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Progesterone levels and relationship with the diagnosis of a corpus luteum by rectal palpation during the estrous cycle in Zebu cows.

To assess the accuracy of rectal palpation for detecting functional luteal tissue during the estrous cycle in Zebu cattle, 20 mature non-lactating Indobrazil cows were palpated twice weekly for 7 1/2 weeks. Blood samples were drawn for progesterone analyses at each palpation. Circulating serum progesterone levels were below 0.5 ng/ml from days 0-4 (Day 0 = day of estrus); they increased thereafter, reaching maximum levels of 3.1 ng/ml on days 9 and 10. Values declined sharply to less than 0.5 ng/ml on day 18. Regardless of the stage of the estrous cycle in 71.3% of the cases (117 out of a total of 164 observations) the circulating progesterone levels corresponded to the results of rectal examination. The criteria to assess this relationship were that the presence of CL as determined by rectal palpation would be accompanied by levels of progesterone higher than 0.5 ng/ml, whereas absence of CL would be accompanied by levels less than 0.5 ng/ml. The correlation was significantly higher (P<0.05) on days 5-17 (77.9%) than on days 0-4 (57.5%) and 18-20 (65%). To assess the correlation of both rectal examination and progesterone levels with the stage of the estrous cycle, we expected that on days 0-4 and 18-20 no palpable CL and progesterone levels less than 0.5 ng/ml would occur, whereas on days 5-17 palpable CL and progesterone levels higher than 0.5 ng/ml would be found. On this basis, a correlation of 45% (18 out of 40 observations) between expected and observed values was found on days 0-4, 76% (79 out of 104) on days 5-17 and 60% (12 out of 20) on days 18-20 of the estrous cycle. Of the total of 55 observations which fell outside the expected values, 71% was due to a wrong diagnosis of CL; 14.5% was due to progesterone levels higher or lower than the expected values, and 14.5% to both laboratory and rectal palpation findings.

Journal Article↗

Pregnancy diagnosis in swine by palpation and by amplitude-depth ultrasound scanning.

The relative accuracy of two pregnancy testing methods for swine were compared in a field study. The procedures used were manual palpation and amplitude-depth ultrasonic scanning. A total of 369 sows were examined by both methods. Seven additional gilts were examined by ultrasound only and 46 sows by palpation per rectum only. The number of correct positive and negative diagnoses made by both methods were calculated, and determination of accuracy as well as comparison between the tests were made on this basis. The relative accuracy was 97.6% for the manual method and 96.8% for the ultrasound method. Both tests had a high sensitivity, 99.2 and 98.9%, respectively. The ability of the tests to detect the non-pregnant animals was not as high, which is reflected by a lower specificity. No significant differences were noted between the two methods. A lower specificity and a lower negative predictive value were provided by ultrasound scanning as compared with those acquired by manual palpation. Both procedures were considered to be quick and convenient to perform. It was concluded that in spite of the new pregnancy testing methods introduced in the swine industry, manual palpation remains the most practical in terms of its accuracy, ease, and the minimal requirement for equipment. In gilts, palpation is unsuitable and ultrasonography currently remains the best choice for the diagnosis of pregnancy.

Journal Article↗

Effects of Alfaprostol and uterine palpation on postpartum interval and pregnancy rate to embryo transfer in Brahman influenced beef cows.

Two trials were conducted to determine the effects of Alfaprostol, a prostaglandin F2 alpha analogue, and uterine palpation on reproductive performance in postpartum beef cows. In Trial J, 143 multiparous and 132 primiparous Brahman crossbred embryo recipient cows were assigned to receive one 5 mg injection of Alfaprostol between 29 and 65 d postpartum or to serve as controls. Alfaprostol treatment between 29 and 42 d postpartum decreased (P<0.05) postpartum interval in multiparous but not primiparous cows. Alfaprostol treatment increased pregnancy rate to embryo transfer. Trial II utilized 369 multiparous Brangus cows, 17 to 49 d postpartum, that were assigned to one of three groups: 1) Alfaprostol plus uterine palpation (APP), 2) Uterine palpation only (UP) or 3) Control. Completion of uterine involution was determined at treatment. Alfaprostol plus uterine palpation decreased postpartum interval regardless of uterine involution, while UP had a greater effect if uterine involution was not complete. Both APP and UP increased the number of cows which were detected in estrus by 80 d postpartum. Alfaprostol and uterine palpation, alone or in combination, can increase postpartum reproductive performance in Brahman crossbred and Brangus beef cows.

Journal Article↗

Ultrasonography or palpation for detection of melanoma nodal invasion: a meta-analysis.

Because treatment of distant melanoma metastases is not very effective, nodal spread should be diagnosed early so that therapeutic lymphadenectomy can be started as early as possible. Physical examination alone often does not detect nodal metastases and palpable nodes cannot be clasified unambiguously. Whether lymph-node ultrasonography-an inexpensive procedure-improves detection of nodal invasion during the initial staging and follow-up of patients with melanoma is controversial. We used meta-analysis techniques for diagnostic tests to assess the merit of ultrasonography and palpation in detection of nodal invasion in patients with melanoma. Five databases were screened until December, 2003. 12 studies, including 6642 patients and 18?610 paired palpation and ultrasound examinations, were eligible. The main limitations were variations in the definition of false negatives, and verification bias. Ultrasonography had a higher discriminatory power (odds ratio 1755; 95% CI 726-4238) than did palpation (21 [4-111]; p=0.0001). Furthermore, positive-likelihood ratios were 41.9 (95% CI 29-75) for ultrasonography and 4.55 (2-18) for palpation; negative-likelihood ratios were 0.024 (0.01-0.03) and 0.22 (0.06-0.31), respectively. Our results showed clearly that ultrasonography detects lymph-node invasion more accurately than palpation, and should therefore probably be used routinely in patients with melanoma.

Adolescent↗

Is manual palpation of uterine contractions accurate?

OBJECTIVE: The aims of this study were to assess the accuracy of uterine contraction palpation, determine whether the accuracy of palpation improves with experience, determine clinical factors that affect the accuracy of palpation, and evaluate the range of intrauterine pressure present when an observer notes the contraction to be mild, moderate, or strong. STUDY DESIGN: A total of 236 observations were obtained by use of intrauterine pressure catheters on 46 laboring patients in the first stage of labor. The blinded observers (obstetrics and gynecology residents, maternal-fetal medicine fellows and faculty, and labor and delivery nurses) were asked to label a contraction as mild, moderate, or strong. Patient's height, weight, parity, and gestational age, use of oxytocin, use of epidural anesthesia, and laboring position, and the level of training of the observer were noted. RESULTS: Mild, moderate, and strong contractions had intrauterine pressures of 35.2 +/- 33.8 mm Hg (+/- 2 SD), 44.9 +/- 35.4 mm Hg, and 55.5 +/- 28.0 mm Hg, respectively. The observers were accurate in predicting contraction strength 49% of the time. There was no improvement in accuracy with increased physician experience. All physicians as a group were more accurate than nurses (p < 0.05). Accuracy was not affected by clinical variables. CONCLUSION: Manual palpation of uterine contractions is an inaccurate means of determining contraction strength.

Female↗

Adverse effect of helicopter flight on the ability to palpate carotid pulses.

STUDY OBJECTIVE: To determine if the air medical helicopter environment compromises the ability to palpate carotid pulses. DESIGN: Using a carotid pulse model, flight nurses were tested for their ability to palpate the simulated carotid pulse at normal (120/80 mm Hg) and low (80/60 mm Hg) blood pressures on the ground and during helicopter flight. SETTING: Palpation tests were performed during flight in an MBB BO-105 twin-turbine engine, single-rotor air medical helicopter; control palpation tests were performed on the ground. TYPE OF PARTICIPANTS: Ten flight nurses. MEASUREMENTS AND MAIN RESULTS: Tracings of pulsatile pressure from the carotid pulse model verified its ability to simulate a wide range of arterial pressures. Analyses of variance for repeated measures, including polynomial contrasts, were performed to compare the number of correct detections of the presence or absence of pulse pressures in flight with the number of correct detections in the two control conditions for both carotid pulse pressures. The mean in-flight number of correct detections was lower than both the preflight and postflight control tests, which were themselves nearly equal, at each simulated carotid pulse pressure. The quadratic terms for both the 120/80 mm Hg trial (F1,14 = 9.28; P = .0087) and the 80/60 mm Hg trial (F1,18 = 5.69; P = .0283) were statistically significant. CONCLUSION: Factors associated with transport of patients in an MBB BO-105 helicopter impair the ability of flight nurses to detect carotid pulses in a simulated physiologic model.

Aircraft↗

The intraoperative assessment of ascending aortic atheroma: epiaortic imaging is superior to both transesophageal echocardiography and direct palpation.

OBJECTIVES: To determine the optimal method for detecting ascending aortic atheroma intraoperatively by comparing manual palpation by the operating surgeon, intraoperative transesophageal echocardiography, and epiaortic ultrasound (linear and phased-array imaging); and to assess risk factors for severe aortic atheroma. DESIGN: A longitudinal prospective study. Assessment of the atheroma by manual palpation was blinded to the results of the ultrasound images. SETTING: The study was performed in a single university tertiary referral hospital. PARTICIPANTS: One hundred consecutive patients undergoing coronary bypass or valve surgery were studied after their written, informed consent. INTERVENTIONS: Potential risk factors were evaluated by both a patient questionnaire and examination of prior hospital records. The ascending aorta was assessed by the following methods: manual palpation by the operating surgeon, intraoperative transesophageal echocardiography, and epiaortic ultrasound (linear and phased-array imaging) performed by an echocardiologist. For analysis, the ascending aorta was divided into three equal segments: proximal, mid, and distal, corresponding to regions of different operative manipulations. MEASUREMENTS AND MAIN RESULTS: Age older than 70 years and hypertension were significant risk factors for severe ascending aortic atheroma with adjusted odds ratios of 3.3 (95% CI, 1.2 to 9.3) and 3.9 (95% CI, 1.3 to 12.0), respectively. There was no significant difference in atheroma detection between the two ultrasonic epiaortic probes in any segment; however, epiaortic probes were superior to manual palpation in all segments and also superior to transesophageal echocardiography in the mid and distal segments of the ascending aorta. CONCLUSIONS: Age older than 70 years and hypertension are significant risk factors for severe ascending aortic atheroma. Intraoperative detection of ascending aortic atheroma is best achieved by epiaortic ultrasound with either a linear or phased array transducer. Transesophageal echocardiography is an insensitive technique for evaluation of mid and distal ascending aortic atheroma and, therefore, of little value in guiding surgical manipulations such as cross-clamping.

Age Factors↗

Magnetic resonance imaging in comparison to clinical palpation in assessing the response of breast cancer to epirubicin primary chemotherapy.

PURPOSE: To investigate whether magnetic resonance imaging (MRI) is superior to clinical palpation in the assessment of response of breast cancer to primary chemotherapy (PC). PATIENTS AND METHODS: Seventy-three patients with T2-4, N0, M0 breast cancer were treated with 3-4 cycles of single agent epirubicin before definitive surgery. MRI was performed at baseline condition and at the end of chemotherapy. RESULTS: According to the WHO criteria, 20 (27.4%) patients attained a complete response (CR) by clinical palpation and 41 (56.2%) a partial response. The corresponding response rate by MRI was 11 (15.1%) and 34 (46.6%), respectively. Residual tumor assessed by MRI better correlated with pathologic measurements (Spearman r : 0.72) than residual tumor assessed by clinical palpation (Spearman r : 0.58). Post-chemotherapy histology evaluation revealed pathologic CR in three cases, only one of them was considered as complete responder by MRI. Residual disease consisted in in situ carcinoma in four cases, one of them was complete responder at MRI, the remaining three showed residual abnormal contrast enhancement indistinguishable from that of invasive tumors. CONCLUSIONS: As compared to pathology specimens, MRI is able to represent the extent of cancer more accurately than clinical palpation. It constitutes a promising technique in assessing the BC response to PC. The current limit of MRI is the scarce specificity in predicting the nature of residual disease.

Adult↗

Inter-examiner and intra-examiner agreement for assessing sacroiliac anatomical landmarks using palpation and observation: pilot study.

Despite the paucity of research into the reliability of static palpation, it is still employed extensively as a diagnostic tool by manual medicine practitioners. This study tested the inter- and intra-examiner agreement of ten senior osteopathic students using static palpation on ten asymptomatic subjects. Four assessments of the posterior superior iliac spine (PSIS), sacral sulcus (SS), and the sacral inferior lateral angle (SILA) on every subject by all examiners resulted in 1200 assessments in total. Kappa (Kg) yielded intra-examiner agreement that ranged between less-than-chance to substantial for the SILA (Kg=-0.05 to 0.69; mean Kg=0.21), and slight to moderate for the PSIS (Kg=0.07 to 0.58; mean Kg=0.33) and the SS (Kg=0.02 to Kg=0.60; mean Kg=0.24), with 50% significant beyond the 0.05 level. Inter-examiner agreement was slight (PSIS Kg=0.04; SILA Kg=0.08; SS Kg=0.07) and significant at the 0.01 level. Intra-examiner agreement was greater than inter-examiner agreement, which was consistent with existing palpation reliability studies. The poor reliability of clinical tests involving palpation may be partially explained by error in landmark location.

Adolescent↗

Scapular position: the validity of skin surface palpation.

The assessment of the resting position of the scapula forms part of the examination of upper quadrant posture. The purpose of this study was to determine if surface palpation is a valid indicator of actual scapular position. Twelve embalmed shoulders were examined and the actual location of three bony scapular landmarks and three bony thoracic landmarks were compared with surface palpation of these locations. The results, based on the upper value for a distance (with 95% confidence), suggested that the difference between the surface location of the root of the spine of the scapula, the acromial angle and the inferior angle would be less than 0.67 cm, 0.98 cm and 0.46 cm respectively from the centre of the bony locations. The difference between the twelfth thoracic spinous process (SP), the SP corresponding with the root of the spine of the scapula, and the SP corresponding with the inferior angle and the surface points would be 1.46 cm, 1.09 cm and 1.01 cm respectively. The results of this study suggest that surface palpation of scapular location is a valid method for determining the actual location of the scapula. The findings also suggest that surface palpation can determine the location of thoracic landmarks, which may serve as reference points for scapular position.

Aged↗

[Vaginal sonography as a method of study in the evaluation of cervix insufficiency. A useful complement to vaginal palpation?].

In a clinical study a group of pregnant women with suspected cervical incompetence was examined by vaginal sonography. Aim of the investigation was to compare results of performed vaginal palpation with results of sonography. 53 pregnant women between 20th und 31st week of gestation were examined by a 5 MHz vaginal sector-scanner probe. After focussing sagittal projection of uterine cervix and lower uterine segment the cervical length and opening of the internal os were assessed prior to cerclage. Postoperative vaginal sonography was performed to ascertain lengthening and stabilization of the incompetent cervix. Comparing results of vaginal palpation and vaginal sonography showed, that the cervical length obtained by sonography was constantly higher in all patients than the results obtained by palpation. This difference became more distinct in the group of patients with extreme cervical incompetence. We are of the opinion that vaginal sonography is an objective method revealing the extent of cervical incompetence. Exact measurement of the cervical length and assessment of the internal os are efficient diagnostic criteria. They complete results of cervical palpation and offer precise information concerning an intended cerclage.

Adolescent↗

Simultaneous palpation of the craniosacral rate at the head and feet: intrarater and interrater reliability and rate comparisons.

BACKGROUND AND PURPOSE: The main purpose of this study was to determine the interrater and intrarater reliability of measurements obtained during palpation of the craniosacral rate at the head and feet. Palpated craniosacral rates of head and feet measured simultaneously were also compared. Subjects. Twenty-eight adult subjects and 2 craniosacral examiners participated in the study. METHODS: A within-subjects repeated-measures design was used. A standard cubicle privacy curtain, hung over the subject's waist, was used to prevent the examiners from seeing each other. RESULTS: Interrater intraclass correlation coefficients (ICCs) were .08 at the head and .19 at the feet. Intrarater ICCs ranged from .18 to .30. Craniosacral rates simultaneously palpated at the head and feet were different. CONCLUSION AND DISCUSSION: The results did not support the theories that underlie craniosacral therapy or claims that craniosacral motion can be palpated reliably.

Adolescent↗

Atlas-axis facet asymmetry. Implications in manual palpation.

STUDY DESIGN: A basic study of six human cervical spines, documenting displacement with applied forces mimicking palpation. OBJECTIVES: To assess the issues of motion palpation of joint restrictions and the inferred link to disease. SUMMARY OF BACKGROUND DATA: Although several investigators have suggested that the issue of asymmetry and normal-abnormal function should be assessed, data are unavailable. METHODS: Atlas-axis specimens were harvested from six cadavers, cleaned of ligamentous and muscle tissue, and potted and secured with dental plaster. Forces (5-25 N) were applied along the mediolateral axis, and the corresponding displacement along three orthogonal axes were documented with infrared diodes and the Optotrak camera system (Northern Digital, Waterloo, Ontario, Canada). Specimen geometry and asymmetry were documented with plain radiographic film and a gimbal apparatus. RESULTS: Each of the six specimens displayed different behavior and differing degrees of asymmetry (e.g., facet inclination 17-35 degrees) so that each was analyzed as a case study. Asymmetrical and discontinuous force-displacement correlations were linked to anatomic asymmetry that appeared to be of natural occurrence. CONCLUSIONS: Asymmetrical joint geometry is common and causes asymmetrical joint dynamics. Thus, a clinician attempting to palpate vertebral motion would be misled by assuming that perceived restricted joint motion universally represented a finding potentially amenable to manipulation. For spine palpation to be a valid indicator for manipulation, the clinician applying it must first be able to differentiate between asymmetrical motion caused by vertebral fixation and that caused by asymmetrical joint anatomy.

Aged↗

Intraoperative palpation for clinically suspicious axillary sentinel lymph nodes reduces the false-negative rate of sentinel lymph node biopsy in breast cancer.

Axillary sentinel lymph node biopsy (SLNB) is widely used to identify the first lymph node draining breast tumors. When the sentinel lymph node is free of metastasis, axillary dissection is avoided because the rest of the nodes are expected to be negative as well. A false-negative rate of 5% is considered acceptable. In the case of a false-negative SLNB, adjuvant local and systemic treatments might be suboptimal. We assessed the effect of intraoperative axillary palpation for clinically suspicious lymph nodes that are not otherwise detected by radioactive tracer or blue dye on the false-negative rate of SLNB in breast cancer patients. Our prospective database of patients having surgery for primary invasive breast cancer and who had a SLNB from 2000 to 2004 was reviewed. Only patients with clinically negative nodes preoperatively were included. The procedure included preoperative injection of radiotracer, with dye injection as backup, and intraoperative palpation of the axilla for suspicious lymph nodes that were not radioactive or blue. Of the 290 patients, 89 (30.7%) had sentinel node involvement by tumor. Seven patients had clinically suspicious nodes identified solely by palpation and not by tracer, in addition to sentinel lymph nodes detected by tracer. In five of the seven patients, the nodes harbored metastasis. In four of these five patients (4.5% of the 89 patients with axillary involvement), the palpable nodes were the only ones involved. A generous axillary incision and systematic palpation of the axilla reduces the false-negative rate and should be a part of the SLNB procedure.

Breast Neoplasms↗

Reproducibility of examiner performance for muscle and joint palpation in the temporomandibular system following training and calibration.

The purpose of this investigation was to assess examiner ability to consistently perform specific tasks related to muscle and joint palpation. Four trained and calibrated examiners were asked 1) to deliver index finger pressures within a high (1.5-2.1 kg) and low (0.5-1.1 kg) target pressure range and 2) to precisely locate one joint palpation and four muscle sites. After passing a calibration test, the performance of the examiners was monitored during the course of a replicability study assessing the consistency of clinical findings during repeated exams for TM disorders. (1) Index finger pressure was regularly tested over a 3-month period with a hand held pressure algometer, and the reading of each trial was recorded. Data analysis showed a high proportion of trials within the pressure range (overall 89.5%). Examiner performance across target range of pressures was statistically different for success rate and mean pressure delivered. The differences in the mean finger pressure delivered by each examiner (intraexaminer variation) was low and varied from 0.12 to 0.22 kg/cm2 for the desired range of pressures. (2) Paired examiners were asked to independently and sequentially mark palpation sites over the forehead, superficial and deep masseter, anterior temporalis, and lateral capsule of the temporomandibular joint. Replicability of site locations was assessed by measuring, with a boley gauge, the distance between sites selected by the paired examiners. Except for the superficial masseter and the anterior temporalis, the paired examiners selected palpation sites within a distance of 7 mm more than 85% of the time.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

On the feasibility of remote palpation using acoustic radiation force.

A method of acoustic remote palpation, capable of imaging local variations in the mechanical properties of tissue, is under investigation. In this method, focused ultrasound is used to apply localized (on the order of 2 mm3) radiation force within tissue. and the resulting tissue displacements are mapped using ultrasonic correlation based methods. The tissue displacements are inversely proportional to the stiffness of the tissue, and thus a stiffer region of tissue exhibits smaller displacements than a more compliant region. In this paper, the feasibility of remote palpation is demonstrated experimentally using breast tissue phantoms with spherical lesion inclusions, and in vitro liver samples. A single diagnostic transducer and modified ultrasonic imaging system are used to perform remote palpation. The displacement images are directly correlated to local variations in tissue stiffness with higher contrast than the corresponding B-mode images. Relationships between acoustic beam parameters, lesion characteristics and radiation force induced tissue displacement patterns are investigated and discussed. The results show promise for the clinical implementation of remote palpation.

Breast↗

Detection of renal anomalies by abdominal palpation in newborn infants.

In a new technique of palpation for renal anomalies in the newborn one hand supports the infant while the fingers of the other hand support the loin and the thumb explores the abdomen. In a series of 11 000 otherwise normal newborn children superficial palpation detected 11 renal anomalies, and deep palpation led to the discovery of another 42 anomalies. One of two other series in which palpation was performed bimanually gave a similar incidence of renal anomalies (0-5%). Early discovery of an asymptomatic anomaly enables early treatment of the complications that are often found in patients with congenital renal anomalies detected in later life.

Humans↗

Dorsalis pedis arterial pulse: palpation using a bony landmark.

INTRODUCTION: The unreliability of the pulse examination of the foot has primarily been due to variability of technique between examiners. Whereas the groove between the medial malleolus and the Achilles tendon more readily defines the location of the posterior tibial pulse, the location of the dorsalis pedis pulse remains vague. In this paper a novel method of locating the dorsalis pedis pulse by physical examination is described. METHODS: Forty one consecutive patients admitted to a general surgery service of a tertiary medical centre within a two month period were examined. Using the dorsal most prominence of the navicular bone as a landmark, the distance to the dorsalis pedis pulse in bilateral lower extremities was measured by palpation and compared to Doppler ultrasound. Measurements were confirmed by two separate examiners blinded to each others' results. RESULTS: The dorsalis pedis artery was palpable in 78% of extremities and present by Doppler ultrasound in 95%. The location of the left dorsalis pedis artery was a mean (SD) 9.8 (1.4) mm by palpation and 11.1 (2.1) mm by Doppler ultrasound from the dorsal most prominence of the navicular bone. The right dorsalis pedis artery was 10.4 (3.4) mm by palpation and 11.5 (0.7) mm from the dorsal most prominence of the navicular bone. No significant differences in location of the dorsalis pedis artery were observed bilaterally between Doppler ultrasound and palpation; No significant differences were observed comparing contralateral dorsalis pedis arteries nor any differences between the examiners' results. CONCLUSION: The dorsal most prominence of the navicular bone provides a bony landmark to readily locate the dorsalis pedis artery. Reliability of the examination may be increased as to the patency of the dorsalis pedis artery by using this dependable anatomic landmark.

Adult↗