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PubMed1982

The effects of bull urine on puberty and calving date in crossbred beef heifers.

The effects of bull urine on the percentage of heifers reaching puberty and on subsequent calving dates were examined with 52 crossbred beef heifers. Heifers were palpated for ovarian condition and classified as prepubertal or pubertal before (Palpation I) and after (Palpation II) eight weekly oronasal treatments with bull urine or water. A larger percentage of urine-treated than water-treated heifers reached puberty during the experimental period (67 vs 32%; P less than .05), supporting the hypothesis that bull urine contains a priming pheromone. Body weight of urine-treated heifers that did not reach puberty by Palpation II was lower than that of water-treated heifers that did not reach puberty (P less than .05), indicating that an association exists between body weight and the response to pheromonal cues in bull urine. There were no treatment differences in pregnancy rate after a 90-d breeding period, and no differences in pregnancy rate between heifers that had reached puberty before the breeding season started and heifers that had not reached puberty. Urine-treated heifers reaching puberty during the experiment calved earlier (P less than .05) in the calving season than did water-treated heifers of the same category. The distribution of these calvings was also different (P less than .01), resulting in a shorter calving season for urine-treated heifers. More heifers that had reached puberty by Palpation II calved in the first 20 d of the calving season that did heifers that had not reached puberty by Palpation II, regardless of treatment group (P = .02). There was a tendency for urine-treated heifers to calve earlier than water-treated heifers, with the exception of urine-treated heifers that had not reached puberty by Palpation II. These data support the hypothesis that there is a priming pheromone in bull urine that can hasten the onset of puberty in beef heifers.

Animals↗
PubMed2000

Percussion of Traube's space--a useful index of splenic enlargement.

OBJECTIVE: To evaluate the sensitivity and specificity of palpation and percussion for splenic enlargement, as the accuracy of many of the clinical maneuvers we perform remains largely unstudied. METHODS: One hundred cases were selected at random from medical wards, and splenic enlargement was assessed by palpation and percussion of the Traube's space (Barkuns method), which was confirmed by the ultrasonography of the abdomen. The results of the various tests were tabulated and assessed statistically. RESULTS: 1) Performance of Traube's space percussion shows 24 true positive and 48 true negative cases, the test thus had an overall sensitivity of 67% and specificity of 75%. It was also found that the BMI of the false negative cases was significantly higher (29.43 Kg/m2). 2) Palpation as a diagnostic maneuver had a high specificity of 96.87% along with high false negative rate with overall low sensitivity of 44.44%. 3) Interpolation of findings of Traube's space percussion and palpation showed that maximum clinical utility could be achieved when both percussion and palpation were positive. CONCLUSION: Percussion of the Traube's space is a useful clinical screening test for splenomegaly, with a sensitivity of 67% and specificity of 75%, as compared to palpation (sensitivity of 44.44% and specificity of 96.87%). And maximum clinical utility is achieved when both percussion and palpation are combined.

Adult↗
PubMed2002

Effects of pelvic floor exercises in middle aged women with a history of naïve urinary incontinence: a population based study.

OBJECTIVE: To follow the effect of a 4-month pelvic floor exercise (PFE) program in women with naïve urinary incontinence with vaginal electromyography (EMG), pressure and palpation and also to compare the initial findings with symptom-free women of the same age. METHODS: The pelvic floor function expressed with vaginal EMG, pressure and palpation was measured before, during and after 4 months of PFEs in 60 previously untreated incontinent women, 50 of whom completed the study. The patients' perception of the situation and the amount of leakage were estimated before and after PFE. The incontinent group was compared at baseline and after PFE with 28 healthy controls. All women in this study (age 53-63) were randomly recruited from a major population based study. RESULTS: At baseline, the incontinent women had significant reductions of both vaginal EMG activity and pelvic floor muscle condition as estimated by palpation compared to the healthy group. During training a successive, significant increase was seen in both EMG, pressure and palpation and the values eventually exceeded those of the healthy women. The measures reflecting improvement of pelvic floor function thus showed a consistent and progressive pattern. The degree of improvement was higher in those with initial high values in the muscle function tests than in the women with lower initial EMG values, pressures and findings on palpation. No differences were seen between patients with a history of stress incontinence and patients with an urge component, i.e. urge or mixed incontinence. Sixty-four percent of the women were satisfied and wanted no further treatment. The median leakage at pad-test decreased from 5 (range 0-328) to 1 (range 0-126) g/24h. The correlation between the vaginal and the pad-test measurements was weak. CONCLUSION: Women with urinary incontinence have a significant reduction of pelvic floor function as estimated with vaginal EMG and palpation as compared to symptom-free controls. A successive normalization of vaginal EMG, pressure and findings at palpation was seen during the 4-month training period. Incontinence of both stress type and with an urge component can be alleviated in most of the women with PFE. These methods might be useful for routine evaluation of the pelvic neuromuscular disorder present in incontinent women.

Electromyography↗
PubMed2002

Cooperative role of E-cadherin and sialyl-Lewis X/A-deficient MUC1 in the passive dissemination of tumor emboli in inflammatory breast carcinoma.

Inflammatory breast carcinoma (IBC) is characterized by florid tumor emboli within lymphovascular spaces termed lymphovascular invasion (LVI). Using a human-scid model of IBC (MARY-X), we have demonstrated using retrovirally-mediated dominant-negative E-cadherin mutant approaches (H-2K(d)-E-cad), that the tumor cell embolus (IBC spheroid) forms on the basis of an intact and overexpressed E-cadherin/alpha, beta-catenin axis which mediates tumor cell-tumor cell adhesion analogous to the embryonic blastocyst and accounts for the compactness of the embolus. The tumor cell embolus (IBC spheroid), in contrast, fails to bind the surrounding vascular endothelial cells both in vitro and in vivo because of markedly decreased sialyl-Lewis X/A carbohydrate ligand-binding epitopes on its overexpressed MUC1 which are necessary for binding endothelial cell E-selectin. This tumor cell-endothelial cell aversion further contributes to the compactness of the IBC spheroid and its passivity in metastasis dissemination. This passivity is manifested by a dramatic increase in metastatic pulmonary emboli following palpation of the primary tumor. In assessing this passivity of metastatic dissemination, we compared the effects of palpation on MARY-X with the effects of palpation on a derived dominant-negative E-cadherin mutant (H-2K(d)-E-cad), as well as other well known human tumoral xenografts exhibiting no (MCF-7, T47D), low (MDA-MB-231, MDA-MB-468) or high (C8161, M24(met)) levels of spontaneous metastasis but no LVI. Palpation of each xenograft similarly increased intratumoral pressure by 200% (10-->30 mmHg) but dramatically increased the numbers and sizes of pulmonary metastases 10-100-fold (P<0.001) only in MARY-X. The mechanism of this effect was through an immediate post-palpation release of circulating tumor emboli detected 2-3 min after palpation (P<0.01) by human cytokeratin 19 RT-PCR of extracted RNA from 300 microl of murine blood. Although circulating human tumor cell-derived growth factors (IGF-I, IGF-II, TGF-alpha and TGF-beta) and angiogenic factors (VEGF and bFGF) were detected by ELISA in murine serum of MARY-X, palpation did not further increase the circulating levels of these factors (P>0.1). Our findings support the cooperative role of E-cadherin and sialyl-Lewis X/A-deficient MUC1 in the passive dissemination of tumor emboli in IBC.

Adenocarcinoma↗
PubMed2000

Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A systematic critical literature review.

OBJECTIVE: To systematically review the peer-reviewed literature about the reliability and validity of chiropractic tests used to determine the need for spinal manipulative therapy of the lumbo-pelvic spine, taking into account the quality of the studies. DATA SOURCES: The CHIROLARS database was searched for the years 1976 to 1995 with the following index terms: "chiropractic tests," "chiropractic adjusting technique," "motion palpation," "movement palpation," "leg length," "applied kinesiology," and "sacrooccipital technique." In addition, a manual search was performed at the libraries of the Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark, and the Anglo-European College of Chiropractic, Bournemouth, United Kingdom. STUDY SELECTION: Studies pertaining to intraexaminer reliability, interexaminer reliability, and/or validity of chiropractic evaluation of the lumbo-pelvic spine were included. DATA EXTRACTION: Data quality were assessed independently by the two reviewers, with a quality score based on predefined methodologic criteria. Results of the studies were then evaluated in relation to quality. DATA SYNTHESIS: None of the tests studied had been sufficiently evaluated in relation to reliability and validity. Only tests for palpation for pain had consistently acceptable results. Motion palpation of the lumbar spine might be valid but showed poor reliability, whereas motion palpation of the sacroiliac joints seemed to be slightly reliable but was not shown to be valid. Measures of leg-length inequality seemed to correlate with radiographic measurements but consensus on method and interpretation is lacking. For the sacrooccipital technique, some evidence favors the validity of the arm-fossa test but the rest of the test regimen remains poorly documented. Documentation of applied kinesiology was not available. Palpation for muscle tension, palpation for misalignment, and visual inspection were either undocumented, unreliable, or not valid. CONCLUSION: The detection of the manipulative lesion in the lumbo-pelvic spine depends on valid and reliable tests. Because such tests have not been established, the presence of the manipulative lesion remains hypothetical. Great effort is needed to develop, establish, and enforce valid and reliable test procedures.

Chiropractic↗
PubMed1994

[How to detect neuropathy in leprosy].

In leprosy, the early detection of peripheral nerve damage is essential for the prevention of disability. To date, there is no consensus on what is the best clinical test to reveal such abnormalities. In this prospective study we examined the effectiveness of five clinical tests to assess radial cutaneous nerve (RCN) damage (the most frequently involved). Light touch was assessed by two nylon threads (based on the Semmes-Weinstein monofilaments testing technique) bent on the skin at a pressure of 0.5 (N. 4 nylon) and 0.2 gram (N. 5 nylon). Pinprick and cooling sensations were examined by a needle and a drop of ether. The nerve thickness was assessed by palpation. Sensory findings were then compared to sensory nerve conduction values of the RCN and a sensitivity analysis was performed. The patient group consisted of 108 consecutive new leprosy sufferers (138 RCN) who attended the Institut de Léprologie Appliquée de Dakar during one year. Diagnosis and classification were based on Ridley and Jopling's criteria (clinical examination, skin smears and biopsy). Normal values were determined among 22 healthy subjects (44 RCN). The best tests in term of sensitivity were palpation (.60), N. 5 nylon (.65) and N. 5 + palpation (.79). Their positive predictive values were .84 (palpation), .94 (N. 5 nylon) and .83 (N. 5 + palpation). The best tests in term of area under the curve were palpation (.66), N. 5 nylon (.71) and N. 5 + palpation (.78). The results remain the same for the lepromatous or tuberculoid leprosy patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed2002

The assessment of levator muscle strength: a validation of three ultrasound techniques.

Levator ani muscle function is traditionally evaluated by palpation or perioneometry. Recently, three different techniques of performing this task by translabial ultrasound have been described. The authors intended to validate these new methods by correlating results with assessments performed by perineometry and palpation. One hundred consecutive women were evaluated prospectively by a physiotherapist and a gynecologist. The physiotherapist undertook an assessment by palpation (Oxford grading) and perineometry (Peritron). The gynecologist performed translabial ultrasound. Both were blinded against each other's results. Correlations between ultrasound and palpation were between 0.52 and 0.62, with displacement of the bladder neck agreeing most closely with palpation. As regards perineometry, correlations were 0.38 to 0.52, and again bladder neck displacement agreed best with the physiotherapeutic assessment. All correlations were highly significant. It appears that the assessment of levator function by ultrasound correlates strongly with vaginal palpation of muscle strength and perineometry.

Adolescent↗
PubMed2000

Measuring radiation fibrosis: the interobserver reliability of two methods of determining the degree of radiation fibrosis.

PURPOSE: To compare the interobserver reliability of the palpation method with the method of measuring tissue compliance with a tissue compliance meter (TCM) on women who underwent breast-conserving surgery and radiotherapy for breast cancer. METHODS AND MATERIALS: Thirty-eight patients and 30 controls were measured with the palpation method by two radiation oncologists and with the TCM by two physiotherapists. Measurements were taken on four locations of the breasts of all 68 women. Reliability coefficients were computed for both methods. A weighted kappa score was computed for the palpation method and this was compared with the intraclass correlation coefficient (ICC) computed for the TCM method. The conditions for direct comparison of these scores were met in this study. RESULTS: A weighted kappa of 0.65 was computed for the palpation method and an ICC of 0.91 was computed for the TCM method. These scores differ significantly from each other (p < 0.01). CONCLUSION: The interobserver reliability of the TCM method is superior to that of the palpation method. However, at locations where the TCM is not applicable, palpation is a good alternative.

Adult↗
PubMed2002

Relationship between prostate volume, prostate-specific antigen nadir, and biochemical control.

PURPOSE: In patients treated with definitive three-dimensional conformal radiotherapy (3D-CRT) for localized prostatic adenocarcinoma, we sought to evaluate the relationship between pretreatment prostate gland volume and posttreatment prostate-specific antigen (PSA) nadir, as well as the relationship of prostate volume and PSA nadir with biochemical control (bNED). Two subgroups were studied: favorable (PSA <10 ng/mL, Gleason score 2-6, and T1-T2A) and unfavorable (one or more: PSA >/=10 ng/mL, Gleason score 7-10, T2B-T3). MATERIALS AND METHODS: A total of 655 men (n = 271 favorable and 384 unfavorable) were treated with 3D-CRT alone between May 1989 and November 1997. All patients had information on prostate volume and a minimum follow-up of 24 months (median 56, range 24-126). Of the 655 men, 481 (n = 230 favorable and 251 unfavorable) remained bNED at time of analysis, with biochemical failure defined in accordance with the American Society for Therapeutic Radiology and Oncology consensus definition. Factors analyzed for predictors of bNED included pretreatment prostate volume, posttreatment PSA nadir, pretreatment PSA, palpation T stage, Gleason score, center of the prostate dose, and perineural invasion (PNI). We also analyzed pretreatment prostate volume and its correlation to prognostic factors. For bNED patients, the relationship between PSA nadir and prostate volume was evaluated. RESULTS: On multivariate analysis, prostate volume (p = 0.04) and palpation T stage (p = 0.02) were the only predictors of biochemical failure in the favorable group. On multivariate analysis of the unfavorable group, pretreatment PSA (p <0.0001), Gleason score (p = 0.02), palpation T stage (p = 0.009), and radiation dose (p <0.0001) correlated with biochemical failure, and prostate volume and PNI did not. For all 481 bNED patients, a positive correlation between pretreatment volume and PSA nadir was demonstrated (p <0.0001). Subgroup analysis of the favorable and unfavorable patients also demonstrated a positive correlation between prostate volume and PSA nadir (p = 0.003 and p = 0.0002, respectively). Using multiple regression analysis, the following were found to be predictive of PSA nadir in all bNED patients: prostate volume (p <0.0001), pretreatment PSA (p <0.0001), palpation T stage (p = 0.0002), and radiation dose (p = 0.0034). Gleason score and PNI were not predictive. For the favorable group, palpation T stage (p = 0.0006), pretreatment PSA (p = 0.0083), prostate volume (p = 0.0186), and Gleason score (p = 0.0592) were predictive of PSA nadir, and PNI and radiation dose were not predictive. In the unfavorable group, prostate volume (p = 0.0024), radiation dose (p = 0.0039), pretreatment PSA (p = 0.0182), and palpation T stage (p = 0.0296) were predictive of PSA nadir, and Gleason score and PNI were not predictive. CONCLUSION: This report is the first demonstration that prostate volume is predictive of PSA nadir for patients who are bNED in both favorable and unfavorable subgroups. PSA nadir did not correlate with bNED status in the favorable patients, but it was strongly predictive in the unfavorable patients. Prostate gland volume was also predictive of bNED failure in the favorable but not the unfavorable group.

Aged↗
PubMed1975

Vaginal stimulation in rats induces prolonged lordosis responsiveness and sexual receptivity.

Sexual receptivity to males resulted from stimulation of the vagina with a glass rod in previously unreceptive ovariectomized, estrogen-treated rats. Several minutes of rejection behavior preceded the receptivity. In a second study, manual palpation was used to determine the duration of the lordosis response facilitation. Initially, all females were unresponsive to manual flank-perineum stimulation (palpation). Vaginal stimulation plus palpation, which together elicit lordosis, facilitated subsequent lordosis responses to palpation. This effect persisted for several hours after the vaginal stimulation was applied. Vaginal stimulation alone, which was ineffective in eliciting lordosis, also facilitated lordosis in response to subsequent palpation. Repeated palpation did not facilitate lordosis. These prolonged effects were independent of hormone treatment.

Animals↗
PubMed1988

Electrocardiographic monitoring of cardiac transplants in mice.

In the murine cardiac model for vascularised transplantation graft function may be monitored by direct palpation, electrocardiography, and graft histology. To assess the merits of these methods, and to measure ischaemic damage, isografts and allografts were examined at regular intervals from 0 to 60 days after grafting. Heart transplants were vascularised from the abdominal great vessels, using microsurgical techniques, with ischaemic times of less than 60 min. Isografts showed no decrease in heart rate over 60 days, as measured by palpation and electrocardiography, but the voltage of the ventricular complex fell progressively over the first 28 days after grafting then remained stable for more than 60 days. The voltage drop was associated with atrophy of myocardial tissue. Allografts in recipients treated with rabbit antimouse antilymphocyte serum were maintained for more than 60 days with little change in palpation rate or recorded heart rate but with significant falls in ventricular complex voltage, reflecting myocardial atrophy and fibrosis. Untreated allografts were rejected in 10-14 days and showed a rapid fall in palpated heart rate, measured heart rate, and ventricular complex voltage. Thus, in this study, palpation of the heart graft gave an accurate measure of the pulse rate and correlated with electrical activity in acutely rejecting grafts, but in long surviving grafts measurement of ventricular complex voltage showed myocardial damage that was not detectable by direct palpation.

Animals↗
PubMed1994

Thyroid volume measurement by ultrasound in children as a tool for the assessment of mild iodine deficiency.

Thyroid ultrasound was used to measure thyroid volume in children and compared with thyroid palpation for the assessment of the prevalence of goiter in an area of mild iodine deficiency. School children, 6-14 yr old, were from control areas (n = 2693; urinary iodine excretion, 110 micrograms/L) or from an area of mild iodine deficiency (IDA; n = 278; urinary iodine excretion, 72 micrograms/L). Thyroid volume determined by ultrasound in control children increased with age (r = 0.62; P < 0.0001) and was significantly correlated with height (r = 0.51; P < 0.0001) and body weight (r = 0.126; P < 0.0001). Both median and mean thyroid volumes were greater in IDA children than in controls. The prevalence of goiter determined by ultrasound was 68 of 268 children (25.3%) in IDA and 105 of 2693 children (3.9%) in the control area (chi 2 = 204; P < 0.0001). Thyroid enlargement, as assessed by palpation, was found in 59 of 268 children (22%) in the IDA group and in 165 of 2693 (6.1%) subjects in the control area (chi 2 = 88; P < 0.0001). Some subjects of the IDA who were judged goitrous by palpation (11.2%) had a normal thyroid volume at ultrasound, and 12.7% of subjects with an abnormal thyroid volume at ultrasound were judged nongoitrous by palpation. In conclusion, 1) thyroid volume in children, as assessed by ultrasound, increases with age and is closely related to the parameters of body growth; 2) in every age group, thyroid ultrasound shows greater thyroid volume in an IDA group than in controls; and 3) a discrepancy between palpation and ultrasound is found in 23.9% of children living in an IDA, confirming that palpation is relatively inaccurate for assessing the prevalence of goiter in mild iodine deficiency. These data indicate that thyroid volume measurement by ultrasound in children provides a useful tool for the assessment of goiter in mild iodine deficiency.

Adolescent↗
PubMed1996

Comparison of methods to evaluate acute rejection in heterotopic heart transplantation in rats.

We compared palpation and electrocardiograms (ECG) as methods of evaluation of acute rejections, and also studied the mode of expression of rejection from histological findings by means of a cervical heart transplantation model in LEW strain rats with (LEW x BN) F1 rats as donors. Evaluation by palpation mainly involved changes in the intensity of the beat of the transplanted heart. With this method, it was also possible to observe changes in the size of the graft, and to investigate these changes over time. Unlike with abdominal heart transplants, the time of cardiac arrest can be clearly determined without any influence from the heart rate of the recipient. But with the ECG evaluation method, it was possible to distinguish clearly between the waveforms of the graft and the recipient waveforms unlike with the conventional lead method. In histological findings, the time of transfer of infiltrating cells into the graft and the time of appearance of CD8 positive cells matched the times when changes occur in the intensity of the beat and in the heart rate seen with palpation. Unlike the palpation and ECG methods, however, these findings are not suitable for evaluation of the time of cardiac arrest of the graft. The graft survival time was 6.1 +/- 0.6 days (n = 73) by palpation and 8.5 +/- 1.8 days (n = 73) by ECG. Since the graft survival time was significantly longer in the ECG evaluation than in the evaluation by palpation (P < 0.001), it appeared better to use these methods independently rather than concurrently in consideration of their features. Histological examination appeared to be useful in experimental systems for clarification of the mode of expression of the acute rejection after its has occurred.

Animals↗
PubMed2000

[Comparison of various examination methods used in ovarian diagnostics in cattle].

In this study diagnostic certainty of ultrasonography and rectal palpation concerning the detection of follicles and C.I. was compared by evaluation of the findings obtained with ultrasonography in waterbath and dissection of the ovaries after slaughter. Clinical examinations were performed on a total of 30 cows (transrectally and ultrasonographically, 5.0 mhz, linear) in slaughterhouse. In the laboratory ovaries were evaluated after slaughter both macroscopically and by ultrasonography in waterbath. Diagnostic reliabilities of these methods were compared. No difference between the methods was determined concerning the longitudinal measurements of corpora lutea (19.96 +/- 4.83 mm, 20.41 +/- 5.41 mm, 21.45 +/- 5.26 mm by ultrasonography, waterbath and macroscopy respectively). By means of determining the correct identification of corpora lutea, the error rate was 24.1% and 17.2% for rectal palpation and ultrasonography respectively. The comparison of rectal palpation and macroscopy showed that three small corpora lutea and two corpora lutea with small cavity were determined wrongly as small follicles and two corpora lutea were determined whereas they were not present actually. With ultrasonography four small C.I. could not be detected and one C.I. with cavity was wrongly determined as follicle. It was noticed that follicles bigger than 10 mm (F2 = 10-15 mm, F3 = 16-20 mm) could be determined more accurately by means of ultrasonography than by rectal palpation (with ultrasonography: F2 = 90.48%, F3 = 100.0%; with rectal palpation, F2 = 61.9%, F3 = 200.0%). The correlation of the findings of rectal palpation or ultrasonography and blood progesterone levels was 86.2% and 89.7% respectively. This accordance was 96.6% for progesterone levels and waterbath and macroscopic findings.

Abattoirs↗
PubMed1990

[The effect of the local anesthesia to the posterior ramus of the mandible in patients with temporomandibular joint problems].

Some clinicians in North America use anesthetic injections to differentiate the symptoms such as pain and stiffness in the facial area and neck in patients with TMJ problems. However, the effects and area which is influenced have not been studied. The purpose of this study was to study procedures and changes following administration of local anesthesia to the posterior ramus of the mandible. Twenty four patients with TMJ problems were used in this study. 0.5ml of 2% Lidocaine (epirenamine included) was injected into the most painful site upon palpation. The pain upon palpation test (following Krogh-Poulsen's method) was compared before and after 50 minutes. Results of this experiment were: 1) decrease of pain upon palpation was found not only in the site. In many cases subjective pain in the head and neck area was also reduced. 2) A significant reduction was found in the pain upon palpation test in the neck area. A highly significant reduction was seen in the Sterunoclydmastoid muscle only in the injected side. In the masticatory muscles. Also, reduction of pain upon palpation was seen in both lateral, medial pterygoid and digastric muscles in the injected side. 3) Contra side lateral pterygoid muscle and trapezius muscle also registered decreased pain upon palpation. 4) The mean values for the injected site were 5.7mm (S.D. 5.9) below the earlobe and the mean depth from the skin surface to the bony surface were 16.6 mm (S.D. 2.7mm). 5) The peak of the subjective effect were seen in one group in 20 minute later injection (early type) and in the 2nd group the peak were seen after 40 minutes (slowly type). 6) We did not experienced any paralysis of the facial nerve in this study.

Diagnosis, Differential↗
PubMedDate not supplied

Interexaminer reliability of eight evaluative dimensions of lumbar segmental abnormality: Part II.

OBJECTIVE: The objectives of this study were to assess the interexaminer agreement of palpation for soft tissue and osseous pain along with visual observations in the lumbar spine. Second, the interexaminer agreement of dermothermograph and surface electromyographic (EMG) scans of the lumbar spine were assessed. Third, to perform these evaluations on symptomatic low back patients. Finally, the most reliable measurements were combined in a multidimensional index of segmental lumbar abnormality, which was assessed for interexaminer agreement. DESIGN: This is an interexaminer reliability study of commonly used palpatory and instrumentation procedures used to assess lumbar segmental abnormality. SETTING: This study was conducted at Pain Assessment and Rehabilitation Center (PARC) and the Center for Clinical Studies (CCS) at Northwestern College of Chiropractic. PATIENTS: The patients involved in this study were symptomatic at the time of examination. The patients were recruited from the CCS clinic and PARC. RESULTS: Palpation for osseous pain produced kappa coefficients ranging from .48-.90. Palpation for soft tissue pain produced kappa coefficients that ranged from .40-.79 and the kappas for visual observation ranged from .34-.84. The dermothermograph and surface EMG scanner were also assessed with the kappa coefficient for their reliability in assessing lumbar segmental abnormality. The kappa coefficients ranged from -.13 to .59 for the surface EMG and 0- .63 for the dermothermograph measurements. Intraclass correlation coefficients for the surface EMG measurements ranged from .20-.55 and the dermothermograph measurements ranged from .01-.55. Palpation for pain (osseous and soft tissue) and visual observation were included in the multidimensional index of abnormality. The interexaminer agreement of detecting a manipulable lesion was evaluated by designating a lesion present with a positive two out of three tests. Kappa coefficients for the multidimensional index of lumbar abnormality ranged from a low of .05 to a high of .52. CONCLUSIONS: Palpation for pain (osseous and soft tissue) and visual observation produced good to excellent interexaminer agreement and were included in the multidimensional index of abnormality. The interexaminer agreement of surface EMG scans and dermothermograph measurements were poor and considered to be clinically unacceptable, thus were not included in the multidimensional index. Palpation for pain is the only spinal assessment procedure to show consistent reliability in a number of studies.

Adolescent↗
PubMed1995

[Combined diagnosis of breast cancer recurrences after conservative treatment. Critical review of 143 consecutive cases].

The diagnostic features are reported of 143 consecutive patients with breast cancer intramammary recurrences observed after conservative treatment, 1984 to 1994. Disease-free interval after surgery was 3.7 years on the average, being longer for the patients receiving postoperative breast irradiation (3.9 vs 3.1 years). The conserved breast was followed-up on a regular basis with palpation and mammography, whereas US and cytology were used only in selected suspicious cases. Palpation, mammography, cytology or US suspected the recurrence in 75, 64, 81 and 77% of cases, respectively. Mammographic false negatives were not explained by breast parenchymal density (Wolfe's pattern) or by breast irradiation, but were likely to be ascribed to the masking effect of surgical scars and distortion. Most failures at cytology were caused by inadequate sampling: when sampling was adequate, cytology exhibited the highest sensitivity (97%). In all, combined palpation + mammography, palpation + cytology and palpation + mammography + cytology diagnosed correctly 97, 98 and 100% of cases, respectively. Palpation should be always combined with mammography in the follow-up of the conserved breast, but US and aspiration cytology should be performed in case of any clinico-radiologic abnormality carrying even a minimal risk of recurrence.

Adult↗
PubMedDate not supplied

Diagnostic value of scrotal sonography in infertile men: report on 658 cases.

Scrotal sonography with a 7.5 MHz sector scanner was performed on 658 consecutive patients of our infertility clinic. The incidence of pathological findings was unexpectedly high. Forty per cent of the patients revealed pathological structures such as varicoceles (21%), hydroceles (7%), epididymal abnormalities (6%), spermatoceles (6%), intratesticular hyper- and hypoechoic changes (4.5%), intratesticular cysts (1%) and tumours or carcinoma in situ (CIS) (0.6%). Sonographic evaluation and measurement of the caput epididymidis was compared with palpation. Sonography distinguished size ranges of "normal" and "thickened" epididymides as diagnosed by palpation. Cystic structures were proven in 56% of cases with "thickened" epididymides. The sonographically determined diameters of doppler-negative blood vessels were significantly smaller than those of doppler-positive vessels. Sonography revealed a higher occurrence of varicoceles than diagnosed by palpation (76% by palpation). Only 58% of sonographically identified hydroceles and only 67% of sonographically detected spermatoceles were detected by palpation. One testicular tumour and one case with CIS were only seen by sonography and not suspected on palpation. The results demonstrate that sonography represents a valuable tool in the routine diagnosis of andrological patients.

Adult↗