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The effect of rectal palpation on the fertility of cyclic mares.

The effect of rectal palpation of fertility of non-lactating, normal cyclic mares was studied over 3 years. During the first year (1971), the conception rates in mares after daily paplaption during oestrus only, and during oestrus and the first 50 days of pregnancy, were not significantly lower (P greater than 0-05) than the conception rates recorded in mares not palpated. No abortions could be attributed to palpation. Oestrus lasted longer (P less than 0-05) in non-palpated than palpated mares. During the second year (1972), first-cycle pregnancy rates in two groups of mares palpated daily during oestrus were lower (P less than 0-05) than those of mares not palpated. Daily palpation and insemination on the palpator's recommendation resulted in fewer (P less than 0-05) inseminations per cycle than in mares inseminated every other day of oestrus. During the third year (1973), the difference of first-cycle conception rates between mares palpated on alternate days of oestrus and those not palpated was not significant. Throughout the three years of the study, first-cycle conception rates following insemination with undiluted semen were higher (P less than 0-025) in non-palpated mares than in palpated mares (45-7 versus 79-2%).

Animals

The diagnostic accuracy of palpation and fine-needle biopsy and an evaluation of their combined use in the diagnosis of breast lesions: report on a prospective study in 1244 women with symptoms.

In 1244 women with breast symptoms an evaluation by means of palpation was made with respect to diagnosis of malignancy according to a four-grade scale ranging from "definite cancer" to "no cancer." Aspiration biopsy and cytologic examination were then performed in 984 breast lesions. The diagnosis from the cytologic evaluation ranged from benign, through three grades of atypia (slight, moderate, grave) to cancer. A histologic diagnosis was made in 411 cases and in 28% it was cancer. Cancer was found in 92.5% of the patients with a palpatory diagnosis of "definite cancer," and in 50% of those with a palpatory diagnosis of "strong suspicion of cancer." In all patients in whom cancer was diagnosed cytologically, the same diagnosis was made at histology, while 87.5% of those with grave atypia at the cytologic examination were diagnosed histologically as having cancer. A false negative cytologic diagnosis was made in 4% of the cancer cases. With a combination of palpation and cytology, 91% of the cancer cases fell within the groups "definite cancer," "strong suspicion of cancer" (palpation)/"cancer," "grave atypia" (cytology). No patients with cancer were evaluated as "no cancer" (palpation)/"no atypia" (cytology). In this group of 697 patients, however, one cancer was discovered after 7 months. The investigation showed that a thorough palpatory evaluation is a prerequisite for a good result of aspiration biopsy, in particular to meet the risk of a false negative cytologic diagnosis. The cytologic examination revealed cancer in 6 and 12 cases, respectively, when palpation gave no or some suspicion of cancer, and in many cases it was able to eliminate malignancy suspected on palpation. Cytologic atypia indicated cancer in a relatively high per cent, but was also noted in many cases found to be benign histologically. The possibilities of reducing the number of "unnecessary" surgical biopsies by using a combination of palpation and cytology is discussed.

Adenofibroma

The reliability of lumbar motion palpation.

OBJECTIVE: This review surveys the literature regarding reliability studies of lumbar motion palpation. DATA SOURCES: Using the indexing terms motion palpation lumbar spine and palpation, the following English language databases were surveyed: a) Medline, including back file; b) Embase; c) Cinahl; and d) Epic. Additionally, a manual search of the Chiropractic Research Archives Collection and JMPT was performed and researchers at Western States Chiropractic College were consulted. Pertinent references cited in bibliographies of retrieved papers were included if contributory. STUDY SELECTION: Studies pertaining to intra- and interexaminer reliability of lumbar motion palpation were reviewed. DATA EXTRACTION: Statistical analysis, subject selection, method of palpation and sources of error are discussed. DATA SYNTHESIS: Multiple variations were noted in type of palpation, subjects examined, statistical analysis and experience of examiners. CONCLUSIONS: To date, most studies have demonstrated marginal to poor interexaminer reliability, while good to moderate intrarater reliability has generally been reported.

Back Pain

Should we palpate foot pulses?

UNLABELLED: Palpation of foot pulses is traditionally used to evaluate patients with arterial disease. This study investigated observer variation in assessment of pedal vessels by pulse palpation and Doppler auscultation. A series of 33 claudicant patients and five controls were examined by a consultant, registrar, SHO and nurse. Dorsalis pedis (DP) and posterior tibial (PT) pulses were palpated and were then examined by Doppler with measurement of systolic pressures. CONTROL GROUP: No disagreement in DP pulses. However, all observers agreed on the presence of a PT pulse in only 70% of limbs. Claudicants: There was better agreement in palpation of the DP pulse (all observers agreed in 67% of limbs), than the PT pulse (all agreed in 53%). This suggests that the DP pulse is easier to palpate than the PT (P less than 0.05). By contrast there was better agreement on Doppler signals from the PT artery, all agreed in 78% of limbs; compared with the DP artery, all agreed in 58% (P less than 0.01). Pressure measurements by the observers agreed to within +/- 0.15 in 88% of claudicant and 100% of control limbs. Pedal pulse palpation in patients with arterial disease is subject to substantial observer error. Doppler pressure measurement is preferable unless pulses are bounding.

Adult

The role of inexperience in measuring tuberculin skin reaction (Mantoux test) by the pen or palpation technique.

We have shown previously that experienced readers can use the palpation or pen method for reading the Mantoux tuberculin skin test with accuracy. In order to investigate if the inexperienced reader can use both methods with the same degree of accuracy, we performed Mantoux tests in 539 healthy subjects, aged 20-57 years (mean 33 years), using the PPD-RT 23 in dose 2 I.U. (1/5000). In random order and a double-blind fashion, an experienced and an inexperienced reader measured the induration after 48 h by the palpation method initially and then by the pen method, without knowing the identity of the subject. Results of the study did not show any significant difference in any range of measurements by the two readers, using either the pen or palpation method (P greater than 0.1). A highly statistically significant linear relationship was found between the measurements by the pen method used by experienced and inexperienced readers (r = 0.823, P less than 0.0001) and between the palpation measurements by the two readers (r = 0.939, P less than 0.0001). We conclude that the effects of an inexperienced examiner in the measurement of of tuberculin skin induration are minimal. Inexperienced readers can use the pen method as accurately as the traditional palpation method.

Adult

[Cervical lymph node metastasis: significance of computerized tomography and palpation. A histologically controlled comparison].

Palpation and CT are used before treatment, in addition to sonography, in patients with tumours in the head and neck for lymph node staging. The accuracy of CT in identifying lymph node metastases is 79% and in our clinical material is similar to the accuracy of palpation (81%). Sensitivity of CT (93%) is better than palpation (82%). Specificity of CT (65%) is less than that of palpation (82%). The high percentage of false positives from CT (35%) is due to enlargement of the lymph nodes resulting from sinus histiocytosis or follicular hyperplasia. CT is significantly superior to palpation in demonstrating the relationship of the lymph nodes to the surrounding tissues (vessels, muscles, bones).

Adult

Palpation as a method for evaluating occlusal discrepancies.

In this study, 30 dentists were surveyed about their methods of palpating teeth for the evaluation of premature contacts. Thirty-eight dentists were then tested to determine their ability to discriminate degrees of prematurity using each of two different methods of palpation. The degree of digital pressure used by each dentist during palpation was also measured. The majority of dentists chose the same method for palpation: a single forefinger overlaying the facial surfaces of the central incisors being evaluated. In the discrimination test, the majority of dentists were able to identify reliably occlusal interference of greater than or equal to 50 microns regardless of the palpation method used.

Adult

Diagnosis of luteal and follicular ovarian cysts by palpation per rectum and linear-array ultrasonography in dairy cows.

The purpose of this study was to determine and compare the accuracy of palpation per rectum and linear-array ultrasonography for diagnosing follicular vs luteal ovarian cysts in cows. Forty-seven examinations of ovarian cysts from 28 cows were diagnosed by palpation per rectum as either a firm, thick-walled structure (luteal cyst) or a soft, thin-walled structure (follicular cyst) during weekly herd examinations. The ovaries of each cow were then examined by ultrasonography. Ultrasonograms of cysts greater than 25 mm in diameter were diagnosed as luteal or follicular cysts and were recorded on videotape for evaluation by a second clinician. Serum progesterone concentrations at the time of examination were determined by radioimmunoassay and used to classify luteal (greater than 0.5 ng/ml) or follicular (less than or equal to 0.5 ng/ml) cysts. Selection of this discriminatory level was based on response of a proportion of cows with luteal cysts that were given 25 mg of prostaglandin F2 alpha at the time of diagnosis by ultrasonography. Sensitivity and specificity of palpation per rectum for diagnosis of type of ovarian cyst were low (43.3 and 64.7%, respectively). In contrast, sensitivity and specificity of ultrasonography were considerably higher (86.7 and 82.3%, respectively). Agreement between the 2 methods of diagnosis was 57.4%. Overall agreement between the 2 clinicians' diagnoses by ultrasonography was 85.1%. On the basis of our findings, we confirm that luteal and follicular cysts cannot be accurately differentiated by palpation per rectum alone. These data suggest that linear-array ultrasonography is more effective than palpation per rectum for diagnosing type of ovarian cyst in cows.

Animals

Rectal palpation and transmission of bovine leukemia virus in dairy cattle.

To determine whether rectal palpation, using common obstetrical sleeves, serves as a mode of transmission of bovine leukemia virus in dairy cattle, field studies were conducted at 2 dairies. At a commercial dairy, significant difference was not observed in rate of seroconversion in heifers and cows in which the same sleeve or new sleeves were used for palpations. At a university dairy, where cattle were used to teach dairy husbandry and veterinary procedures, significantly (P less than 0.02) greater rate of seroconversion was observed in heifers and cows palpated with unwashed common sleeves than that observed in heifers and cows palpated with sleeves washed between use. Although rectal transmission of bovine leukemia virus under field conditions was documented, it was related to frequency of palpation and age of cattle.

Animals

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

The palpator: an instrument for measuring the positions of bones in three dimensions.

In order to measure the three-dimensional (3D) position of the shoulder girdle bones, as well as the 3D positions of muscle attachments and joint surfaces in cadaver experiments, a measurement instrument, called the palpator, was developed. The palpator is composed of an open chain of four links connected by four hinges. By recording the rotation of the hinges using potentiometers, the position of the end-point of the palpator can be calculated. After the identification of 23 parameters of the palpator, a measurement accuracy of 1.43 mm is obtained.

Biomechanical Phenomena

[A histologically controlled study of the value of sonography and palpation for the detection and exclusion of neck lymph node enlargements and metastases].

Preoperative evaluation of cervical lymph nodes by ultrasound and palpation was compared retrospectively in 123 patients with tumours on the head and neck. The diagnostic accuracy was higher by ultrasound (96.5%) than by palpation (85.5%). Hence, the sensitivity for detecting cervical metastases was also higher for ultrasound than for palpation (96% versus 83%), because of the reduced false negative findings. Specificity, however, was higher for palpation (82%) than for ultrasound (74%). Ultrasound was superior in delineating the relationship of metastases to adjacent tissues (vessels). Major disadvantages of ultrasound were the higher percentage of false positive findings (26%) and absence if delineation of the relationship to bony structures.

Adult

Sonography versus palpation in the detection of regional lymph-node metastases in patients with malignant melanoma.

High-resolution real-time sonography was done in 217 patients with malignant melanoma to compare its value in detecting regional lymph-node metastases with that of palpation. Lymph-node metastases were found in 29 patients by ultrasound whereas, by palpation, metastases were detected in 15 patients only. The presence of metastases was proven by histopathology after surgical lymphadenectomy in these ultrasound positive cases. Thus sonography was superior to palpation, and in addition permitted distinction between metastatic changes and inflammatory lymph-node enlargement. Ultrasound is recommended for preoperative staging as well as in postoperative monitoring of patients with malignant melanoma.

Adult

[Comparative studies of the uterine cervix in pregnancy using palpation and vaginal sonography].

Ultrasonography and manual palpation were used to evaluate the uterine cervix of 71 pregnant women between 14th and 36th week of gestational age. The sonographic length of the uterine cervix was about 4.2 cm according to the relevant cervix palpation (Group I), about 3.2 cm in the moderately shortened cervix (Group II) and about 2.8 cm in the severely shortened cervix (Group III). The distance between the surface of the ectocervix to the urinary bladder corresponded to the cervical palpation showing a constant difference of about 0.5 cm. No difference could be found in the width of the upper cervix. The index was determined as ratio of the sonographically ascertained cervical length and width of the supravaginal cervix. A value of 0.8 or lower describes a cervical incompetence of a higher degree and signifies an unfavourable prognosis. The evaluation of cervical incompetence and the relevance of the sonographically detected opened internal os have not yet been clarified. A hitherto unsolved problem is the dilatation of the cervical canal in case of immature palpatory findings with traumatic anamnesis.

Adult

Palpation thyroiditis (multifocal granulomatour folliculitis).

Disseminated inflammatory lesions constituting a multifocal granulomatous folliculitis in the thyroid are described. These lesions were present in the majority (greater than 83%) of thyroids removed surgically because of thyroid or nonthyroid (carcinoma of the larynx) disease. They also were found at autopsy in patients who died while hospitalized but not in those who died at home. An identical lesion was produced experimentally in dogs by vigorously squeezing their thyroids. The human folliculitis is believed to result from traumatic injury or rupture of isolated thyroid follicles caused by palpation of the gland (palpation thyroiditis). Palpation thyroiditis may have little, if any, clinical importance. The remote possibility that it might be associated with iatrogenically produced metastasis of thyroid carcinoma is being investigated.

Adenoma

Palpation vs pen method for the measurement of skin tuberculin reaction (Mantoux test).

In order to test the degree of concordance between ballpoint pen and palpation methods of measuring the skin induration after a Mantoux tuberculin test, we conducted a prospective, double-blind study. We performed a Mantoux skin test in 1,340 healthy subjects, aged 18 to 25 years, using the tuberculin PPD-RT 23, dose 2 IU, (1/5,000), of the Pasteur Institute, equivalent to 5 TU PPD-S. The same experienced reader, who was able to see only the site of the test (forearm), measured the induration after 48 hours by the palpation method, initially, and by the pen method later the same day, without knowing the identity of the examined person. Results of the study did not show any significant difference in any range of the measurements (p greater than 0.1) by the two methods. We conclude that the pen method is as reliable as the traditional palpation method. The sensitivity and the specificity of the two methods are comparable. Even though our study was not designed to investigate the effects with an inexperienced examiner, given the simplicity of the pen method, it could be the method of choice, especially for less experienced examiners.

Adolescent

Endotracheal tube placement in infants determined by suprasternal palpation: a new technique.

In order to decrease complications of improper endotracheal tube positioning, a method of placing the tube by palpation within the suprasternal notch was devised. The method proved to be simple and effective. The accuracy was verified by fluoroscopy and a clinical study comparing this technique with others is reported. No complications of the technique were noted. Once palpation was reliable, the proper position of the tube tip was defined. From measurements taken from routine inspiratory chest radiographs on 142 infants, it was found that a point midway between the medial ends of the clavicle (IMP) was a good position because it approximates the true tracheal midpoint and, therefore, is a good landmark on a chest radiograph. This point allows for movement of the tube tip with head positioning and of the carina with respiration. The tube tip can be placed near the IMP by the suprasternal palpation technique. This method, therefore, is useful in emergency situations or on initial intubations to avoid improper position of the tube tip prior to radiograph verification.

Auscultation

[Comparison of the data of palpation and ultrasonic examination in assessing the dimensions of the thyroid gland].

Comparison of the thyroid-sizes estimated by palpation and ultrasonic scanning in 282 women and 178 men has shown that if the thyroid is small (from 0 to 2nd degree, according to O. V. Nikolayev's classification), its size cannot be estimated by palpation and this method fails to assess the endemic goiter in epidemiologic surveys. Correlation between the thyroid size estimated by palpation and its ultrasonically assessed volume has made up 0.346 (p < 0.001) in women and 0.193 (p < 0.01) in men. Ultrasonic assessment of the thyroid volume appears useful both for clinical and epidemiologic studies.

Female