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PubMed1988

Investigation of anorectal function.

Anorectal function tests were performed in 280 consecutive patients, who were referred for evaluation of different anorectal disorders. The relationship between the estimated anal sphincter pressure on digital palpation and the measured pressure on anal manometry was investigated and the interrelationship between anal manometry, rectal capacity and the saline infusion test was defined. A significant correlation (P less than 0.001) was found between digitally and manometrically measured anal sphincter pressure. Considering the relationship between the three specific anorectal function tests, only manometry and the saline infusion test correlated to some extent (P less than 0.01). This study shows that digital palpation is helpful in anorectal function investigation, but to establish the exact anal pressures, anal manometry is mandatory. Furthermore, the poor correlation observed indicates that single tests represent different aspects of anorectal function and therefore they need to be performed together.

Adolescent↗
PubMed1988

Screening for breast cancer: some clinical aspects.

There is little doubt that screening by palpation and mammography will reduce the mortality from breast cancer. Most of the studies have been designed to test survival difference and, following diagnosis, patients were treated by a variety of surgeons and methods. We present clinical and pathological data on 32 asymptomatic patients who were screened and found to have breast cancer. Investigation and treatment was performed by one surgeon according to a defined protocol. We confirm that mammography is a more sensitive diagnostic tool than palpation and describe how a review of the patient with the suspicious mammogram will increase the incidence of palpable tumours. We stress the importance of fine-needle aspiration cytology as a diagnostic and localization method. The low incidence of axillary node metastasis in patients with invasive carcinoma is described. More importantly, no patient in this series required treatment by mastectomy. In our experience patients with breast cancer detected by screening are eminently suitable for treatment by breast conservation.

Adult↗
PubMed1991

Detection of colorectal liver metastases using intraoperative ultrasonography.

Intraoperative ultrasonography of the liver has been carried out in 99 patients undergoing surgery for colorectal cancer. Palpation of the liver, preoperative abdominal ultrasonography and computed tomography scanning were also performed in all patients. Metastases were identified in 26 of the 99 patients (26 per cent). Intraoperative ultrasonography diagnosed more metastases than palpation, abdominal ultrasonography or CT scanning, identifying metastases in 24 of the 26 patients, including six patients in whom the metastases were not detected by any other technique. Identification and localization of impalpable liver metastases is therefore possible using intraoperative ultrasonography.

Colorectal Neoplasms↗
PubMed1983

Determination of axillary nodal status in surgery of breast carcinoma: a prospective study of thirty-five patients.

Thirty-seven axillary status of patients with breast carcinoma was studied with preoperative and peroperative palpation before mastectomy and total axillary dissection. Special attention was paid to the clinical suspiciousness and size of axillary nodes. The preoperative axillary palpation gave false diagnosis of axillary content 27% of the time and peroperative, 19%. Of all 249 nodes studied, 54 were found to contain malignant growth in routine histological examination. Mean diameter of malignant nodes was 12.4 mm and of benign nodes, 6.3 mm. The most clinically suspect axillary lymph node gave correct diagnosis of axillary status in 72% of the cases. The 2 most suspect lymph nodes together were positive in 89%. There was no case with histologically positive axilla where none of the 3 most suspect lymph nodes was malignant. We conclude that at least the 3 most suspect axillary lymph nodes must be removed for histological examination to be sure that axillary metastasizing of breast carcinoma can be found by routine histological examination.

Adult↗
PubMed1993

Nonpalpable occult and metastatic papillary thyroid carcinoma.

The results of palpation, ultrasound, and detailed pathology were compared in 50 patients undergoing total thyroidectomy. Of the 211 nodules recognized by pathology, palpation detected 24% and ultrasound detected 43%. There were 14 patients with palpable papillary carcinomas, and 12 of these 14 had metastatic foci in other portions of the gland. Metastatic foci would have been left in 10 patients if only a lobectomy had been performed and would have been left in 6 patients if only a subtotal thyroidectomy (as defined in this report) had been performed. Of the 33 patients with benign palpable nodules, 5 had occult papillary carcinomas. In 2 of those 5 patients, the occult carcinomas would not have been removed if a less-than-total thyroidectomy had been performed. The significance of these occult and metastatic papillary carcinomas is discussed.

Carcinoma, Papillary↗
PubMed2006

Photoacoustic imaging of valves in superficial veins.

BACKGROUND AND OBJECTIVES: In intravenous access to veins there is a risk of puncturing venous valves or blocking of the catheter by the valves. Therefore, we have investigated whether and how photoacoustic imaging (PAI), which visualizes the lumen of blood vessels, can be used to detect these valves. STUDY DESIGN/MATERIALS AND METHODS: Venous valves in superficial veins on the dorsal side of the hand of human volunteers were located by palpation and visual inspection. Next, this location was imaged using PAI. RESULTS: In 16 of 21 human volunteers venous valves that were found by palpation could be observed by PAI as local discontinuities in the imaged vessel. From these images, four characteristic features by which venous valves can be recognized in photoacoustic images were identified. CONCLUSIONS: PAI has the potential to be applied in the detection of venous valves.

Acoustics↗
PubMed1998

Elasticity reconstructive imaging by means of stimulated echo MRI.

A method is introduced to measure internal mechanical displacement and strain by means of MRI. Such measurements are needed to reconstruct an image of the elastic Young's modulus. A stimulated echo acquisition sequence with additional gradient pulses encodes internal displacements in response to an externally applied differential deformation. The sequence provides an accurate measure of static displacement by limiting the mechanical transitions to the mixing period of the simulated echo. Elasticity reconstruction involves definition of a region of interest having uniform Young's modulus along its boundary and subsequent solution of the discretized elasticity equilibrium equations. Data acquisition and reconstruction were performed on a urethane rubber phantom of known elastic properties and an ex vivo canine kidney phantom using <2% differential deformation. Regional elastic properties are well represented on Young's modulus images. The long-term objective of this work is to provide a means for remote palpation and elasticity quantitation in deep tissues otherwise inaccessible to manual palpation.

Algorithms↗
PubMed2003

Transabdominal ultrasound measurement of pelvic floor muscle activity when activated directly or via a transversus abdominis muscle contraction.

AIMS: The purpose of the present study was to compare the effectiveness of instruction to contract the pelvic floor muscles (PFM), the transversus abdominis (TrA), and the TrA + PFM visualized as displacement of the pelvic floor by ultrasound. MATERIALS AND METHODS: Twenty female physical therapists, mean age 41.1 years (range 26-56) participated in the study. A 3.5 MHz 35 mm curved linear array ultrasound transducer (Dornier Medtech) was placed in the mid-sagittal plane immediately suprapubically, angled at 15-30 degrees from the vertical depending on subcutaneous fat and anatomical variations, to image the pelvic floor. Six trials of three maneuvers in random order were performed: contraction of PFM, TrA, and TrA + PFM. RESULTS: In spite of correct contractions assessed by palpation and clinical observation, one subject demonstrated a downward movement of the pelvic floor during PFM contraction on ultrasound. Six subjects (30%) showed a downward movement during a TrA- contraction, and two during the combined TrA + PFM contraction. Instruction to contract PFM produced significantly greater mean displacement: 11.2 mm (95% CI 7.2-15.3) than TrA 4.3 mm (95% CI -0.2-8.8), P < 0.01, and combination: 8.5 mm (95% CI 5.2-12), P = 0.04. Hence, instruction of PFM contraction produced a 61.6% greater displacement of the pelvic floor in the correct direction than a TrA contraction. CONCLUSIONS: It is concluded that ultrasound is a more valid method than palpation and clinical observation to assess PFM function, and that instruction to contract the PFM produces a significantly more effective pelvic floor muscle contraction than instruction to perform a TrA contraction.

Abdomen↗
PubMed2005

Pelvic floor muscle training is effective in women with urinary incontinence after stroke: a randomised, controlled and blinded study.

AIMS: The aim of this study was to evaluate the effect of Pelvic Floor Muscle Training (PFMT) in women with urinary incontinence (UI) after ischemic stroke. MATERIALS AND METHODS: Three hundred and thirty-nine medical records of stroke patients were searched. Twenty-six subjects were randomised to a Treatment Group (14 subjects) or a Control Group (12 subjects) in a single blinded, randomised study. The intervention included 12 weeks of standardised PFMT. The outcome measures were: (1) diary recording the frequency of voiding, the number of incontinence episodes and used pads; (2) 24-hr home pad test; and (3) vaginal palpation of pelvic floor muscle evaluating function, strength, static and dynamic endurance. RESULTS: Twenty-four subjects with urge, stress and mixed stress/urge incontinence, completed the study, 12 in each group. A significant improvement in frequency of voiding in daytime (Treatment Group/Control Group: 7/8 at pre-test, 6/9 at post-test (median values), P=0.018), 24-hr pad test (Treatment Group/Control Group: 8/12 to 2/8 g P=0.013) and dynamic endurance of pelvic floor muscle (Treatment Group/Control Group: 11/20 to 20/8 contractions of Pelvic Floor Muscle, P=0.028) was demonstrated in the Treatment Group compared to the Control Group. A significant improvement in frequency of voiding in daytime (decreased from seven to six, P=0.036), pelvic floor muscle function (P=0.034), strength (P=0.046), static endurance increased from 9 to 30 sec (P=0.028) and dynamic endurance increased from 11 to 20 contractions (P=0.020) was also demonstrated within the Treatment Group, but not in the Control Group. CONCLUSION: PFMT had a significant effect in women with UI after stroke measured by diaries, pad tests and vaginal palpation.

Adult↗
PubMed2003

Assessment of para-aortic lymph nodes by intraoperative sonography in gynecological malignancies: a preliminary report.

OBJECTIVE: To investigate the usefulness of intraoperative sonography for the assessment of para-aortic lymph nodes in gynecological malignancies. METHODS: The assessment of para-aortic lymph node swelling by computed tomography (CT), palpation during surgery and intraoperative sonography was performed in 43 women with a gynecological malignancy. The sensitivity, specificity and predictive values of each technique for assessment of node metastasis were examined in the 33 women who underwent para-aortic lymphadenectomy. For each of the three assessment techniques, the number of para-aortic lymphadenectomies that would have been performed and the number of women who would have had missed metastasis were evaluated assuming a para-aortic lymphadenectomy would be performed only when swollen nodes were detected. RESULTS: Para-aortic nodes were assessed to be swollen by CT, palpation, and intraoperative sonography, respectively, in one, six and 10 of 43 women in total, and in one, six and nine of the 33 women who underwent para-aortic lymphadenectomy. The sensitivity and negative predictive value of intraoperative sonography were 100%, while the specificity and positive predictive value of CT were 100%. If para-aortic lymphadenectomy had been performed only when swollen nodes were detected by intraoperative sonography, the number performed would have decreased from 33 to nine without missing lymph-node metastasis. CONCLUSION: Intraoperative sonography has potential for the assessment of para-aortic lymph nodes in gynecological malignancies.

Aorta↗
PubMed1988

The scintigraphic Murphy sign.

Focal gallbladder tenderness is the most important physical finding in suspected acute cholecystitis. We describe a technique using palpation of the abdomen with the placement of a radioactive marker on the point of maximum tenderness. Correlation of the marked area to the location of the gallbladder fossa is made. This integration of palpation and scintigraphy might enhance the cholescintigraphic diagnosis of acute cholecystitis.

Acute Disease↗
PubMed1991

Transanorectal ultrasonography in the staging of anal epidermoid carcinoma.

Fifty consecutive patients with anal canal epidermoid carcinoma were evaluated by transanorectal ultrasonography (TRUS) at diagnosis. Forty-six patients were treated with primary radiotherapy plus bleomycin. Twenty-eight of the last 30 patients underwent, in addition, planimetric volume determination. The ultrasound findings were compared with clinical stage as assessed by digital palpation. Tumours in clinical stages T1-2 showed evidence of penetration through the anorectal muscular wall at ultrasound (UT3-4) in two-thirds of the cases. This was the case in all tumours in clinical stages T3-4. A clear correlation between tumour size, depth of invasion, and tumour volume, respectively, and residual tumour after a "pre-operative" dose of 40 Gy plus bleomycin was found. When combining clinical stage with TRUS, all tumours classified as T1-2/UT1-2 had a complete response (CR) after the first radiotherapy period, whereas the corresponding figures for those with deep invasion ultrasonographically (T1-2/UT3-4 and T3-4/UT3-4) were 64 percent and 0 percent, respectively. It thus appears that TRUS could complement digital palpation in staging anal canal carcinoma.

Adult↗
PubMedDate not supplied

Evaluation of goiter endemia by ultrasound in schoolchildren in Val Sarmento (Italy).

Ultrasonography is an excellent and objective method for assessing thyroid volume, especially in children where clinical evaluation is inaccurate. The aim of this study was to evaluate the presence of goiter by thyroid ultrasound and palpation in 244 schoolchildren, 6 to 14 years old, living in some rural villages of Val Sarmento, a mountain area of Basilicata, Italy. In 1996 we revealed the presence of endemic goiter in 25% of the schoolchildren evaluated by palpation, according to World Health Organization (WHO) criteria, and in 15.9% of the schoolchildren evaluated by ultrasonography (7.5 MHz linear probe). The median urinary iodine excretion, taken from an extemporaneous sample of the first urines in the morning, was 62.2 microg/l. This study includes Val Sarmento, an area with mild-moderate grade (Grade I) of iodine deficiency, suggesting the need for iodine prophylaxis. Furthermore, it proves that the measurement of thyroid volume by ultrasonography is an essential instrumental method for a correct epidemiological study of endemic goiter, particularly in areas where there is mild iodine deficiency.

Adolescent↗
PubMed2001

Thyroid volumes in schoolchildren of Tehran: comparison with European schoolchildren.

Since the normative values of thyroid volume ultrasonography results from European schoolchildren were endorsed by the World Health Organization (WHO), few studies have addressed the limitation of the recommended references as universal normative values for thyroid volume. Our objective was to describe thyroid volume measured by ultrasonography in Tehranian schoolchildren and compare them with the WHO normative values. Cross-sectional studies were performed in 2016 schoolchildren, aged 6-15 yr, in Tehran 10 yr after distribution of iodized salt. Data were collected on age, sex, weight, height, thyroid size by palpation and ultrasonography, and urinary iodine. Age/sex and body surface area (BSA) upper limits (97th percentile) of thyroid volume were derived. The goiter prevalence was 42% by palpation, 31% grade 1 and 11% grade 2. Median urinary iodine was 21.2 microg/dl. The 97th percentiles were comparable in girls and boys of all ages. Applying the WHO thyroid volume references to the Tehranian children, they did not show any enlarged thyroid based on BSA and on age, even in 11% of children with grade 2 (visible) goiter. In the Tehranian children, the best predictors of thyroid volume were BSA, height and weight. Using linear regression, the 97th percentile of thyroid volume from Tehranian children were lower than the corresponding references from the WHO normative values. The results indicate that a thyroid volume reference based on weight alone would perform as well as the one based on BSA. In addition, until the adoption of a new applicable international reference for thyroid volume, the use of local reference in the screening of children for thyroid enlargement is recommended.

Adolescent↗
PubMed2003

Thyroid volumes in schoolchildren of the Emirates.

Iodine deficiency is a major public health problem, an enlarged goiter being its most apparent manifestation. Recent studies have used US as an accurate and precise method of measuring thyroid size. The aim of this study was to describe thyroid volumes measured by US among school-aged children in the United Arab Emirates. Cross-sectional studies were performed in 4,381 school children, aged 6-17 yr in three locations in the Emirates. Data were collected on age, sex, weight, thyroid size by palpation and US, and urinary iodine. Age/sex and body surface area (BSA) upper limits of thyroid volume were derived. Median urinary iodine in Abu Dhabi, Al Ain and in rural areas of Dubai were 9.9, 12.0 and 9.6 mg/dl respectively. The goiter prevalence by palpation was 28.1%, 26.4% grade 1 and 1.7% grade 2. There was significant difference in median and upper limit of thyroid volumes between boys and girls (p < 0.001). The thyroid volumes of subjects, as assessed by US, progressively increased with age for both sexes (r = 0.53, p < 0.001). In schoolchildren in the Emirates, the best predictors of thyroid volume were BSA, height and weight. The thyroid volumes of the children in this study appear comparable with those reported in a European survey in 1997.

Adolescent↗
PubMed2006

Accuracy of needle placement in ACJ injections.

Localization of the Acromioclavicular joint (ACJ) even at arthroscopic surgery may be difficult because of its small size, osteophytes, variable anatomy of the joint and capsule. Therefore injection of the ACJ in the clinic may well be inaccurate. The aim of this study was to review the clinical accuracy of needle placement in ACJ injections, if performed without the aid of image intensification. Sixty patients with 66 shoulders were injected in the Day Unit in our department. The joint was palpated clinically, and the needle was placed in the site thought to be in the AC Joint. An image intensifier was then used to check the position of the needle in the AP and axillary views. The needle was considered correctly placed if between the bony boundaries of the acromion and clavicle. This was found in only 26 injections (39.4%). The remaining 40 injections (60.6%) were misplaced, either laterally in 21 injections (31.8%), medially in 13 (19.8%), anteriorly in 3 (4.5%) and inferiorly in 3 injections (4.5%). Theses were then reinserted under image intensifier guidance. The misplaced injections would have lead to inaccurate clinical outcomes, and decision making. This study is similar to other studies in that X-ray guidance improves the accuracy of injections and surgery. However the potential error rate for the small, anatomically variable AC joint is high. There is a 60% potential for ACJ injections to be out of the joint if performed by palpation alone, and we recommend the routine use of image intensification guidance.

Acromioclavicular Joint↗
PubMed2000

Palpatory method used to identify the recurrent laryngeal nerve during thyroidectomy.

The major complication of thyroid surgery, occurring in 1% to 6% of cases, is injury to the recurrent laryngeal nerve (RLN). A simple method to identify the RLN during thyroid surgery is described by the authors. It consists in palpation of the nerve caudally to the inferior pole of the thyroid, after the nerve has been made taut by the upward and medial traction of the thyroid gland. This method was used on 47 human cadavers and 45 patients with benign thyroid diseases. It made it possible to identify the RLN in all of the cadavers and 52 of the 55 identifications during 45 thyroidectomies (in 10 total thyroidectomies the identification was bilateral). Laryngeal motility was normal in all patients at postoperative laryngoscopy. Using the palpation before dissection in the region of the inferior thyroid artery, the traditional viewing method became easier and safer, reducing the risk of injury where it is most likely to occur to the nerve.

Cadaver↗
PubMed2005

[Female geriatric patients with urinary incontinence symptoms and their control over pelvic floor muscles].

UNLABELLED: Not only do anatomy and function of the pelvic floor play an important role as possible causes of female urinary incontinence, they are also crucial for its therapy. The aim of this case control study of female geriatric patients with symptoms of urinary incontinence was to determine the knowledge about their pelvic floor and to assess their ability to contract pelvic floor muscles voluntarily and reflexly. METHODS: A total of 377 female geriatric patients with symptoms of urinary incontinence were investigated in a Basis Assessment for Urinary incontinence. The ability to contract their pelvic floor muscles was examined by a digital vaginal palpation. The extent of the registered muscle strength was graded by the Modified Oxford Grading Scale by Laycock (1994). RESULTS: Of the patients, 65.5% were not aware of their pelvic floor and were not able to contract the pelvic floor muscles (Grade 0 to 1 by Laycock), 22% had an inaccurate knowledge and only performed an insufficient pelvic floor muscle contraction (Grade 2 by Laycock). Only 12.5% could contract their pelvic floor muscles properly (Grade 3 to 4 by Laycock). A subgroup of 83 patients had already absolved pelvic floor exercises in the past, 80 patients with conventional instructions, 3 patients with digital vaginal control. In this subgroup 54.2% of the patients were not able to contract the pelvic floor muscles (Grade 0 to 1 by Laycock) 25.3% only performed an insufficient contraction (Grade 2 by Laycock), while 20% were able to perform a sufficient and powerful contraction (Grade 3 to 4 by Laycock). The three patients in the past controlled by a digital vaginal palpation were part of this group and managed a pelvic floor muscle strength Grade 4 by Laycock. A high percentage of female geriatric patients with symptoms of urinary incontinence have a lack of understanding regarding the position and function of their pelvic floor. These results suggest that conventional pelvic floor muscle exercises without specific control are not an appropriate method to improve geriatric patients' ability to contract their pelvic floor muscles and to prevent urine leakage.

Aged↗