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Journal of the Korean Society of... Jul 2022The male breast is a non-functional and rudimentary organ, but similarly to the female breast, it can be affected by various diseases. In contrast to female breast... (Review)
Review
The male breast is a non-functional and rudimentary organ, but similarly to the female breast, it can be affected by various diseases. In contrast to female breast cancer, male breast cancer has a low incidence, and there is no established breast cancer screening program for male patients. Therefore, the diagnostic evaluation is usually performed in male patients with symptoms such as palpability or pain in the breasts. Furthermore, most adult male patients who visit breast clinics sometimes present with not only breast symptoms but also axillary symptoms, and both the breast and axilla are usually examined during breast ultrasonography in daily clinical practice. The purpose of this pictorial essay was to present the sonographic features of various palpable breast and axillary lesions in adult male patients.
PubMed: 36238906
DOI: 10.3348/jksr.2021.0122 -
South African Family Practice :... Sep 2022A palpable breast lump is a common presentation of breast disease to a general practitioner. Fortunately, investigation of most of these lumps will lead to a benign...
A palpable breast lump is a common presentation of breast disease to a general practitioner. Fortunately, investigation of most of these lumps will lead to a benign diagnosis. It is essential to have a clear and systematic approach when investigating a palpable breast lump to avoid over investigation with the resultant increase in healthcare cost and anxiety. This article will discuss an approach to evaluating and diagnosing a palpable breast lump in the primary care setting.
Topics: Breast; Breast Diseases; Female; Humans; Mammography; Palpation; Ultrasonography, Mammary
PubMed: 36226953
DOI: 10.4102/safp.v64i1.5571 -
Children (Basel, Switzerland) Aug 2021Traditional open orchiopexy is still a standard of treatment for palpable undescended testicles. Recently several authors reported successful results using a... (Review)
Review
BACKGROUND
Traditional open orchiopexy is still a standard of treatment for palpable undescended testicles. Recently several authors reported successful results using a laparoscopic approach in the treatment of palpable cryptorchidism. The present systematic review and meta-analysis investigated the utility of laparoscopic orchiopexy for palpable cryptorchidism.
METHODS
Scientific databases (PubMed, Scopus, Web of Science, and EMBASE) were systematically searched for relevant articles using the following terms: (palpable cryptorchidism or palpable undescended testes) AND (laparoscopic orchiopexy or laparoscopic orchiopexy). The inclusion criteria were all children with unilateral or bilateral palpable undescended testes who underwent laparoscopic orchiopexy (LO) compared to children who underwent conventional open orchiopexy (CO). The main outcomes were the proportion of children requiring redo-orchiopexy and the incidence of postoperative complications. Secondary outcomes were duration and the cost of surgery.
RESULTS
The final meta-analysis included five studies involving 705 children; LO, = 369 (52.3%) and CO, = 336 (47.7%). The majority of the included patients had unilateral palpable cryptorchidism. No significant differences were found in regard to average age at the time of surgery and follow-up periods between the investigated groups. No statistically significant differences were found in regard to redo-orchiopexy rates (RR = 0.22, 95% CI 0.03-1.88, = 0.17), early complications (RR = 0.66, 95% CI 0.21-2.08, = 0.48) and incidence of testicular atrophy (RR = 0.36, 95% CI 0.03-3.88, = 0.40). No significant differences in the operative duration were observed among the groups. Laparoscopy was associated with higher costs in most of the studies.
CONCLUSION
LO is safe and effective in children with palpable cryptorchidism. The rates of redo-orchiopexy as well as an incidence of early complications and testicular atrophy rates are comparable to CO.
PubMed: 34438568
DOI: 10.3390/children8080677 -
Breast Cancer (Tokyo, Japan) 2005In Japan, mammography was endorsed for breast cancer screening in women aged 40 and over by the Ministry of Health, Labor and Welfare in 2004. The spread of mammographic... (Review)
Review
In Japan, mammography was endorsed for breast cancer screening in women aged 40 and over by the Ministry of Health, Labor and Welfare in 2004. The spread of mammographic screening has caused an increase in the incidence of non-palpable breast cancer. Precision reading for mammography is necessary to detect non-palpable breast cancer. When mass and focal asymmetric density is noted, it is important to analyze the density, density gradient, internal structure, margin and associated findings. Calcifications are classified by morphology and distribution mainly. It is necessary to distinguish secretor-type calcifications from necrotic-type calcifications. The Iwate Cancer Association performed a population-based screening program for breast cancer using mammography combined with clinical breast examination of 42,065 women in Iwate Prefecture from 1999 to 2003. A total of 2,329(5.7%)women were recalled and the 112 cases(0.27%) of cancer were detected in 114 breasts. Of 114 breast cancers, 40 (35%) were non-palpable and 74(65%) were palpable. The early breast cancer (stage 0 and I) rate of the non-palpable group was significantly higher than that of the palpable group (90% and 47%, p = 0.0003). The node-negative rate of the non-palpable group was significantly higher than that of the palpable group (92% and 68%, p = 0.011). It is expected that mammographic screening will be expanded and that the mortality rate from breast cancer in Japan will decrease, as in Europe and the United States.
Topics: Breast Neoplasms; Female; Humans; Japan; Lymphatic Metastasis; Mammography; Mass Screening; Physical Examination; Sensitivity and Specificity
PubMed: 16286905
DOI: 10.2325/jbcs.12.258 -
Seminars in Ultrasound, CT, and MR Aug 2006Ultrasound use should be considered in most instances of a palpable breast finding, particularly in young women. A primary advantage is the ability to directly correlate... (Review)
Review
Ultrasound use should be considered in most instances of a palpable breast finding, particularly in young women. A primary advantage is the ability to directly correlate the physical exam finding with imaging. Ultrasound is useful in characterizing palpable masses as well as detecting cancer in women with negative mammograms. The negative-predictive value of imaging for cancer in the evaluation of a palpable lump is very high, which may reassure women with low-suspicion palpable findings. Short-term follow-up of a palpable mass with benign features may be feasible, though further study is needed to establish criteria. A suspicious dominant palpable finding should be further evaluated even if imaging is negative.
Topics: Age Factors; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Mammography; Physical Examination; Predictive Value of Tests; Ultrasonography
PubMed: 16915997
DOI: 10.1053/j.sult.2006.05.003 -
Journal of Breast Imaging Sep 2019A palpable breast abnormality is one of the most common presenting clinical breast complaints. Although the majority of palpable abnormalities are benign, they are among...
A palpable breast abnormality is one of the most common presenting clinical breast complaints. Although the majority of palpable abnormalities are benign, they are among the most common presenting symptoms of breast cancer, and those breast cancers detected symptomatically tend to have poorer prognosis than their screen-detected counterparts. Clinical breast examination is a vital part of the workup of palpable abnormalities. However, as physical exam features of most masses are not reliable for categorization of malignancy, imaging evaluation is necessary. Choice of imaging modality, which includes diagnostic mammography and breast ultrasound, is dependent upon patient age. Ultrasound is the primary imaging modality for evaluation of palpable masses in women younger than 30 years of age because of its high negative predictive value and sensitivity and lack of ionizing radiation. For women aged 30-39 years, ultrasound or mammography can be performed as the initial imaging evaluation, with ultrasound maintaining a high sensitivity in women younger than 40 years old. Mammography, often followed by ultrasound, is the recommended imaging evaluation sequence for women aged 40 and older. Utilization of advanced imaging modalities for evaluation of the palpable area of concern is not supported by evidence.
PubMed: 38424759
DOI: 10.1093/jbi/wbz040 -
Pediatrics Oct 1986We examined 548 healthy neonates and infants to document the frequency, size, and location of palpable lymph nodes. The subjects consisted of 214 neonates from birth to...
We examined 548 healthy neonates and infants to document the frequency, size, and location of palpable lymph nodes. The subjects consisted of 214 neonates from birth to 4 weeks of age and 334 infants from 4 weeks to 1 year of age. All of the infants were asymptomatic and had been free of major or minor systemic or cutaneous infections in the past. Of the 214 neonates, 73 (34%) had palpable nodes at one or more sites. Of the 334 infants, 190 (57%) had palpable lymph nodes. Inguinal, cervical, and axillary lymph nodes can be palpable in neonates and infants. Supraclavicular nodes are not generally palpable. The commonest site of palpable nodes is the inguinal area in neonates and the cervical area in older infants. It would appear that the palpable nodes noted in the neonatal period do not disappear but persist. This knowledge is useful in determining when adenopathy may be abnormal.
Topics: Axilla; Female; Humans; Infant; Infant, Newborn; Inguinal Canal; Lymph Nodes; Male; Neck; Palpation
PubMed: 3763263
DOI: No ID Found -
Clinical Anatomy (New York, N.Y.) Jul 2005Palpation of the posterior belly of the digastric muscle in the postmandibular region is included in many study protocols and examination schemes of the masticatory... (Review)
Review
Palpation of the posterior belly of the digastric muscle in the postmandibular region is included in many study protocols and examination schemes of the masticatory system. The aim of the present investigation was to systematically search the dental/medical literature to find evidence for the palpability of this muscle. In August 2004, a systematic search was carried out using different electronic databases (PubMed, Cochrane Library, Web of Science, Japana Centra Revuo Medicina, MedPilot, Latin American and Caribbean Health Sciences, and three on-line databases of dental journals not listed currently in Medline), supplemented by manual search in the Austrian journal Stomatologie. Additional manual searches were carried out in the Journal of Orofacial Pain and Journal of Dental Research to identify pertinent abstracts of scientific congresses. One relevant hit was found in the Japanese database. The manual search showed one pertinent congress abstract. In both publications, the authors concluded that due to anatomical reasons the posterior belly of the digastric muscle was not palpable. Hence, evidence is lacking that the posterior digastric muscle is accessible to palpation. Because the postmandibular region is usually tender upon palpation, a high incidence of positive findings can be expected even among healthy subjects. This may lead to wrong clinical judgments, possibly provoking unnecessary diagnostic and therapeutic measures.
Topics: Humans; Masticatory Muscles; Palpation; Reproducibility of Results; Temporomandibular Joint Disorders
PubMed: 15971213
DOI: 10.1002/ca.20104 -
British Journal of Sports Medicine Mar 2017Gluteal tendinopathy (GT) is a source of lateral hip pain, yet common clinical diagnostic tests have limited validity. Patients with GT are often misdiagnosed, resulting...
PURPOSE
Gluteal tendinopathy (GT) is a source of lateral hip pain, yet common clinical diagnostic tests have limited validity. Patients with GT are often misdiagnosed, resulting in inappropriate management, including surgery. This study determined the diagnostic utility of clinical tests for GT, using MRI as the reference standard.
METHODS
65 participants with lateral hip pain were examined to evaluate the ability of clinical tests to detect MRI-determined GT (an increase in intratendinous signal intensity on T2-weighted images). Palpation of the greater trochanter and several clinical pain provocation tests applying compressive and tensile loads on the gluteal tendons were investigated. MRI of the painful hip was examined by a radiologist, blind to clinical findings.
RESULTS
Pain reported within 30 s of standing on the affected limb conclusively moves a (nominal) 50% pretest probability of GT presence on MRI to a post-test probability of 98% (specificity 100%, positive likelihood ratio ∼12), whereas no pain on palpation (80% sensitivity) would rule out its presence. 20 participants (31%) had GT on MRI but clinically negative (ie, not positive on palpation and another test).
CONCLUSIONS
Keeping in mind that the sample size was small (ie, possibly underpowered for indices of diagnostic utility with low precision), the results of this study indicate that a patient who reports lateral hip pain within 30 s of single-leg-standing is very likely to have GT. Patients with lateral hip pain who are not palpably tender over the greater trochanter are unlikely to have MRI-detected GT.
Topics: Adult; Aged; Arthralgia; Female; Hip Joint; Humans; Isometric Contraction; Magnetic Resonance Imaging; Male; Middle Aged; Patient Positioning; Physical Examination; Sensitivity and Specificity; Tendinopathy
PubMed: 27633027
DOI: 10.1136/bjsports-2016-096175 -
World Journal of Surgery 1989The diagnosis of spigelian hernia presents greater difficulties than its treatment. The clinical presentation varies, depending on the contents of the hernial sac and... (Review)
Review
The diagnosis of spigelian hernia presents greater difficulties than its treatment. The clinical presentation varies, depending on the contents of the hernial sac and the degree and type of herniation. The pain, which is the most common symptom, varies and there is no typical pain of spigelian hernia. Findings to facilitate diagnosis are palpable hernia and a palpable hernial orifice. Large, easily palpable spigelian hernias are not a diagnostic problem. It is small hernias and hernial orifices that are overlooked because they are masked by the subcutaneous fat and an intact external aponeurosis. In the absence of a palpable orifice or sac, persistent point tenderness in the spigelian aponeurosis with a tensed abdominal wall most strongly suggests the diagnosis. Spigelian hernia can be ruled out in patients without palpable tenderness. Ultrasonic scanning can be recommended for verification of the diagnosis in both palpable and nonpalpable spigelian hernia. The hernial orifice and sac can also be demonstrated by computed tomography, which gives more detailed information on the contents of the sac than does ultrasonic scanning. The treatment of spigelian hernia is surgical, and the risk of recurrence is small. A gridiron incision is excellent for operations for palpable hernias. If the hernia cannot be palpated preoperatively, preperitoneal dissection through a vertical incision is recommended. This gives good exposure, facilitates hernioplasty, and permits preperitoneal exploration and treatment of other abdominal wall hernias. The incision is also suitable for exploratory laparotomy, which should be performed on patients with abnormal ultrasonographic or computed tomographic findings in whom no palpable hernia can be detected preoperatively.
Topics: Diagnosis, Differential; Hernia, Ventral; Humans; Tomography, X-Ray Computed; Ultrasonography
PubMed: 2683401
DOI: 10.1007/BF01658873