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PubMed1989

Clinical relevance of pedal pulse palpation in patients suspected of peripheral arterial insufficiency.

Previous studies in patients with peripheral arterial disease (PAD) have shown that the prognosis is relatively good when the distal systolic ankle index (ankle systolic pressure/arm systolic pressure) is above 50% and the distal toe systolic pressure is above 40 mmHg. In 132 patients suspected of PAD in the legs we investigated the relationship between the presence of pedal pulse and the distal systolic pressure in order to discover what diagnostic and prognostic information could be found from pulse palpation alone. The prospective study consisted of three consecutive series (A, 51 patients; B, 42 patients; and C, 39 patients); three of the authors palpated the arteries of the patients' feet: one author in each series. The palpatory findings were related to the distal systolic pressures. When pedal pulses were present we found: (a) ankle indices above 50%; and (b) toe systolic pressures above 40 mmHg. These minimal pressure values were reproducible in the three series. Furthermore, patients lacking palpable pulses in both feet had ankle indices below 90%. We conclude: (a) if pulses are palpable on both feet of a patient the prognosis for progression is relatively good regarding the patient's PAD; (b) if pedal pulse is palpable an arteriosclerotic ulcer on the foot will heal; and (c) patients lacking palpable pulses in both feet actually suffer from PAD.

Adult↗

PubMed2002

Validity of nodule palpation in a Simulium neavei-transmitted onchocerciasis area in Uganda.

The objective of this study was to evaluate the prevalence of palpable nodules as a rapid indicator for onchocerciasis endemicity in at-risk communities where Simulium neavei s.s. is the transmitting vector. We used data collected from 13 villages in Uganda to determine the validity of this rapid assessment method. The prevalence of palpable nodules was closely associated with the microfilarial prevalence (R2 = 0.603, P = 0.002), with the community filarial load (R2 = 0.620, P = 0.001) and with the prevalence of onchodermatitis. Nodule palpation in males more than 20 years old, using a cut-off point of 40% and higher for the nodule prevalence, had a sensitivity of 92% and a specificity of 100% in correctly identifying communities in need of urgent intervention with ivermectin mass treatment. Cut-off points were based on World Health Organization recommendations. Thus, nodule palpation can replace skin snipping to identify communities at serious risk of S. neavei-transmitted onchocerciasis.

Animals↗

PubMed2005

[Comparision of ovulation synchronization (OVSYNCH) with the selective induction of oestrus using PGF2alpha after rectal palpation in a dairy herd].

The efficacy of a protocol for the synchronization of ovulation followed by timed Al (OVSYNCH) was compared with a reproductive management protocol based on induction of oestrus after rectal palpation using PGF2alpha on a commercial dairy farm in Brandenburg, Germany. Cows in the OVSYNCH group (n = 309) were treated between 62 and 68 days in milk (DIM) with 0.02 mg of buserelin (GnRH analogue) intramuscularly (i.m.). Seven days later 0.75 mg of tiaprost (PGF2alpha-analogue) were administered i.m. to regress the corpus luteum (C.I.). All cows received a second treatment with GnRH another 48 hrs later and were inseminated 16 to 20 hrs after the second GnRH-treatment (72 to 78 DIM). Cows in the PGF group (n = 302) were examined by rectal palpation between 69 and 75 DIM. Cows with a C.I. received 0.75 mg of tiaprost to induce oestrus. Cows were inseminated on observed oestrus. Cows not inseminated within 14 days after treatment were re-examined between 83 and 89 DIM. For both groups, the voluntary waiting period was set at 72 DIM. Service rate was higher (86.4 vs. 63.2 %, P < 0.05), days to first service (77 +/- 11 vs. 86 +/- 19 days, P < 0.001) and days open (102 +/- 34 vs. 109 +/- 35 days, P < 0.05) were shorter in the OVSYNCH group. First service conception rate (40.3 vs. 42.4 %), conception rate to all services (37.9 vs. 40.0 %) and the proportion of pregnant cows at 200 DIM were similar in the OVSYNCH evaluation for the total costs per pregnancy in 71 different cost scenarios showed only slight differences between the groups. Mean costs per pregnancy were euro 235.43 and euro 235.08 for the OVSYNCH and the PGF group, respectively. Quality of oestrus as assessed by the Al technician did not reveal a relationship to conception rate after OVSYNCH and timed Al. However, swelling, hyperaemia and a moist vestibulum were positively associated with conception rate.

Animals↗

PubMed1989

[Findings of pulse palpation and non-invasively measured blood pressure values of the posterior tibial artery in arterial occlusive disease].

In 37 test persons with healthy vessels and 103 patients with arterial obstructive disease the clinical findings of the pulse palpation were related to the results of the systolic Doppler pressure measurement in the region of the posterior tibial artery. The experience of the investigator, physical influences, local extravascular factors as well as parameters of the central haemodynamics proved to be significant. A palpation of the pulse was successful in peripheral systolic pressure values lying higher than 90 Torr, so that here a judgement of the function alone became possible with the help of the palpatory pressure measurement of the posterior tibial artery. Unfavourable local conditions, however, can be followed by negative tactile findings of the pulse also in higher pressure values.

Arterial Occlusive Diseases↗

PubMed1982

Clinical clue of severe aortic stenosis. Simultaneous palpation of the carotid and apical impulses.

In patients with severe aortic stenosis, simultaneous palpation of the carotid and apical impulses yields a palpable lag time between the two. Apexcardiograms and carotid pulse tracings were recorded in 66 control subjects and in 30 patients with aortic stenosis. Using QRS peak as reference, the peak appearance time of the carotid pulse tracings and apexcardiograms was measured, and the difference was calculated as palpable lag time; 21/30 patients had a palpable lag time, whereas nine did not; 22/30 patients with aortic stenosis had aortic valve areas of less than 1 sq cm. Twenty-one of these 22 patients had a palpable lag time. The sensitivity of a palpable lag time for aortic valve areas of less than 1 sq cm was 95%, specificity 100%, positive predictive value 100%, and negative predictive value 89%. The group means for measured lag times between controls (70 +/- 7 ms) and those patients with aortic stenosis (133 +/- 7 ms) showed a definite difference. The palpable lag time by linear regression analysis had an r of .68, third in rank to the aortic valve gradient and ECG for predicting aortic valve area. Multiple regression analysis found the palpable lag time, ECG, syncope, and shudder waves together able to predict the aortic valve area (r = .85).

Adolescent↗

PubMed1989

Metastatic neck disease. Palpation vs ultrasound examination.

Nodal disease is a diagnostic problem in head and neck oncology. Current methods for investigation of the neck are not satisfactory as far as differentiation between necks with positive nodes and those with negative nodes is concerned. In the present study, the results of palpation and ultrasound examination were compared with histopathologic examination results of 120 neck dissection specimens. Furthermore, the value of ultrasound examination, combined with cytologic examination, of neck nodes was evaluated. Ultrasound examination was characterized by high sensitivity, ie, 96.8%; specificity was 32.0%. When the results of ultrasound-guided fine-needle aspiration biopsy were added to the ultrasound findings, specificity was as high as 92.9%. From these results, it was concluded that ultrasound examination with fine-needle aspiration biopsy is an accurate method for assessment of the neck in head and neck oncology.

Biopsy, Needle↗

PubMed1997

A gamma detector probe with ex vivo detection of carcinoid tumors superior to intraoperative palpation.

BACKGROUND: Despite the generally successful scintigraphic detection of endocrine tumors with [(111)In]-DTPA-D-[Phe1]-octreotide (OctreoScan, Mallinckrodt Medical, Petten, The Netherlands), its intraoperative application awaits the development of suitable gamma detectors. This study describes a novel probe (H-probe2) and its ex vivo efficacy for the detection of midgut carcinoid tumors. METHODS: The probe measures 180 mm x 24 mm, and contains a bismuth germinate crystal connected to a photomultiplicator tube, a lead shield, and a tantalum collimator with an angled, 3-mm wide opening. It was characterized in a test bench utilizing solublilized (111)In and 99mTc, and 8 fresh operative specimens containing 26 histologically verified midgut carcinoid tumors (2-40 mm) from patients exposed to OctreoScan. Measurements were made at 2.5-mm intervals over the entire specimens and presented three dimensionally. RESULTS: The test bench analysis supported efficient shielding, and a total collimation of 27 degrees for (111)In and 20 degrees for 99mTc. In addition to 18 palpable tumors, 4 of 6 surgically occult tumors (2-3 mm in dimension) could be discovered with H-probe2. Small tumors in close apposition to a large tumor could not be separated. Wellcounter examination showed that tumors detected with the H-probe2 exhibited 1.7-84.1 times higher radionuclide uptake than the surrounding normal tissue. CONCLUSION: Ex vivo analysis of H-probe2 supported detection of tumors inaccessible to surgical palpation, but its clinical efficiency awaits intraoperative evaluation.

Carcinoid Tumor↗

PubMed2000

Assessment of neck tissue fibrosis using an ultrasound palpation system: a feasibility study.

Fibrotic change in the soft tissue of the neck is a common side-effect after radiotherapy treatment for cancers of the head and neck region. The development of a quantitative approach for the assessment of neck tissue stiffness using an ultrasound palpation system (UPS) is reported. A testing protocol was established with the participation of eight normal subjects and four patients who had neck fibrosis after previous radiotherapy to the neck. Six reference sites were assessed on each side of the neck in each subject. Site-dependence, inter-observer variability, and intra-observer variability were further evaluated by measurement of sites 1 cm anterior, posterior, superior and inferior to two of the reference sites on each side of the neck, and by repeating measurements using a second observer on the same occasion and using the same observer one week afterwards. The mean tissue Young's modulus for normal subjects was 12.8 +/- 3.9 kPa, and that of the radiotherapy-treated patients ranged from 46.4 to 108.3 kPa. The modulus shows limited variation among anatomical sub-sites within the neck. For a confidence level of 95%, there was a variation of +/- 14.2% for site-dependence, +/- 15.2% for inter-observer, and +/- 7.2% for intra-observer tests for the group of normal subjects. The variation in the patients was +/- 13.6% for site-dependence, and +/- 13.1% for the inter-observer test.

Adult↗

PubMed1991

Relationship between the left spermatic vein diameter measured by ultrasound and palpated varicocele and Doppler ultrasound findings.

Fifty cases admitted to the urological clinics of Turkish State Railways Hospital, Ankara, were examined by scrotal ultrasonography in order to find the relationship between the left spermatic vein diameter measured by ultrasound and palpated varicocele and Doppler ultrasound findings. In the measured 5-6 mm spermatic vein diameters palpable varicocele and venous regurgitation were found in 100%, in the measured 3-4 mm diameters palpable varicocele was found in 50% and venous regurgitation in 64.5%, and in the measured 1-2 mm diameters palpable varicocele was found in 16% and venous regurgitation in 24%.

Adult↗

PubMedDate not supplied

Alexithymia and hypersensitivity to touch and palpation.

Alexithymia appears to be directly related to the process of somatization of psychological distress that has not found verbal expression. The lack of a meaningful dialogue between mother and child in early infancy may predispose the development of an alexithymic strategy in expressing psychic and psychosocial stress. This can occur in the form of unpleasant bodily sensations or pain. The human skin is, in addition to the oral and gastrointestinal organs, the earliest contact sphere between the young infant and the environment. In a group of 312 randomly chosen patients at an outpatient primary health care clinic a significant relationship was found between palpational hypersensitivity to touch on the one hand and somatization proneness and the degree of alexithymia on the other hand.

Adult↗

PubMed1980

The feasibility of palpating the lateral pterygoid muscle.

Although dysfunction of the lateral pterygoid muscle could contribute to the pain associated with TMJ disorders, it has been demonstrated through the use of dissections and lateral head radiographs that it is not possible to palpate the lateral pterygoid muscle directly by conventional clinical techniques without applying pressure through the overlying superficial head of the medial pterygoid muscle. The possibility of confusing temporal muscle hypersensitivity with that of another muscle in this region is suggested.

Aged↗

PubMed1992

Tenderness on palpation and occlusal abnormalities in temporomandibular dysfunction.

Tenderness on palpation indicates objective painful symptoms. This study investigated the tenderness of the temporomandibular joint, muscles and their relation to occlusion in patients with temporomandibular dysfunction. Two hundred ten patients were examined; 96% had tenderness and 80% of cases of tenderness were diagnosed as occlusally related. The average number of tender areas was 5.4 per patient, despite the contribution of occlusion. Tenderness was observed most frequently in the lateral pterygoid muscle, followed by the insertion of temporal muscle. There was no correlation of temporomandibular joint tenderness to muscle tenderness, while tenderness of certain muscles to each other was correlated. Differences were related to the state of occlusion in the number of tender areas, to the ratio to tenderness of elevator muscles to horizontally acting muscles, and to the frequency of unilateral tenderness. The association of muscle tenderness and occlusion was suggested.

Adolescent↗

PubMed1988

Size of breast cancer on ultrasonography, cut-surface of resected specimen, and palpation.

In the period from January 1985 to May 1987, 68 patients with palpable breast cancers were studied to compare the size on ultrasonography with the size of the cut-surface of the resected specimen. Both the width (mediolateral size) and height (size in depth) were delineated as smaller on ultrasonography than on the cut-surface of resected specimens. The difference in size between ultrasonography and resected specimen was greater for the width than for the height. These results can explain why breast cancer has a greater ratio of height to width on ultrasonography. The ratio of the width on palpation to that on ultrasonography was also evaluated. These ratios proved to be useful in differentiating breast cancer from benign lesions.

Breast Neoplasms↗

PubMed2005

Cervicothoracic angina identified by case history and palpation findings in patients with stable angina pectoris.

OBJECTIVE: To investigate the decision-making process of an experienced chiropractor in diagnosing noncardiac musculoskeletal chest pain of cervicothoracic angina in patients with stable angina pectoris, based on patient history and clinical examination. Secondly, to examine the possibility of obtaining an objective diagnostic rule tool for the identification of cervicothoracic angina and to validate the diagnosis of this disorder. METHODS: A nonrandomized prospective trial was performed at a university hospital. A total of 516 of 972 consecutive patients referred for coronary angiography because of known or suspected angina pectoris were asked to participate in the study. Of these, 275 gave informed consent to a standardized manual examination of their spine and thorax. Diagnoses of an experienced chiropractor on cervicothoracic angina patients. Myocardial perfusion imaging and coronary angiography were used for validation. A set of candidate variables from patient history and clinical examination were tested for their role in the decision-making process. RESULTS: Eighteen percent of the patients were diagnosed with cervicothoracic angina. Of these, 80% had normal myocardial perfusion compared to 50% of cervicothoracic angina-negative patients. The main determinants of the decision-making process could be identified. CONCLUSION: An experienced chiropractor could identify a subset of patients with angina pectoris as having cervicothoracic angina. Systematic manual palpation of the spine and thorax could be used as part of the clinical examination together with basic cardiological variables to screen patients with chest pain allowing for improvements in referral patterns for specialist opinion or angiography.

Adult↗

PubMed2001

Transvaginal sacrospinous colpopexy by palpation-a new minimally invasive procedure using an anchoring system.

OBJECTIVES: To evaluate the preliminary results and complications of a new, minimally invasive, transvaginal sacrospinous colpopexy for vault and uterovaginal prolapse. METHODS: Twelve women, 41 to 79 years old, underwent sacrospinous fixation by palpation using the Raz Anchoring System (RAS) between October 1998 and September 1999. The vaginal vault prolapse was grade II and III in 4 and 6 patients, respectively. Two patients had grade III uterovaginal prolapse. Two patients underwent RAS alone, and 10 underwent RAS in conjunction with simultaneous related vaginal surgery. Eleven patients underwent vaginal vault and one uterovaginal fixation. RAS features two components: first, a 15-mm-long cylindrical titanium anchor and second, a disposable inserter. A penetration limiter tube allows one to penetrate the sacrospinous ligament up to the desired depth. The anchor is released into the ligament and then the vaginal apex is fixed in place. RESULTS: The minimum and mean follow-up was 12 and 16 months, respectively. The operative time to complete the colpopexy ranged from 8 to 15 minutes. We recorded only one recurrent vaginal vault prolapse due to pull-through of the suspension sutures through the vagina. No significant perioperative complications occurred. No de novo or recurrent cystocele, rectocele, enterocele, stress urinary incontinence, urgency, or frequency was seen. Defecation was normal in all patients. Coital function was normal in 8 patients who were still sexually active. No patient experienced perineal or buttock pain. CONCLUSIONS: RAS seems to be quick, easy, safe, and effective in the suspension of vaginal apex to the sacrospinous ligament, but our preliminary results must be confirmed by controlled prospective studies with a larger number of patients and wider follow-up.

Adult↗

PubMed1981

Why palpate the radial artery?

The palpability of the radial-artery wall was assessed before death in 43 patients and compared with the histology of the artery at necropsy. There was no relationship between the degree of palpability and the histological changes of atheroma or of Mönckeberg's sclerosis, or the presence of clinical vascular disease. It is suggested that palpation of the wall of the radial artery provides no useful clinical information.

Aged↗

PubMed2003

In vivo real-time freehand palpation imaging.

Previous experience with laboratory fixtures and off-line processing of elasticity data showed that problems occurring in data acquisition often resulted in poor elasticity image quality. A system for real-time estimation and display of tissue elastic properties using a clinical ultrasonic imaging system has been developed. A brief description of that system and the initial clinical tests of that system are reported. Experience with real-time freehand elasticity imaging shows that images with high contrast-to-noise ratios are consistently obtained. Images of breast lesions were acquired with freehand palpation using standard linear-array ultrasound (US) transducers. Results in volunteer patients show that high-quality elasticity images are easily obtained from in vivo breast studies. The key element to successful scanning is real-time visual feedback of B-mode and strain images that guide the patient positioning and compression direction. Results show that individual images of axial strain in tissues can be quite misleading, and that a "movie loop" of side-by-side B-mode and strain images provides significantly more information. Our preliminary data suggest that the strain image sequences for various breast pathologies are unique. For example, strain images of fibroadenomas lose contrast with increasing precompression, but those of invasive ductal carcinoma have high negative contrast (dark relative to "normal" tissue) for a wide range of precompression. In addition, a comparison of the lesion area measured in B-mode vs. strain images, for a representative image from the sequence, appears to be a sensitive criterion for separating invasive ductal carcinoma from cyst and fibroadenoma.

Algorithms↗

PubMed1987

Palpation of the femoral and popliteal pulses: a study of the accuracy as assessed by agreement between multiple observers.

Six vascular surgeons independently examined 44 legs in patients with suspected peripheral arterial disease. Each surgeon recorded whether the femoral and popliteal pulses were present or absent, and if thought to be present, whether they were normal or reduced in amplitude. Interobserver agreement was determined by calculating both observed agreement (Po) and agreement after correction for chance (kappa-k). The results were calculated both for each possible pair of surgeons and as an overall value for all possible pairs combined. Agreement as to whether pulses were present or absent was significantly better than expected by chance but was only moderately good (overall kappa for femoral pulse = 0.53, and overall kappa for popliteal pulse = 0.52). More often than not, agreement as to whether the pulses were normal or reduced was no better than expected by chance (overall kappa for femoral pulse = 0.15, and overall kappa for popliteal pulse = 0.01). For each assessment, agreement was no better for the more experienced than the less experienced pairs of surgeons. The results indicate that more objective methods than pulse palpation are required to determine whether there is significant disease in the aorto-iliac and femoro-popliteal arterial segments.

Arterial Occlusive Diseases↗