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At least 1,243 records · Page 69Linked to original sources
PubMed1991

Determining the pulse for infant CPR: time for a change?

The accepted standard for determining cardiac arrest in infants is the use of palpation of the brachial pulse to detect pulselessness. The investigators have observed that CPR-certified individuals have difficulty locating the brachial pulse in infants. Therefore, the purpose of this study was to determine if a more effective way exists for assessing the pulse in an infant. Of the 102 subjects tested, 84 correctly assessed the apical pulse by placing a naked ear against the chest wall, whereas only 48 correctly palpated the brachial pulse. The study results demonstrated that there was a statistically significant (p less than 0.001) difference between the two methods for assessing pulses in infants. This indicates that the apical pulse method is a faster and more accurate method for locating the pulse in an infant, and should be used during cardiopulmonary resuscitation.

Auscultation↗
PubMedDate not supplied

CT evaluation of anaplastic thyroid carcinoma.

CT findings in 19 patients with anaplastic thyroid carcinoma were compared retrospectively with pathologic findings and the results of palpation. The carcinoma appeared as a large mass of low attenuation accompanied by dense calcification in 58% of the patients; there was necrosis in 74%. Often, adjacent structures were infiltrated. CT correctly showed tumor invasion of the carotid artery (7/7), internal jugular vein (9/10), larynx (5/6), trachea (8/10), esophagus (4/5), mediastinum (5/5), and regional lymph nodes (14/16). Seven patients (50%) had necrotic nodes. CT was superior to palpation in the detection of a primary tumor in one patient and of metastatic nodes in seven patients. It suggested a suitable place for biopsy in two patients, leading to a correct diagnosis. CT altered surgical planning in five patients with intrathoracic extension of the thyroid tumor, and in three patients with laryngeal or esophageal invasion of the tumor. CT can increase diagnostic accuracy in patients with anaplastic thyroid carcinoma by suggesting a likely diagnosis and by indicating an appropriate site for biopsy. It is indispensable in the planning of surgery for patients with this disorder.

Adult↗
PubMed1990

[Thyroid gland volume. Methods of its determination and their significance].

For the assessment of the volume of the thyroid gland palpation, sonography or scintigraphy can be used. Palpation serves only as orientation, it underrates large goitres and a false positive diagnosis of goitre cannot be ruled out. Sonography uses a static echotomographic method or a dynamic empirical method. Echotomography is at present the most reliable method of assessment of the thyroid volume in vivo. The value of conventional scintigraphy for assessment of the thyroid volume is only historical, more accurate three-dimensional radionuclide diagnostic methods are so far not currently available in this country.

Humans↗
PubMed1990

Endotracheal tube cuff pressure assessment: pitfalls of finger estimation and need for objective measurement.

Estimation of endotracheal (ET) cuff pressure by finger palpation is one of the methods currently used in the clinical setting. We compared the accuracy of this method with instrumental intracuff pressure measurement in tracheal model tests by 20 members of our ICU team. Four different ET tubes at three different pressure levels were examined. Accuracy for the estimated method by finger palpation was 69% for high pressures, 58% for normal pressures, and 73% for low pressures. We observed differences in terms of sensitivity, specificity, and positive predictive power between different tubes reflecting differences in tube characteristics and interobserver variability. We conclude that precise intracuff pressure measurement is mandatory to prevent complications of over- or underinflation.

Clinical Competence↗
PubMed1990

The role of experience in clinical accuracy.

A randomized controlled trial was performed to study the effect of various teaching techniques on students performing sacroiliac motion palpation tests. This trial assessed the interexaminer reliability of interns in their final year at a chiropractic college, and compared their results prior to and following 1 year of clinical experience. The study also compared the intra- and interexaminer reliability of experienced clinicians. The results were analyzed via the Kappa coefficient. Kappa values for interns ranged from 0.00 to 0.30, with no significant differences noted at the end of 1 year of clinical experience. The interexaminer reliability of experienced clinicians was 0.00 to 0.167, whereas their intraexaminer reliability ranged from 0.15 to 1.00. These results question the role of experience in improving clinical accuracy between examiners performing sacroiliac motion palpation. Results analyzed for intraexaminer agreement were moderate to almost perfect. We conclude that experience does not play a significant role in the diagnostic test analyzed, but rather that clinicians may establish their own criteria by which to determine the standards of a given test.

Chiropractic↗
PubMed1989

[Macro-anatomical studies on the palpability of the lateral inferior pterygoid muscle].

In order to diagnose muscular dysfunction associated with the lower pterygoid muscle common intraoral palpation techniques require this muscle to be touched with the fingertip or a probing instrument. A macro-anatomical study using heads of humans has been done to demonstrate morphometrically the origin of the M. pterygoideus lateralis inferior in relation to neighbouring structures. In a majority of cases intraoral palpation of the lower pterygoid muscle is probably impossible.

Humans↗
PubMed1989

Effect of surgical manipulation, placental fluid, and flunixin meglumine on fetal viability and prostaglandin F2 alpha release in the gravid uterus of mares.

Twenty-one pregnant mares with single or twin conceptuses between 41 and 65 days of gestational age were allotted to 5 treatment groups. A ventral median celiotomy was performed in all mares. In group-1 mares (3 mares, single conceptus), the uterus and fetus were palpated for 5 minutes. In group-2 mares (3 mares, single conceptus, flunixin meglumine), 250 ml of sterile placental fluid was injected into the nongravid uterine horn. In group-3 mares (4 mares, unicornuate twin conceptuses), group-4 mares (3 mares, unicornuate twin conceptuses, flunixin meglumine), and group-5 mares (8 mares, bicornuate twin conceptuses, flunixin meglumine), 1 conceptus was removed from the uterus via hysterotomy. All mares received progesterone prophylactically until day 100 of gestation or until the fetus died. The 3 mares in group 1 delivered clinically normal, live foals. The mean prostaglandin F2 alpha metabolite (PGFM) plasma concentration peaked at 180 +/- 5.2 pg/ml during uterine manipulation and fetal palpation, then declined to baseline by 1 hour. Free placental fluid (group 2) undermined the chorioallantois ventrally and resulted in fetal death within 3 hours after surgery. The mean PGFM plasma concentration peaked at 39 +/- 4 pg/ml following injection of placental fluid. None of the remaining fetuses in the 7 mares with unicornuate twin conceptuses (groups 3 and 4) survived. Five mares with unicornuate twin conceptuses (group 5) delivered single viable foals. In another mare in group 5, the fetus was alive 4 days after surgery, when the mare was euthanatized for a fractured femur.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗
PubMed1977

[Clinical value of rectal digital examination in early diagnosis of colorectal cancer (author's transl)].

A prospective study was carried out on a series of 1500 patients of a gastro-enterological and surgical unit in order to evaluate critically the accuracy of rectal digital examination as a single tool in the early diagnosis of colorectal tumours. The patients in this study were explored independently by two investigators, first by rectal digital palpation and afterwards by means of the proctosigmoidoscope. Endoscopy confirmed the presence of 239 tumours, 96 of these being diagnosed histologically as carcinoma. Comparative analysis of the results of physical and endoscopic examination demonstrated that digital palpation provided a correct diagnosis in 58 out of 239 tumours, equivalent to an accuracy of 24.3% for tumours within the reach of the rectoscope, and 10% for all colorectal tumours. Hence, rectal examination should not be used as single diagnostic tool in screening for large bowel cancer. A multiphasic screening system, including investigations for occult blood, proctosigmoidoscopy, endoscopic polypectomy and determination of colon-embryonic-antigen levels is discussed to obtain better results in general health screening, early diagnosis and avoidance of incurable colorectal carcinomas and the early detection of recurrence.

Colonic Neoplasms↗
PubMed1988

Selective screening for abdominal aortic aneurysms with physical examination and ultrasound.

Abdominal aortic aneurysm (AAA) is an important cause of preventable death in older persons. Persistently high rupture mortality rates indicate that these deaths can be prevented only by early detection and treatment of AAA. In an effort to develop an effective and efficient program of AAA detection, we selectively screened a high-risk population. Men aged 60 to 75 years with hypertension and/or coronary artery disease were randomly selected from a general medicine clinic and screened with physical examination and ultrasound. Eighteen previously unsuspected aneurysms, 3.6 to 5.9 cm in size (mean, 4.4 cm), were detected in 201 patients, for a prevalence of 9% (95% confidence interval: 4.7% to 13.3%). The specificity and positive predictive value of ultrasound were each 100%. Abdominal palpation detected only half of these aneurysms, but missed none in patients with an abdominal girth less than 100 cm (n = 6). This degree of sensitivity did not occur with "routine" examinations and requires that the examination be directed specifically toward AAA detection. We conclude that undiagnosed AAAs are common in this large subgroup of the clinic population, that ultrasound is an excellent screening test for AAAs, and that physical examination may be adequate for screening thin patients. We recommend that every two or three years persons over the age of 50 years undergo careful abdominal palpation aimed at detecting AAAs, as part of the periodic health examination. We further recommend that obese older men at high risk for AAA have at least one-time screening with abdominal ultrasound, regardless of findings on physical examination.

Abdomen↗
PubMed1988

Skin surface temperature over the temporomandibular joint and masseter muscle in patients with craniomandibular disorder.

Skin surface temperature was measured over the temporomandibular joint (TMJ) and over the origin of the superficial portion of the masseter muscle in 59 patients with craniomandibular disorder of different character. Forty patients suffered from disorder of muscular origin, 11 from non-specific arthritis and 8 from symptomatic osteoarthrosis. The degree of mandibular dysfunction was estimated by the clinical dysfunction score and index. The temperature was measured by a thermistor applied to the skin. The clinical dysfunction score of the patients varied between 1 and 25 units. Eleven patients had a clinical dysfunction index of I, 22 had II and 26 had III. The temperature over the TMJ varied between 31.3 degrees C and 36.7 degrees C, and over the masseter muscle between 31.1 degrees C and 35.5 degrees C. The patients with unilateral tenderness to palpation of the TMJ and who were diagnosed to have TMJ arthritis had a higher skin surface temperature over the symptomatic than non-symptomatic joint. It was concluded that tenderness to palpation of the TMJ in patients with TMJ arthritis is associated with raised skin surface temperature over the joint.

Adolescent↗
PubMed1988

Reading the tuberculin skin test. Who, when, and how?

A prospective study of 806 healthy volunteers was carried out to determine the value of induration 24 hours after placement of purified protein derivative, if patients can accurately read their own tests, and if the pen and palpation methods are comparable. Subjects were actively employed health workers between 20 and 64 years of age without active tuberculosis. All subjects were tested using 5 tuberculin units of purified protein derivative via the Mantoux technique. Induration was quantitated by trained readers at 24 hours and at 48 to 72 hours. Patients were asked to read their own tests as well at 48 to 72 hours. The amount of induration at 24 hours was highly predictive of eventual findings at 48 to 72 hours. The patients' abilities to read their own tests were poor. Significant differences were noted between the pen and palpation methods. The degree of induration noted 24 hours after placement of 5 tuberculin units of purified protein derivative is valuable in a screening population. Most decisions, however, should still be based on results measured at 48 to 72 hours. Results with the pen technique must be interpreted with caution in the 5- to 14-mm range. The patients' readings of their own results are inaccurate and should never be relied on to make clinical decisions.

Adult↗
PubMed1987

Somatic investigation of the infertile man.

The investigation of the male partner of an infertile couple is described. The medical history should include diseases, operations, traumata of the intrascrotal organs, exposure to X-rays, the use of drugs and any viral infection. The second part of the investigation is the physical examination. This should include: the accurate assessment of the body configuration, a varicocele examination, palpation of testis, epididymis and vas deferens, and rectal palpation of the prostate.

Embryo Transfer↗
PubMed1987

Economics of Brucella ovis control in sheep: epidemiologic simulation model.

The epidemiology and economics of Brucella ovis control in a hypothetical, commercial sheep flock (100 rams and 2,500 ewes) were investigated. The investigation consisted of an epidemiologic simulation model, reported here, and a decision-tree analysis, reported in a companion paper. The epidemiologic model was designed to simulate the transmission and persistence of B ovis in a ram flock during the mating season as well as the nonmating (isolation) season. A constant contact rate was selected for the nonmating season and a varying contact rate was selected for the mating season to reflect changes in numbers of ewes in estrus. These contact rates were used to evaluate all possible combinations of 5 control alternatives for flock infection rates ranging from 0% to 38%. Vaccination was found to be more effective as a control strategy when the prevalence of flock infection was high (greater than 15%); however, it did not substantially reduce B ovis transmission when the prevalence of flock infection was low (less than 10%). The effect of increasing vaccine efficacy from 40% to 80% had minimal effect on incidence of new cases. The speed with which B ovis could be eradicated depended on the initial prevalence of infection and the screening tests used (palpation, semen testing for leukocytes, and ELISA). All combinations of screening tests verified the usefulness of palpation. Simulation model results indicated that it may be feasible to eradicate B ovis from flocks with moderate to high (10% to 38%) prevalence of infection by culling on the basis of 2 sequential tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Economics of Brucella ovis control in sheep: computerized decision-tree analysis.

The epidemiology and economics of Brucella ovis control in a hypothetical, commercial sheep flock (100 rams and 2,500 ewes) were investigated. The investigation consisted of an epidemiologic simulation model, reported in a companion paper, and a decision-tree analysis, reported here. It was predicted from the simulation model that B ovis could be eradicated successfully in 2 test periods (less than 1 year) from a flock by using intensive screening and culling. A computerized decision-tree program was used to determine the economically optimal control strategy among several alternatives. Two versions of the program were used to determine the optimal alternative, based on minimizing the expected monetary loss (deterministic) and minimizing the associated risk (stochastic). The economically optimal alternative was to screen the rams by means of palpation, semen testing, and ELISA prior to the mating season. Rams positive to any test were culled. After the mating season was completed, the optimal action was to use ELISA for the remaining rams and to cull all that were ELISA positive. The cost of this alternative was approximately $6,150, or less than one half the annual cost of a vaccination program ($12,800) or no program ($13,550). Continuing palpation and semen testing were considered worthwhile on the basis of detecting new cases of B ovis infection and in maintaining high flock fertility. Similarly, the cost of annual use of ELISA was small (approximately $100), compared with the potential cost of not detecting a new case of B ovis infection.

Animals↗
PubMed1987

Tissue compliance meter for objective, quantitative documentation of soft tissue consistency and pathology.

A new instrument is described, the tissue compliance meter (TCM), for quantitative and objective recording of soft tissue consistency. This quality is appreciated at present only by the subjective method of palpation. Use of the TCM therefore offers a method to quantify palpation of tissue consistency and to document findings objectively. The handheld instrument allows immediate and simple reading of the depth of penetration of a rubber disc at a known pressure. The relation between the achieved penetration and employed pressure expresses the compliance. The TCM consists of a rubber disc with the surface of 1 cm2 attached to a force gauge. The depth of penetration of the rubber tip is indicated by a disc which slides on the shaft of the force gauge. Normal values were established for men and women over muscles which are frequently affected by spasm. Tissue compliance measurement can document changes in soft tissue consistency which occur in muscle spasm, spasticity, swelling, tumors, lumps, hematomas, etc. Use of the TCM provides the most sensitive and earliest objective indication of either healing and resolution in soft tissue pathology or occurrence of complications. Changes in muscle tone such as reduction of spasm, tension, or spasticity can be recorded. The effects of different types of physical therapy can thus be documented objectively.

Connective Tissue↗
PubMed1985

Reliability study of detection of somatic dysfunctions in the cervical spine.

A reliability study was conducted to determine whether palpatory findings on the cervical spine, obtained under normal chiropractic clinical conditions were reproducible. Forty normal freshman chiropractic students underwent static and motion palpation of their cervical spines by three different chiropractors. Intra- and inter-examiner reliability of findings was assessed by concordance statistics (weighted kappa). There was statistically significant agreement of findings for all three examiners only for fixations in the lower cervical spine. There was a total lack of statistical agreement of fixation findings, both intra- and inter-examiner, in the middle cervical area. Agreement of fixation findings was intermediate for the upper cervicals and also for the other palpation parameters that were used (e.g. muscle spasms and pain) throughout the cervical spine. The results generally indicate a relatively high level of replicability of palpatory findings in a normal asymptomatic population by 'typical' chiropractors. The relation of these palpatory findings to vertebral lesions, or subluxations, are unknown.

Cervical Vertebrae↗
PubMed1985

Posterior interosseous palsy after dental treatment: case report.

Unilateral posterior interosseous nerve palsy occurred in a woman after deep palpation by her dentist during treatment for temporomandibular joint (TMJ) syndrome. Weakness of wrist and finger extension was noticed by the patient after the dentist used techniques of "applied kinesiology," including "pressure-point palpation." Electromyography confirmed the localization. This case exemplifies nerve damage caused by unorthodox treatment directed at the musculoskeletal system.

Arm↗
PubMed1979

[The conduction of labor and postlabor periods following cesarean section].

Out of 11315 childbirths under review, 109 women (0.96%) with state after secio caesarea were delivered of a child in the period from 1970 to 1978. In 63.3% of the cases it was possible to achieve a vaginal birth. With 450 caesarean sections, 2 cases of the mother mortality occurred. -- A comparison between the sectio and the re-sectio indications does not show any difference. -- Uterus rupture was noticed in 2 cases. -- In a comparative study, general palpating of the uterus is contrasted with a conservative behaviour involving haemorrhage, blood-pressure, and pulse controls. -- As a result, manual re-palpating is again recommended, however, should not be forced. In certain individual cases a conservative behaviour is also justified.

Cesarean Section↗