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Objectives: Determine the frequency at which palpation of two fontanelles is possible, in order to describe a new clinical diagnosis approach: "the two fontanelles sign"., Materials and Methods: Descriptive study established in the obstetric and gynecology department at Lyon-Sud university hospital between March and November 2013. We followed-up one thousand successive singleton deliveries in cephalic presentation after 30 weeks of gestation. Before starting expulsive efforts, the number of fontanelles perceived (1, 2 or any) was documented. If the number of fontanelles were not noted, the patient was excluded., Results: Nine hundred and seventy-eight patients were included. In 39.3% of cases (n=384), 2 fontanelles were found, in 57.5% (n=563) only one and in 3.2% (n=31), none., Conclusion: Both fontanelles palpation is frequently possible and enables quality control of fetal head presentation variety without ultrasound assessment. In order to prove the reliability of clinical examination, study comparing presentation ultrasonography and digital examination finding 2 fontanelles is needed., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objectives: Back pain is often attributed to increased tension in the back muscles, regardless of whether the tension is primary or related to a disc/facet pathology. We hypothesized that when either lower back pain or neck pain is unilateral, the muscle tension would be more pronounced on the painful side and could be detected by palpation alone (i.e., without the need to apply pain-triggering manoeuvres)., Methods: Patients with unilateral neck or lower back pain were enrolled in the study. Participants with scoliosis, obesity, a history of spinal surgery or pain radiating below the knee or the elbow were excluded. The patients were examined by comparative muscle palpation only. The examiner was unaware of which body side was painful and the patient was told to remain still and silent. The spinal muscles were examined bilaterally, with superficial and deep palpation. The examiner had to determine on which side the tension was greater. The patients' age, body mass index, time since onset of symptoms and Rolland Morris (lower back pain) and INDIC (neck pain) functional disability questionnaire scores were recorded., Results: Ninety-one patients with unilateral lower back pain (35 males, 56 females; mean±SD age: 45.2±15 yrs) and 94 patients with unilateral neck pain (26 males, 68 females, 49.1±15 yrs) were enrolled in the study. The lower back pain and neck pain were right-sided in 50 (54.9%) and 53 (56.4%) of cases, respectively. The examiners correctly identified the painful side in 64.8% of the cases of lower back pain (a significantly better percentage than chance alone (i.e. 50%), P=0.02) and 58.5% (P=0.10) of the cases of neck pain. In lower back pain patients, the results were better for right-side pain than for left-side pain (70.0% and 58.5% of correct answers, respectively, ns). In neck pain patients, the results were better for left-side pain than right-side pain (61% and 56.6%, respectively, ns). There were no significant differences between the two examiners' respective performance levels. The patients' clinical parameters did not appear to influence successful detection of the painful side., Conclusion: Our findings suggest that palpation can detect increased muscle tension in a limited proportion of cases., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Objective: To determine the indications and prerequisites for operative vaginal delivery., Methods: Articles were searched using PubMed and Cochrane library., Results: Indications for operative vaginal delivery are non-reassuring fetal status (NP4), no progress from 30minutes of adequate active pushing, maternal exhaustion (NP5), or medical indications to avoid Valsalva (NP5). Operative vaginal delivery (Thierry's spatulas, forceps, and vacuum delivery) before that cervix is fully dilated and fetal head is fully engaged is not recommended (NP4). Obstetricians have to know patient medical record and the fetal head position before performing operative vaginal delivery (NP5). The reliability of transvaginal examination to determine the fetal engagement and intrapartum fetal head position is 88% and 80% respectively (NP2). Transabdominal ultrasound assessment is recommended in cases of doubts about the fetal head position (NP5). Available data are not sufficient to fully contraindicated midpelvic operative delivery. Each case should be considered individually and depending on the skill of the obstetrician (NP5). Obstetricians should be aware that they may wrongly consider the fetus engaged in the midpelvis in 6% of cases, whereas it is not really engaged. Moreover, the presence of factors predictive of failed operative vaginal delivery must contraindicated midpelvic operative vaginal delivery and indicated a cesarean delivery (NP5). In general, midpelvic operative vaginal delivery is not recommended. Routine instrumental delivery in theatre and episiotomy for operative vaginal delivery are not recommended (NP3 and NP4, respectively)., Conclusions: Recommendations for operative vaginal delivery should be respected to minimize both fetal and maternal trauma. Obstetricians should anticipate the complications that may occurred following operative vaginal delivery.

Introduction: We report the development of an arthroscopic severity score for scapholunate instability based on dynamic testing of the scapholunate joint., Method: Seventy patients who had a scapholunate instability diagnosed by arthroscopy were reviewed. There were 21 static instabilities, 19 dynamic instabilities and 30 preradiographic instabilities. The arthroscopic finding was systematized. In the radiocarpal space the scapholunate interosseous ligament was seen and palpated. In the midcarpal space, the dynamic manoeuvre of dissociation was done using the examining hook., Results: An arthroscopic classification was developed: in stage 0, it is impossible to put the tip of the hook between the scaphoid and the lunate; in stage 1, it is possible to put the tip of the hook between the scaphoid and the lunate; in stage 2, it is possible to create a scapholunate diastasis with the use of a twisting motion applied to the hook; in the stage 3, the 2.7-mm arthroscope passes between the scaphoid and lunate from the midcarpal to the radiocarpal space. We found 4 stage 1, 43 stage 2 and 23 stage 3., Discussion: Even if other diagnostic tools such as the arthroscanner or MRI are able to diagnose scapholunate interosseous ligament tears, wrist arthroscopy is for us the Gold Standard to quantify and directly explore the scapholunate joint. The goal of the score of severity presented here is to guide the different therapeutic indications.

This article provides information on breast cancer in women and emphasizes nurses' key role in clinical breast examination. Since women must be shown how to perform proper breast self-examination as a precautionary measure for early cancer detection, it is essential that nurses themselves be able to conduct a quality examination. Following a brief review of the anatomy and physiology of breasts, the manuscript gives instructions on the correct procedure to enable interested nurses to take on independent and interdependent functions in their practice setting. The author also underlines errors to be avoided.

Pain induced by pinching the peritoneum betrays a pathology of that membrane. It is absent when the peritoneum is perfectly healthy. Pain is elicited by a special palpation technique. Clinically and statistically, the presence of this pain is pathognomonic, but it does not inform on the aetiology. In the present study the most frequent causes of positive abdominal peritoneal pinching test were peritoneal tuberculosis, followed by portal hypertension with or without liver cirrhosis.

The value of endorectal sonography for the diagnosis of prostatic cancer was established after retrospective interpretation of sonographic data issued from 213 patients without prior knowledge of either clinical or pathological data. Endorectal sonography was performed with a mechanical sectorial high frequency (7.5 MHz) probe realized by the authors. A pathology report (73 biopsies, 52 TUR, 7 suprapubic adenomectomy specimens) was available for 132 patients: 25 pathological examinations were interpreted as normal, 41 adenomas, 24 prostatitis or fibrosis and 42 cancers (5 clinical stage T0, 22 T1, 2 T2 and 13 T3). Specificity for the diagnosis of cancer was respectively 65% or 79% according to the normality reference considered, i.e. either the group of patients having a normal pathological control (90 patients) or the same group plus another group of patients with a normal rectal examination (171 patients). Sensitivity for the diagnosis of cancer was only 48%: 53% of cancers were falsely interpreted as prostatitis or adenomas and 9% as normal (2 T0 and 2 T1). The large proportion of local stages without capsular involvement (29/42) is partly responsible for this lack of sensitivity. Sonography can reveal the presence of abnormalities in the echostructure of the gland but does not allow tissue characterization. Rectal examination and sonography are complementary techniques. In the same study, rectal examination had a 48% specificity and a 92% sensitivity.

The parathyroid glands may be located anywhere and hidden in the thick thyroid gland sheath, so that the duration of parathyroidectomy is impossible to predict. For accurate and rapid identification and assessment of the nodule to be dissected, the authors advocate a two-finger method: one index finger palpates the whole length of the posteromedial segment of the thyroid sheath, while the other index finger penetrates into the thyroid cavity. Fourteen parathyroid adenomas and 39/40 hypertrophied glands were detected by this method. Results were negative in 12 cases with unconfirmed biological diagnosis of hyperparathyroidism.

The School of Centre Broca has improved the clinical procedures of early detection of breast carcinoma. For 421 checked up carcinomas, including micro-carcinomas, in more than 9 out of 10 cases, the diagnosis has been based on the inspection signs. The latter has to be a dynamical inspection. Description is given of the various phases of this inspection, i.e. postural phases and phases of mobilization. The rate of the false negative clinical results does not exceed the one of each of the para-clinical investigations (mammography or thermography). An early detection of a mass may be made if each practioner contraints himself to perform systematically in his female patients the dynamic inspection of the breast.