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The Turkish Journal of Gastroenterology... Mar 2023About one-third of chronically constipated patients have an evacuation disorder, and dyssynergic defecation is a common cause of the evacuation disorder. In dyssynergic... (Review)
Review
About one-third of chronically constipated patients have an evacuation disorder, and dyssynergic defecation is a common cause of the evacuation disorder. In dyssynergic defecation, the coordination between abdominal and pelvic floor muscles during defecation is disrupted and patients cannot produce a normal bowel movement. The etiology of dyssynergic defecation is still unknown. Although a detailed history taking and a careful examination including digital rectal examination could be useful, other modalities such as anorectal manometry and balloon expulsion test are necessary for the diagnosis. Biofeedback therapy is one of the most effective and safe treatments. Here, we provide an overview of dyssynergic defecation as well as how to diagnose and manage this condition.
Topics: Humans; Defecation; Constipation; Manometry; Anal Canal; Biofeedback, Psychology; Digital Rectal Examination; Ataxia
PubMed: 36919830
DOI: 10.5152/tjg.2023.22148 -
Home Healthcare NowRespiratory illnesses often require acute care admissions and are a leading cause of death globally, thus creating a financial burden for healthcare systems. Home... (Review)
Review
Respiratory illnesses often require acute care admissions and are a leading cause of death globally, thus creating a financial burden for healthcare systems. Home healthcare clinicians can significantly reduce morbidity and hospital readmissions by becoming proficient at respiratory assessment. This article aims to assist homecare clinicians in performing a respiratory assessment in a logical and structured approach, including inspection, palpation, percussion, and auscultation. This article reviews the anatomy and physiology of the respiratory system and describes subjective and objective respiratory assessment. It is anticipated that becoming adept at these skills will enable home healthcare clinician to assess and identify those patients at risk for deterioration and readmission.
Topics: Humans; Physical Examination; Auscultation; Percussion; Palpation; Hospitalization; Patient Readmission
PubMed: 37417569
DOI: 10.1097/NHH.0000000000001184 -
European Urology Oncology Dec 2023Annual digital rectal examination (DRE) is recommended as a stand-alone screening test for prostate cancer (PCa) in Germany for 45+ yr olds. DRE diagnostic performance...
BACKGROUND
Annual digital rectal examination (DRE) is recommended as a stand-alone screening test for prostate cancer (PCa) in Germany for 45+ yr olds. DRE diagnostic performance in men as young as 45 yr old has not been proved by a screening trial.
OBJECTIVE
To determine DRE diagnostic performance in a screening trial.
DESIGN, SETTING, AND PARTICIPANTS
This analysis was conducted within the multicentric, randomized PROBASE trial, which enrolled >46 000 men at age 45 to test risk-adapted prostate-specific antigen (PSA) screening for PCa.
INTERVENTION
(1) DRE was analyzed as a one-time, stand-alone screening offer at age 45 in 6537 men in one arm of the trial and (2) PCa detection by DRE was evaluated at the time of PSA-screen-driven biopsies (N = 578).
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
(1) True-/false-positive detection rates of DRE as compared with PSA screening and (2) DRE outcome at the time of a prostate biopsy were evaluated.
RESULTS AND LIMITATIONS
(1) A prospective analysis of 57 men with suspicious DRE at age 45 revealed three PCa. Detection rate by DRE was 0.05% (three of 6537) as compared with a four-fold higher rate by PSA screening (48 of 23 301, 0.21%). The true-positive detection rate by DRE relative to screening by PSA was 0.22 (95% confidence interval [CI] = [0.07-0.72]) and the false-positive detection rate by DRE was 2.2 (95% CI = [1.50-3.17]). (2) Among PSA-screen-detected PCa cases, 86% had unsuspicious DRE (sensitivity relative to PSA was 14%), with the majority of these tumors (86%) located in the potentially accessible zones of the prostate as seen by magnetic resonance imaging.
CONCLUSIONS
The performance of stand-alone DRE to screen for PCa is poor. DRE should not be recommended as a PCa screening test in young men. Furthermore, DRE does not improve the detection of PSA-screen-detected PCa.
PATIENT SUMMARY
Our report demonstrated the poor diagnostic performance of digital rectal examination in the screening for prostate cancer in young men.
Topics: Male; Humans; Middle Aged; Digital Rectal Examination; Prostate-Specific Antigen; Early Detection of Cancer; Prostatic Neoplasms; Prostate
PubMed: 37806841
DOI: 10.1016/j.euo.2023.09.008 -
Physical Therapy Aug 2020There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective...
OBJECTIVE
There is a lack of consensus on which abdominal or pelvic floor muscle (PFM) exercises to recommend for the treatment of diastasis recti abdominis (DRA). The objective of this study was to investigate the immediate effect of abdominal and PFM exercises on interrecti distance (IRD) in women with DRA who are parous.
METHODS
In this cross-sectional study, 38 women who were parous, with a mean age of 36.2 years (SD = 5.2), diagnosed with DRA participated. IRD was assessed with 2-dimensional real-time ultrasonography during rest and during 8 randomly ordered different exercises. A paired t test was used to compare the IRD at rest with the IRD recorded during each exercise as well as the differences between exercises. Means with 95% CI are reported.
RESULTS
Head lift and twisted curl-up exercises significantly decreased the IRD both above and below the umbilicus. Above the umbilicus, the mean IRD difference from rest during head lift was 10 mm (95% CI = 7 to 13.2), whereas during twisted curl-up it was 9.4 mm (95% CI = 6.3 to 12.5). Below the umbilicus, the corresponding values were 6.1 mm (95% CI = 3.2 to 8.9) and 3.5 mm (95% CI = 0.5 to 6.4), respectively, but PFM contraction, maximal in-drawing, and PFM contraction + maximal in-drawing increased the IRD (mean difference = -2.8 mm [95% CI = -5.2 to 0.5], -4.7 mm [95% CI = -7.2 to -2.1], and - 5.0 mm [95% CI = -7.9 to -2.1], respectively).
CONCLUSIONS
Head lift and twisted curl-up exercises decreased the IRD both above and below the umbilicus, whereas maximal in-drawing and PFM contraction exercises only increased the IRD below the umbilicus. A randomized controlled trial is needed to investigate whether head lift and twisted curl-up exercises are effective in permanently narrowing the IRD.
IMPACT
To date there is scant scientific knowledge of which exercises to recommend in the treatment of DRA. In-drawing and PFM contraction leads to an acute increase in IRD, while head lift and twisted curl-up leads to an acute decrease in IRD in postpartum women. There is a need for high-quality randomized controlled trials to investigate if there is a long-term reduction in IRD by doing these exercises over time. The acute IRD increase and decrease during the different exercises is also present in a sample of women with larger separations.
Topics: Abdominal Muscles; Adult; Cross-Sectional Studies; Diastasis, Muscle; Exercise Therapy; Female; Humans; Muscle Contraction; Palpation; Parity; Pelvic Floor; Pregnancy; Rectus Abdominis; Ultrasonography
PubMed: 32302393
DOI: 10.1093/ptj/pzaa070 -
Optics Letters Sep 2021Optical palpation maps stress at the surface of biological tissue into 2D images. It relies on measuring surface deformation of a compliant layer, which to date has been...
Optical palpation maps stress at the surface of biological tissue into 2D images. It relies on measuring surface deformation of a compliant layer, which to date has been performed with optical coherence tomography (OCT). OCT-based optical palpation holds promise for improved clinical diagnostics; however, the complexity and cost hinder broad adoption. In this Letter, we introduce coherence function-encoded optical palpation (CFE-OP) using a novel optical profilometry technique that exploits the envelope of the coherence function rather than its peak position, which is typically used to retrieve depth information. CFE-OP utilizes a Fabry-Perot laser diode (bandwidth, 2.2 nm) and a single photodiode in a Michelson interferometer to detect the position along the coherence envelope as a function of path length. This technique greatly reduces complexity and cost in comparison to the OCT-based approach. We perform CFE-OP on phantom and excised human breast tissue, demonstrating comparable mechanical contrast to OCT-based optical palpation and the capability to distinguish stiff tumor from soft benign tissue.
Topics: Humans; Palpation; Phantoms, Imaging; Tomography, Optical Coherence
PubMed: 34525040
DOI: 10.1364/OL.430117 -
Cureus Mar 2021In the panorama of scientific literature, there is a paucity of literature on how to palpate the heart area in the osteopathic setting and relevant indications on which... (Review)
Review
In the panorama of scientific literature, there is a paucity of literature on how to palpate the heart area in the osteopathic setting and relevant indications on which palpatory sensations the clinician should perceive during the evaluation. The article reviews the fascial anatomy of the heart area and the heart movements derived from magnetic resonance imaging (MRI) studies and describes the landmarks used by the cardiac surgeon to visualize the mediastinal area. The text sets out possible suggestions for a more adequate osteopathic palpatory evaluation and describes any tactile sensations arising from the patient's chest. To the knowledge of the authors, this is the first article that seeks to lay solid foundations for the improvement of osteopathic manual medicine in the cardiology field.
PubMed: 33816036
DOI: 10.7759/cureus.14187 -
Journal of Osteopathic Medicine May 2023In this article, the authors will discuss a modified anatomy-based neck and thyroid examination that allows for a more comprehensive evaluation. It is the opinion of the...
In this article, the authors will discuss a modified anatomy-based neck and thyroid examination that allows for a more comprehensive evaluation. It is the opinion of the authors that an organ and its function are best evaluated utilizing the following steps: anatomy-based inspection and palpation, imaging, and blood tests. Approximately half of the lateral part of the thyroid is deep to the sternocleidomastoid (SCM) and sternothyroid muscles, which makes it rather difficult to palpate the entire gland utilizing prior physical examination techniques. The goal of this modified anatomy-based thyroid examination is to minimize the number of structures between the physician's fingers and the patient's thyroid by utilizing neck flexion, side bending, and rotation. If one approaches the thyroid from behind the patient, nodules can be missed due to the muscles and transverse processes overlaying them. The incidence of thyroid cancer in the United States is drastically increasing, which demonstrates the importance of a more thorough thyroid palpation. Our anatomy-based approach may allow for earlier detection and therefore earlier treatment.
Topics: Humans; Thyroid Neoplasms; Physical Examination; Palpation
PubMed: 36940275
DOI: 10.1515/jom-2023-0005