STUDY DESIGN: Retrospective case study by clinical and radiological data analysis. PURPOSE: To analyze different types of vertebral anomalies and the incidence of associated intraspinal anomalies in the Indian population. OVERVIEW OF LITERATURE: This is the largest study of congenital scoliosis and associated intraspinal anomalies in Indian population. Incidence of intraspinal anomaly in this series is 47% which is higher than previous literature. Hemivertebra was the most common anomaly as seen in previous studies. METHODS: A total of 119 patients with congenital scoliosis who underwent surgery between December 2006 and December 2012 were studied. Data was reviewed with medical records, plain radiographs, and magnetic resonance imaging (MRI) scans. RESULTS: Thoracolumbar curve was most common, seen in 43.6% of patients. In addition to scoliotic deformity, kyphosis was seen in 26% of patients. Failure of formation, the most common vertebral anomaly, was seen in 51.2% of patients, failure of segmentation was seen in 19.3% of patients, and there were 29.4% patients having both formation and segmentation anomalies. Hemivertebra was the most common vertebral anomaly seen in 66.3% of patients and for whom 63.2% were in thoracic spine. Intraspinal anomalies were associated with 47% of patients with congenital scoliosis. Tethered cord was the most common intraspinal abnormality and was found in 48.2% patients with intraspinal anomalies. The patients with failure of segmentation and mixed deformities were found to have a significantly higher incidence of intraspinal anomalies (65% and 57%, respectively) than those with failure of formation (34%). Out of 31 patients with kyphotic deformity 29% had intraspinal anomalies, and amongst them tethered cord was the most common anomaly seen in 66% patients. Out of 12 patients with neurocutaneous markers, 83% patients had intraspinal anomaly. CONCLUSIONS: Intraspinal anomalies were seen in 47% of patients with congenital scoliosis in the Indian population. Tethered cord was the most common intraspinal anomaly, seen in 48% cases of congenital scoliosis. Hemivertebra was seen in 66% cases and was the most common vertebral defect. Hence MRI imaging of whole spine should be done in all cases of congenital scoliosis before any surgical intervention. Special attention should be given to physical examination and visualization of any neurocutaneous markers, which are associated with a higher incidence of intraspinal anomalies; absence of a neurocutaneous marker, however, does not rule out intraspinal anomaly.
Congenital Abnormalities ; Humans ; Incidence ; Kyphosis ; Magnetic Resonance Imaging ; Medical Records ; Physical Examination ; Retrospective Studies ; Scoliosis* ; Spine ; Statistics as Topic

OBJECTIVE: Thyroid nodule measurement using ultrasonography (US) is widely performed in various clinical scenarios. The purpose of this study was to evaluate inter-observer variation in US measurement of the volume and maximum diameter of thyroid nodules. MATERIALS AND METHODS: This retrospective study included 73 consecutive patients with 85 well-defined thyroid nodules greater than 1 cm in their maximum diameter. US examinations were independently performed by using standardized measurement methods, conducted by two clinically experienced thyroid radiologists. The maximum nodule diameter and nodule volume, calculated from nodule diameters using the ellipsoid formula, were obtained by each reader. Inter-observer variations in volume and maximum diameter were determined using 95% Bland-Altman limits of agreement. The degree of inter-observer variations in volumes and the maximum diameters were compared using the Student's t test, between nodules < 2 cm in maximum diameter and those with > or = 2 cm. RESULTS: The mean inter-observer difference in measuring the nodule volume was -1.6%, in terms of percentage of the nodule volume, and the 95% limit of agreement was +/- 13.1%. For maximum nodule diameter, the mean inter-observer difference was -0.6%, in terms of percentage of the nodule diameter, and the 95% limit of agreement was +/- 7.3%. Inter-observer variation in volume was greater in nodules of < 2 cm in maximum diameter, compared to the larger nodules (p = 0.035). However, no statistically significant difference was noted between the two groups regarding maximum nodule diameters (p = 0.511). CONCLUSION: Any differences smaller than 13.1% and 7.3% in volume and maximum diameter, respectively, measured by using US for well-defined thyroid nodules of > 1 cm should not be considered as a real change in size.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Observer Variation ; Organ Size/physiology ; Physical Examination/*statistics & numerical data ; Retrospective Studies ; Thyroid Gland/pathology/*ultrasonography ; Thyroid Nodule/*ultrasonography ; Young Adult

The environment around working process of the referees during matches will burden him or her physically by doing specific actions frequently and give negative effects on musculoskeletal system. In order to find out musculoskeletal pain has occurred on specific muscles, surveys have been taken by 44 referees in K-league for this thesis. We evaluated the differences between referee and assistant referee. Fourteen (87.5%) referees and twenty-four (89.3%) assistant referees stated that they had one musculoskeletal pain. For referees, 43.8% had hamstring pains, 31.3% had calf muscle pains, and 25% had low back pains. For assistant referees, 39.3% felt knee pains, 32.1% had adductors pains, 28.5% felt calf muscle pains. Therefore, with the data analysis by dividing their roles, both groups had similar effect on hamstring and knee joint. For the question asking for the personal reasons of the pains were 61.4% of 'Carelessness of physical fitness', 47.7% of 'repetition of certain actions', and 43.2% of 'lack of treatment after being damaged'. Also, in order to prevent pain, the referees answered that they train personally (40.9%), rest appropriately (20.5%), and go to hospital for treatment (18.2%). After receiving the result of this study, training programs and education are needed to prevent pain. Moreover, on the next study, fundamental causes of the pains should be found by using history taking, physical examination, medical and scientific machines in order to analyze the movements of the referees' human dynamics.
Education ; Football ; Humans ; Knee ; Knee Joint ; Low Back Pain ; Muscles ; Musculoskeletal Pain* ; Musculoskeletal System ; Myalgia ; Physical Examination ; Statistics as Topic

Humans ; Occupational Exposure ; statistics & numerical data ; Occupational Health ; Physical Examination ; Surveys and Questionnaires

PURPOSE: This study was to investigate factors that influence health examination for unmarried women. METHODS: A correlation study was carried out with 144 unmarried women with an age range of 35~49 years through self-administered questionnaires. This questionnaire included Health Belief Model modifying factors (demographic . sociological, structural, and cues to action variables). Data were analyzed using descriptive statistics, chi2-test, multiple logistic regression. RESULTS: The mean age of participants was 37.2+/-2.67 years. Rates for breast cancer, cervical cancer and comprehensive health examination were each 34.7%, 38.2% and 94%. In multiple logistic regression analysis, influencing factors on physical examination were age(OR=0.06, 95% CI: 0.02~0.26), personal medical insurance (OR=6.30, 95% CI: 1.60~24.82), housemate (OR=7.63, 95% CI: 2.58~22.52), exercise (OR=3.72, 95% CI: 1.37~10.12) in breast cancer examination, and age (OR=0.08, 95% CI: 0.02~0.34; OR=0.07, 95% CI: 0.01~0.85), personal medical insurance (OR=14.17, 95% CI: 2.94~68.23), sexual experiences (OR=3.38, 95% CI: 1.28~8.91), drinking (OR=2.92, 95% CI: 1.14~7.49) in cervical cancer examination. CONCLUSION: The results emphasize the necessity of preparing nursing education and intervention in consideration of associated factors which influence on the health examination in unmarried women.
Breast Neoplasms ; Cues ; Drinking ; Early Detection of Cancer ; Education, Nursing ; Female ; Humans ; Insurance ; Logistic Models ; Physical Examination ; Surveys and Questionnaires ; Single Person* ; Statistics as Topic ; Uterine Cervical Neoplasms

This study was done to evaluate the efficacy of health check-ups in children in detecting metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) by comparing the pediatric health promotion center with the pediatric obesity clinic. Children who visited a pediatric health promotion center (n=218) or a pediatric obesity clinic (n=178) were included. Anthropometric data, blood pressure, laboratory tests, and abdominal ultrasonography were evaluated. Two different criteria were applied to diagnose metabolic syndrome. The prevalence of metabolic syndrome in the 2 units was 3.2%-3.7% in a pediatric health promotion center and 23%-33.2% in a pediatric obesity clinic. Significant differences were observed in the prevalence of each component of metabolic syndrome between the 2 units including abdominal adiposity, blood pressure, serum triglycerides, and fasting blood glucose (P<0.05). The prevalence of NAFLD was 8.7% and 71.9% in the 2 units according to liver enzymes and 5.9% and 61.8% according to ultrasonography (P<0.05). The prevalence of metabolic syndrome and NAFLD was higher among patients visiting the obesity clinic targeting obese children than that among patients visiting the health promotion center offering routine check-ups. An obesity-oriented approach is required to prevent obesity-related health problems in children.
Adolescent ; Causality ; Child ; Child, Preschool ; Comorbidity ; Female ; Health Promotion/*utilization ; Humans ; Male ; Metabolic Syndrome X/*diagnosis/epidemiology ; Non-alcoholic Fatty Liver Disease/*diagnosis/epidemiology ; Obesity/*diagnosis/epidemiology ; Physical Examination/*statistics & numerical data ; Prevalence ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Factors ; Sensitivity and Specificity ; Young Adult

BACKGROUND: Ultrasonography is an important diagnostic tool for many aspects of clinical medicine. It is a non-invasive method of examination that provides high-resolution images in real time. However, some dermatologists may be anxious about the efficacy of ultrasonography. OBJECTIVE: To evaluate the diagnostic accuracy and to assess the utility of diagnostic ultrasonography for subcutaneous benign lesions. METHODS: The study included 96 patients with subcutaneous benign lesions who underwent ultrasonography and then received a pathologic diagnosis after biopsy or surgery at our hospital from July 2010 to December 2012. This study evaluated the number of cases in which the preoperative diagnosis after ultrasonography or just after physical examination agreed to the pathologic diagnosis. RESULTS: Ultrasonography significantly increased the diagnostic yield of subcutaneous benign lesions (after physical examination, 54.2%; after ultrasonography, 84.4%; p<0.001). The sensitivity for the diagnosis of lipoma (after physical examination, 70%; after ultrasonography, 92.5%; p<0.001) and the specificity for the diagnosis of epidermal cyst (after physical examination, 84.1%; after ultrasonography, 94.2%; p<0.001) significantly increased after ultrasonography. The sensitivity for the diagnosis of epidermal cyst and pilomatricoma also tended to increase after ultrasonography. CONCLUSION: The study results suggested that ultrasonography is useful for diagnosis and/or preoperative examination of subcutaneous benign lesions.
Biopsy ; Clinical Medicine ; Epidermal Cyst ; Humans ; Lipoma ; Physical Examination ; Pilomatrixoma ; Sensitivity and Specificity ; Statistics as Topic

BACKGROUND: Intra-class correlation coefficients (ICCs) provide a statistical means of testing the reliability. However, their interpretation is not well documented in the orthopedic field. The purpose of this study was to investigate the use of ICCs in the orthopedic literature and to demonstrate pitfalls regarding their use. METHODS: First, orthopedic articles that used ICCs were retrieved from the Pubmed database, and journal demography, ICC models and concurrent statistics used were evaluated. Second, reliability test was performed on three common physical examinations in cerebral palsy, namely, the Thomas test, the Staheli test, and popliteal angle measurement. Thirty patients were assessed by three orthopedic surgeons to explore the statistical methods testing reliability. Third, the factors affecting the ICC values were examined by simulating the data sets based on the physical examination data where the ranges, slopes, and interobserver variability were modified. RESULTS: Of the 92 orthopedic articles identified, 58 articles (63%) did not clarify the ICC model used, and only 5 articles (5%) described all models, types, and measures. In reliability testing, although the popliteal angle showed a larger mean absolute difference than the Thomas test and the Staheli test, the ICC of popliteal angle was higher, which was believed to be contrary to the context of measurement. In addition, the ICC values were affected by the model, type, and measures used. In simulated data sets, the ICC showed higher values when the range of data sets were larger, the slopes of the data sets were parallel, and the interobserver variability was smaller. CONCLUSIONS: Care should be taken when interpreting the absolute ICC values, i.e., a higher ICC does not necessarily mean less variability because the ICC values can also be affected by various factors. The authors recommend that researchers clarify ICC models used and ICC values are interpreted in the context of measurement.
Adolescent ; Biomedical Research/*methods/*standards ; Cerebral Palsy ; Child ; Child, Preschool ; Computer Simulation ; Databases, Factual ; Female ; Humans ; Male ; Models, Theoretical ; Orthopedics/*methods/*standards ; Physical Examination ; Range of Motion, Articular ; Reproducibility of Results ; Research Design ; Statistics as Topic ; Young Adult

BACKGROUND: Symphalangism is a rare congenital difference characterized by ankylosis of interphalangeal (IP) joints of the fingers and toes. In adults, there were several attempts to restore the stiff joints into mobile ones, but these treatment options resulted in poor outcomes and could not be applied to growing children. Here, we report our experiences on surgical treatment for children who had symphalangism of the hand. METHODS: We treated 36 joints in 17 children with symphalangism of the hand using dorsal capsulotomy and collateral ligament release. The diagnoses were based on history, physical examination, and simple radiographs. Affected fingers were classified according to our grading system. Simple compressive dressing was applied using Coban after surgery. Passive range of motion (ROM) exercise was started on day one or 2 postoperative, with the help of a hand therapist and patients' parents. The patients were prescribed passive ROM exercises for at least 2 hours a day over a period of 6 months. RESULTS: A single surgeon operated on 30 proximal IP joints, 3 distal IP joints, and 3 IP joints of the thumb. Twenty six joints were classified as grade I, and 10 as grade II. The ROM of affected joints, which was 7.8 +/- 8.1 (mean +/- SD) degrees preoperatively, increased to 46.8 +/- 18.6 degrees at final follow-up. The final ROM was significantly better in grade I joints, especially when the children had operations at ages 24 months or younger. CONCLUSIONS: Symphalangism of the hand in children, can be restored into a mobile joint by release of the collateral ligament, a dorsal capsulotomy, and postoperative physical therapy.
Age Factors ; Ankylosis/radiography/surgery ; Child ; Child, Preschool ; Female ; Finger Joint/abnormalities/radiography/surgery ; Humans ; Infant ; Joint Diseases/classification/*congenital/radiography/surgery ; Ligaments/surgery ; Male ; Orthopedic Procedures/methods ; Physical Examination ; *Range of Motion, Articular ; Statistics, Nonparametric ; Treatment Outcome

BACKGROUND: Symphalangism is a rare congenital difference characterized by ankylosis of interphalangeal (IP) joints of the fingers and toes. In adults, there were several attempts to restore the stiff joints into mobile ones, but these treatment options resulted in poor outcomes and could not be applied to growing children. Here, we report our experiences on surgical treatment for children who had symphalangism of the hand. METHODS: We treated 36 joints in 17 children with symphalangism of the hand using dorsal capsulotomy and collateral ligament release. The diagnoses were based on history, physical examination, and simple radiographs. Affected fingers were classified according to our grading system. Simple compressive dressing was applied using Coban after surgery. Passive range of motion (ROM) exercise was started on day one or 2 postoperative, with the help of a hand therapist and patients' parents. The patients were prescribed passive ROM exercises for at least 2 hours a day over a period of 6 months. RESULTS: A single surgeon operated on 30 proximal IP joints, 3 distal IP joints, and 3 IP joints of the thumb. Twenty six joints were classified as grade I, and 10 as grade II. The ROM of affected joints, which was 7.8 +/- 8.1 (mean +/- SD) degrees preoperatively, increased to 46.8 +/- 18.6 degrees at final follow-up. The final ROM was significantly better in grade I joints, especially when the children had operations at ages 24 months or younger. CONCLUSIONS: Symphalangism of the hand in children, can be restored into a mobile joint by release of the collateral ligament, a dorsal capsulotomy, and postoperative physical therapy.
Age Factors ; Ankylosis/radiography/surgery ; Child ; Child, Preschool ; Female ; Finger Joint/abnormalities/radiography/surgery ; Humans ; Infant ; Joint Diseases/classification/*congenital/radiography/surgery ; Ligaments/surgery ; Male ; Orthopedic Procedures/methods ; Physical Examination ; *Range of Motion, Articular ; Statistics, Nonparametric ; Treatment Outcome