ABSTRACT
Objectives@#This is a diagnostic test research study to evaluate the various existing methods of thyroid examination and their comparison with the novel modified Rose method. It also aims to measure inter-examiner variation in clinical findings based on the level of education and training, as compared to ultrasonography.@*Methodology@#This cross-sectional study was conducted at a tertiary care hospital with 83 patients presenting to surgery OPD with neck swelling. Each patient was examined by one trained Junior Resident and a Surgery Consultant with all the four methods and with ultrasonography. Data was analysed by Stata-14, agreement between the two categorical variables was assessed by Kappa. In case of continuous variable agreement was assessed by Intra class correlation and Bland-Altman plot.@*Results@#Modified Rose method by the consultant has the highest sensitivity (98%) and diagnostic odds (210) as compared to others but its specificity ranges from 46.7-91.1% to diagnose retro-sternal extension of a goiter. It has 93.98% agreement for identification of nodules. It has a high specificity (Consultant - 100%, Resident - 95.5%) with relatively lower sensitivity (Consultant - 94%, Resident - 86.8%) to diagnose solitary thyroid nodule (STN) but the sensitivity and specificity for diagnosing a multinodular goitre (MNG) was high. However, the highest sensitivity to diagnose STN was highest with Crile’s method, but specificity was low. Lahey’s method was a better clinical method to palpate lymph nodes compared to the other three.@*Conclusion@#Examination in modified Rose’s position is a better method of clinical examination of thyroid especially in patients with occult substernal extension. Lahey’s method is a better method to examine cervical lymph nodes.
ABSTRACT
BACKGROUND AND OBJECTIVES: Enlargement of the inferior turbinates can be caused by allergic rhinitis, vasomotor rhinitis, or emotional responses. However, the effects of general anesthesia and the Rose position on the enlargement of the turbinates are unknown. The aim of this study is to evaluate the effects of general anesthesia and the Rose position on the size of the inferior turbinates and nasal passage. MATERIALS AND METHODS: Fifty patients undergoing tonsillectomy with or without adenoidectomy or snoring surgery without nasal pathology from February, 2007 to July, 2007 at a university hospital were included in the study. The size of the inferior turbinates was measured under the following conditions:1) pre-anesthesia in the supine position;2) post-anesthesia in the supine position;3) post- anesthesia, lying in the Rose position, and 4) at the end of the operation 30 to 50 minutes after anesthesia, with endoscopic nasal photographs. Using an acoustic rhinometry, the minimal cross-sectional area of the nasal cavity was, during conditions one and four, listed above, simultaneously. RESULTS: The size of the inferior turbinates was increased statistically in condition three, post-anesthesia, lying in the Rose position, and condition four, at the end of surgery 30 to 50 minutes after anesthesia, compared to condition one, pre-anesthesia lying in the supine position. In addition, the minimal cross-sectional area of the nasal cavity was decreased in condition one compared to condition four. CONCLUSION: The size of the inferior turbinates was influenced by general anesthesia and the Rose position, presumably due to engorgement of the venous sinuses and/or mucosal edema.