic findings in cruciate ligaments and meniscal injuries of knee and to evaluate the accuracy of clinical examination and MRI with the gold standard arthroscopy. Methods A prospective diagnostic double-blind study was conducted on 104 consecutive patients admitted to the outdoor/casualty with trauma to the knee complaining of knee pain/locking/ instability, from August 2012 to June 2014. All the patients were subjected to clinical examination, MRI scanning and diagnostic arthroscopy. Variables like sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical examination and MRI against arthroscopy were evaluated. Results The sensitivity, specificity and accuracy of clinical examination for anterior cruciate ligament tears were 94.7%, 71.4% and 88.5% and for MRI were 94.7%, 78.6% and 90.4%, respectively; for posterior cruciate ligament tears 100%, 100% and 100% for clinical examination and for MRI 80%, 97.9% and 96.2%, respectively. These values for medial meniscus tears were 76.5%, 68.6% and 71.2% for clinical examination and 88.2%, 62.8% and 71.2% respectively for MRI. For lateral meniscus tears, 40%, 94.6% and 78.8% for clinical examination and 46.7%, 89.2% and 76.9% respectively for MRI. Conclusions A skillfully performed clinical examination establishes a diagnosis on which an arthroscopic procedure can be planned, reserving MRI scans for patients where the clinical examination fails to establish a diagnosis or cannot be performed. Decision to use MRI should be based on the criteria that it would confirm, expand the diagnosis or change diagnosis in such a way that alters the proposed treatment.

Abstract 18614: Rheumatic Heart Disease Screening in Schools Through Portable Echocardiography: Data From the PROVAR Study

Introduction: The accuracy of clinical examination is limited for early diagnosis of Rheumatic Heart Disease (RHD). The 2012 World Heart Federation (WHF) Criteria provides standardized echocardiographic (echo) guidelines for diagnosis of RHD. There is sparse data on echo prevalence of RHD in Brazil. Objective: Assess the prevalence of RHD in students (6-18 years) from public schools in low-income areas in Belo Horizonte, Brazil. Methods: Over 4-days, experts used standard portable echo machines (GE, Vivid-Q) and the 2012 WHF Criteria to determine RHD prevalence. All consented and present children at the visited schools were eligible for participation. Studies identified as abnormal were blindly read by a second cardiologist, with non-agreement adjudicated by a third. RHD prevalence by gender and age (5-11 & 12-18) were compared using Fisher’s Exact Test. Results: A total of 1381 students were screened across four schools in urban Belo Horizonte, Brazil. The mean age was 13.6±2.8 years, range 5-18 years; 59.3% were female. The prevalence of RHD was 3.8% (53/1381): 3.4% borderline RHD (n=47) and 0.4% definite RHD (n=6). Of these cases, 46 (86.8%) had pathologic mitral regurgitation (≥2cm, seen in 2-views, pan-systolic, and velocity ≥3m/sec) and 7 had pathologic aortic regurgitation (≥1cm, seen in 2-views, pan-diastolic, and velocity ≥3m/sec). One child had mixed mitral and aortic valve disease. There were no cases of mitral or aortic stenosis. There was no difference in RHD prevalence between males and females (p=0.57), but older children had a higher prevalence rate (5-11 years 1.3% vs. 12-18 years 4.5%, p=0.01). Minor congenital heart disease was detected in 8 additional children (5.8%), including one large ASD that was referred for closure. Conclusions: WHF Criteria make it possible to obtain and accurately compare echo prevalence of RHD among different regions of the world. The PROVAR study shows that, among children living in low-socioeconomic conditions in urban Brazil, RHD remains a significant health burden, comparable to that in other low-resource communities. Screening older children has higher yield. Contemporary data such as these provide justification for investing in comprehensive RHD control programs both in Brazil, and around the globe.

Accuracy of clinical examination and chest X-ray compared to lung ultrasound in postoperative cardiac surgery patients

Accuracy of clinical examination and chest X-ray compared to lung ultrasound in postoperative cardiac surgery patients

ARTHROSCOPIC DETERMINATION OF ACCURACY OF CLINICAL EXAMINATION IN INJURIES WITH INTERNAL DERANGEMENT OF KNEE

Abstract Background: For the diagnosis of knee injuries some investigations along with detailed history and clinical examination such as arthrography and arthroscopy are required, which increase the authenticity of diagnosis. Objective: To determine diagnostic accuracy of pre-operative clinical diagnosis with arthroscopic diagno-sis in internal derangement of knee. Methods: This was a Comparative cross sectional study. Conducted at Department of Orthopaedic Sur-gery and Traumatology (DOST) Unit - 1, King Edward Medical University, Mayo Hospital Lahore. Total 45 patients having symptomatic knee injuries, were inclu-ded in this study. After taking informed consent from these patients, a clinical diagnosis of medial meniscus tear (MMT), lateral meniscus tear (LMT), anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament(MCL) and lateral collateral ligament (LCL) injury of knee was made, confirmation with magnetic resonance imaging (MRI) was done and those patients having positive clinical and MRI findings of above mentioned injuries arthro-scopy was carried out and then findings of both clini-cal examination and arthroscopy were compared to find out the diagnostic accuracy of clinical examinat-ion. Data was analyzed with the help of SPSS version 20. Results: Mean age of all 45 patients was 29.51 ± 8.72 years. Minimum and maximum age of patients was 18 and 48 years respectively. Clinical examination is 70.83% sensitive and 19.05% specific for medial meniscus tear. Clinical examination has 50% Positive predictive value and 36.36% Negative predictive value. For the diagnosis of Lateral Meniscal tear, clini-cal examination is 16.67% sensitive and 89.47% speci-fic. While clinical examination has 20% positive pre-dictive value and 87.5% negative predictive value. For ACL rupture diagnosis clinical examination is 72.73% sensitive and 66.67% specific. While clinical examina-tion has 85.71% positive predictive value and 47.06% negative predictive value. Conclusion: Results of this study clearly revealed that diagnostic accuracy of clinical examination for the diagnosis of internal derangement of knee shows vari-ability. Clinical examination findings have high sensi-tivity for diagnosis of MMT and ACL injuries while it shows very low sensitivity for LMT. While specificity of clinical examination for diagnosing LMT and ACL was high but for MMT was low. Key Words: Arthroscopy, Clinical Examination, Internal derangement, Knee.

Accuracy in detecting knee effusion with clinical examination and the effect of effusion, the patient's body mass index, and the clinician's experience

The purpose of this study was to determine the accuracy of detecting knee effusion with clinical examination and to evaluate whether the amount of effusion, patient obesity, and the clinicians' experience affect the clinicians' decisions in patients with knee osteoarthritis. Patients presenting with knee pain were examined by two residents with different levels of experience and underwent ultrasonographic examination, including measurement of effusion in the medial, mid, and lateral aspects of the suprapatellar bursa. One hundred seventy-two knees of 86 patients were examined. Of the knees investigated, 127 (73.8%) had effusion. The consistency between ultrasonographic and resident examination were weak (κ = 0.193, p = 0.007 and κ = 0.349, p < 0.001), although the more experienced senior resident had a stronger agreement. The overall inter-rater agreement between the two residents was low (κ = 0.254). The senior resident had a significantly higher accuracy ratio (p = 0.036). In the knees without effusion, the two examiners had no agreement (κ = -0.028, p = 0.856); however, the ratios of the true decisions were similar (p = 1.0). The accuracy of the less experienced resident's decisions was affected by effusion depth (p = 0.005). Clinicians' decisions and their accuracy in detecting knee effusion during clinical examination were different, especially in the absence of effusion. The consistency between ultrasonography and residents was low. The accuracy of clinical examination was affected by effusion depth and experience, but not by patient obesity.

Clinico-radiological correlation in the diagnosis of ligament and meniscus injuries at knee joint: A prospective study

Purpose: The purpose of this study was to determine the MRI appearances and various patterns of ligament and meniscus tears in knee joint injuries and to correlate the clinical findings with MRI findings. Materials and Methods: Our study included 50 patients, who were referred to radiology department for MRI of knee joint following injury. Prior to MRI, a detailed clinical and local examination was done in all the subjects. MRI was carried out on MAGNETOM Avanto 18 Channel 1.5 Tesla Machine by Siemens India Ltd and the standard protocol consisted of PD(TE 45 TR 2800), T2W(TE 73 TR 5090), fat suppressed T2W(TE 26 TR 5000) spin echo sequences in axial, sagittal and coronal planes. The MRI findings were compared with arthroscopic findings in 30 subjects and in rest of the subjects characteristic MRI features were considered diagnostic. Results: Diagnostic accuracy of clinical examination (83%) was relatively low as compared to MR examination (88%) in our study. The percentage correlation between clinical and MRI findings regarding presence or absence of ligament/meniscus tear was highest in case of PCL tears (94%). Amongst ligament injuries, complete tear of ACL alone was the most common injury (53%) and ACL injury was most commonly associated with MM injury (16%), intrasubstance tears were more common than attachment site tears. Conclusions: MR is unique in its ability to evaluate the architecture as well as the surface of ligaments and menisci. MRI is more sensitive than clinical examination in diagnosing ligament and meniscus injuries.

Evaluation of Clinical Efficacy of the Sensifemme® Device in the Diagnosis of Breast Lump

INTRODUCTION: Breast cancer is the most common malignant tumor among women after no melanoma skin cancer and an important cause of cancer mortality. Secondary prevention strategies emphasize breast self-examination, clinical breast examination and mammography. Mammography is the major method for early detection of disease. Self-examination and clinical breast examination have low sensitivity and there is no evidence to decrease mortality from breast cancer. The Sensifemme® device is a glove with three layers of polyurethane with a thickness of 0.5 mm and has a mineral oil interposed between these layers. Between the inner and middle layer, there is enough space for the examiner s hand to be introduced during the use of the device. The glove was developed to allow greater slippage examiner s hand on the breast, which would increase the sensitivity of clinical examination and self-examination. The aim of this study was to evaluate the clinical efficacy of the Sensifemme® device in the diagnosis of breast lump. MATERIALS AND METHODS: Prospective, randomized, double-blind study in which 75 patients in breast diseases outpatient of Department of Gynecology of Escola Paulista de Medicina from Universidade Federal de Sao Paulo, were randomized into two groups; the patients in group 1 were first examined by Sensifemme® device and group 2 were examined without device as control group. Subsequently all patients underwent bilateral ultrasound to confirm or exclude the physical examination findings. RESULTS: The mean age of patients was 43 years old and 90 breast lumps were detected after clinical examination and ultrasound, distributed in 74% solid nodules and 26% cystic nodules. In the group Sensifemme® device sensitivity was 74%, specificity was 61.5% and accuracy was 71.5%. In the control group was, respectively, 63%, 65. 3% and 63. 7%. The effectiveness of the Sensifemme® device was significantly higher in the nodules smaller than 2 cm and in cases that the distance between skin and lump was 1 to 2 centimeters. DISCUSSION: The self-examination and clinical breast examination are not sufficient for breast cancer screening. However, breast awareness may alert the patients about any changes in the breasts and lead them to a medical service earlier. The self-examination is recommended with the practice of health education and knowledge of the body. The Sensifemme® device showed positive impact by helping to improve the accuracy of clinical examination. CONCLUSION: The Sensifemme® device was more effective than the clinical examination performed without the device in the diagnosis of breast lump, which can facilitate the detection of breast lesions and increase the sensitivity of clinical examination, without reducing the importance of mammography.

Accuracy of Clinical Examination, Digital Mammogram, Ultrasound, and MRI in Determining Postneoadjuvant Pathologic Tumor Response in Operable Breast Cancer Patients

Accuracy of Clinical Examination, Digital Mammogram, Ultrasound, and MRI in Determining Postneoadjuvant Pathologic Tumor Response in Operable Breast Cancer Patients

Accuracy of Clinical Examination, Digital Mammogram, Ultrasound, and MRI in Determining Postneoadjuvant Pathologic Tumor Response in Operable Breast Cancer Patients

To determine the accuracy, positive predictive value (PPV), and negative predictive value (NPV) of clinical examination and breast imaging techniques in determining pathologic complete response in patients with locally advanced breast cancer after neoadjuvant therapy. A retrospective review was performed of data collected from patients treated with either neoadjuvant hormonal or chemotherapy between January 2005 and September 2010. Patients were evaluated by one of three surgical breast oncologists before neoadjuvant therapy and within 1 month before surgery by clinical breast examination (CBE), digital mammogram, breast ultrasound, and/or magnetic resonance imaging (MRI). The accuracy, NPV, and PPV of each modality was calculated on the basis of the final pathologic report. Available data from the literature was synthesized. Sixty-two tumors in 61 patients with a mean age of 56 (range 34-87) years were evaluated. Overall accuracy ranged from 54% (CBE) to 80% (breast ultrasound). All modalities had a PPV greater than 75% for identifying the presence of residual disease. The PPV of each modality was generally higher in the younger patients. The NPV of all methods was less than 50%. The accuracy and NPV were compromised even further in younger patients. The combination of our own data with data available from the literature revealed MRI to be superior with regard to accuracy and PPV, but the NPV of MRIs remained poor at 65%. All measured tests are good at predicting the presence of disease on final pathology, but none are able to reliably predict a pathologic complete response.

Diagnostic accuracy of preoperative clinical examination in upper limb injuries

Background:Injuries in hands and forearms may cause significant discomfort and disability.Aim:To evaluate the accuracy of preoperative clinical examination in depicting lesions caused by penetrating wounds of hands or forearms.Setting and Design:This prospective study was conducted from August 2006 to September 2009 at Kashani University Hospital, Isfahan University of Medical Sciences, Iran.Materials and Methods:Two hundred and fifty patients with clean penetrating injury to the hand/forearm were enrolled in this study. After patient's data registration, a careful clinical examination and routine exploration without expansion of wound were done by an orthopedic resident. Each tendon was tested at each joint level. Nerves were evaluated with a two-point discrimination test, and arteries were tested with palpable pulses. Surgical exploration was done by a single hand surgeon in operation room. Accuracy of clinical examination was compared to surgical examination.Results:During the study period, 180 (72%) males and 70 (28%) females with mean age of 28±4 years participated. The preoperative examination showed a predominance of the volar zone IV injuries followed by volar zone II, III, thumb zone II, volar zone V and thumb zone III. Despite the enough accuracy of preoperative examinations in dorsal side injuries of hands and forearms (error rate = 8.3%), the preoperative examinations significantly underestimated the amount of damage to soft tissues on the volar side of hands and forearms (error rate = 14%).Conclusions:The precise surgical evaluations should be considered in patients with penetrating injury to the hand or forearm, especially in those with volar side injuries.

Management of varicose veins: Status of clinical examination and Colour Doppler in the present Indian scenario

Varicose veins affect a significant percentage (40%) of the middle-aged population. It may not cause any mortality in the patients but causes a significant morbidity if left untreated. It is important to properly localize the problem before surgical management, to avoid recurrence of the disease. Clinical examination, if done alone for evaluation of patients of varicose veins, has a sensitivity of 90% for the saphenofemoral junction. But for perforator incompetence, it has a sensitivity of 61.5% only. There are likely chances that incompetent perforators are missed and may lead to recurrence of disease. Colour duplex ultrasound is an important non-invasive method for identification of superficial venous and perforator incompetence. It is especially valuable in detecting saphenopopliteal and perforator incompetence where accuracy of clinical examination is very low. It can help in localizing the perforators more precisely so that surgery can be performed by small incisions, especially at places where the facility for subfascial endoscopic surgery (SEPS) is not available. The authors recommend Color Doppler sonography in all patients of varicose veins before subjecting them to surgery as it is available in most of the district level centres in India.

Measurement of residual tumour size after neo-adjuvant chemotherapy for locally advanced breast cancer: accuracy of clinical examination, mammography, ultrasound and magnetic resonance imaging

Measurement of residual tumour size after neo-adjuvant chemotherapy for locally advanced breast cancer: accuracy of clinical examination, mammography, ultrasound and magnetic resonance imaging

Fetal head position during the second stage of labor: Comparison of digital vaginal examination and transabdominal ultrasonographic examination

Objective To study the correlation between digital vaginal and transabdominal ultrasonographic examination of the fetal head position during the second stage of labor. Methods Patients ( n = 110) carrying a singleton fetus in a vertex position were included. Every patient had ruptured membranes and a fully dilated cervix. Transvaginal examination was randomly performed either by a senior resident or an attending consultant. Immediately afterwards, transabdominal ultrasonography was performed by the same sonographer (OD). Both examiners were blind to each other's results. Sample size was determined by power analysis. Confidence intervals around observed rates were compared using chi-square analysis and Cohen's Kappa test. Logistic regression analysis was performed. Results In 70% of cases, both clinical and ultrasound examinations indicated the same position of the fetal head (95% confidence interval, 66–78). Agreement between the two methods reached 80% (95% CI, 71.3–87) when allowing a difference of up to 45° in the head rotation. Logistic regression analysis revealed that gestational age, parity, birth weight, pelvic station and examiner's experience did not significantly affect the accuracy of the examination. Caput succedaneum tended to diminish ( p = 0.09) the accuracy of clinical examination. The type of fetal head position significantly affected the results. Occiput posterior and transverse head locations were associated with a significantly higher rate of clinical error ( p = 0.001). Conclusion In 20% of the cases, ultrasonographic and clinical results differed significantly (i.e., >45°). This rate reached 50% for occiput posterior and transverse locations. Transabdominal ultrasonography is a simple, quick and efficient way of increasing the accuracy of the assessment of fetal head position during the second stage of labor.