Predictors of proficient technique and successful lesion detection in breast self-examination

Seventy-three women attending a health fair completed a questionnaire that measured demographic and health history variables, knowledge, and current practice of breast self-examination (BSE), Multidimensional Health Locus of Control (MHLC; Wallston, Wallston, & DeVellis, 1978), and components of the Health Belief Model (HBM; Rosenstock, 1974) in relation to breast cancer and BSE. These variables formed the basis of a conceptual model of BSE behavior that was examined by having each woman participate in a behavioral trial with a breast model in which her BSE technique and ability to detect simulated tumors was assessed. Regression analyses revealed that self-confidence in the efficacy of BSE was the best single predictor of proficient BSE. Powerful others HLC, knowledge of correct BSE behaviors, and chance HLC, respectively, also contributed significantly to the variance in performance. As anticipated, successful lesion detection was most strongly associated with more proficient BSE technique and higher frequency of BSE practice in the past six months. Internal HLC scores were not predictive of either behavioral measure. Similarly, except for perceived efficacy of BSE, HBM variables showed no strong relationships to observed behavior.

Diagnostic palpation of the spine: a review of procedures and assessment of their reliability

Spinal palpation as employed by practitioners of manipulative therapy is a common diagnostic tool used to identify manipulable lesions. Three methods of diagnostic palpation are static palpation, active motion palpation and passive motion palpation. As a diagnostic technique, spinal palpation suffers from a lack of research on its statistical reliability. Assessment of the clinical efficacy of manipulative therapy would be better addressed if a statistically reliable method of palpatory diagnosis were developed.

Accuracy of precordial palpation for detecting increased left ventricular volume

Objective data on the reliability of precordial palpation in detecting left ventricular enlargement are scarce. Therefore, we evaluated 41 patients by physical examination and two-dimensional echocardiography to determine the relation between the location of the apex and left ventricular end-diastolic volume. An apical impulse lateral to the mid-clavicular line or greater than 10 cm from the mid-sternal line was sensitive but not specific as an indicator of left ventricular enlargement. In patients without left ventricular hypertrophy, an apical diameter greater than 3 cm in the left lateral decubitus was sensitive (92%) and specific (91%) for an enlarged left ventricle. The positive and negative predictive values were 86% and 95% respectively. Therefore, the location of the apical impulse in relation to the mid-clavicular line or the mid-sternal line is not a reliable indicator of increased left ventricular end-diastolic volume. However, an apical impulse greater than 3 cm may be an accurate indicator of left ventricular enlargement.

Prevention and differential of scrotal cancer

Testicular self-examination is the most efficient method for early detection of scrotal cancer. These tumors are the most common neoplasm in young adult males, yet health teaching in this area is often overlooked. Several types of testicular cancer and associated risk factors have been identified. The examination is explained and teaching strategies are discussed using a developmental approach with adolescents and young adults.

Comparison of two techniques for detecting cardiac activity in infants

In the 1980 Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care, the recommended method for determining cardiac arrest in infants was changed from palpation of the apical impulse to palpation of the brachial pulse. The importance of adequately assessing the heart beat before initiating chest compressions due to the potential hazards is well established. This study was designed to ascertain which pulse parents could palpate most readily and accurately count within a given time. The results demonstrated the brachial pulse was much easier to palpate and more accurately counted by parents than the apical impulse. These findings formed the basis for the 1980 revised recommendation for determining cardiac arrest in infants.

[Combined touching and palpation in parathyroid surgery]

The parathyroid glands may be located anywhere and hidden in the thick thyroid gland sheath, so that the duration of parathyroidectomy is impossible to predict. For accurate and rapid identification and assessment of the nodule to be dissected, the authors advocate a two-finger method: one index finger palpates the whole length of the posteromedial segment of the thyroid sheath, while the other index finger penetrates into the thyroid cavity. Fourteen parathyroid adenomas and 39/40 hypertrophied glands were detected by this method. Results were negative in 12 cases with unconfirmed biological diagnosis of hyperparathyroidism.

Clinical anatomy and physiology of the spleen

Knowledge of the anatomy and function of the spleen is essential for the assessment of its role in disease. Of particular importance is the contribution of the spleen to the immune response and defence against infection, and the need to preserve this by a more conservative approach to the management of the ruptured spleen. Information regarding the segmental blood supply is being reassessed for possible application in surgery, while other methods of protecting children from episodes of overwhelming infection following splenectomy are in the process of evaluation.

[Potentials of self-examination in detecting ovarian tumors]

The clinical picture and primary diagnosis of 739 benign, 114 border-case and 115 early-stage malignant ovarian tumors are discussed. It was established that 8.4-11% of patients had detected tumors themselves by palpation. The detection of tumors by a considerable number of patients provided a basis for developing practical recommendations on self-examination procedures, which include inspection of the abdomen, surface and deep palpation. Application of these procedures will contribute to better diagnosis of ovarian cancer.

A comparison of intrarectal Doppler and rectal abdominal palpation for pregnancy testing in goats

Two methods of pregnancy diagnosis--rectal abdominal palpation and the intrarectal Doppler technique--were compared for accuracy in the female goat (does). Three veterinarians were given a short period of instruction as to the use of these methods, after which 38 does were evaluated by both methods by each veterinarian. The percentage of correct determination for pregnant does ranged from 94% to 100% for examiners using the intrarectal Doppler technique and from 94% to 97% for the rectal abdominal palpation. The percentage of correct determinations for nonpregnant does ranged from 25% to 75% for intrarectal Doppler technique and was 75% for rectal abdominal palpation; however, the number of nonpregnant does was small and did not allow a valid conclusion. The results indicated that both methods are reasonably accurate for pregnancy diagnosis in does at 55 days or more after breeding and can be learned with only brief training. However, rectal abdominal palpation appears to be more hazardous with respect to rectal injury and abortion and, therefore, would not be the preferred method.

Breast screening by breast self-examination: an evaluation of teaching methods and materials

A base-line survey of women's opinions on breast cancer and breast self-examination (BSE) suggested a link between high awareness of BSE and a view of breast cancer as the most worrying illness they could suffer. Data from pre-teaching questionnaires compares awareness of and performance of BSE with six opinions related to the vulnerability of women to breast cancer and to possible outcomes. Inferences from statistically significant associations, which also replicated survey findings, led to the development of three alternative models of teaching methods. The findings also suggest that "concern" is a more accurate term than "anxiety" in describing perceptions of vulnerability and of BSE.

Scrotal palpation

Proper examination of the scrotum consists of inspection, palpation and, if indicated, transillumination. Inspection may reveal the hypoplastic appearance of an undescended testicle; enlargement caused by a testicular mass; the "bag of worms" signifying a varicocele; findings typical of torsion of the spermatic cord, or the "blue dot" sign, which indicates torsion of the appendix testis or appendix epididymis. During palpation, the testis must be differentiated from the epididymis.

The peripheral pulse following arterial injury

There has been little attention paid to the persistence of the pulse following complete forearm arterial transection, and we found no report that has established the etiology or frequency of this phenomenon. Eighteen patients with documented complete radial or ulnar artery transections were evaluated. Nine of the 18 patients had persistently palpable pulse distal to the transections. Seven of the pulses were due to retrograde flow and two were due to transmission from the proximal arterial stump or large collaterals. The Allen test was accurate in demonstrating arterial occlusion in each case. Digital compression of the intact artery eliminated the pulse in those cases due to retrograde flow. Documentation of flow direction and collateral vessels was performed with the Doppler directional velocity meter. The fallibility of the peripheral pulse following complete arterial injury is stressed. The Allen test, digital compression of the intact artery, and Doppler studies should be performed on patients with suspected arterial injuries. The exploration of all wounds in the region of major arteries from which profuse bleeding has occurred is recommended.

Self-examination and clinical examination of the breast

The techniques of self breast examination and the clinical examination of the breasts are described briefly. The potential value and the limitations of these tests in screening for breast cancer are reviewed. In a Cancer Society Monograph in 1958, Haagensen said, "It is probable that, from the point of view of the greatest possible gain in early diagnosis, teaching women how to examine their own breasts is more important than teaching the technique of breast examination to physicians, for we must keep in mind the fact that at least 98 percent of the women who develop breast carcinoma discover their tumors themselves." Unfortunately, this is still true today. There is urgent need to focus research on methods to detect breast cancer in its early stages. Caution is emphasized in widespread advocacy of breast self examination without adequate supporting evidence of its efficacy. There is need for a well-designed, prospective study of breast self examination with full attention to a rigorous research design and methodology.

[A simple clinical investigation method for the approximative rapid determination of the antetorsional angle of the neck of femur (author's transl)]

The author comes to the conclusion that palpatory determination of the antetorsional angle, if executed by a skilled diagnostician, can often save an x-ray film and hence cost and radiation exposure, especially in nonadipose children, supplying satisfactory information on the torsional conditions at the end of the femur near the hip, within a few seconds' time, taking the examination technique into consideration. Antetorsion of the femur at the hip is defined. The aetiomorphology of the antetorsional angle cannot be considered as an independent phenomenon, since it can be viewed only within the overall interplay of the torsional conditions of the leg. In this connection it becomes evident that there is a well-defined relationship between antetorsion of the femur near the hip and apical position of the trochanter major. The so-called "antetorsion-ddependent, externorotatory trochanter major effect" ist expressed mathematically by the trochanter major retrotorsional angle, which is in fact the only way to properly determine the antetorsional angle via manual palpation.

Diagnosis of breast cancer: clinical and preclinical

While a tentative diagnosis of lesion type can be made fairly accurately on the basis of a patient's history, combined with a thorough examination, and the use of diagnostic aids, biopsy and histologic examination remain the only absolute means of determining whether a lesion is benign, premalignant, or malignant.