Résumé
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.
Résumé
Thirty two patients having complex renal stones in the age group of 10-60 years were studied to detect hyperparathyroidism (HPT). The clinical diagnosis varied from bilateral renal stones in 20 (62.5%),2 (6.22%) had large unilateral stone, 2 (6.622%) had recurrent bilateral renal calculi and 4 (12.5%) had unilateral recurrent calculi. Serum calcium was raised (> 10.5 mg%) in 9 (20%) cases. Parathyroid hormone (PTH) was found raised, ranging from 80-1330 pg/ml (N : 16-65 pg/ml) in 9 (28%) cases out of 32. Hypercalcemia (> 10:5 gm %) was found in 7 out of 9 cases of HPT whereas in other 2 cases it was normal (8.9 mg %) and upper normal (1 O.3mg %) respectively. Hypercalciuria (>250mgl24 hrs) was found in 5 patient ofHPT and rest 3 patients had normal levels. Serum phosphate was found in the range of 1.4-7.1mg% (N : 2.5-6.8mg %) in 30 cases, on patient had < 2.5mg % and one patient had >6.8mg %. One patient with hypercalcemia had both urinary calcium as well as PTH normal. Dual subtraction scan (thallium and technetium) was done in all 9 patients with raised PTH. Scan was positive with adenoma in 4 (12.5%) cases. One patient 15 years old girl with a positive scan had both serum calcium and 24 hrs. urinary calcium levels normal with raised PTH (90-100 pg/ml). Scan reported doubtful hyperplasia in one (3.12%) patient out of 32. This patient, a multiple stone passer had normal serum calcium as well as 24 hrs. urinary calcium with raised PTH (99.60) pg/ml). 4 cases (12.5%) had a normal scan. Four (12.5%) cases with positive scan underwent parathyroidectomy (PTX). Serum calcium and PTH concentration dropped to normal levels in the postoperative period. Rest of the cases of HPT with normal and doubtful scans are under follow up.