Background: Estimation of fetal weight through ultrasound or clinically, is important in the management of pregnant women. In low resource settings, where ultrasound is scarce, determination of the superior clinical method between Johnson’s rule and palpation method is of significant value. Objective: The objective of this study was to determine the best clinical method in estimating fetal weight in term parturients in a tertiary government hospital. 140 term mothers with singleton pregnancies in cephalic presentation were included in this study. Methodology: Fetal weight was estimated using both palpation method and Johnson’s rule and compared to the actual fetal weight. Effects of body mass index (BMI), cervical dilatation, and engagement on the accuracy of both methods were evaluated using one-way ANOVA and test of proportions. The accuracy of both methods were calculated by mean absolute error and bias. Bland-Altman analysis was used to see limits of agreement and the mean difference between estimated fetal weight to actual birthweight. Results: Mean estimated fetal weight (EFW) was 2846.39 ± 427.29g by Johnson’s and 2904.29 ± 372.79g by palpation with a mean actual birthweight of 3028.30 ± 441.52g. Using paired t-test, no significant differences were found in EFW by the two methods and actual birthweight. Palpation had more estimates that differed from actual by < 100 grams at 41.43% compared to 16.43% for Johnson’s with p < 0.001. Lower bias (7.11%) was seen in palpation compared to Johnson’s (12.09%) and with more precise estimates. Conclusion Palpation method is more accurate and reliable than Johnson’s rule. Clinical palpation is easy, cost effective, simple and should be considered as a diagnostic tool for fetal weight estimation especially in rural areas. The effect modifiers are cervical dilation for palpation and engagement for Johnson’s. BMI has no effect in accuracy of estimates in both methods.
Fetal Weight ; Fetus ; Prenatal Care ; Palpation ; Research Design ; Health Services

Professor - has gradually improved the clinical application of channel palpation treatment based on his more than 50 years clinical practice, and has accumulated rich experience in acupuncture treatment of polymyalgia rheumatica. He believes that "wind, cold and dampness" are the external causes of the disease, physical factors, uncomfortable mood and uncontrolled diet are the internal causes. The meridian-collateral theory is utilized in the diagnosis and detection of the disorders of , and meridians, internal and external causes are solved by expelling the wind, warming the channel to eliminate the coldness, transforming the dampness to relieve pain and regulating the activity. Three cases of clinical application on polymyalgia rheumatica were included in this paper.
Acupuncture Points ; Acupuncture Therapy ; Humans ; Meridians ; Palpation ; Polymyalgia Rheumatica

Ultrasound elastography (USE) of the pancreas allows pancreatic tissue stiffness assessment by virtual palpation. Two main types of USE are used. For the pancreas strain elastography applying by endoscopic ultrasound has been established for the characterisation of small solid pancreatic lesions (SPL). In larger SPL >30 mm the results are less convincing mainly due to the heterogenicity of the lesions but also by concomitant changes of the surrounding pancreatic parenchyma. The current role of shear wave elastography has to be determined. This article reviews the current use of elastography of the pancreas.
Elasticity Imaging Techniques ; Palpation ; Pancreas ; Ultrasonography

PURPOSE: The aim of this study was to evaluate the applicability of machine learning methods that combine data on age and prostate-specific antigen (PSA) levels for predicting prostate cancer. MATERIALS AND METHODS: We analyzed 943 patients who underwent transrectal ultrasonography (TRUS)-guided prostate biopsy at Chungnam National University Hospital between 2014 and 2018 because of elevated PSA levels and/or abnormal digital rectal examination and/or TRUS findings. We retrospectively reviewed the patients’ medical records, analyzed the prediction rate of prostate cancer, and identified 20 feature importances that could be compared with biopsy results using 5 different algorithms, viz., logistic regression (LR), support vector machine, random forest (RF), extreme gradient boosting, and light gradient boosting machine. RESULTS: Overall, the cancer detection rate was 41.8%. In patients younger than 75 years and with a PSA level less than 20 ng/mL, the best prediction model for prostate cancer detection was RF among the machine learning methods based on LR analysis. The PSA density was the highest scored feature importances in the same patient group. CONCLUSIONS: These results suggest that the prediction rate of prostate cancer using machine learning methods not inferior to that using LR and that these methods may increase the detection rate for prostate cancer and reduce unnecessary prostate biopsy, as they take into consideration feature importances affecting the prediction rate for prostate cancer.
Biopsy ; Chungcheongnam-do ; Digital Rectal Examination ; Forests ; Humans ; Logistic Models ; Machine Learning ; Medical Records ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies ; Support Vector Machine ; Ultrasonography

Peripheral artery disease (PAD) is the most frequent cause of reduced perfusion in peripheral arteries. Patients with PAD often have manifestations of atherosclerosis of the lower limb, although both symptomatic and asymptomatic disease is common. The clinical signs of PAD can differ in diabetic and non-diabetic patients. Diabetic patients are at high risk for PAD characterized by symptoms of intermittent claudication or critical limb ischemia. However, the majority of PAD patients are clinically asymptomatic. In addition to history taking, physical examinations including inspection of the skin, palpation of leg and foot pulses, and determination of the ankle-brachial index (ABI) are considered for diagnosis of PAD. The ABI measurement is the easiest and most common investigative technique for PAD. For hemodynamic assessment, additional diagnostic modalities could be considered.
Ankle Brachial Index ; Arteries ; Asymptomatic Diseases ; Atherosclerosis ; Cardiology ; Diabetes Mellitus ; Diagnosis ; Extremities ; Foot ; Heart ; Hemodynamics ; Humans ; Intermittent Claudication ; Investigative Techniques ; Ischemia ; Leg ; Lower Extremity ; Palpation ; Perfusion ; Peripheral Arterial Disease ; Physical Examination ; Skin

PURPOSE: The purpose of this study was to investigate magnetic resonance imaging (MRI) and 3-dimensional transperineal ultrasound (3D-TPUS) features of pelvic floor dysfunction (PFD) in symptomatic women in correlation with digital palpation and to define cut-offs for hiatal dimensions predictive of muscle dysfunction. METHODS: This prospective study included 73 women with symptoms suggesting PFD. 3D-TPUS, MRI, and digital palpation of the levator ani muscle were performed in all patients. Levator hiatal antero-posterior (LHap) diameter and area (LH area) were measured at rest and at maximum muscle contraction. RESULTS: The reduction in LHap diameter and LH area during contraction was significantly less in women with underactive pelvic floor muscle contraction (UpfmC) than in those who had normal pelvic floor muscle contraction by digital palpation (P<0.001). Statistically significant positive correlations (P<0.001) were found between the Modified Oxford Score and 3D-TPUS and MRI regarding the reduction in the LHap diameter (r=0.80 and r=0.82, respectively) and LH area (r=0.60 and r=0.70, respectively). A reduction in LHap of <6.5% on 3D-TPUS and <7.6% on MRI predicted UpfmC with sensitivities of 46.2% and 82.7%, respectively. A reduction in LH area of <3.4% on 3D-TPUS and <3.8% on MRI predicted UpfmC with sensitivities of 75.0% and 88.5%, respectively. MRI was more sensitive in detecting levator avulsion (63.4%) than 3D-TPUS (27.1%). CONCLUSION: MRI and 3D-TPUS had strong positive correlations with findings on palpation, and at certain cut-offs for hiatal dimensions, they can be used as complementary and objective tools to improve the accuracy of diagnosis and management planning of PFD.
Diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Muscle Contraction ; Palpation ; Pelvic Floor ; Prospective Studies ; Ultrasonography

PURPOSE: Although the height of a rectal tumor above the anal verge (tumor height) partly determines the treatment strategy, no practical standard exists for reporting this. We aimed to demonstrate the differences in tumor height according to the diagnostic modality used for its measurement. METHODS: We identified 100 patients with rectal cancers located within 15 cm of the anal verge who had recorded tumor heights measured by using magnetic resonance imaging (MRI), colonoscopy, and digital rectal examination (DRE). Tumor height measured by using MRI was compared with those measured by using DRE and colonoscopy to assess reporting inconsistencies. Factors associated with differences in tumor height among the modalities were also evaluated. RESULTS: The mean tumor heights were 77.8 ± 3.3, 52.9 ± 2.3, and 68.9 ± 3.1 mm when measured by using MRI, DRE, and colonoscopy, respectively (P < 0.001). Agreement among the 3 modalities in terms of tumor sublocation within the rectum was found in only 39% of the patients. In the univariate and the multivariate analyses, clinical stage showed a possible association with concordance among modalities, but age, sex, and luminal location of the tumor were not associated with differences among modalities. CONCLUSION: The heights of rectal cancer differed according to the diagnostic modality. Tumor height has implications for rectal cancer’s surgical planning and for interpreting comparative studies. Hence, a consensus is needed for measuring and reporting tumor height.
Colonoscopy ; Consensus ; Digital Rectal Examination ; Humans ; Magnetic Resonance Imaging ; Multivariate Analysis ; Phenobarbital ; Rectal Neoplasms ; Rectum

PURPOSE: The response to neoadjuvant chemoradiotherapy (CRT) for rectal cancer can be assessed using digital rectal examination, endoscopy and magnetic resonance imaging (MRI). Precise assessment of clinical complete response (CR) after CRT is essential when deciding between optimizing surgery or organ-preserving treatment. The objectives of this study were to correlate the CR finding in endoscopy and MRI with pathologic CR and to determine the appropriate approach for combining endoscopy and MRI to predict the pathologic CR in patients with rectal cancer after neoadjuvant CRT. METHODS: This retrospective cohort study included 102 patients with rectal cancer who underwent endoscopy and MRI at 2–4 weeks after CRT. We assigned a confidence level (1–4) for the endoscopic and MRI assessments. Accuracy, sensitivity, and specificity were analyzed based on the endoscopy, MRI, and combination method findings. Diagnostic modalities were compared using the likelihood ratios. RESULTS: Of 102 patients, 17 (16.7%) had a CR. The accuracy, sensitivity, and specificity for the prediction CR of endoscopy with biopsy were 85.3%, 52.9%, and 91.8%, while those of MRI were 91.2%, 70.6%, and 95.3%, and those of combined endoscopy and MRI were 89.2%, 52.9%, and 96.5%, respectively. No significant differences were noted in the sensitivity and specificity of any each modality. The prediction rate for CR of the combination method was 92.6% after the posttest probability test. CONCLUSION: Our study demonstrated that combining the interpretation of endoscopy with biopsy and MRI could provide a good prediction rate for CR in patients with rectal cancer after CRT.
Biopsy ; Chemoradiotherapy ; Cohort Studies ; Digital Rectal Examination ; Endoscopy ; Humans ; Magnetic Resonance Imaging ; Methods ; Rectal Neoplasms ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: The open reduction of craniofacial bone fractures requires internal fixation using metal plates and screws, which have been considered the gold standard. However, metal implants pose a risk of palpation, protrusion, and foreign body reaction, and they may require an additional operation for removal. Recently, good results have been reported for absorbable implants which complement the disadvantages of metal implants. This study presents the results of using absorbable mesh, plates, and screws with cyanoacrylate for more accurate and firmer fixation of comminuted fractures of the maxilla. METHODS: In total, 235 patients underwent operations for comminuted fractures of the maxilla. From January 2012 to December 2014, absorbable mesh and screws were used in 114 patients, while from January 2015 to December 2017, absorbable mesh, plates, and screws with cyanoacrylate were used in 121 patients. Open reduction of the bone fragments was performed, after which absorbable implants were accurately molded and fixed by screws. RESULTS: All patients underwent postoperative computed tomography scans, which showed highly accurate reduction and firm fixation in the patients who underwent procedures using absorbable implants, screws, and cyanoacrylate. There were no postoperative complications or cases of abnormal facial contour. CONCLUSION: When absorbable implants and screws are used for maxillary fractures, no additional surgery to remove the metal plate is required. In addition, the use of cyanoacrylate enables accurate and firm fixation of the tiny bone fragments that cannot be fixed with screws.
Absorbable Implants ; Complement System Proteins ; Cyanoacrylates ; Foreign-Body Reaction ; Fractures, Bone ; Fractures, Comminuted ; Fungi ; Humans ; Maxilla ; Maxillary Fractures ; Palpation ; Postoperative Complications

Prostate cancer (CaP) is the most common cancer diagnosed among men in the United States and the fifth most common cancer among men in Korea. Unfortunately, the early stages of CaP may have no symptoms. Thus, early detection is very important and physicians managing voiding dysfunction must have awareness about CaP. The traditional tests used for early detection of CaP are the prostate-specific antigen (PSA) blood test and digital rectal examination. However, a high PSA level is not specific for CaP. Benign prostatic hyperplasia, prostatitis, urinary tract infection, and urinary retention can all cause a high PSA level. Thus, no test shows sufficient accuracy to truly be useful for screening men for CaP. A prostate biopsy is the only method that yields a definitive diagnosis of CaP; however, this test is invasive and uncomfortable. Recently, new biomarkers for CaP detection have been proposed to improve the accuracy of the PSA test. In this review, we summarize our knowledge of various new biomarkers, including PSA-associated biomarkers (the prostate health index and 4Kscore), molecular biomarkers (PCA3, TMPRSS2: ERG fusion gene, and various miRNAs), and proteomics-associated biomarkers, and the ways in which they may improve the detection rate of CaP. Accordingly, this review can raise awareness about CaP to physicians managing voiding dysfunction and be a good reference for them.
Biomarkers ; Biopsy ; Diagnosis ; Digital Rectal Examination ; Discrimination (Psychology) ; Early Detection of Cancer ; Hematologic Tests ; Humans ; Korea ; Male ; Mass Screening ; Methods ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Prostatitis ; United States ; Urinary Retention ; Urinary Tract Infections