Simple Clinical Methods Research Articles

Reliability of the assessment of scapular posterior tilt angle using the smartphone and scapular movement during arm elevation in healthy individuals and patients with frozen shoulder: a cross-sectional study.

Frozen shoulders are associated with abnormal scapular movements. However, scapular posterior tilt movement in frozen shoulders has not been investigated using simple clinical methods. This study aimed to clarify the reliability of scapular posterior tilting movement using a smartphone and scapular posterior tilting movement in healthy individuals and patients with frozen shoulder. The participants were 22 healthy young (age 25.9±4.1 years), 22 healthy middle-aged (age 52.6±4.4 years), and 37 individuals with frozen shoulder (age 56.0±7.0 years). Scapular posterior tilting movement was measured at shoulder flexion 0° (0° posterior tilt), shoulder flexion 90° (90° posterior tilt), and scapular tilt excursion using a smartphone. The intrarater reliability was calculated using the intraclass correlation coefficient (1, 3). Intrarater reliability at 0° posterior tilt and 90° posterior tilt was 0.76 and 0.84, respectively. The 0° posterior tilt was not significantly different among the three groups (P=.90). The 90° posterior tilt was not significantly different among the three groups (P=.06). The scapular tilt excursions were significantly greater in the frozen shoulder group than in the middle-aged group (P=.03). Measurement of scapular posterior tilting movement using a smartphone was highly reliable. The frozen shoulder might compensate for the limited arm elevation of the glenohumeral joint by scapular posterior tilting movement.

Rapid microRNA detection method based on DNA strand displacement for ovarian cancer cells.

The current cancer detection methods are heavily dependent on the component analysis of corresponding cancer antigens. There is a lack of effective and simple clinical methods of ovarian cancer screening, which hinders the early identification for ovarian cancer and its treatment. To develop a simple and rapid method for quantitative analysis of ovarian cancer, we developed a DNA strand displacement-based method and finished the rapid detection of miR-21 in ovarian cancer cells within 5 min by a one-step isothermal reaction. The fluorescence intensity trajectory had a good linear relationship with miR-21 concentrations in the range of 100 fM-100 nM, with a lower limit of 6.05 pM. This detection method is simple, faster, and accurate. Besides, it can be applied to detect the miRNA biomarkers of other cancers by changing the preset sequences of toehold.

Prevalence of peripheral neuropathy among type 2 diabetes mellitus patients in a rural health centre in South India

There is a huge burden of diabetes-related complications, both microvascular and macrovascular, in India. With the rising prevalence of diabetes mellitus (DM), this translates to an increasing number of people with complications of DM. Diabetic peripheral neuropathy (DPN) is the most common complication among DM patients with a prevalence ranging from 18.8 to 61.9% in India. Early diagnosis of DPN can reduce associated complications. Screening services at the primary healthcare level can aid early diagnosis of complications and improve health outcomes among DM patients. This study aimed to assess the prevalence of DPN and its risk factors among the type 2 DM patients attending a rural health centre. A cross-sectional study was conducted among 390 type 2 DM patients attending the Rural Health and Training Centre of Sri Ramachandra Medical College & Research Institute. Data was collected using a standardized questionnaire followed by general inspection and physical examination of the feet. Blood sample was taken to estimate HbA1c and urine sample was collected to detect presence of albumin. Among the 390 participants, 175 (44.9%) had neuropathy of which 87 (51.5%) were symptomatic. Educational status of primary schooling and less (OR = 3.34; p < 0.001), duration of DM (OR = 1.73; p = 0.038), higher HbA1c levels (OR = 2.87; p = 0.018), presence of urine albumin (OR = 2.57; p = 0.033) and peripheral vascular disease (OR = 2.85; p < 0.001) were predictors for DPN. The present study shows that the prevalence of peripheral neuropathy is high in rural areas. Regular screening using simple clinical bedside methods and affordable tools can help early identification of DPN and prevent complications like foot ulcer which ultimately leads to amputation.

Measurement of Lumbar Spine Functional Movement in Low Back Pain.

Individuals with low back pain (LBP) present with alterations or limitations of spinal mobility. The identification of simple clinical methods for evaluating functional movement of the spine is necessary to allow quantification of the degree of movement impairment and permit monitoring of patient improvement with rehabilitation. This study evaluated movement of the spine in 20 patients with chronic nonspecific LBP compared with 19 pain-free participants using a novel measurement device that permits the dynamic assessment of spinal movement in a rapid and subject-specific manner. Two flexible sensor strips were fixed paravertebrally to the spine with each sensor strip measuring angles in 12 predetermined, adjacent, 25-mm-long segments. Maximum range of motion (ROM) and average angular velocity (AAV) of lumbar and pelvic movement were measured within identical angular and temporal frames during the descending and ascending phase of active lumbar flexion, extension, rotation, and lateral flexion following a standard choreography. Participants with LBP completed a number of questionnaires including the Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, and Spielberger State-Trait Anxiety Inventory. Across all movements, the individuals with LBP displayed 10% to 15% less ROM (P<0.05) and 15% to 30% less AAV (P<0.05) at both the pelvis and lumbar regions compared with controls. ROM as well as AAV, in most cases, were negatively correlated (R=-0.49 to -0.75) with the Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, and Spielberger State-Trait Anxiety Inventory in the LBP group (all P<0.05) especially during the initial descending phase of movement. This study provide support for the utility of this device for quantifying movement impairments in individuals with fairly low levels of LBP and general functional limitations. The results show that velocity measurements rather than ROM show the greatest differences in individuals with LBP compared with asymptomatic participants. Impaired lumbar and pelvis movement was correlated to the individuals with LBP's degree of anxiety, fear, and catastrophizing.

An Assessment of 2 Objective Measurements of Web Space Position

To describe 2 simple objective clinical methods of measuring the web position between fingers and to determine their intra-observer and inter-observer reliabilities. Two observers examined the second, third, and fourth web spaces on both hands of 30 adult healthy volunteers. The web index measured the web height as a relative ratio to constant anatomical landmarks on both fingers subtending the web. The dorsal web index took reference from the distance between the metacarpophalangeal and proximal interphalangeal joints, whereas the palmar web index was measured in relation to the distance between the most proximal basal digital and proximal interphalangeal joint creases. The intraclass correlation coefficient was used to determine intra-observer and inter-observer reliability. Intraclass correlation coefficient values for intra-observer and inter-observer reliability were greater than 0.80, indicating excellent agreement. There was no statistically significant difference between the dorsal or palmar measurement methods in terms of reliability. The dorsal or palmar measurement method may be reliably used in healthy adults to establish a web index that describes the web position. The palmar method is considered easier to perform. Diagnostic III.

Hemodynamically Significant Arterial Inflow Stenosis in Dysfunctional Hemodialysis Arteriovenous Fistulae and Grafts

Hemodynamically significant arterial inflow stenosis in dysfunctional fistulae and grafts is poorly understood. No reliable clinical methods exist to detect arterial inflow stenosis. In this study, we assessed the accuracy of a novel screening method to detect arterial inflow stenosis in dysfunctional fistulae and grafts following successful juxta-anastomotic and venous outflow intervention. We prospectively evaluated all patients (N= 204) referred to our academic center for angiographic evaluation of a dysfunctional dialysis fistula/graft from May 1, 2006 to June 30, 2007. Following successful angioplasty/stenting of the venous outflow and juxta-anastomotic areas, patients were screened for arterial inflow stenosis. The screening method involved detection of 1) weak thrill, or sluggish blood flow on the post-intervention angiogram, 2) low mean arterial blood pressures in the dialysis access arm compared to the contralateral arm, and 3) inadequate blood flow at the first hemodialysis session post-intervention. If patients screened positive for any of these, they were further evaluated for arterial inflow stenosis. Fifteen patients (15/204) were positive for arterial inflow stenosis on screening study. Eleven of those 15 had arterial stenosis on angiography, giving our screening method a positive predictive value of 73.3%. Eight patients were successfully treated by angioplasty/stenting. Two patients successfully underwent surgical intervention. Two year patency of revascularization was 91% (10/11). Hemodynamically significant arterial inflow stenosis occurs and can be detected by simple clinical methods. Interventions for correction of the arterial inflow stenosis are successful.

Evaluation of the thorax shape in the transverse plane with simple clinical technique

Cobb angle measures the shadows of the two limit vertebrae while scoliotic deformity is a complex 3D phenomenon. There is a deficiency of simple clinical methods of thorax shape evaluation. The objective of the study was to investigate the technique measuring thorax transverse plane deformity in patients with idiopathic scoliosis.

Facioscapulohumeral muscular dystrophy: a prospective study of weakness and functional impairment

Only isolated prospective studies have attempted to chart the natural history of facioascapulohumeral muscular dystrophy (FSHD), a benign myopathy with notoriously variable clinical manifestations and progression. This 10-year prospective study was performed to document by simple clinical methods the natural history of 16 patients with moderately advanced FSHD. Limb strength was evaluated by the bedside manual muscle test. Global weakness was documented as a composite average muscle score (AMS). Limb function was evaluated by a non-linear grading system of important functional milestones. A scale of activities of daily living (ADL) was used to assess disability across multiple functional domains in a home environment. Six-monthly evaluations determined a linear deterioration of the mean AMS that reached statistical significance from baseline at the 5-year interval. Half of patients showed a functional decline of the arms by one grade. All patients maintained useful hand function. Three quarters of patients suffered functional decline of the legs, commonly by one grade. All patients remained ambulant. Interval analyses showed a linear deterioration of the mean ADL score that reached statistical significance from baseline at the 5-year interval. Functional deterioration was mostly due to impaired shoulder girdle activities. This study of a relatively homogeneous subgroup of FSHD patients showed a predictable rate of clinical progression in a muscle disease with a notoriously variable clinical presentation and outcome. Natural history data obtained in this study could serve as positive controls for future therapeutic trials in this patient population. The chosen clinical parameters proved useful tools for charting clinical disease progression. Functional tests proved advantageous, because decline was based partly on patient self-reports, thereby improving time and cost effectiveness.

A survey of paediatric caudal extradural anaesthesia practice

Introduction: Caudal extradural anaesthesia (CEA) is a common technique with wide application in paediatric anaesthesia [1]. An ‘on line’ World Wide Web survey of paediatric anaesthetists was undertaken to delineate any differences in the practice of this procedure. Methods: A web based questionnaire was devised to survey the practice of caudal extradural anaesthesia in children by anaesthetists who were members of the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI). The questionnaire was designed to collect information on the experience of the anaesthetist, techniques employed, drugs used and the use of the caudal extradural catheter technique for continuous extradural anaesthesia and analgesia. Results: E-mails were sent to 600 anaesthetists and there were 366 useable on-line replies. The majority of respondents had greater than 5 years of paediatric anaesthetic experience and performed up to ten caudal extradural procedures a month. The commonest device used was a cannula (69.7%) with 68.6% using a 22G device. Those with less than 15 years experience tended to employ a cannula while anaesthetists with greater than 15 years experience favoured a needle technique. Most anaesthetists (91.5%) did not believe that there was a clinically significant risk of implantation of dermoid tissue into the caudal extradural space. The majority of anaesthetists used a combination of clinical methods to confirm correct placement of a needle or cannula and injection of local anaesthetic into the caudal extradural space. Only 27 respondents indicated that they used ultrasound. The local anaesthetic agents used were bupivacaine (43.4%), levobupivacaine (41.7%), ropivacaine (13.4%) and lignocaine (1.5%). A total of 104 anaesthetists used more than one type of local anaesthetic. Drug additives used included clonidine (42.3%), ketamine (37.5%) and opioids (18.1%). The caudal catheter technique was used by 43.6% of anaesthetists. For a single shot caudal injection most anaesthetists (74%) used gloves only with fewer adopting the ‘no touch’ technique (15.2%) or use of glove, gown and mask (10.8%). Anaesthetists with greater than 10 years experience tended to use a ‘no touch’ technique. Discussion: Caudal extradural anaesthesia is an extremely common technique among those surveyed. Most anaesthetists use a cannula to access the caudal space which is in variance with the description of the technique in the peer review literature. However, the needle technique still tends to be used by anaesthetists with more than 15 years of experience. The majority of anaesthetists concur with the lack of evidence that there is a risk of implantation of dermoid tissue into the caudal extradural space. The anaesthetists surveyed tended to use a combination of simple clinical methods to identify correct placement of local anaesthetic in the caudal space. Ultrasound is rarely used. This may change when ultrasound become more readily available. Despite the greater safety margin of levobupivacaine, bupivacaine is used slightly more frequently. This may be due to cost. Ketamine and clonidine are the most commonly used additives. The caudal extradural catheter technique is used by a large proportion of anaesthetists despite there being few commercially available sets of equipment [2]. While most anaesthetists wear gloves for asepsis some still employ a more traditional no-touch technique. Conclusion: To our knowledge this is the first electronic large scale survey of anaesthetists who perform caudal extradural anaesthesia in children. The findings of this survey provides a snap shot of current practice and act as a useful reference for the development of enhanced techniques and new equipment to improve safety and efficacy in the future.

Eosinophilic glomerulonephritis in children in Southwestern Uganda

Acute renal disease is common in sub-Saharan Africa, with high mortality. Its etiology is poorly understood; quartan malaria owing to Plasmodium malariae was implicated in previous series. Few previous studies have included histological data; furthermore, much of the literature pre-dates the human immunodeficiency virus (HIV) epidemic. We report prospective analysis of acute proteinuric renal disease in children in rural Uganda. Clinical and laboratory data are presented on 65 patients (aged 2-14 years, mean 8.4; 35 male, 30 female) in 41 of whom histological diagnosis was obtained by renal biopsy. The most frequent histological finding was endocapillary proliferative glomerulonephritis (GN) in 27/41 cases, in 20 of which eosinophils were very prominent. No cases showed features of HIV nephropathy. Malarial films were positive in 11 cases: all owing to Plasmodium falciparum. Patients were treated with diuretics, antihypertensives, and supportive measures. Corticosteroids were rarely used, being reserved for patients with minimal changes on renal biopsy. Clinical outcomes were fair: 91% of patients survived to discharge. We conclude that acute GN is common in children in Uganda, that an unusual eosinophilic proliferative GN is the most frequent histological finding, that HIV is not implicated as an important factor in this age group, and that good outcomes can be achieved using simple clinical and laboratory diagnostic methods. Renal biopsy in selected cases is feasible and helpful, especially in allowing rational use of corticosteroids and other potentially toxic treatments. Symptomatic treatments and careful supportive care will allow the majority of children to recover.

Validation of a system of foot ulcer classification in diabetes mellitus.

The lack of a simple, robust classification of diabetic foot ulcers has critically hampered research into optimum patterns of care. We have therefore attempted validation of the previously published S(AD) SAD system, which is based on grading of ulcer features using simple clinical methods. This was a prospective study in which 300 people with ulcers newly referred to a hospital-based multidisciplinary clinic between 1 January 2000 and 1 July 2002 were classified at the time of their first assessment. If a patient had more than one episode, the last to occur was selected as the index ulcer. If two or more ulcers were registered simultaneously, the one which was regarded as the more significant was chosen. Ulcers were categorized according to area, depth, sepsis, ischaemia and neuropathy. All patients were followed for at least 6 months, or until death if earlier. Outcome criteria used were healed and unhealed (unhealed persisting, unhealed at amputation or death) and were cross-tabulated with different baseline variables. Ulcers healed in 209 of the 300 patients (69.7%), while 30.0 (10%) had been resolved by amputation (eight major; 22 minor) and 32 (10.7%) by death. Twenty-nine (9.7%) persisted unhealed. There were significant differences in outcome according to area (chi2=25.9, P < 0.001), depth (chi2=33.8, P < 0.001), sepsis (chi2=13.5, P = 0.004) and arteriopathy (chi2 = 33.7, P < 0.001), but not to denervation (chi2=5.1, P = 0.16). The strength of these associations was confirmed using Somers d: area (rs= -0.24, P < 0.001), depth (rs= -0.32, P < 0.001), sepsis (rs= -0.15, P < 0.01), arteriopathy (rs= -0.30, P < 0.001), denervation (rs= -0.10, P = 0.08). Logistic regression analysis using area, depth, sepsis and arteriopathy as independent variables, and those which contributed significantly to the model were area (P = 0.01), depth (P < 0.001) and arteriopathy (P < 0.001). These data demonstrate that simple clinical methods can be used to categorize features of individual ulcers, and that area, depth and arteriopathy contribute independently to a model to predict outcome. A system of classification such as this is an essential requirement for the categorization of populations with similar features and similar prognosis, which may then be used as the basis for prospective research into optimal wound management.

Simple manual reduction of anterior dislocation of shoulder joint

目的 为临床提供4种肩关节脱位手法整复的简便方法;为手术单人操作的顺利完成提供可靠保障,减少患者痛苦.方法其要点是让患者侧坐在椅子上,患肩以骑跨式放在椅背之顶端,让椅背顶端将腋下顶起,使肱骨上端自然得到一种向外推挤的力量.结果59例患者,酌情选用4种方法之一,均由一名术者单人操作完成,省时、省力、无并发症,患者易接受.结论这四种肩关节复位法简便易行、效果可靠,患者痛苦少,术者容易理解和掌握。

The significance of late developmental crowding to early treatment planning for incisor crowding

Incisor crowding has traditionally been attributed to discrepancies in either tooth-jaw size or interarch tooth-size ratios. Such concepts have led orthodontists to develop mixed and permanent dentition space and interarch tooth-size analyses to assist in the diagnosis of crowded dentitions. Treatment plans have emphasized the removal of 4 premolars in an attempt to stabilize the dentition. Although individuals with large teeth may tend to have more incisor crowding, several factors other than tooth size may contribute to incisor crowding, for example, altered resting or functional activity in the facial and masticatory muscles. Thus, changes in occlusion, incisor crowding-spacing, lower anterior face height, and mandibular and maxillary retrognathism or prognathism have all been induced in primates through the application of a single chronically acting, environmental impact, such as either altered tongue posture or oral respiration.1-4 In addition, similar changes have been shown in human beings that were partially reversible after removal of the environmental impact.5,6 Thus, adverse neuromuscular changes, such as chronic mouth open breathing, have been associated with narrowing of both arches and lingual inclination of the incisor teeth and crowded dentitions.1,7-10 These dentoalveolar and skeletal changes were partially or fully reversible without orthodontic therapy after removal of the chronic input8,10 It follows that judicious orthodontic expansion procedures might be warranted to assist recovery in such cases after removal of the neuromuscular insult. We are indebted to the University of Washington for their documentation of late developmental crowding up to age 40 in orthodontically untreated as well as treated individuals. Study of untreated individuals at the University of Toronto shows that this phenomenon continues to at least age 70. Such crowding seen during the teen and adult years cannot be called tooth-jaw size discrepancy and must be neuromuscular in nature. Strong evidence supports the view that many of the crowdings we see during the mixed dentition are also neuromuscular or developmental. In a previous study9 of the relationship between mandibular incisor crowding and nasal mucosal swelling, cephalometric and dental cast variables from 30 male and 20 female children (8 to 13 years old) with chronic nasal mucosal swelling were compared with matched controls. These controls were orthodontically untreated and had no history of airway obstruction. The nasal mucosal swelling was confirmed with active posterior rhinomanometry and a headout volume-displacement plethysmograph. The subjects with nasal mucosal swelling had significantly (P < .001) more mandibular incisor crowding aDepartment of Orthodontics, University of Toronto. Reprint requests to: Donald G. Woodside, CM, DDS, MSc(D), PhD(hc), Department of Orthodontics, University of Orthodontics, 124 Edward Street, Toronto, Ontario, Canada M5G 1G6. Copyright © 2000 by the American Association of Orthodontists. 0889-5406/2000/$12.00 + 0 8/1/106117 doi.10.1067/mod.2000.106117 The significance of late developmental crowding to early treatment planning for incisor crowding

Detrusor instability and low compliance may represent different levels of disturbance in peripheral feedback control of the micturition reflex.

Detrusor instability is a major cause of urinary incontinence in females. Its cause is unknown. Diagnosis is made with cystometry. A phasic pressure rise during cystometry diagnoses the unstable detrusor, and a non-phasic pressure rise the stable "low-compliance" detrusor. The aim was to test the hypothesis that such cystometric findings may represent different levels of disturbance in peripheral feedback control of a prematurely activated, but otherwise normal micturition reflex. Of 169 neurologically normal female incontinent patients (mean age, 50; mean parity, 3) urodynamically tested, 40 had detrusor instability and 16 had low compliance. Digital support of bladder base tested the peripheral control mechanism, and hand-washing the central control mechanism. The data were applied to a non-linear feedback equation with one variable, X(NEXT) = cX(1 - X), where c = central inhibition and X = fraction of possible nerve impulses in the micturition circuit. During filling, all 16 low-compliance patients had a bladder in the activated but stable closed state. Fourteen of the detrusor instability group could not suppress the micturition reflex and lost urine. During hand-washing, unexpectedly greater urine loss was noted in the low-compliance group (13 of 16) than in the detrusor instability group (24 of 40), chi2 (P < 0.005). With digital stretching, urge symptoms disappeared within a few seconds in 18/20 patients, and detrusor instability was suppressed in six patients. The bladder has two stable states: open and closed. Closure is regulated by central and peripheral components. In the female, the peripheral component is controlled by the pelvic floor stretching the vagina to support the urine column. This prevents inappropriate activation of the micturition stretch receptors. In patients with low compliance, this peripheral control mechanism was sufficient to maintain the micturition reflex in an activated but stable closed state. In patients with detrusor instability, the micturition reflex could not be suppressed, swinging between the open and closed states. Demonstration of a peripheral musculoelastic control mechanism unlocks a new direction for management of female patients with non-neurological bladder instability. It is possible, using simple clinical methods based on digital vaginal stretching, to predict cure of instability by surgical tightening of the vagina and its supporting ligaments.

Detrusor instability and low compliance may represent different levels of disturbance in peripheral feedback control of the micturition reflex

Background Detrusor instability is a major cause of urinary incontinence in females. Its cause is unknown. Diagnosis is made with cystometry. A phasic pressure rise during cystometry diagnoses the unstable detrusor, and a non-phasic pressure rise the stable “low-compliance” detrusor. The aim was to test the hypothesis that such cystometric findings may represent different levels of disturbance in peripheral feedback control of a prematurely activated, but otherwise normal micturition reflex. Of 169 neurologically normal female incontinent patients (mean age, 50; mean parity, 3) urodynamically tested, 40 had detrusor instability and 16 had low compliance. Digital support of bladder base tested the peripheral control mechanism, and hand-washing the central control mechanism. The data were applied to a non-linear feedback equation with one variable, XNEXT = cX(1 − X), where c = central inhibition and X = fraction of possible nerve impulses in the micturition circuit. Results During filling, all 16 low-compliance patients had a bladder in the activated but stable closed state. Fourteen of the detrusor instability group could not suppress the micturition reflex and lost urine. During hand-washing, unexpectedly greater urine loss was noted in the low-compliance group (13 of 16) than in the detrusor instability group (24 of 40), χ2 (P < 0.005). With digital stretching, urge symptoms disappeared within a few seconds in 18/20 patients, and detrusor instability was suppressed in six patients. Interpretation The bladder has two stable states: open and closed. Closure is regulated by central and peripheral components. In the female, the peripheral component is controlled by the pelvic floor stretching the vagina to support the urine column. This prevents inappropriate activation of the micturition stretch receptors. In patients with low compliance, this peripheral control mechanism was sufficient to maintain the micturition reflex in an activated but stable closed state. In patients with detrusor instability, the micturition reflex could not be suppressed, swinging between the open and closed states. Conclusions Demonstration of a peripheral musculoelastic control mechanism unlocks a new direction for management of female patients with non-neurological bladder instability. It is possible, using simple clinical methods based on digital vaginal stretching, to predict cure of instability by surgical tightening of the vagina and its supporting ligaments. Neurourol. Urodynam. 18:81–91, 1999. © 1999 Wiley-Liss, Inc.

Simple and cost effective clinical methods for measuring neuromuscular fade responses with emphasis on "train of four" fade.

To evaluate different pressure transducers, available in the operating room for pressure measurements, interfaced with common monitoring equipment, for quantitation of the train of four (TOF) fade during clinical neuromuscular block (NMB). We determined evoked pressure changes produced by the thumb in response to TOF stimuli. We studied the responses of: a) a membrane disc device, and b) modified pressure transducers which were placed directly under the distal phalanx of the thumb of the clenched hand. The responses were displayed/recorded on OR monitors. The optimal positioning of these thumb pressure sensing (TPS) devices and their sensitivity and accuracy during onset, spontaneous (partial) recovery and pharmacologic reversal of NMB, were determined in anesthetized patients during muscle relaxation (Vecuronium) and reversal (Neostigmine). Simultaneous comparisons were made on twenty eight patients between the TOF fade responses obtained by the TPS devices and by conventional electromyographic and/or mechanomyographic methods. Comparisons were made either between pairs of data (e.g. "t" test, correlation coefficients, measuring agreement) or between several "treatment" groups (ANOVA of repeated measures). Correlations between the results of the TPS devices and the other methods were the closest (r- > 0.8) at higher TOF (T4/T1) ratios (e.g. during reversal. Measuring agreement was satisfactory and no significant differences were detected between the regression data (e.g. slope, residuals, x-axis of the regression lines) of the T4/T1 ratios vs. time when comparing EMG and TPS data during reversal of NMB. Measuring quantitatively the TOF fade by TPS devices is an economically feasible method for determining the adequacy of recovery from clinical non-depolarizing NMB.

Diagnosis of cancer-associated vascular disorders

Unexplained thromboembolism may be an early indicator of the presence of a malignant tumor before signs and symptoms of the tumor itself become obvious. A survey of the MEDLINE data-base was conducted concerning cancer-associated vascular disorders and their role in the diagnosis of hidden cancer. The spectrum of vascular disorders heralding occult cancer and the associated laboratory abnormalities were scrutinized. Deep venous thrombosis was associated with a significantly higher frequency of malignancy during the first 6 months after diagnosis. Malignancies were found using simple clinical and diagnostic methods; additional screening was not cost-efficient. Other signs associated with deep venous thrombosis that increased the probability of an occult cancer were age older than 50 years, multiple sites of venous thrombosis, associated venous and arterial thromboembolism, thromboembolism resistant to warfarin therapy, and paraneoplastic syndrome. Among vascular syndromes, only cutaneous leukocytoclastic vasculitis presenting after the age of 50 years was consistently associated with cancer. Preliminary data with an antigen specific to tumor tissue, the cancer procoagulant, suggested its possible role as a tumor marker. The sensitivity for all samples analyzed from cancer patients was 80% and the specificity was 83%. Data from the literature enabled us to outline clinical clues that might distinguish patients with cancer-associated vasculopathies from those unaffected by malignancies. Preliminary data with an antigen specific to tumor tissue, the cancer procoagulant, suggested its possible role in detecting early stage cancer. However, large-scale prospective studies are not currently available to evaluate the role of these clues and laboratory assays in the diagnosis of early stage cancer.

Diagnosis of cancer‐associated vascular disorders

BACKGROUND Unexplained thromboembolism may be an early indicator of the presence of a malignant tumor before signs and symptoms of the tumor itself become obvious. METHODS A survey of the MEDLINE data-base was conducted concerning cancer-associated vascular disorders and their role in the diagnosis of hidden cancer. The spectrum of vascular disorders hearalding occult cancer and the associated laboratory abnormalities were scrutinized. RESULTS Deep venous thrombosis was associated with a significantly higher frequency of malignancy during the first 6 months after diagnosis. Malignancies were found using simple clinical and diagnostic methods; additional screening was not cost-efficient. Other signs associated with deep venous thrombosis that increased the probability of an occult cancer were age older than 50 years, multiple sites of venous thrombosis, associated venous and arterial thromboembolism, thromboembolism resistant to warfarin therapy, and paraneoplastic syndrome. Among vascular syndromes, only cutaneous leukocytoclastic vasculitis presenting after the age of 50 years was consistently associated with cancer. Preliminary data with an antigen specific to tumor tissue, the cancer procoagulant, suggested its possible role as a tumor marker. The sensitivity for all samples analyzed from cancer patients was 80% and the specificity was 83%. CONCLUSIONS Data from the literature enabled us to outline clinical clues that might distinguish patients with cancer-associated vasculopathies from those unaffected by malignancies. Preliminary data with an antigen specific to tumor tissue, the cancer procoagulant, suggested its possible role in detecting early stage cancer. However, large-scale prospective studies are not currently available to evaluate the role of these clues and laboratory assays in the diagnosis of early stage cancer. Cancer 1996;77:1759-67.

Influence of feeding, blood sampling method and type of anaesthesia on renal function parameters in the normal laboratory rat

With sophisticated experiments it is necessary to handle laboratory animals many times. To determine the effect of minor handling a series of experiments was performed to measure the impact of fasting, anaesthesia, blood collection method and serum creatinine analysis on renal function. Simple clinical methods to measure renal function parameters such as diuresis, urinary osmolality, urinary creatinine excretion and serum creatinine were used. During fasting a significant increase (P < 0.01) in diuresis and a significant decrease (P < 0.01) in urinary osmolality were noted. Fasting and anaesthesia have the additional effect of significantly decreasing (P < 0.05) urinary creatinine excretion. Blood sampling method also has a significant impact on serum creatinine: venous sampling causes false-positive differences compared with simultaneous arterial sampling.

Deep venous thrombosis and occult malignancy: an epidemiological study.

To determine the risk of subsequent cancer in patients with deep venous thrombosis confirmed by venography. Follow up of all patients who had venography for suspected deep venous thrombosis during 1984-88. Patients were traced through a cancer registry up to 1 January 1991. 4399 patients who had phlebography in one hospital. General hospital in Malmö, Sweden, serving a population of 230,000. Number of cancers recorded. 4399 patients had venography for suspected deep venous thrombosis; 604 were known to have a malignancy at the time of venography and were excluded from further analysis. 1383 had deep venous thrombosis, 150 of whom subsequently developed cancer. 182 of the 2412 patients without thrombosis developed cancer. During the first six months after venography 66 patients with thrombosis developed malignancy compared with 37 patients without thrombosis (P < 0.0001). 38 of the cancers in the deep venous thrombosis group were detected by history, physical examination, and laboratory tests. Three patients had postoperative or post-traumatic deep venous thromboses. Only two of the remaining patients would have benefited from early detection by extensive screening. After six months the incidence of cancer was identical in patients with and without thrombosis. Deep venous thrombosis is associated with a significantly higher frequency of malignancy during the first six months after diagnosis. Malignancies can be found with simple clinical and diagnostic methods and extensive screening is not required.