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PubMed1996

Testicular cancer: to screen or not to screen?

OBJECTIVES - To evaluate the evidence for and against routine testicular cancer screening by primary health care providers and patients (testicular self examination). SETTING - Low reported frequency of routine screening for testicular cancer attributed to poor knowledge of the disease and how to screen for it. METHODS - Literature based evaluation of the screening suitability of testicular cancer as a disease and palpation of the testis as the proposed screening test, and of the effectiveness of screening for testicular cancer. RESULTS - Testicular cancer is not a major public health problem. Its low prevalence makes routine screening cost ineffective. As a screening test for the disease, palpation has high sensitivity but its levels of specificity and positive predictive value are unacceptable. Palpation of the testes has not been shown to reduce mortality or morbidity. CONCLUSION - There is insufficient evidence to justify routine screening for testicular cancer by health care providers and patients. This lack of evidence may better explain the low reported levels of screening than can ignorance of the evidence available.

Adult↗
PubMed2005

Research diagnostic criteria for temporomandibular disorders: a calibration and reliability study.

The aim of this study was to investigate the reliability between different examiners when using the axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The hypothesis was that the standardized RDC/TMD examination protocol enables calibrated examiners to evaluate all examination items reliably. After calibration training by the RDC/TMD calibration team including the calibration of palpation pressure and the performance of the standardized examination protocol, four examiners, blinded to the patients' medical histories examined 24 subjects in a randomized sequence. One experienced examiner was the standard (hierarchical calibration). The recorded measurements strictly followed the RDC/TMD. Intraclass correlation coefficients (ICC), bias and precision were calculated to estimate interrater reliability. Acceptable (0.75 > or = CC > 0.4) to excellent (ICC > 0.75) reliability was found for 20 of the 23 (87%) examinations. Only sub-retromandibular muscle palpation and joint sound vibration recordings on lateral excursion showed poor-results (ICC < or = 0.4). The RDC/TMD examination protocol enables calibrated examiners to perform most (87%) examination items with satisfactory reliability. Therefore multi-site studies based on the RDC/TMD examination protocol may become feasible, keeping in mind the unsatisfactory reliability of 13% of the items (clicking during laterotrusion to the ipsilateral side, palpation of the posterior and submandibular region).

Adolescent↗
PubMedDate not supplied

Respiratory assessment.

The ability to carry out and document a full respiratory assessment is an essential skill for all nurses. The elements included are: an initial assessment, history taking, inspection, palpation, percussion, auscultation and further investigations. A prompt initial assessment allows immediate evaluation of severity of illness and appropriate treatment measures may warrant instigation at this point. Following this, a comprehensive patient history will be elicited. Clinical examination of the patient follows and involves inspection, palpation, percussion and auscultation. At this point, consideration must be given to preparation of a light, warm, quiet, private environment for examination and suitable patient positioning. Inspection is a comprehensive visual assessment, while palpation involves using touch to gather information. The next stages are percussion and auscultation. While percussion is striking the chest to determine the state of underlying tissues, auscultation entails listening to and interpreting sound transmission through the chest wall via a stethoscope. Finally, further investigations may be necessary to confirm or negate suspected diagnoses.

Auscultation↗
PubMed2000

Referred craniofacial pain patterns in patients with temporomandibular disorder.

BACKGROUND: Referred pain is prevalent in the craniofacial region, and it would be helpful for dental practitioners to have drawings delineating regions with a high probability for a patient's referred pain source. METHODS: The author applied firm pressure for approximately five seconds to trigger points, nodules of spot tenderness, and selected masticatory structures within the head and neck region on 230 patients with temporomandibular disorder, or TMD. As firm pressure was being applied, subjects were asked whether pain was developing or intensifying in a location different than that being palpated. RESULTS: One hundred ninety-six subjects (85 percent) reported that referred pain was being generated. The cheek area, ear and forehead were the most frequently reported sites of referred pain generation; palpation over the trapezius muscle, lateral pterygoid area and masseter muscle were the most common sources of referred pain to the craniofacial region. The author provides figures displaying common referred pain sites and their sources. CONCLUSIONS: Patients with TMD often report referred craniofacial pain arising from palpation of the head and neck region. The author found that the pattern between referred pain source and site was consistent and predictable. PRACTICE IMPLICATIONS: Practitioners should consider craniofacial pain's propensity for referral when treating patients with TMD. Practitioners can use the figures presented to determine regions of high probability for a patient's referred pain source.

Adolescent↗
PubMed1983

[Early detection of pregnancy of the rat].

A manual palpation method has been devised for early detection of pregnancy of the rat. One hand gently restrains the animal by holding it from behind in the usual manner. The thumb of the other hand is placed on the posterior abdomen and the first three fingers on the ventral midline. The three fingers were pressed gently upward and laterally. The embryos can then be palpated through the abdominal wall between the thumb and the three fingers. The number of fetuses was not affected by this palpation method. Using this technique, pregnancy was detected on the 5th day of gestation with an accuracy rate of 80% and between the 6th and 9th days with a 100% accuracy.

Animals↗
PubMed2004

Surgical significance of abnormal internal carotid arteries in velocardiofacial syndrome in 43 consecutive hynes pharyngoplasties.

OBJECTIVES: To determine: (1) the incidence of surgically significant, abnormal internal carotid arteries (ICAs) in velocardiofacial syndrome (VCFS); (2) the implications for a Hynes pharyngoplasty; (3) the reliability of preoperative investigations in detecting surgically significant abnormal ICAs. DESIGN: Prospective data collection with blind reassessment of nasendoscopy recordings. SETTING: Two-site, tertiary referral cleft unit. PATIENTS: Forty-three consecutive patients with VCFS who underwent a Hynes pharyngoplasty (six had a subsequent revision). INTERVENTIONS: Intraoral examinations, lateral videofluoroscopy, nasendoscopy when possible, and intraoperative palpation of the posterolateral pharyngeal walls. Only one patient had a magnetic resonance angiography (MRA). MAIN OUTCOME MEASURES: Incidence of surgically significant pulsations; modifications to surgical procedure; and correlation of surgical findings with preoperative nasendoscopy and MRA. RESULTS: Five patients (11.6%) had abnormal pulsations noted at the time of the Hynes. In no patient was the decision to perform a Hynes altered as a result of abnormal pulsations. Two patients had minor adjustments to the Hynes flaps to avoid exposing/damaging the ICA. In one patient an abnormal ICA was exposed during elevation of the left Hynes flap. This was covered uneventfully by routine closure of the secondary defect. Pulsations were noted in only 3 of 24 assessable preoperative nasendoscopies. CONCLUSIONS: A Hynes pharyngoplasty is not contraindicated in VCFS, even if abnormal pulsations are present. Examination and palpation of the pharyngeal walls after the patient is positioned for surgery appear to be reliable in detecting abnormal pulsations and allow accurate surgical planning. Routine vascular imaging, even in patients with pulsations on preoperative nasendoscopy is not essential and may not always be reliable, as shown by the variation in endoscopic, MRA, and intraoperative findings. This further re-emphasizes the importance of palpating the pharyngeal walls once the patient is positioned for surgery.

Adolescent↗
PubMed1989

1989 ARRS Executive Council Award. Exercise-enhanced MR imaging of variations in forearm muscle anatomy and use: importance in MR spectroscopy.

31P MR spectroscopic studies of forearm exercise frequently assume that the volume sampled is appropriate for the muscle of interest and that individual variations in muscle anatomy and use are not important. Postexercise MR imaging was used to assess variations in the size, location, and use of forearm flexors and the accuracy of palpation as a method for locating the muscle of interest. By using the information obtained with MR, the effects of errors in surface-coil position relative to the muscle of interest on 31P MR spectroscopy were examined. In the midforearm of seven men, the greatest diameter of the flexor carpi ulnaris was 29 +/- 4 mm, and that of the flexor digitorum superficialis was 28 +/- 6 mm. However, in the proximal forearm, 58 +/- 10% of the diameter was covered by the palmaris longus, when present (79% of subjects). An unexpected finding was that a focal portion of the superficial finger flexor was used primarily as a wrist flexor in 26% of subjects. Palpation incorrectly identified flexor muscle margins by more than 15 mm in 50% of attempts. When a surface coil was positioned over wrist flexors during handgrip, attenuation of exercise-induced changes in 31P spectra resulted. Exercise-enhanced MR imaging reveals variations in forearm muscle anatomy and use that are common and difficult to appreciate by palpation. It therefore allows improved localization of the sensitive volume for MR spectroscopic studies of muscle physiology.

Adult↗
PubMed2000

Tender point sensitivity, range of motion, and perceived disability in subjects with neck pain.

STUDY DESIGN: Descriptive analysis of impairment and disability measures in subjects with neck pain. OBJECTIVES: To identify discrete tender points and overall pressure sensitivity and assess relationships among palpation tenderness, active cervical range of motion, visual analog scale pain scores, and Sickness Impact Profile disability scores. BACKGROUND: Palpation tenderness and cervical range of motion are used to evaluate patients with neck pain, but their ability to predict patient-perceived pain and disability is unknown. METHODS AND MEASURES: We studied 45 women and 15 men with neck pain (mean age, 35 +/- 7 years). Group 1 included 30 persons who had not sought treatment, and group 2 included 30 persons who had just been referred for treatment. RESULTS: Subjects demonstrated low mean pressure pain thresholds of tender points (2.3 +/- 1.3 kg). Regression analysis showed that only neck flexion predicted pain (R2 = 0.23), with decreased flexion associated with higher pain levels. Sickness Impact Profile total score was predicted by neck rotation (R2 = 0.31), group (R2 = 0.16), tender point pressure pain threshold (R2 = 0.04), and neck retraction (R2 = 0.03). Decreased neck rotation, neck retraction, and pressure pain thresholds were associated with higher disability. CONCLUSIONS: Neither palpation tenderness nor cervical range of motion were strong predictors of pain and disability in subjects with neck pain.

Adult↗
PubMed1997

Pelvic floor findings in urinary incontinence--results of conditioning using vaginal cones.

BACKGROUND: Conservative treatment of urinary incontinence (UI) may be more reliable if it is associated with improved testing of pelvic floor function. The results of cone training in patients and healthy controls are compared. METHODS: Voluntary contractions of pelvic floor muscles in 16 women with genuine stress incontinence, 14 with mixed stress/urge incontinence, and eight healthy controls were assessed by digital transvaginal palpation, manometry, and inspection using the so-called speculum-lift test. In addition, the capability to hold vaginal cones was investigated. All examinations were done before and after four-week cone training (Femcon 20-70 g). RESULTS: Prior to cone training, no pelvic floor response was recordable from eight women (27%) by palpation and from seven women (23%) by inspection. After training, contractions were restored in all women. The best post-training results were obtained by palpation (27 positive responses), followed by manometry (25 women, 83%), and speculum-lift test (13 women, 43%). The capability to hold vaginal cones was also improved. Initial weights in 15 UI patients (50%) were lower (cone No. 1-2) than in eight healthy women (cone No. 5). Average contractility increased from 5 to 9.7 mmHg in patients and from 17.5 to 23.1 mmHg in healthy women. Twenty-four patients (80%) were cured (57%) or improved (23%). Twenty-six asked for continuation of cone training. CONCLUSIONS: Pelvic floor conditioning with vaginal cones is a good alternative to poor acceptance or insufficient availability of conventional exercises.

Adult↗
PubMed1986

Mandibular dysfunction in adolescents. II. Prevalence of signs.

The prevalence of signs of mandibular dysfunction was studied in 285 17-year-old adolescents living in the municipality of Skellefteå. They were subjected to a functional examination of the masticatory system. The commonest clinical signs were tenderness to palpation of the masticatory muscles (41%) and clicking sounds from the temporomandibular joints (22%). The tenderness to palpation was generally located to the lateral pterygoid muscle and the insertion of the temporal tendon. Girls were tender to palpation oftener (p less than 0.05) than boys. Unilateral contact in the retruded position was recorded in 77% of the subjects. Mediotrusion interferences were found in 30% of the subjects. Signs of clinical dysfunction were found in 56% and were significantly commoner in girls than in boys (p less than 0.01). Since mild and moderate signs of mandibular dysfunction obviously make an early appearance, a routine dental examination should include a functional evaluation of the stomatognathic system, to identify patients who should be observed more closely.

Adolescent↗
PubMed1982

Factors affecting accuracy of pregnancy diagnosis in cattle.

When pregnancy was diagnosed by concentration of progesterone in milk 23 days postinsemination in 3014 cows, 76.9% of positive and 93.8% of negative diagnoses were confirmed by uterine palpation or return to estrus. Agreement between diagnosis by uterine palpation and diagnosis by milk progesterone test increased for at least 50 days after insemination. Accuracy of laboratory diagnosis of pregnancy increased as concentration of progesterone in the milk sample increased, making it possible to identify cows likely to return to estrus by a low concentration of progesterone in milk 23 days after insemination. There were 352 cows (11.7%) for which concentration of progesterone in the milk sample collected on the day of insemination was higher than normal during estrus. Exclusion of these cases increased the accuracy of pregnant diagnosis by 7.1% and not pregnant diagnosis by 3.1%. From a pragmatic viewpoint, pregnancy diagnosis by concentration of progesterone in milk was accomplished most effectively by quantitative assaying of only one sample collected 23 days after insemination and assigning to the absolute concentration of progesterone a probability that pregnancy will be verified after 50 days or more of gestation by uterine palpation.

Animals↗
PubMed1998

Biopsy-based diagnosis of prostate cancer in 1290 patients referred for prostate examination: results according to the PSA level, digital rectal examination and ultrasonography.

Authors present their retrospective study of 1290 patients referred for prostate evaluation. The risk of cancer was analysed according to PSA, rectal palpation and ultrasound examination. Among the 1290 patients, 54.8% had cancer. The risk of cancer was multiplied by 2.8 when the PSA was between the normal limit and 10 ng/ml, by 7.5 when it exceeded 10 ng/ml, by 4.0 when rectal palpation was abnormal and by 1.6 when a hypoechogenic zone was present. Although a hypoechogenic zone does not improve the detection of cancer compared to PSA and rectal palpation, an increased PSA level even lower than 10 ng/ml indicates biopsies.

Adult↗
PubMed1999

Estimated fetal weight. Maternal vs. physician estimate.

OBJECTIVE: To compare the accuracy of fetal weight estimation as determined by laboring, parous women vs. by a physician using abdominal palpation. STUDY DESIGN: Four hundred seventy-one laboring, term, parous women underwent abdominal palpation by a physician and were subsequently asked to estimate the weight of their fetus, unaware of the physician's determination. Mean absolute error and percentage of fetal weight estimates within 10% of actual birth weight for both maternal and physician estimates were compared using Student's t test. Linear regression analysis was employed to determine whether maternal age, parity and race influenced the accuracy of the maternal estimation. In a similar fashion, level of physician training was analyzed to determine its impact on clinical fetal weight estimations. RESULTS: There were no statistical differences in mean absolute error (331 vs. 324 g) or percentage of fetal weight estimates within 10% of actual birth weight (62% vs. 60.9%) between maternal and physician determinations, respectively. Maternal age, race and parity did not influence the woman's ability to accurately predict fetal weight. Greater physician experience did not improve clinical fetal weight determinations. CONCLUSION: Parous women can subjectively estimate the weight of their fetus just as accurately as a physician using abdominal palpation. Neither maternal factors nor physician experience improves fetal weight estimations.

Adult↗
PubMed1999

Intra-operative procedures to localize endocrine tumours of the pancreas and duodenum.

Somatostatin receptor scintigraphy is the best imaging method to identify the presence of neuroendocrine gastroenteropancreatic tumours. Nevertheless, a well structured surgical approach incorporating specific intra-operative methods can localize those tumours that cannot be readily detected by this imaging technique. In the case of gastrinoma, standard palpation allows duodenal tumour detection in approximately 60% of cases, endoscopic transillumination, in more than 80%. Furthermore, adding duodenotomy, 95-97% duodenal tumours can be localized. Intraoperative ultrasound, instead, does not add much to standard palpation in duodenal gastrinoma localization. For insulinoma detection, among the intra-operative methods, inspection gives the poorest results, identifying the lesion in only 20% of cases. Palpation offers better results, localizing 60-80% of insulinomas. The introduction of intra-operative ultrasound has revolutionized the ability to find pancreatic insulinoma, allowing the surgeon to identify the insulinoma in nearly every patient.

Duodenal Neoplasms↗
PubMed1975

Monitoring and evaluating the physiological changes in the horse with acute abdominal disease.

Initial examination and therapy, and the avoidance of maltreatment are emphasized. Gastric decompression is of prime importance, after which no compound should be administered via stomach tube. Where large amounts of high starch grains are fed, primary acute gastric dilatation must be differentiated from that secondary to small bowel dilatation, by immediate gastric intubation and irrigation of the cardia with lidocaine. If cessation of pain and improvement of peristalsis and general attitude follow, the former state may be assumed. If pain persists and peristalsis does not improve markedly, one should assume small bowel displacement. Rectal examination is helpful in initial evaluation: impactions, inguinal herniation and ileocaecal intussusception may be diagnosed and small bowel displacement suspected. Palpation of one or more distended loops of bowel in the ventral middle third of the abdomen indicates small bowel displacement or ileus and flaccid distension. Distinction by rectal palpation alone is difficult. Palpation of the gas-distended apex of the caecum in the middle third of the abdomen is virtually pathognomonic for 180 degrees rotation of the large bowel. Abdominal paracentesis yielding true sanguineous effusion indicates a necrotizing segment of the bowel. If negative, such a segment is absent, or there is an infarcted segment, not yet damaged to the point of leaching whole blood, or the necrotizing segment is outside the peritoneal cavity, i.e., in the thorax, intussuscepted into the caecum, or herniated into the inguinal canal. Recurrent colics frequently may be due to verminous arteritis but the relationship to diet should be investigated. Recurrent colics after grain ingestion with occult blood in the faeces may be due to ulcers; such cases respond well to grain withdrawal. The advantages and disadvantages of phenothiazine-derived tranquillizers are discussed. They are contra-indicated if there is any evidence of circulating volume insufficiency but are benefical in many instances through improved peripheral perfusion of organs provided circulating volume is adequate, i.e., early in acute abdominal disease prior to development of circulatory insufficiency. They should not be administered if immediate surgery is contemplated because of hypotensive effects. The administration of oral antibiotics (Neomycin) early in the course of the disease is encouraged. This is contra-indicated if the horse is already toxic, when it should receive parenteral antibiotics, preferably chloromycetin. Tetracyclines may predispose to the later development of salmonella diarrhoea. Absolute analgesia should be provided; our preference is the magnesium sulphate-chloral hydrate solutions. Administration of mineral oil is desirable in initiation of peristalsis, depression of Gram-negative overgrowth and softening of impactioning obstructions but nothing should be administered per os if the stomach has required decompression.

Abdomen, Acute↗
PubMed2002

Temporo-mandibular joint kinetics and chewing cycles in children. A 3-year follow-up.

OBJECTIVES: To report the temporo-mandibular joint (TMJ) kinetics and masticatory function in healthy children. DESIGN: Temporo-mandibular joint palpation and electrognathographic registrations of chewing cycles were repeated for 3 years in order to evaluate changes. SETTING: Healthy children without systemic pathologies, decayed cavities and previous dental treatment. SAMPLE AND METHODS: Electrognathographic (EGN) registration of masticatory cycles and TMJ palpation were carried out on 52 patients (mean age: 5 years 8 months, range: 5 years 1 month, 6 years 8 months), by two university researchers, once a year for 3 consecutive years. TMJ palpation, differentiated TMJ synchronism (simultaneous bilateral opening movement) and TMJ asynchronism (not simultaneous bilateral opening movement), TMJ subluxation and click were observed. Electrognathographic registrations differentiated normal and abnormal jaw chewing cycles, and narrow and large cycles. RESULTS: Temporo-mandibular joint asynchronism was evident in 34 of 52 patients in the primary dentition, in 42 of 52 patients after the eruption of the first permanent molar, and in 31 of 52 patients after the eruption of the permanent incisors. TMJ subluxation increased during the full period of observation. Three temporomandibular clicks appeared after the eruption of the permanent incisors. Altered mastication was not always associated with TMJ disorders. CONCLUSIONS: In children, normal chewing cycles can coexist with occlusal discrepancies, cranio-facial growth and TMJ alterations.

Child↗
PubMed2000

[The evaluation of cervical lymph node metastasis of laryngeal cancer using magnetic resonance imaging (MRI)].

OBJECTIVE: To assess the potential or limitation of MRI for demonstrating the pathological cervical lymphnodes. METHOD: A prospective diagnostic study on cervical lymphnode metastasis from laryngeal carcinoma was performed for 19 cases undergone neck dissection (5 cases undergone bilateral neck dissection, 24 specimens of neck dissection were collected in total). With pathological findings as the criterion, sensitivity and specificity and accuracy were calculated for palpation and MRI examination of all patients. RESULT: MRI had obviously higher sensitivity specificity and accuracy than palpation. Besides the changes in size and shape of the metastatic lymphnodes, the intensity of MRI inside the metastatic lymphnodes was showed as mixed hypo-isointensity in T1WI and hyper intensity in T2WI. CONCLUSION: MRI examination was accurate in detecting cervical lymphnode metastasis and could image occult lymphnodes which are inaccessible on palpation. Thus, MRI will probably play an important role in the evaluation of malignant lymphnode metastasis.

Adult↗
PubMedDate not supplied

Ultrasonographic detection of regional lymph node metastases in patients with intermediate or thick malignant melanoma.

Careful monitoring of regional lymph nodes and early detection of metastases in malignant melanoma patients has an impact on their survival, since it may permit beneficial surgical therapy. Palpation is routinely used in clinical practice. The value of ultrasonography for routine follow-up of melanoma patients, still, is not generally accepted. The aim of our study was to assess the sensitivity and specificity of ultrasound and clinical examination respectively, in the detection of melanoma regional node metastases. Additionally, we evaluated whether early detection of metastases improved overall survival. One hundred and forty-eight melanoma patients with an intermediate or thick primary lesion were followed between January 1997 and May 2001. Clinical examination and concomitant regional lymph node ultrasonography were performed, every 3-4 months. If suspicious findings were identified, regional lymph node dissection was undertaken. Forty-four from the initial 148 patients relapsed with regional lymph nodal metastases. In 11 patients (25%) palpation failed to reveal the disease and metastases were depicted only by ultrasonography. In only 1 patient ultrasonography was false-negative. The sensitivity and specificity of palpation were 72.7 and 97% respectively, while those of ultrasonography were 97.7 (p<0.001) and 98% respectively. Ultrasonography was more sensitive in detecting lymph node metastases in the axilla (100%) and the groin (93.3%). When overall survival of patients presenting with local-regional recurrence was calculated--depending on the number of involved lymph nodes--a survival benefit (p<0.05) was found for patients with only one lymph node metastasis. In conclusion, ultrasonography is superior to clinical examination in the early detection of regional lymph node metastases from an intermediate or thick malignant melanoma and should be a part of those patients' surveillance.

Adult↗