(In following, are  described only auscultatory percussion reflexes, signs, manoeuvres and tests, which are routinely assessed, in order to perform Biophysical Semeiotics. Other interesting reflexes, specific and useful in ascertaining both physiological and pathological particular conditions, are exhaustively illustrated in previous articles: See Bibliography).

Manoeuvres.

1) Erythropoietin Evaluation (Baserga's Sign): with the subject to be examined as usually psichophysically relaxed and in supine position, doctor assesses for the first time the RESHS (See later on); soon thereafter, doctor  must stimulate trigger-points of the the skin at the level of VII – VIII thoracic dermatomeres (i.e., right and/or left quadrants of abdominal surface), by pinching with mean intensity for about  15 sec. Kidneys size increases, due to renal congestion and, then, appears their decongestion, which stimulates also Erythropoietin secretion. After 3-5 sec. interruption of such stimulation, RESHS has to be evaluated for the second time: in healthy, latency time of gastric aspecific reflex – during persistent digital pressure on mean line of sternal body and iliac crests (spleen trigger-points are not useful) lowers from basal value 10 sec. to 6 sec., due to bone marrow stimulation by Erythropoietin (E.) under physiological condition. Interestingly, in case of iron deficiency syndrome, with or without anemia, E. receptors of the bone marrow become less or  not  sensitive at all to the this substance,  so that lt. persists identical (= 10 sec.) in a second evaluation, analogously in case of lowered E. secretion, because of kidneys insufficiency, (for instance, hydronephrosis secondary to high lithiasic obstruction syndrome). Of interest, analogously  E. evaluation can be performed by means of “intense” digital pressure, lasting 10 sec., applied on cutaneous projection area of the heart, and with identical procedure, described above. In case of ischaemic heart disorder, or in case of other cardiac disease, lt. of RESHS does not lower, at all, due to the basal  excessive secretion  of E., NO free radical and  natriuretic peptide type A, from the diseased heart, which brings about receptors down-regulation in both bone marrow and kidneys (See later on : Nad assessement).

2) Ferrero-Marigo’s Manoeuvre. At rest, one evaluates muscle biceps-gastric aspecific and/or – caecum reflex (NN= 12 sec. age-dependent). After insulin acute peak secretion, provoked by lasting pinching of mean intensity of VI thoracic dermatomer (skin above costal arch, right or left, along middle-parasternal clavicular line), for 12 sec. exactly,   doctor has to estimate  lt. of reflex for a second time: in healty, it results unchanged, whereas in case of hyperinsulinemia-insulinresistance lt. appears to be > 12 sec., e.g. 14 sec., in direct relation to receptor disorder , i.e. hyposensitivity.

3) Restano’s Manoeuvre. It is composed of the simultaneous application of boxer’s test plus  apnea test (See later on), i.e. a dynamic sensitized test, since it induces sympahetic hypertone. Restano’s Manoeuvre is very useful, for instance, in evaluating RESHS in case of numerous diseases, when basal value (lt. = 10 sec. intensity 1 cm.) seems to be normal, but after the manoeuvre becomes clearly pathological : lt lowers to 3 sec., with intensity > 1 cm. and enhancing lt. of 8 sec.or less (Restano’s Manoeuvre type B); in type A intensity is £ 1 cm. and enanhing lt. 9 sec. In healthy, all parameters are unchanged: sometimes intensity of reflex is < 1,5. There is, morevoer, the so-called modified Restano’s manoeuvre: subject to be examined clenching only  one fist, so that is possible utilizing the pulp of a finger of the other hand, by performancing digital microvascularunit diagram, useful in identifying oncological terrain. (See later on).

4) Valsalva’s Manoeuvre. Notoriously, this manouvre  provokes increasing of acetyl-choline, unavoidable, for instance, in the biophysical evaluation of endothelial function evaluation. This manoeuvre is  so well known, that I leaves out to describe it.

Reflexes.

1) Caecum reflex. Stimulating  a large number of trigger-points of all biological systems, after a variable latency time (lt), in healthy fixed in well defined tissue, brings about caecum dilation: physiologically, the reflex lasts £ 4 sec., and then the viscera volume returns to basal size for >3 <4 sec., i. e.  for the same  time as the fractal dimension, calculated in a more sophysticated and refined manner.

2) Caecum-esophageal reflex. Digital pressure on cutaneous projection of caecum provokes esophageal dilation, whereas LES contracts physiologically for 4-6 sec. In case of colon diverticuli LES contraction persists for 10 sec. precisely in a characteristic manner, .

3) Caecum-gastric aspecific reflex. In healty, digital pressure, as described above, brings about gastric aspecific reflex of intensity < 1 cm., whereas  in case of gastritis intensity  of reflex raise to ³ 1 cm.

4) Caecum-duodenal reflex. In healthy, stimulating caecum trigger-points evokes duodenal dilation fo 3 sec., followed by duodenal contraction of ³ 1cm.. In case of duodenitis the duodenal contraction does not arise, indicating a duodenal disorder, even silent.

5) Caecum-ureteral reflex. Light digital pressure on caecum projection area provokes three ureteral reflexes, i.e. upper, middle and lower ureteral reflex, which allow doctor to evaluate vasomotility and vasomotion of this viscera.

6) Cerebral-gastric aspecific reflex. Digital pressure (type I) and/or nail pressure (type II = pathological) bring about gastric aspecific reflex. In healthy, lt. of type I reflex is 6 sec., while type II reflex, absent under physiological condition, araise in case of epileptic focus, even silent, i.e. in asymptomatic patients, as well as in other cerebral pathologies, as meningitis, tumour, a.s.o., in association with type I , which reveals a lt < 6 sec.

7) Cerebral-caecum reflex. Cerebral trigger-points stimulation provokes caecum dilation; these parameters, however,  appear to be the same as those of cerebral-gastric aspecific reflex. Obviously, it can be utilized particularly in patient, who underwent complete gastrectomy.

8) Cerebral-ureteral reflex. Digital pressure of low-mean jntensity, on cerebral trigger-points, provokes three ureteral reflexes, upper, middle a lower ureteral reflex. They are unavoidable  also to evaluating  cerebral vasomotility and vasomotion, even in well localized area.

9) Cerebral cholecystic reflex. Under above-described conditions, stimulating cerebral trigger-points causes the cholecystic reflex, i.e. cholecyst dilates.

10) Cholecyst-esophageal reflex. Digital pressure on cholecyst cutaneous projection area brings about esophageal reflex and His’s angle raising.

11) Cholecyst-gastric aspecific reflex. Digital pressure on cholecyst trigger-points (See earlier) provokes gastric aspecific reflex.

12) Cholecyst-caecum reflex. Under above-illustrated condition appears caecum dilation.

13) Cholecyst-ureteral reflex. In healthy, the light stimulation of cholecyst trigger-points induces the three ureteral reflexes, described above: upper, middle and lower ureteral tracts dilate and, then, fluctuates in a chaotic-deterministic manner.

14) Colon descending-caecum reflex. Stimulating trigger-points of descending colon provokes caecum dilation (See V. 9).

15) Colon descending ureteral reflex. Once more, light digital pressure on the descending colon causes three ureteral reflexes, illustrated above, unavoidable in evaluating both vasomotiliy and vasomotion of descending colon.

16) Descending colon-esophageal reflex. Intense digital pressure on descending colon causes esophageal dilation, while His’s angle raises clearly and LES contracts for 4-5 sec. physiologically. On the contrary,  LES contraction lasts characteristically 10 sec. in case of descending colon diverticula, allowing doctor to identifying this disease.

17) Descending colon-gastric aspecific reflex. Under the same condition, described above, appears the gastric aspecific reflex.

18) Esophageal Reflex.  A large number of reflexes, starting from nervous receptors localized in almost all biological systems, end in esophageal wall, causing its dilation and LES contraction, lasting for diverse time, organ-depending, in both physiological and pathological conditions. 

19) Gastric aspecific reflex. In daily practice represents the most frequent reflex to be ascertained, under both physiological and pathological situations, due to the fact that in the stomach, notoriously, bring to an end numerous reflexes, originating from everywhere in human body. “Vagale” gastric aspecific reflex : fundus and body of stomach are dilated, whereas antral-pyloric region contracts. Less frequent is “sympathetic” gastric aspecific reflex, in which  the stomach dilates completely.

20) Liver-gastric aspecific reflex. Intense digital pressure on liver projection area of the skin provokes the gastric aspecific reflex.

21) Liver-caecum reflex. Under above-described condition, caecum dilates.

22) Liver-ureteral reflexes. Light digital pressure on liver projection area brings about three ureteral reflexes, useful in evaluating vasomotility and vasomotion.

23) Oculo-gastric aspecific, -esophageal, caecun  and –ureteral reflex. Analogously, light-mean digital pressure on an eye-ball (when eye is closed, of course) causes the known reflexes after a latency time different, in relation to local condition.

24) Pancreatic-caecum, -gastic aspecific, -ureteral and –esophageal reflex. Prolonged pinching at level of VI thoracic dermatomere (skin of right or left hypochondrium, i.e. the skin covering costal arch,  right or left, along middle-parasternal-line) causes the well known reflexes.

25) Splenic reflex. Stimulating numerous trigger-points provokes splenic reflex, i.e. the  size of spleen increases for about 6 sec. due to it congestion, and thereafter it comes back to normal, basal value.

26) Splenic gastric aspecific, -caecum, -ureteral reflex. Digital pressure of mean intensity, applied on cutaneous projection area of spleen causes the well known reflexes.

27) Ureteral reflex. Ureteral reflex (es) is (are) provoked by the stimulation of numerous trigger-points of all tissues; there are three important ureteral reflexes, which really play a primary role in evaluating vasomotility and vasomotion of all biological systems, because their fluctuations parallel those of arterioles (= upper ureter), interstitum (ureter “in toto”) and, respectively, nutritional capillaries and  venules (= lower ureter). These ureteral reflexes enabled  me to investigate clinically tissue-microvessel-units of every biological systems, allowing thus the foundation of the Clinical Microangiology.

Signs.

1) Bella’s sign, classic and variant. In case of retrocaecal appendicitis, until now really difficult to recognize clinically (but not only at the bed-side) with the aid of old, accademic, physical semeiotics, the patient bends its stretced right leg towards abdomen: the “spontaneous” GTC rapidly appears (100% of cases), after a gastric aspecific reflex of only 1-2 sec.  lt and lasting  3 sec.: Bella’s Sign “classic” (Bella’s Sign “variant”: patient bends the left leg in identical manner, as described earlier, with the same results in case of appendix located in left ileo-pelvic region). In  healthy, under identical above-described conditions, lt of gastric aspecific reflex is 10 sec., duration > 5 sec. and GTC intensity is < 2 cm.  Interestingly, the degree of reflexes paramaters results the same in next signs, pointing out internal and external coherence of biophysical semeiotic theory.

2) Berti-Riboli’s sign. The patient is invited “to press down its abdomen as to evacuate” (simulated evacuation test; practically,  patient carries out Valsalva’s manoeuvre): immediatly stomach dilates (i.e. the gastric aspecific reflex suddenly appears), then,  after 3 sec. precisely, stomach contracts rapidly in intense manner:  GTC Sign  of ³ 2 cm.. In healty individual, under identical condition, lt of gastric aspecific reflex is 10 sec., duration > 5 sec. and, finally, GTC  < 2cm. : Berti-Riboli’s Sign. Analogously, but most desirably, doctor applies digital pressure on precise cutaneous projection area of the inflammed appendix, previously localized by means of auscultatory percussion: rapidly arise the same reflexes above-illustrated, with identical parameters, including GTC.

3) Curri’s sign. In patients, former involved by myocardial infarct, upper ureteral reflex is spontaneously present, and fluctuates in chaotic-deterministic manner, although with low fractal dimension.

4) Daneri’ sign. In healthy, minimal vertical diameter of broncho-vascular-hilar system in both lungs appears to be < 2 cm.. In case of polmonary disease as well as during BALT activation this value increases, in relation to the severity of underlying disorder. If only one lung is diseased, Daneri’sign is “asimmetric”.

5) Domenichini’s sign. During apnea test, the diameter of broncho-vascular-hilar system decreases to minimal value, physiologically, for exact 3,5 sec.; in case of lung disorder or BALT activation increases in characteristical manner: duration 4,5 sec. in infections due to Gram-positive agents, rheumatic diseases, tumours; duration 5,5  sec. in infections caused by Gram-negative bacterial agents, and finally 7 sec. (most intense of all) in flu viruses.

6) Gastric Tonic Contraction Sign: stimulating numerous trigger-point causes stomach tonic contraction, after a gastric aspecific reflex which lasts only a few sec. (< 6 sec.): interestingly lt., duration and  intensity of these reflexes are correlated with the seriousness of underlying disorder, allowing thus a “quantitative” clinical monitoring.

7) Massucco’s sign.  In presence of prostatic cancer, since early stage, cutaneous pinching of prostate trigger-points (the skin of inguinal region, right and left), provokes gastric aspecific reflex after 3-4 sec. lt, and, soon thereafter, the Gastric Tonic Contraction. In healty, lt is >6 sec. and GTC is always absent.

8) Provoked splenomegaly sign. In healthy, intense digital pressure on liver projection are, induces splenomegaly, due to its congestion, wich lasts only for 3-4 sec. In case of porta vein hypertension splenomegaly persists longer, in direct relation to the severity of liver disorder.

Syndromes

1) Autoimmune syndrome. Stimulating trigger-points, where immunocomplexes are deposited, causes Gastric Tonic Contraction and spleen decongestion, after  a gastric aspecific reflex and spleen congestion lasting only 3 sec. Of interest, identical biophysical semeiotic signs are brought about, in a characteristic manner, by persistent pinching of dorsal (back) site of a hand in case of connective tissue diseases.

2) Cystic syndrome. In presence of cyst in whatever organ as well as of dilation of an artery, e.g., or viscera,  as ureter, digital pressure stimulates local trigger-points, carrying out esophageal, gastric aspecific, and ureteral “in toto” reflex (= ureter dilates in every part).

3) Congenital Acidosic Enzyme-Metabolic Histangiopaty Syndrome (CAEMH). This syndrome points out a mitochondrial, inherited, functional    cytopathology: digital pressure on cutaneous projection area of right cerebral hemisphere provokes the gastric aspecific reflex, which appears more intense than that brought about by identical stimulation applied on left cutaneous area of homolateral cerebral hemisphere, indicating the prevalence of right Planum temporale.

4) Reticulo-Endothelial System Hyperfunction Syndrome  (RESHS).  This very useful syndrome corresponds to both erythrocyte sedimentation rate (ESR) and proteins electrophoresis, but is more sensitive and specific. This syndrom has to be ascretained most often  in daily pracice. In healthy, digital pressure of mean intensity, applied on medial sternal-body line, iliac crests and cutaneous projection of spleen, after 10 sec. exactly, provokes gastric aspecific reflex (besides caecum dilation and spleen decongestion). In practice, it is enough to assess exclusively gastric aspecific reflex. There are three types of RESHS: RESHS “complete”, when sternal-body, iliac crests and spleen are trigger-points for the syndrome. The lt appears to be 6 sec. or less, in case of infective diseases, caused by Gram-positive bacilli, viruses of  common infancy diseases, rheumopathies and malignancy. An other type is RESHS “intermediate”: spleen is trigger-point of the syndrome, but gastric aspecific reflex is clearly less intense during spleen stimulation, pointing out infection caused by Gram-negative agents. Finally, RESHS incomplete indicates characteristically the presence of flu viruses: the spleen stimulated does not provoke any reflex.

Tests.

1) Apnea Test : the subject to be evaluated is invited to not breath, bringing about sympathetic hypertone.

2) Boxer’s Test: closing intensively both hands (fists) an individual provokes sympathetic hypertone. We have to remember, at this point, Restano’s manoeuvre, i.e. simultaneous application of both tests: apnea and boxer’s test.

3) Simulated Defecation Test: doctor asks the patient “to  press down its abdomen as to evacuate” (simulated evacuation test; practically  patient is invited to carry out Valsalva’s manoeuvre) and acetyl-choline concentration increases, allowing to evaluate,e.g., endothelial function.

4) Simulated Feeding Test: doctor obtain identical results, illustrated above.

5) Simulated Stress Test: an individual thinks to speek in public or remember an earlier doleful events, inducing thus sympathetic hypertone.

6) Tests of Diabetes Melitus Identification: in presence of  diabetes mellitus, light-moderate hand or digital pressure on internal site of an arm (or, for instance,  internal /external site of breast) after lt. > 3 sec. causes gastric aspecific reflex lasting 3 sec. before reinforcing. Interestingly, in Diabete Mellitus lt. is £ 3 sec. in inverse relation to glucose concentration. In case of glycosilated proteins enhancing, digital pressure on finger-pulps provokes, after a lt of 3-4 sec., a first gastric aspecific reflex (wich, in characteristical manner, increases slowly and persistently), and then, after 4-5 sec. (NN = 6sec.) one observes another reflex: the second lt. is  in inverse  relation to glycosilated proteins  concentration. Of greatest interest, stimulating pancreas trigger points (VI thoracic dermatomere, i. e. the skin on costal margine, right or left, along para-sternal- middle-clavicular line) provokes  ureteral reflex “in toto” of intensity > 1 cm.: characteristic sign of Non-Insulin-Dependent DM.  Moreover, digital pressure on trigger-points of SST-RH neuronal centre (i.e., 2 cm above and 2 cm. before external acoustic meatus) in diabetic patient causes, after lt 6 sec. exactly,  a first pancreatic congestion of intensity ³ 2 cm. (NN = 2 cm.), which lasts for 6 sec.( if oncological terrain is absent), followed by pancreatic decongestion for exact 25 sec. Finally, a second pancreatic congestion appears and persists only 6-7 sec. (NN = 8 sec. exactly), in inverse relation to diabetes mellitus seriousness. Of interest, in case of Hyperinsulinemia-Insulinresistance later parameter appears more lasting: > 8 sec., directly correlated with the severity of this pathological situation.

7) Fist Test: The subject closes intensively a hand. In healthy, after lt. ³ 7 sec., appears the caecum reflex (and gastric aspecific reflex), indicating tissue acidosis. Opening the hand, after 3 sec. exactly of interruption, doctor evaluates for a second time this parameters: physiologically, lt. increases to  ³ 10 sec.. On the contrary, in case of circulatory disorder, e.g. ATS, arterial hypertension or when arterial peripheral resistances are increased and Microcirculatory Functional Resrve is altered, lt. of caecum reflex (or gastric aspecific reflex) is clearly lowered:  £ 6 sec., but the intensity is increased > 2 cm.

8) Simulated Movement Test: thinking   to move  arm, hand, finger a.s.o., brings about hyperemia in relative cerebral centre, i.e. there is localized microcirculatory activation type I, associated.

9) Simulated Urination Test: an individual is invited to press its abdomen as to urinate. In healthy, appears suddenly ureteral reflex “in toto” as well as gastric aspecific reflex, which last only for 3-4 sec. and then rapidly disappears.  On the contrary, in case of urinary tract disorder, non neoplastic in origin, including Benign Prostatic Hypertrophy, both reflexes persist for longer time.  Interestingly, in case of malignancy of urinary tract, after 3-5 sec. gastric aspecific reflex is rapidly followed by the characteristic Gastric Tonic Contraction. In case of renal cyst, apart from its size and degree, the test causes cystic syndrome: in practice, ureter dilates “in toto”. Finally, in presence of renal-lithiasis, even clinally silent, arises the typical “litiasic” reflex : both stomach and uretere dilate intensively, but soon thereafter followes its reduction of 1/3 of intensity.

Particular Evaluations.

1) Cholesterol and Triglycerid (tissue) Evaluation. Digital (hand) pressure of mean intensity, applied on cutaneous prjection of the liver, physiologically provokes gastric aspecific reflex after lt. of  ³  7 sec.  with a duration  < 4 sec.  and intensity £ 2 cm. Thereafter, the reflex diseappears completely for > 3 sec. < 4 sec.(differential latency time, which notoriously parallels to fractal dimension: 3,81). When lipids synthesis is pathologically increased, the liver-gastric aspecific reflex presents a typical behaviour: lt. < 7 sec., intensity > 2 cm. e duration > 4 sec.  Interestingly, the reflex  does not entirely disapear, residuing a small gastric aspecific reflex, the intensity of which is directly related to that of lipids synthesis. Of particular interest is the sensibilized evaluation by mean of Ferrero-Marigo’s Manoeuvre (See earlier): apart from present lipids concentration, the persisting  gastric aspecific reflex – the residuing one -  appears to be > 2cm., although its basal value is in normal ranges, as in patient with earlier hyperlipidemia but normal at the moment.

2) Hyperinsulinemia-Insulinresistance Test.  By means of  renogram as well as surrenogram,  the assessement of this dangerous and insidious situation,  because almost always asymptomatic, can be easily performed. As a matter of facts, in healthy, acute insulin secretion peak provokes augmentation of kidney size of 3 cm., after lt. of about 10 sec.; kidney fluctuations (Phase C in diagrams) last for 8 sec.  (NN = 6 sec.). On the contrary, due to receptors  down regulation, kidney size increasing is smaller or completely absent, in correlation with the seriousness of hyperinsulinaemia-insulinresistance. Under identical condition, surrenogram provides to doctor the same information: in healthy, the first oscillations persist in normal intensity ranges, but in case of hyperinsulinaemia-insulinresistance, starting from the third normal fluctuation , one observes fluctuation lowered, lasting AL +PL only 5 sec. (NN = 6sec.), due to microcirculatory inactivation , provoked by the hormon, under pathological condition.

3) Natriuretic Atrial Peptides (A and B) Evaluation: in order to assess NAD type A, i.e. NAD synthesized by heart, doctor applies “intense” digital pressure on cutameous heart projection area and simultaneously evaluates kidney behaviour, namely congestion of the kidney. In healthy,  starting 5 sec. from the beginning of pressure application on precordium, kidney transverse diameter augments of about 3 cm. and its fluctuations show the maximal intensity, 1,5 cm., i.e. Highest Spikes, with AL + PL (duration) lasting 8 sec. On the contrary, in presence of heart coronary disease, excluding early stage, kidney congestion appears to be clearly smaller than normal value, in direct correlation with the seriousness of underlying disorder. In fact, in case of severe myocardial ischaemia, kidney size does not change, because NAD level is really increased, but receptors sensitivity is lowered, due to  receptors down-regulation. The assessement of  NAD type B (B = brain), synthesized also by cardiac ventricles, doctors applies intense hand or digital pressure on cutaneous projection area of the parietal lobe, right and/or left, because other cerebral convolutions cannot synthesize NAD type B,  and simoltaneously estimates  - See above – kidney behaviour: the response is normal in patient with coronary heart disease, whereas in brain vascular disorder as well as in other cerebral pathologies, response appears to be smaller than normal  or completely absent, in correlation with disease seriousness. In conclusion, my findings  allow to state that in both cerebral and myocardial ischaemia, due to renal receptors down-regulation, although NAD secretion is really intense, augmentation  of the kidneys size, secondary to congestion, is absent or statistically not significant.

4)  Renal Function Evaluation by load of water. It is an original bed-side evaluation of renal function, related in a satisfactory way to RPF and GFR. At first, in a indivual in supine position and psycho-physically relaxed,doctor assesses renal diameters, evaluated as minimal degree, renogram, i.e the chaotic-deterministic fluctuations of kidney besides period, duration and intensity of ureteral peristaltic wave. In healthy, following data are observed: 6 cm. x 12 cm.,  Phase C (kidney congestion) duration 6 sec., oscillation intensity varying between 0,5 cm. and 1,5 cm. in a chaotic-deterministic manner, period fluctuating between 9 sec. and 12 sec. In addition, the peristaltic wave period at base-line is 18 sec., intensity < 1 cm. and, finally, duration of urether dilation is 3 sec. exactly. Soon thereafter, subject is administered 250 cc. water and then, after a latency time of 3 minute, the degree of above- mentioned parameters, are evaluated for a second time. “Minimal” kidney diameters increases (> 6 cm. and respectively > 12 cm.), renogram appears to be of “vagal” type,i.e. Phase C is clearly augmented with 7-8 sec. duration  and all fluctuations are identical, as far as intensity and period are concerned. In addition, ureteral peristaltic wave shows an incresed intensity (³ 1 cm.) lasting for 6 sec. (doubled than that at base-line) and a period decreased to 12 sec. exactly. Actually, the degree of the numerous renal parameters are related in a satisfactory manner to RPF, while ureteral parameters are correlated with GFR.

5) Uric Acid Pool Expansion. In healthy, pinching  (or digital pressure, applied on)   bended auricular helix, between thumb and finger, provokes gastric aspecific reflex after lt. of exact  10 sec.  On the contrary, when acid uric pool expansion is present, for instance during renal colic,  above-mentioned  stimulation causes the reflex after a shorter latency time (e.g. < 7 sec.), in inverse correlation with the severity of underlying disorder. Of interest, in case of articular or abarticular gout, both digital and ungueal pressure on the diseased “sinovium” induce gastric aspecific riflex and lt is in inverse correlation with disease seriousness.  Finally, of special interst is the sensitivized  assessement by  means of Ferrero-Marigo’s  manoeuvre (See earlier): even in previous episode of uric acid pool expansion, in at moment  only apparently healty individual, i.e. apart from actual acid uric blood level, doctor observes pathological values of the reflex.

Velocimetry (neologism, indicating the clinical, original study of peristaltic waves)

Assessement of the velocity of peristaltic wave (evaluated as time of conduction)

1) Esophagus. Physiologically, cutaneous pinching  at the level of sternal manubrium brings about  a peristaltic wave, which reaches cardias region after 5-6 sec. along great stomach curvature. Doctor can observe this event with the aid of auscultatory percussion of the stomach. On the contrary, in esophageal pathology, independent from it origin, including thus hiatal hernia, lt. or time of conduction araise to 7-8 sec. in directe correlation with intensity of disorder.

2) Cholecyst-Choledochus.  Cutaneous pinching at right of cholecyst projection area originates a peristaltic wave in this viscera, wich is perceived at the level of mean third of choledochus after 5 sec. precisely. In case of cholecystitis, cholelithiasis, adenoma or tumour, conduction time increases to 8 sec.

3) Colon. Cutaneous pinching and/or digital pressure on the right iliac fossa provoke a peristaltic wave, which reaches descendent colon-sygma after 30 sec. exactly:  with the bell-piece of stethoscope located  on left abdominal quadrants, doctor applies percussion of descent colon , estimating easily the time of wave conduction.

4) Stomach-Duodenum. Auscultatory percussion of the stomach and duodenum allows doctor  to assess the time of conduction of a peristaltic wave, originated as usually at cardias level, due to cutaneous pinching immidiately under sternal xiphoid process, which reaches antral-pyloric region in 5 sec. and duodenum (II duodenal segment) in 7 sec.

Last update: March 18, 2018