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PubMed1999

Assessment of the level of sensory block after subarachnoid anesthesia using a pressure palpator.

UNLABELLED: In a cross-over study, we compared two methods of assessing the level of sensory block during subarachnoid anesthesia: the traditional pinprick sensation or a novel pressure palpator exerting a pressure of 650 g. Fifty patients scheduled for transurethral surgery under subarachnoid anesthesia were randomly assigned to be tested for spread of sensory block. In Group 1, the pressure palpator was followed by pinprick; in Group 2, the reverse sequence was used. Evaluation was performed 15 and 25 min after the subarachnoid injection of 2 mL of 5% lidocaine hyperbaric solution. In Group 1, the level of sensory block assessed with the pressure palpator was 1.7 +/- 3.2 cm (0.5 +/- 1.2 dermatomes) higher than that with the pinprick at 15 min, and 2.2 +/- 3.4 cm (0.6 +/- 1.0 dermatomes) higher than that with the pinprick 25 min after the block. In Group 2, the difference was accentuated. The level of sensory block assessed by pinprick 15 min after subarachnoid lidocaine was 5.7 +/- 4.8 cm (1.2 +/- 0.9 dermatomes) lower than the level with the pressure palpator, and 4.2 +/- 3.3 cm (0.9 +/- 0.6 dermatomes) lower than that with the pressure palpator at 25 min. In all instances, the pressure palpator gave a significantly higher assessment than the pinprick. We conclude that the pressure palpator, when preceded by the pinprick test, is associated with an increased threshold. This method may be useful in assessing the sensory block produced by subarachnoid anesthesia. IMPLICATIONS: A novel pressure palpator that maintains the integrity of the epidermis was used to assess the level of sensory block after subarachnoid anesthesia and was compared with the standard method of the pinprick sensation. This method assessed the block consistently higher than the pinprick method, but it may have advantages as a noninvasive sensory test.

Aged↗
PubMed1988

Intraoperative ultrasonographic localization of islet cell tumors. A prospective comparison to palpation.

The purpose of the present study was to evaluate prospectively the value of intraoperative ultrasound scanning (IOUS) in localizing islet cell tumors by comparing results of IOUS to those of palpation during 44 consecutive laparotomies for gastrinoma (36) or insulinoma (8). All patients had preoperative radiographic imaging studies and selective venous sampling for hormones, which guided the subsequent laparotomy. Any suspicious finding by palpation and/or IOUS was resected. Pathologic evidence of islet cell neoplasm served as the reference standard. Five patients were excluded from analysis because neither palpation nor IOUS had suspicious findings and no islet cell tumor was found. Seven pancreatic insulinomas were found in seven patients. IOUS was as sensitive as palpation at localizing insulinomas. Twenty-three pancreatic gastrinomas were found in 19 patients. IOUS was equal to palpation in the ability to localize gastrinomas. Gastrinomas that were successfully imaged by IOUS were significantly larger than gastrinomas that were not imaged. Twelve extrapancreatic gastrinomas were found in nine patients, and palpation was more sensitive than IOUS at localizing these small duodenal wall tumors. Five patients (11%) had their surgical management changed by IOUS. Two patients had pancreatic tumors (one gastrinoma and insulinoma) enucleated that would not have been found without IOUS, and three patients had resections of pathologically proven malignant islet cell tumors based on sonographic findings. All five patients were cured with short follow-up. The present results demonstrate that palpation and IOUS are complementary because IOUS can image tumors that are not palpable and IOUS can provide additional information concerning malignant potential not detected by palpation.

Adenoma, Islet Cell↗
PubMedDate not supplied

Solitary thyroid nodule. Comparison between palpation and ultrasonography.

OBJECTIVE: To determine the accuracy of clinical palpation in the diagnosis of solitary thyroid nodule in comparison with ultrasonographic findings. METHODS: From a computerized database of 1774 patients with the diagnosis of nodular thyroid disease made from January 1990 through December 1991 at our institution, we retrieved and reviewed the medical records of the 193 patients who underwent ultrasonography of the thyroid (42 patients with multinodular glands on palpation were excluded). Nodules were categorized as "solitary" or "dominant nodule of a multinodular gland." Concordance rates were measured between results of palpation and ultrasonographic findings. RESULTS: Of 151 patients included in the study, 78 had solitary nodules on ultrasonography and 73 had multiple nodules. Of those with multiple nodules, 49 had two nodules and 24 had three or more nodules. Of clinically palpable nodules, 89% were 1 cm or greater in diameter. In 72% of the patients with multiple nodules, the other nodules not identified on palpation were less than 1 cm in diameter. The overall concordance rate between the size of the solitary nodule or the dominant nodule in a multinodular gland estimated with clinical palpation and the actual size seen on ultrasonography was 72%. The relationship between multiple nodules and malignancy was not statistically significant. CONCLUSIONS: Our results suggest that (1) a palpable solitary nodule represents a multinodular gland in about 50% of patients, (2) clinical palpation is less sensitive than thyroid ultrasonography in identifying multiple nodules, and (3) palpation is reliable only if a nodule is at least 1 cm in diameter. We recommend that small, occult (impalpable) thyroid nodules not be considered clinically important; they do not warrant further evaluation unless ultrasonographic features suggest malignancy or the nodule increases in size.

Adult↗
PubMed1984

Is femoral pulse palpation accurate in assessing the hemodynamic significance of aortoiliac occlusive disease?

Palpation of the common femoral artery pulse has been the mainstay in the clinical assessment of the significance of aortoiliac disease for deciding whether to perform a suprainguinal versus an infrainguinal bypass. This study was performed to assess the accuracy of clinical pulse palpation in comparison to intraarterial pressure measurements of 31 common femoral arteries in 21 patients. Pulse palpation was graded as to the presence (abnormal) or absence (normal) of hemodynamically significant aortoiliac occlusive disease while at rest. A femorobrachial index of less than 0.9 was considered hemodynamically significant. Data were analyzed by decision matrix analysis. Results demonstrated pulse palpation to be 100 percent sensitive, 54 percent specific, and 61 percent accurate. The negative predictive value of normal pulse to palpation was 100 percent, but the positive predictive value for an abnormal pulse to palpation was only 29 percent. Even though pulse palpation should remain an integral part in the clinical assessment of the peripheral vascular tree, it should be used with caution in the clinical decision-making process.

Aortic Diseases↗
PubMed2000

Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles.

OBJECTIVES: To determine the interexaminer reliability of palpation of three characteristics of trigger points (taut band, local twitch response, and referred pain) in patients with subacute low back pain, to determine whether training in palpation would improve reliability, and whether there was a difference between the physiatric and chiropractic physicians. DESIGN: Reliability study. SETTING: Whittier Health Campus, Los Angeles College of Chiropractic. PARTICIPANTS: Twenty-six nonsymptomatic individuals and 26 individuals with subacute low back pain. INTERVENTION: Twenty muscles per individual were first palpated by an expert and then randomly by four physician examiners. MAIN OUTCOME MEASURES: Palpation findings. RESULTS: Kappa scores for palpation of taut bands, local twitch responses, and referred pain were .215, .123, and .342, respectively, between the expert and the trained examiners, and .050, .118, and .326, respectively, between the expert and the untrained examiners. Kappa scores for agreement for palpation of taut bands, twitch responses, and referred pain were .108, -.001, and .435, respectively, among the nonexpert, trained examiners, and -.019, .022, and .320, respectively, among the nonexpert, untrained examiners. CONCLUSIONS: Among nonexpert physicians, physiatric or chiropractic, trigger point palpation is not reliable for detecting taut band and local twitch response, and only marginally reliable for referred pain after training.

Adult↗
PubMed1997

Lymph node sonography versus palpation for detecting recurrent disease in patients with malignant melanoma.

The aim of this study was to examine the efficacy of lymph node palpation versus high resolution lymph node sonography for the detection of lymph node metastases in patients with malignant melanoma. We retrospectively evaluated 2256 pairwise lymph node examinations of the cervical, axillary and inguinal region by palpation and sonography in 264 patients with resected melanomas greater than 0.75 mm of invasion thickness. Lymph node metastases occurred in 50 patients (19%) which were detected in 38 (76%) by both methods in agreement. In 7 cases (14%) palpation failed, in 3 cases (6%) sonography failed and in 2 cases both methods failed to identify metastases. The overall sensitivity of detecting metastatic disease was 82% for palpation and 90% for sonography which was statistically not different. The overall specificity by sonography (99%) was significantly better than for lymph node palpation (88%). Taking into account the results of this analysis, we conclude that patients with a negative result by lymph node palpation do not need further sonography for verification. However, any suspect result by palpation should be additionally evaluated by lymph node sonography in order to rule in or out metastatic disease.

Adolescent↗
PubMed2003

Reproducibility and repeatability: errors of three groups of physiotherapists in locating spinal levels by palpation.

Location of spinal levels by palpation is an essential part of physiotherapy assessment and treatment of spinal musculoskeletal conditions. This study aimed to (i) investigate the reproducibility and repeatability of three groups of physiotherapists in locating three randomly selected spinal levels by palpation, (ii) explore whether these groups were palpating similar points at each level, and (iii) investigate whether there were differences in palpation across the spinal levels tested. Reproducibility was estimated using a convenience sample of 30 physiotherapists: 13 undergraduate students, 10 clinicians, and seven manual therapists (MTs). Repeatability was investigated using six physiotherapists (two students, two clinicians and two MTs). Each therapist palpated the spinous processes (C5, T6, L5) once for reproducibility, and 10 times for repeatability, on each asymptomatic model. The skin overlying the spinal levels was marked with an invisible pen. Using an ultra-violet light, marks were transcribed onto transparent plastic strips for analysis, and the distances were measured with an electronic caliper. Repeated measures analyses of variance (ANOVA) indicated poor reproducibility across therapists at all spinal levels (F=18.43, P=0.001), but good repeatability within therapists (F=2.09, P=0.161). Students produced different mean locations of their palpatory marks from the other two groups in two spinal levels. Clinicians and MTs were more reproducible than students, and located similar levels. Palpation of L5 spinous process presented the most difficulty, for all groups. Further research is needed to compare different methods of palpation and explore whether reproducibility can be improved.

Adult↗
PubMed1997

Palpation as a method of fever determination in Malawian children who are less than 5 years old: how reliable is it?

Fever is a common occurrence in children who are < 5 years old and palpation of the forehead may or may not be a reliable method for determining fever in such children. In a study of 1120 Malawian children of this age attending outpatient's clinics, each child's mother and a clinical officer (CO) were asked to palpate the child's forehead and decide whether the child was febrile (felt warm or very warm) or afebrile (felt normal). The rectal temperature of each child was then taken using a thermometer and the child considered febrile if this temperature was > or = 38 degrees C. Using palpation, mothers judged 973 (86.9%) of 1120 children to be febrile and CO judged 565 (50.4%) of 1118 to be febrile, whereas thermometer readings indicated 410 (36.7%) to be truly febrile. False-positives (i.e. afebrile children judged to be febrile by palpation) accounted for 574 (59.0%) of the 973 children who were considered febrile by their mothers and 228 (40.4%) of the 565 children so considered by CO; mothers reported significantly more false-positives than CO (P < 0.05). False-negatives (i.e. febrile children judged to be afebrile by palpation) accounted for 11 (7.5%) of the 147 children who were considered afebrile by their mothers and 73 (13.2%) of the 553 children so considered by CO; CO reported significantly more false-negatives than mothers (P < 0.05). Overall, mothers were as likely as CO to misjudge a child (721/1120 v. 781/1118; P > 0.05). Although the sensitivity of mothers and CO in determining fever was similar (97.3% v. 82.2%; P > 0.05), CO gave a higher degree of specificity than the mothers (67.8% v. 19.2%; P < 0.000001). Although the present results indicate that palpation is not a reliable method of determining fever in children who are < 5 years old, caregivers should continue to use palpation as a useful first step in deciding when a child needs to be referred.

Body Temperature↗
PubMed1975

The diagnostic accuracy of palpation and fine-needle biopsy and an evaluation of their combined use in the diagnosis of breast lesions: report on a prospective study in 1244 women with symptoms.

In 1244 women with breast symptoms an evaluation by means of palpation was made with respect to diagnosis of malignancy according to a four-grade scale ranging from "definite cancer" to "no cancer." Aspiration biopsy and cytologic examination were then performed in 984 breast lesions. The diagnosis from the cytologic evaluation ranged from benign, through three grades of atypia (slight, moderate, grave) to cancer. A histologic diagnosis was made in 411 cases and in 28% it was cancer. Cancer was found in 92.5% of the patients with a palpatory diagnosis of "definite cancer," and in 50% of those with a palpatory diagnosis of "strong suspicion of cancer." In all patients in whom cancer was diagnosed cytologically, the same diagnosis was made at histology, while 87.5% of those with grave atypia at the cytologic examination were diagnosed histologically as having cancer. A false negative cytologic diagnosis was made in 4% of the cancer cases. With a combination of palpation and cytology, 91% of the cancer cases fell within the groups "definite cancer," "strong suspicion of cancer" (palpation)/"cancer," "grave atypia" (cytology). No patients with cancer were evaluated as "no cancer" (palpation)/"no atypia" (cytology). In this group of 697 patients, however, one cancer was discovered after 7 months. The investigation showed that a thorough palpatory evaluation is a prerequisite for a good result of aspiration biopsy, in particular to meet the risk of a false negative cytologic diagnosis. The cytologic examination revealed cancer in 6 and 12 cases, respectively, when palpation gave no or some suspicion of cancer, and in many cases it was able to eliminate malignancy suspected on palpation. Cytologic atypia indicated cancer in a relatively high per cent, but was also noted in many cases found to be benign histologically. The possibilities of reducing the number of "unnecessary" surgical biopsies by using a combination of palpation and cytology is discussed.

Adenofibroma↗
PubMed2004

An investigation into the validity of cervical spine motion palpation using subjects with congenital block vertebrae as a 'gold standard'.

BACKGROUND: Although the effectiveness of manipulative therapy for treating back and neck pain has been demonstrated, the validity of many of the procedures used to detect joint dysfunction has not been confirmed. Practitioners of manual medicine frequently employ motion palpation as a diagnostic tool, despite conflicting evidence regarding its utility and reliability. The introduction of various spinal models with artificially introduced 'fixations' as an attempt to introduce a 'gold standard' has met with frustration and frequent mechanical failure. Because direct comparison against a 'gold standard' allows the validity, specificity and sensitivity of a test to be calculated, the identification of a realistic 'gold standard' against which motion palpation can be evaluated is essential. The objective of this study was to introduce a new, realistic, 'gold standard', the congenital block vertebra (CBV) to assess the validity of motion palpation in detecting a true fixation. METHODS: Twenty fourth year chiropractic students examined the cervical spines of three subjects with single level congenital block vertebrae, using two commonly employed motion palpation tests. The examiners, who were blinded to the presence of congenital block vertebrae, were asked to identify the most hypomobile segment(s). The congenital block segments included two subjects with fusion at the C2-3 level and one with fusion at C5-6. Exclusion criteria included subjects who were frankly symptomatic, had moderate or severe degenerative changes in their cervical spines, or displayed signs of cervical instability. Spinal levels were marked on the subject's skin overlying the facet joints from C1 to C7 bilaterally and the motion segments were then marked alphabetically with 'A' corresponding to C1-2.Kappa coefficients (K) were calculated to determine the validity of motion palpation to detect the congenitally fused segments as the 'most hypomobile' segments. Sensitivity and specificity of the diagnostic procedure were also calculated. RESULTS: Kappa coefficients (K) showed substantial overall agreement for identification of the segment of greatest hypomobility (K = 0.65), with substantial (K = 0.76) and moderate (K = 0.46) agreement for hypomobility at C2-3 and C5-6 respectively. Sensitivity ranged from 55% at the C5-6 CBV to 78% at the C2-3 level. Specificity of the procedure was high (91 - 98%). CONCLUSION: This study indicates that relatively inexperienced examiners are capable of correctly identifying inter-segmental fixations (CBV) in the cervical spine using 2 commonly employed motion palpation tests. The use of a 'gold standard' (CBV) in this study and the substantial agreement achieved lends support to the validity of motion palpation in detecting major spinal fixations in the cervical spine.

Cervical Vertebrae↗
PubMedDate not supplied

Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum.

BACKGROUND: A range of health care practitioners use cranial techniques. Palpation of a cranial rhythmic impulse (CRI) is a fundamental clinical skill used in diagnosis and treatment with these techniques. There has been little research establishing the reliability of CRI rate palpation. OBJECTIVE: This study aimed to establish the intraexaminer and interexaminer reliability of CRI rate palpation and to investigate the "core-link" hypothesis of craniosacral interaction that is used to explain simultaneous motion at the cranium and sacrum. DESIGN: Within-subjects, repeated-measures design. SUBJECTS: Two registered osteopaths, both with postgraduate training in diagnosis and treatment, using cranial techniques, palpated 11 normal healthy subjects. METHODS: Examiners simultaneously palpated for the CRI at the head and the sacrum of each subject. Examiners indicated the "full flexion" phase of the CRI by activating silent foot switches that were interfaced with a computer. Subject arousal was monitored using heart rate. Examiners were blind to each other's results and could not communicate during data collection. RESULTS: Reliability was estimated from calculation of intraclass correlation coefficients (2,1). Intrarater reliability for examiners at either the head or the sacrum was fair to good, significant intraclass correlation coefficients ranging from +0.52 to +0.73. Interexaminer reliability for simultaneous palpation at the head and the sacrum was poor to nonexistent, ICCs ranging from -0.09 to +0.31. There were significant differences between rates of CRI palpated simultaneously at the head and the sacrum. CONCLUSIONS: The results fail to support the construct validity of the "core-link" hypothesis as it is traditionally held by proponents of craniosacral therapy and osteopathy in the cranial field.

Adult↗
PubMedDate not supplied

[Diagnostic validity of palpation in horses with back problems].

There is a regularly high proportion of x-ray findings indicating a pathological deterioration of the equine vertebral column which do not correlate with the clinical symptoms. Therefore, palpation remains one of the most important clinical examination methods to determine whether or not a horse is suffering from back pain. The aim of this study was to check the validity of palpation results of horses with an assumed back problem. The palpation results of 167 horses were evaluated in retrospect: If the palpation proceeds under following conditions, positive palpation results agree with an primary back problem in about 100% of cases: 1. Hind limb lameness, being the most likely reason for misleading positive palpation results, has to be ruled out. 2. Only reproducible painful behavior is allowed to be interpreted as positive. Under these conditions a negative palpation result is correct in about 72% of cases. For the examiner it is important to keep in mind that an apparent Kissing Spine-Syndrome can exist without being palpable. By means of clinical examination it is not always possible to distinguish between painful and normal reactions. In doubtful cases diagnosis can be made by a "diagnostic therapy", or better by scintigraphy.

Animals↗
PubMed1990

Detection of corpora lutea and follicles in cows: a comparison of transvaginal ultrasonography and rectal palpation.

The ovaries of 59 pluriparous cows of unknown reproductive history were palpated, scanned and dissected on the day of slaughter to compare the accuracy of rectal palpation and transvaginal ultrasonography with a 5 MHz linear array for the detection of corpora lutea and follicles. The rectal palpation was first carried out to judge the presence of follicles of more than 5 mm diameter, and corpora lutea which were classified as young (days 1 to 4), mid-cycle (days 5 to 16) or old (days 17 to 21) according to morphological criteria. The cows were then examined for follicles and corpora lutea by ultrasonography and the corpora lutea were again classified directly as young, mid-cycle or old according to their appearance. The cows were then slaughtered, their ovaries dissected, and the follicles over 5 mm in diameter were counted and the corpora lutea were classified in the above mentioned age categories. For the detection of a mid-cycle corpus luteum the sensitivity and predictive value of rectal palpation were, respectively, 83.3 per cent and 73.2 per cent and for ultrasonography the sensitivity and predictive value were 80.6 per cent and 85.3 per cent, respectively. However, both techniques were inaccurate for the detection of young and old corpora lutea. For detecting follicles ultrasonography was a significantly better method than rectal palpation. Ultrasonography detected 95 per cent of follicles larger than 10 mm whereas rectal palpation detected only 71 per cent of these follicles. Both techniques failed with follicles 5 to 10 mm in diameter; only 21.5 per cent were detected by rectal palpation and 34.3 per cent by ultrasonography.

Animals↗
PubMed1989

Lack of evidence of transmission of bovine leukemia virus by rectal palpation of dairy cows.

A study was undertaken in a California dairy to estimate the risk of transmission of bovine leukemia virus associated with rectal palpation of cows. The probability of seroconversion within 3 months after rectal palpation was examined as a function of the prevalence of infection in cows at the time of palpation. It was hypothesized that the probability of seroconversion within 3 months after palpation would be higher for cows in a group with high prevalence of infection than for cows in a group with low prevalence. The probability of seroconversion after rectal palpation was equal to 0.034, and results of logistic regression, using data from 1,116 noninfected and 1,047 infected cows, did not indicate any significant association between probability of seroconversion after rectal palpation and prevalence of infection (P = 0.189). Results of this study suggest that risk of bovine leukemia virus transmission by rectal palpation typically used in reproductive tract examination of cows either does not occur or is uncommon.

Animals↗
PubMed1997

The variability of shoulder motions recorded by means of palpation.

OBJECTIVE: The objective of this methodological study is the quantification of the sources of variability in the recorded three-dimensional motions of the shoulder mechanism for comparative purposes. BACKGROUND: The palpation and subsequent digitization of skeletal landmarks of the shoulder mechanism is a non-invasive and relatively easy method to quantify shoulder orientations. Comparison of individual motions is subject to the accuracy of the palpation method, the magnitude of kinematic redundancy of the shoulder mechanism and inter-subject differences in morphology and physiology. Quantification of these sources of variance, i.e. the palpation error, motoric noise and inter-subject differences, demonstrated the accuracy of the method and the potential validity of the descriptive motion parameters, e.g. Cardan angles, in intra- and inter-individual studies for clinical, ergonomical and biomechanical studies. METHODS: The orientations of the shoulder bones were recorded five times for each of five subjects by palpation and digitization of 12 skeletal landmarks for 10 equidistant arm elevation postures in the scapular plane. The orientations were described by means of Cardan angles. The palpation error was determined at a standardized initial rest position and expressed by Cardan angles for each recorded posture. Adding motoric noise and inter-subject differences gave the inter-individual variance. RESULTS: The palpation error was approximately 2 degrees. The major recorded variance originated from motoric noise (+/-33%) and inter-subject difference (+/-55%). CONCLUSIONS: The palpation method is an accurate means of recording the three-dimensional orientations of the shoulder mechanism and for intra-individual studies. However, inter-subject variability is large.

Journal Article↗
PubMed1993

[Palpation and sonography in after-care of head-neck tumor patients: comparison of ultrasound tumor entity parameters].

The ranking of postoperative palpation and sonography is examined in respect of imaging of neck lymph node enlargement and neck lymph node metastases or lymphomas, using a prospective study involving 127 patients whose head and neck tumours had already undergone treatment. These patients had been subjected to tumour aftercare for an average period of 26 months. Sonography is well suited for detecting the presence of enlarged neck lymph nodes, the accuracy being 97.5%. In this study palpation was clearly less safely defined, the accuracy being only 85%. The following results were obtained in respect of the specific imaging of metastases: sensitivity of palpation (75%) is below that of sonography (M/Q ratio) (93%). In respect of specificity palpation also yielded poorer results than sonography (M/Q ratio 94%) because of the relatively high proportion of false positive palpations (17%). The reason for this is non-differentiation between reactively enlarged lymph nodes and lymph nodes metastases. The advantage of sonography vs palpation by using the M/Q ratio is therefore the accuracy of the findings (94% sonography, 81% palpation) and hence the clear reduction in false positive and false negative findings. Furthermore, sonography can image the exact relationship to surrounding tissue and especially the vessels. The drawback of sonography is that lymph nodes < 9 mm maximal diameter cannot be assessed with the safety and accuracy mentioned above. Sonomorphological criteria such as the central marrow reflex and a widened lymphatic node cortex enhance diagnostic safety of the sonographic expansion parameters to yield an assessment of tumour status.

Adult↗
PubMed1999

Distal pulse palpation: is it reliable?

The aim of this study was to evaluate the reliability of distal pulse palpation. The dorsalis pedis and the tibialis posterior arteries of 25 patients with suspected lower limb arterial disease were independently palpated by three vascular surgeons and three medical students in the outpatient clinic and by two vascular nurses and one physician in the vascular laboratory. The palpation findings were compared to the ankle/brachial index (ABI). Palpable and unpalpable pulses were best separated with ABI 0.76 as the cutoff point. The degree of misdiagnosis was unacceptably high, with an underdiagnosis of more than 30%. The agreement was highest (kappa 0. 68, good) among the vascular laboratory personnel in the peaceful vascular laboratory and lowest (kappa 0.38, fair) among the vascular surgeons in the busy outpatient clinic. The poor agreement and the high proportion of misdiagnosis obtained in the outpatient clinic argue against the use of pulse palpation as a single diagnostic method. Palpable pulses with low ABIs clearly state the need for more objective measurements whenever ischemia is suspected. Yet, by carefully palpating both pedal arteries under good, nonhurried conditions the reproducibility and accuracy of pulse palpation can be tolerable.

Adult↗
PubMed2004

Which is important in the evaluation of metastatic lymph nodes in head and neck cancer: palpation, ultrasonography, or computed tomography?

OBJECTIVE: Evaluate palpation, ultrasonography (USG), and computed tomography (CT) with respect to their value for comparative determination of metastatic lymph nodes in head and neck cancer. STUDY DESIGN: A prospective study was conducted in a tertiary referral hospital. During September 1996 and April 1999, clinical investigation, USG, and CT were performed preoperatively on 48 patients who would undergo neck dissection for primary head and neck malignancy. The presence of metastatic lymph nodes in pathologic specimens were compared with the findings of palpation, CT, and USG. RESULTS: Twenty-two of the patients had positive lymph nodes on pathologic investigation. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for palpation are 64%, 85%, 74%, 78%, and 75% respectively. Respective values for USG and CT for sensitivity, specificity, negative predictive value, positive predictive value, and accuracy are 72%, 96%, 80%, 94%, and 85% and 81%, 96%, 85%, 90%, and 87%. CONCLUSION: All of the pretreatment evaluation methods, palpation, CT, and USG yield results that are significantly different from the histopathologic results, suggesting that no pretreatment study can accurately assess the requirement to histopathologically stage the neck. USG findings are more correlated with the pathologic findings than palpation, but CT gives the most effective and reliable results when it is combined with USG in neck staging. Preoperative USG and CT scanning of the neck by an experienced radiologist is essential and useful for diagnosis, staging, and therapy choices. SIGNIFICANCE: Statistical analysis was done with chi(2) test. The difference between histologic findings and palpation is significant (P = 0.0005). The difference between histologic findings and USG and CT is significant (P = 0.0001 and P = 0.0001).

Adult↗