Sample records for auscultation

  1. Auscultation

    ... is usually done using a tool called a stethoscope. Health care providers routinely listen to a person's ... unborn infants. This can be done with a stethoscope or with sound waves (called Doppler ultrasound). Auscultation ...

  2. Heart Auscultation Detection

    Mahesh Vikramsinh Bhosale


    Full Text Available The paper describes a system for analyzing of heart auscultation so every person can get information about their own heart condition. The auscultation means the sound created by any organ due to turbulent blood flow. The murmurs are heart abnormal sounds. The murmur can be detected and analyzed by using Digital Signal Processing (DSP stethoscope but looking cost aspect a system should have maximum accuracy level. The noise in audio files (.wave is degraded by using Finite Impulse Response (FIR filtering. The designed system calculates Root Mean Square (RMS value and Low Energy Rate (LER for sound signals directly taken from internet by using MATLAB platform. From the calculation, system classifies the signal either normal or murmur signals. Results are consulted with a physician. If signals are normal then Root Mean Square value is less than 0.3 (RMS0.8.

  3. Auscultation of the respiratory system


    Auscultation of the lung is an important part of the respiratory examination and is helpful in diagnosing various respiratory disorders. Auscultation assesses airflow through the trachea-bronchial tree. It is important to distinguish normal respiratory sounds from abnormal ones for example crackles, wheezes, and pleural rub in order to make correct diagnosis. It is necessary to understand the underlying pathophysiology of various lung sounds generation for better understanding of disease proc...

  4. Heart murmurs auscultation as professional learning problems

    Leonid B. Naumov


    Objective: To compare the effectiveness of traditional and innovative methods of training for heart auscultation in medical students, physicians, and medical teachers, to find out the major reasons of the deficient auscultative skills, and to determine a place and significance of alternative methods of auscultation training.Methods: By principle of other equal conditions, the comparison of traditional and algorithmic diagnostics by the same auscultative signs in textual tasks, magnetic sound ...

  5. Hybrid High-Fidelity Auscultation Scope Project

    National Aeronautics and Space Administration — To address the NASA Johnson Space Center's need for a space auscultation capability, Physical Optics Corporation proposes to develop a Hybrid High-Fidelity...

  6. [Building an educational software about the auscultation of breathing sounds].

    Melo, Francisca Nellie de Paula; Damasceno, Marta Maria Coelho


    The aim of this study was to discuss the experience of building an educational software about the auscultation of breathing sounds. In the process, Lev Semenovic Vygotsky's pedagogic theoretical framework was used, and the content was delimited so as to encompass the auscultation method step by step. The objective of the auscultation was to classify normal and strange sounds and their particular stethoacoustic characteristics. For the development of the system was used 3D technology, including virtual personification of the patients, nurses and objects. A virtual environment for the auscultation using simulation procedures was used as well. It was concluded that initiatives such as that, although facing many difficulties, bring important contributions to teaching-learning of contents related to nursing education. PMID:17310574

  7. Modified stethoscope for auscultation of temporomandibular joint sounds

    Dagar, Sanjiv Rajender Singh; Turakiya, Viral; Pakhan, Ashok J; Jaggi, Nitin; Kalra, Amit; Vaidya, Vidya


    Background: Purpose of this study was to modify the stethoscope which can auscultate the temporomandibular joint (TMJ) sounds more precisely than conventional stethoscope, and fabrication of stethoscope compatible software which analyses the auscultated sound and gives documentary evidence of that analysis in the form of graph. Materials & Methods: The conventional stethoscope was modified by attaching a custom made soundscope with a recording device which can be place...

  8. A Study of New Pulse Auscultation System

    Ying-Yun Chen


    Full Text Available This study presents a new type of pulse auscultation system, which uses a condenser microphone to measure pulse sound waves on the wrist, captures the microphone signal for filtering, amplifies the useful signal and outputs it to an oscilloscope in analog form for waveform display and storage and delivers it to a computer to perform a Fast Fourier Transform (FFT and convert the pulse sound waveform into a heartbeat frequency. Furthermore, it also uses an audio signal amplifier to deliver the pulse sound by speaker. The study observed the principles of Traditional Chinese Medicine’s pulsing techniques, where pulse signals at places called “cun”, “guan” and “chi” of the left hand were measured during lifting (100 g, searching (125 g and pressing (150 g actions. Because the system collects the vibration sound caused by the pulse, the sensor itself is not affected by the applied pressure, unlike current pulse piezoelectric sensing instruments, therefore, under any kind of pulsing pressure, it displays pulse changes and waveforms with the same accuracy. We provide an acquired pulse and waveform signal suitable for Chinese Medicine practitioners’ objective pulse diagnosis, thus providing a scientific basis for this Traditional Chinese Medicine practice. This study also presents a novel circuit design using an active filtering method. An operational amplifier with its differential features eliminates the interference from external signals, including the instant high-frequency noise. In addition, the system has the advantages of simple circuitry, cheap cost and high precision.

  9. Temporal comparison of ultrasound vs. auscultation and capnography in verification of endotracheal tube placement

    Pfeiffer, P; Rudolph, S S; Neimann, Jens Dupont Børglum;


    This study compared the time consumption of bilateral lung ultrasound with auscultation and capnography for verifying endotracheal intubation.......This study compared the time consumption of bilateral lung ultrasound with auscultation and capnography for verifying endotracheal intubation....

  10. Cardiac auscultation training of medical students: a comparison of electronic sensor-based and acoustic stethoscopes

    Jensen Torstein; Høyte Henning; Gjesdal Knut


    Background To determine whether the use of an electronic, sensor based stethoscope affects the cardiac auscultation skills of undergraduate medical students. Methods Forty eight third year medical students were randomized to use either an electronic stethoscope, or a conventional acoustic stethoscope during clinical auscultation training. After a training period of four months, cardiac auscultation sk...

  11. Auscultation of Velcro Crackles is Associated With Usual Interstitial Pneumonia.

    Sellarés, Jacobo; Hernández-González, Fernanda; Lucena, Carmen M; Paradela, Marina; Brito-Zerón, Pilar; Prieto-González, Sergio; Benegas, Mariana; Cuerpo, Sandra; Espinosa, Gerard; Ramírez, José; Sánchez, Marcelo; Xaubet, Antoni


    Auscultation of Velcro crackles has been proposed as a key finding in physical lung examination in patients with interstitial lung diseases (ILDs), especially in idiopathic pulmonary fibrosis (IPF). However, no studies have been carried out to assess the association of Velcro crackles with other clinical variables.We evaluated a cohort of 132 patients, prospectively and consecutively included in our ILD diagnostic program at a tertiary referral center. All patients were auscultated during the physical examination. The patients were divided into 2 groups: "presence" or "nonpresence" of bilateral Velcro crackles.Of all patients assessed, 83 (63%) presented Velcro crackles in the respiratory auscultation. Patients with Velcro crackles usually had more frequently cough and dyspnea at the moment of diagnosis. Forced vital capacity (P = 0.002) and lung diffusion capacity for carbon monoxide (P = 0.04) was lower in these patients. The ILD-GAP index was higher in the group with Velcro crackles (P = 0.01). All patients with usual interstitial pneumonia (UIP) in high-resolution computed tomography and all patients with final IPF diagnosis presented Velcro crackles. In multivariate analysis, the presence of Velcro crackles was independently associated with an UIP pattern.In patients suspected of having ILD, the auscultation of Velcro crackles was associated with UIP, a possibility which must be taken into consideration in early ILD detection in primary care. PMID:26844464

  12. Digital stethoscope system: the feasibility of cardiac auscultation

    Pariaszewska, Katarzyna; Młyńczak, Marcel; Niewiadomski, Wiktor; Cybulski, Gerard


    The application of the digital stethoscope system is a new tendency in methods of cardiac auscultation. Heart sounds, generated by the fluctuations of blood velocity and vibrations of muscle structure, are an important signal in the primary diagnosis of heart diseases. Since the XIXs century for physical examination an analog stethoscope was used, but the development of microelectronics enable the construction of digital stethoscopes which started modern phonocardiography. The typical hardware of the system could be divided into analog and digital parts, respectively. The first one consists of microphone and pre-amplifier. The second one contains a microcontroller with peripherals for data saving and transmission. Usually the specialized software is applied for the signal acquisition and digital signal processing (filtering, spectral analysis and others). This paper presents an overview of methods used in cardiac auscultation and expected developing path in the future. It also contains the description of our digital stethoscope system, which is planned to be used in poliphysiographical studies.




    Full Text Available AIM OF THE STUDY: To study the effectiveness of intermittent Fetal Heart auscultation in detecting fetal distress and its correlation with Apgar score. STUDY DESIGN: The Study includes 1000 women in labor with live fetuses between 29-40 weeks of gestation. All patients were monitored by intermittent fetal heart auscultation (IA using a stethoscope or a hand held Doppler device. Monitoring was done every 15 min. in the 1st stage of labor and every 5min in the 2nd stage of labor. FHR was counted for at least 1 min. immediately following a contraction and the rate as well as rhythm was noted. Results of fetal monitoring were correlated with the Apgar score of the neonate. PLACE OF STUDY: The study was conducted in the department of Obstetrics and Gynecology, ESI Hospital, Sanathnagar, Hyderabad, A.P. over an 8 month period from May 2013 to December 2013 after taking permission of the ethics committee. RESULT: Out of the 1000 cases, 75 cases were detected to have fetal distress on auscultation (7.5%. At delivery, 16 patients (21.3% of these 75 cases had an Apgar score less than 7. Out of the remaining 925 patients who had no clinical evidence of fetal distress, 6 of them (0.6% delivered a neonate with an Apgar score less than 7. Statistical analysis of this data showed a sensitivity of intermittent auscultation in detecting fetal distress resulting in low Apgar score as 93.7% with a specificity of 74.3%. These results are similar to the published results of continuous Electronic Fetal Monitoring (EFM. CONCLUSION: Detection of fetal distress by IA is not inferior to the more invasive and expensive methods of EFM. In a country like India, where expensive monitoring gadgets are available at only a few centers, IA is an effective alternative.

  14. Combining Simulated Patients and Simulators: Pilot Study of Hybrid Simulation in Teaching Cardiac Auscultation

    Friederichs, Hendrik; Weissenstein, Anne; Ligges, Sandra; Möller, David; Becker, Jan C.; Marschall, Bernhard


    Auscultation torsos are widely used to teach position-dependent heart sounds and murmurs. To provide a more realistic teaching experience, both whole body auscultation mannequins and torsos have been used in clinical examination skills training at the Medical Faculty of the University of Muenster since the winter term of 2008-2009. This training…

  15. The development of a new cardiac auscultation test: How do screening and diagnostic skills differ?

    Nielsen, Tommy; Mølgaard, Henning; Ringsted, Charlotte Vibeke;


    BACKGROUND: Newly qualified doctors are expected to be able to conduct a cardiac auscultation unassisted, but studies show conflicting results regarding cardiac auscultation skills. METHODS: A two-part test instrument was designed containing innovative recordings of heart sounds from patients...

  16. Autonomous detection of heart sound abnormalities using an auscultation jacket.

    Visagie, C; Scheffer, C; Lubbe, W W; Doubell, A F


    This paper presents a study using an auscultation jacket with embedded electronic stethoscopes, and a software classification system capable of differentiating between normal and certain auscultatory abnormalities. The aim of the study is to demonstrate the potential of such a system for semi-automated diagnosis for underserved locations, for instance in rural areas or in developing countries where patients far outnumber the available medical personnel. Using an "auscultation jacket", synchronous data was recorded at multiple chest locations on 31 healthy volunteers and 21 patients with heart pathologies. Electrocardiograms (ECGs) were also recorded simultaneously with phonocardiographic data. Features related to heart pathologies were extracted from the signals and used as input to a feed-forward artificial neural network. The system is able to classify between normal and certain abnormal heart sounds with a sensitivity of 84% and a specificity of 86%. Though the number of training and testing samples presented are limited, the system performed well in differentiating between normal and abnormal heart sounds in the given database of available recordings. The results of this study demonstrate the potential of such a system to be used as a fast and cost-effective screening tool for heart pathologies. PMID:20169844

  17. A High Performance Approach to Improving Auscultation Capability in Noisy Environments Project

    National Aeronautics and Space Administration — Some commercial auscultation devices pick up all sounds without filtering out the background noise. Although the electronic stethoscopes made by 3M and Thinklab...

  18. Carotid Artery Ultrasonographic Assessment in Patients from the Fremantle Diabetes Study Phase II with Carotid Bruits Detected by Electronic Auscultation

    Knapp, Arthur; Cetrullo, Violetta; Sillars, Brett A.; Lenzo, Nat; Davis, Wendy A; Davis, Timothy M. E.


    Background: Electronic auscultation appears superior to acoustic auscultation for identifying hemodynamic abnormalities. The aim of this study was to determine whether carotid bruits detected by electronic stethoscope in patients with diabetes are associated with stenoses and increased carotid intima-medial thickness (CIMT).

  19. Digital auscultation of the uterine artery: a measure of uteroplacental perfusion.

    Riknagel, Diana; Dinesen, Birthe; Zimmermann, Henrik; Farlie, Richard; Schmidt, Samuel; Toft, Egon; Struijk, Johannes Jan


    This observational study investigated digital auscultation for the purpose of assessing the clinical feasibility of monitoring vascular sounds in pregnancy. The study was performed at the Regional Hospital Viborg, Denmark, and included 29 pregnant women, 10 non-pregnant women and 10 male participants. Digital auscultation was performed with an electronic stethoscope bilaterally near the uterine arteries and correlated to the clinical diagnosis of preeclampsia (PE), intrauterine growth restriction (IUGR) or normal pregnancy in the group of pregnant participants. In the group of non-pregnant participants, digital auscultation was performed as control measurements in the same anatomical positions. The auscultations displayed pulse waveforms comprising systolic and diastolic periods in 20 of the 29 pregnant participants. However, in the non-pregnant and male participants, the pulse waveforms were absent. The pulsatile patterns are thus likely to originate from the arteries in relation to the pregnant uterus. In the participants displaying pulse waveforms, the presence of a dicrotic notch appeared with a sensitivity of 89% and a specificity of 100% in the discrimination of normal pregnancies (n  =  11) from pregnancies with PE or IUGR (n  =  9), (p  <  0.001). This preliminary study shows the potential of identifying vascular complications during pregnancy such as preeclampsia and intrauterine growth restriction. The morphology of the derived pulse contour should be investigated and could be further developed to identify pathophysiology. PMID:27328380

  20. Cardiac auscultation training of medical students: a comparison of electronic sensor-based and acoustic stethoscopes

    Jensen Torstein


    Full Text Available Abstract Background To determine whether the use of an electronic, sensor based stethoscope affects the cardiac auscultation skills of undergraduate medical students. Methods Forty eight third year medical students were randomized to use either an electronic stethoscope, or a conventional acoustic stethoscope during clinical auscultation training. After a training period of four months, cardiac auscultation skills were evaluated using four patients with different cardiac murmurs. Two experienced cardiologists determined correct answers. The students completed a questionnaire for each patient. The thirteen questions were weighted according to their relative importance, and a correct answer was credited from one to six points. Results No difference in mean score was found between the two groups (p = 0.65. Grading and characterisation of murmurs and, if present, report of non existing murmurs were also rated. None of these yielded any significant differences between the groups. Conclusion Whether an electronic or a conventional stethoscope was used during training and testing did not affect the students' performance on a cardiac auscultation test.

  1. Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography

    Pfeiffer, P; Bache, Stefan Holst; Isbye, D L;


    Ultrasound (US) may have an emerging role as an adjunct in verification of endotracheal intubation. Obtaining optimal US images in obese patients is generally regarded more difficult than for other patients. This study compared the time consumption of bilateral lung US with auscultation and capno...... capnography for verifying endotracheal intubation in obese patients....

  2. Cardiac auscultation via simulation: a survey of the approach of UK medical schools

    Owen, Samantha Jayne; Wong, Kenneth


    Background A decline in clinical skills of medical students and junior doctors is well documented. We aim to determine how the 32 UK medical schools utilise simulated heart sounds to develop medical students’ cardiac auscultation skills. Methods Representatives of all 32 UK medical schools were contacted with a survey questionnaire. Data analysis was carried out using SPSS. Continuous variables e.g. teaching group size were described using median and interquartile range (IQR). Results 27 Medi...

  3. A computer-aided MFCC-based HMM system for automatic auscultation.

    Chauhan, Sunita; Wang, Ping; Sing Lim, Chu; Anantharaman, V


    Auscultation, the act of listening to the sounds of internal organs, is a valuable medical diagnostic tool. Auscultation methods provide the information about a vast variety of internal body sounds originated by various organs such as heart, lungs, bowel, vascular disorders, etc. In this study, a cardiac sound registration system has been designed incorporating functions such as heart signals segmentation, classification and characterization for automated identification and ease of interpretation by the users. Considering a synergy with the domain of speech analysis, the authors introduced Mel-frequency cepstral coefficient (MFCC) to extract representative features and develop hidden Markov model (HMM) for signal classification. This system was applied to 1381 data sets of real and simulated, normal and abnormal domains. Classification rates for normal and abnormal heart sounds were found to be 95.7% for continuous murmurs, 96.25% for systolic murmurs and 90% for diastolic murmurs by a probabilistic comparison approach. This implies a high potential for the system as a diagnostic aid for primary health-care sectors. PMID:18045582

  4. Barrages et essais en vraie grandeur : auscultation et surveillance

    Bordes, Jean-Louis


    La conception et la réalisation des barrages relèvent de la méthode expérimentale compte tenu de la difficulté à modéliser le corps de l’ouvrage et sa fondation. Le site et la structure qui y est implantée, constituent un laboratoire. La surveillance du comportement pour contrôler la sécurité et améliorer l’économie, s’appuie sur l’observation et l’auscultation par la mesure. On retrace dans cet article, l’histoire de la constitution des outils nécessaires à l’obtention d’une mesure cohérente...

  5. A new automatic blood pressure kit auscultates for accurate reading with a smartphone

    Wu, Hongjun; Wang, Bingjian; Zhu, Xinpu; Chu, Guang; Zhang, Zhi


    Abstract The widely used oscillometric automated blood pressure (BP) monitor was continuously questioned on its accuracy. A novel BP kit named Accutension which adopted Korotkoff auscultation method was then devised. Accutension worked with a miniature microphone, a pressure sensor, and a smartphone. The BP values were automatically displayed on the smartphone screen through the installed App. Data recorded in the phone could be played back and reconfirmed after measurement. They could also be uploaded and saved to the iCloud. The accuracy and consistency of this novel electronic auscultatory sphygmomanometer was preliminarily verified here. Thirty-two subjects were included and 82 qualified readings were obtained. The mean differences ± SD for systolic and diastolic BP readings between Accutension and mercury sphygmomanometer were 0.87 ± 2.86 and −0.94 ± 2.93 mm Hg. Agreements between Accutension and mercury sphygmomanometer were highly significant for systolic (ICC = 0.993, 95% confidence interval (CI): 0.989–0.995) and diastolic (ICC = 0.987, 95% CI: 0.979–0.991). In conclusion, Accutension worked accurately based on our pilot study data. The difference was acceptable. ICC and Bland–Altman plot charts showed good agreements with manual measurements. Systolic readings of Accutension were slightly higher than those of manual measurement, while diastolic readings were slightly lower. One possible reason was that Accutension captured the first and the last korotkoff sound more sensitively than human ear during manual measurement and avoided sound missing, so that it might be more accurate than traditional mercury sphygmomanometer. By documenting and analyzing of variant tendency of BP values, Accutension helps management of hypertension and therefore contributes to the mobile heath service. PMID:27512876

  6. Autonomous auscultation of the human heart employing a precordial electro-phonocardiogram and ensemble empirical mode decomposition.

    Botha, J S F; Scheffer, C; Lubbe, W W; Doubell, A F


    The research presented in this paper serves to provide a tool to autonomously screen for cardiovascular disease in the rural areas of Africa. With this tool, cardiovascular disease can potentially be detected in its initial stages, which is essential for effective treatment. The autonomous auscultation system proposed here utilizes recorded heart sounds and electrocardiogram signals to automatically distinguish between normal and abnormal heart conditions. Patients that are identified as abnormal by the system can then be referred to a specialist consultant, which will save a lot of unnecessary referrals. In this study, heart sound and electrocardiogram signals were recorded with the prototype precordial electro-phonocardiogram device, as part of a clinical study to screen patients for cardiovascular disease. These volunteers consisted of 28 patients with a diagnosed cardiovascular disease and, for control purposes, 34 persons diagnosed with healthy hearts. The proposed system employs wavelets to first denoise the recorded signals, which is then followed by segmentation of heart sounds. Frequency spectrum information was extracted as diagnostic features from the heart sounds by means of ensemble empirical mode decomposition and auto regressive modelling. The respective features were then classified with an ensemble artificial neural network. The performance of the autonomous auscultation system used in concert with the precordial electro-phonocardiogram prototype showed a sensitivity of 82% and a specificity of 88%. These results demonstrate the potential benefit of the precordial electro-phonocardiogram device and the developed autonomous auscultation software as a screening tool in a rural healthcare environment where large numbers of patients are often cared for by a small number of inexperienced medical personnel. PMID:20614209

  7. Intelligent Structured Intermittent Auscultation (ISIA): evaluation of a decision-making framework for fetal heart monitoring of low-risk women

    Maude, Robyn M; Skinner, Joan P; Foureur, Maralyn J


    Background Research-informed fetal monitoring guidelines recommend intermittent auscultation (IA) for fetal heart monitoring for low-risk women. However, the use of cardiotocography (CTG) continues to dominate many institutional maternity settings. Methods A mixed methods intervention study with before and after measurement was undertaken in one secondary level health service to facilitate the implementation of an initiative to encourage the use of IA. The intervention initiative was a decisi...

  8. Intermittent Auscultation in Labor: Could It Be Missing Many Pathological (Late) Fetal Heart Rate Decelerations? Analytical Review and Rationale for Improvement Supported by Clinical Cases.

    Sholapurkar, Shashikant L


    Intermittent auscultation (IA) of fetal heart rate (FHR) is recommended/preferred in low risk labors. Its usage even in developed countries is poised to increase because of perceived benefit of reduction in operative intervention and some disillusionment with the cardiotocography (CTG). Many national guidelines have stipulated regimes (frequency/timing) of IA based on level IV evidence. These tend to get faithfully and exactingly followed. It was observed that deliveries of many unexpectedly asphyxiated infants occurred despite rigorously performed and documented IA compliant with the guidelines. This triggered a reappraisal of the robustness of IA leading to this focused review supplemented by two anonymized cases. It concludes that the current methodology of IA may be flawed in that it poses a risk of missing many or most late (pathological) FHR decelerations, one of the foremost goals of IA. This is because many late decelerations reach their nadir before the end of the contraction. Thus the currently recommended auscultation of FHR for 60 seconds after the contraction by all national guidelines seemed to encompass their "recovery" phase and appeared to be misinterpreted as normal FHR or even as a reassuring accelerative pattern in the clinical practice. A recent recommendation of recording of the FHR as a single figure (rather than a range) does not remedy this anomaly and seems even less informative. It would be better to auscultate FHR before and after the contractions (or contraction to contraction) and take the FHR just before the contraction as the baseline FHR and interpret the FHR after contraction in the context of this baseline. This relatively simple improvement would detect most late FHR decelerations thus ameliorating the risk and significantly enhancing the patient safety. PMID:26566404

  9. Auscultation d'ouvrages avec un capteur géotextile à fibres optiques Earthworks surveillance with a fiber optic sensor-enabled geotextile

    ARTIERES, Olivier ; BRIANÇON, Laurent ; ROBINET, Alain


    Full Text Available Pour évaluer la sécurité d'un ouvrage en terre, il est indispensable de disposer et de pouvoir interpréter des données d'auscultation, mais les mesures sont parfois difficiles à mettre en place et pas toujours fiables sur le long terme. Avec l’insertion de fibres optiques dans un géotextile, la solution TenCate GeoDetect® est le premier système d'auscultation conçu spécifiquement pour les applications géotechniques. Implantée depuis huit ans avec succès sur de nombreux ouvrages, elle permet d’accéder à des informations jusqu’ici très difficiles à obtenir et ceci avec une grande précision.The monitoring solution is based on geotextile and fibre optics composite sensors, to measure both strain and temperature. It is very accurate as the detection thresholds are respectively lower than 0.02 % and 0.1°C, either on localized works or on long linear infrastructures of several tens of kilometres. It is now used for more than 6 years on several walls, embankments on piles or over potential cavities, basins, landfills and dykes.

  10. Dental auscultation for nursing personnel as a model of oral health care education: development, baseline, and 6-month follow-up assessments.

    Wårdh, Inger; Berggren, Ulf; Hallberg, Lillemor R M; Andersson, Lars; Sörensen, Stefan


    Oral health care has been shown to have low priority in nursing and has been only partly successful. To create more positive effects than those achieved through traditional oral health care education, this project tested an educational model for nursing staff personnel. In addition to traditional oral health care education, some of the nursing staff members passed an additional dental auscultation period and served as oral care aides. The aides were responsible for the oral health care of the residents at their nursing facilities (intervention group). The intervention nursing facilities were compared with facilities where nursing personnel only received a traditional oral health care education program. Assessments were made at baseline and at a 6-month follow-up. At follow-up it was shown that the nursing staff in the intervention group gave higher priority to the oral health care work than the nursing staff in the control group. PMID:11905448

  11. O uso da ausculta cervical na inferência de aspiração traqueal em crianças com paralisia cerebral The use of cervical auscultation in tracheal aspiration in children with cerebral palsy

    Ana Maria Furkim


    Full Text Available OBJETIVO: comparar a detectabilidade da ausculta cervical na avaliação clínica com a comprovação da aspiração na videofluoroscopia da deglutição em crianças com paralisia cerebral tetraparética espástica com disfagia orofaríngea. MÉTODOS: estudo retrospectivo com análise de 101 prontuários de crianças, na faixa etária de 1 a 12 anos, pertencentes a uma instituição, com diagnóstico de paralisia cerebral tetraparética espástica e que foram encaminhadas e avaliadas por equipe interdisciplinar. Foi realizada anamnese com avaliação clínica da alimentação com ausculta cervical e videofluoroscopia da deglutição. RESULTADOS: os resultados estatísticos mostraram que há relação significante entre a ausculta cervical positiva e a penetração ou aspiração laríngea constatada na videofluoroscopia da deglutição e que a ausculta cervical negativa está mais associada à não penetração/aspiração. CONCLUSÃO: concluiu-se que a ausculta cervical pode ser utilizada para inferência do risco de aspiração e, portanto, como alerta para atuação precoce nessa população, além da vantagem de ser um método não invasivo.PURPOSE: to compare the efficacy of cervical auscultation during the clinical evaluation with the confirmation of aspiration in the videofluoroscopy of deglutition in oropharyngeal dysphagic children with tetraparetic cerebral palsy. METHODS: retrospective study with analysis of 101 notes of children, between 1 and 12-year old, enrolled in one institution, with the diagnosis of cerebral palsy spastic quadriplegia and referred and evaluated by interdisciplinary team. Clinical history, clinical evaluation of feeding with cervical auscultation and videofluoroscopy of deglutition were performed. RESULTS: the statistical results showed significance between positive cervical auscultation and laryngeal penetration or aspiration during the videofluoroscopy of deglutition and a negative cervical auscultation is

  12. Non-invasive automatic blood pressure measurement with equivalent auscultation%等效听诊法无创自动测量血压计的提出

    解良勤; 刘彦刚


    介绍两种无创自动测量血压计—听诊法(又称柯氏音法)血压计和示波法(又称振荡法)血压计的工作原理,指出导致测量准确度不理想的原因。通过仔细观察传统听诊器法水银血压计测量血压的过程,发现伴随着柯氏音响的同时,水银柱会抖动。可根据水银柱第一次抖动和最后一次抖动确定收缩压和舒张压的现象,认真分析提出了准确度能大幅提高的等效听诊法无创自动测量血压计。指出在现有示波法无创自动测量血压计的基础上,实现等效听诊法无创自动测量血压计,不仅完全可行,而且非常简易。%In this paper, the authors described the existing two non-invasive automatic methods for blood pressure measurements of auscultation blood pressure measurement and oscillography blood pressure measurement and explored the cause for its inaccurate measurement. Through the observation of measuring the blood pressure with tradition mercury blood pressure measurement process, we found that mercury wobbled with sound. According to the first jitter sure systolic blood pressure and the last time jitter sure diastolic blood pressure, we concluded that we can greatly improve the accuracy of non-invasive automatic measure blood pressure measurement with equivalent auscultation. Based on the existing methods, non-invasive automatic measure blood pressure measurement with equivalent auscultation is simple and feasible.

  13. ACTENA : Auscultation des cables tendus non accessibles : programme de recherche national supporté par l'Agence National de la Recherche et par Electricité de France : Rapport scientifique final

    Chazelas, Jean Louis; FORTIER, Stéphane; Abraham, Odile; BAYLASSAC, Jean Paul; BENMEDAKHENE, Salim; BOURSE, Gérard; FRACHELET, Franck; CHAIX, Jean François; COMELOUP, Gilles; Cottineau, Louis Marie; DEFER, Didier; Degauque, Pierre; Deschamps, Marc; GAILLET, Laurent; Garnier, Vincent


    Le programme de recherches ACTENA visait à ouvrir de nouvelles approches et à développer différentes méthodes d'auscultation non destructives des câbles tendus non accessibles dans le génie civil, essentiellement les câbles de précontrainte et les câbles d'ancrage des murs de soutènement. Le diagnostic de la pérennité de la précontrainte appelle deux réponses : la force de tension est-elle pérenne ? les ruptures passées ou en cours dans le câble réduisent-elle gravement les coefficients de sé...

  14. Changes of Volitionally Swallowing Sounds Detected by Cervical Auscultation among Healthy Youth%利用颈部听诊法对健康青年人自主控制吞咽时吞咽音变化的分析

    张庆苏; 柴本勇


    目的 利用颈部听诊法分析健康青年人在自主控制吞咽时吞咽音的参数变化.方法 37名健康青年志愿者分别进行3ml和10 ml水的吞咽,吞咽方式设定为用力吞咽、正常吞咽以及轻吞咽,利用颈部听诊技术采取志愿者的吞咽声,并将采取的声音进行电脑声学参数分析,主要选择吞咽音间期(SSD)、平均吞咽音振幅(ASA)和平均声谱频率(MSF)3个参数数据,对不同吞咽方式下以及不同水容量下的吞咽音进行比较.结果 用力吞咽时MSF高于其他两种吞咽方式(P<0.05);10 ml水吞咽时SSD、ASA和MSF均明显高于3 ml水吞咽(P<0.01).结论 健康人对吞咽动作进行主动控制时,吞咽声音的频率体现健康青年人对吞咽方式主动控制的变化,下咽液体容量变化时吞咽声音的声音间期、平均频率以及平均振幅均发生变化.%Objective To analyze the change of swallowing sounds in healthy youth by cervical auscultation (CA). Methods 37 young volunteers swallowed 3 ml and 10 ml water respectively by forced swallowing (FS), normal swallowing (NS) and soft swallowing (SS), the swallowing sounds were collected by CA, and the swallowing sound duration (SSD), average swallowing sound amplitude (ASA) and mean swallowing sound spectral frequency (MSF) were compared among different swallowing ways and water volumes. Results MSF was higher in FS than in NS and SS (P<0.05). All the indexes were significantly higher in 10 ml water than in 3 ml water (P<0.01). Conclusion Healthy swallowing sound recorded by CA can be volitionally controlled by the healthy individual consciousness in swallowing ways and the liquid volumes. SSD, ASA and MSF of the swallowing sound increase with water volume.

  15. Accuracy of abdominal auscultation for bowel obstruction

    Breum, Birger Michael; Rud, Bo; Kirkegaard, Thomas; Nordentoft, Tyge


    AIM: To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction. METHODS: Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann(®) Electronic Stethoscope. The recordings were processed...

  16. A construção de um software educativo sobre ausculta dos sons respiratórios La construcción de un software educativo sobre la auscultación de los sonidos respiratórios Building an educational software about the auscultation of breathing sounds

    Francisca Nellie de Paula Melo


    Full Text Available O estudo objetivou relatar a experiência da construção de um software educativo sobre a ausculta dos sons respiratórios. Nesse processo, aplicou-se o referencial pedagógico de Lev Semenovic Vygotsky, e delimitou-se o conteúdo de modo a abarcar o método da ausculta passo a passo, as finalidades, a classificação dos sons normais e adventícios e as respectivas características estetoacústicas. Para o desenvolvimento do sistema, foi utilizada a tecnologia 3D, incluindo avatares (personificações virtuais do paciente, do enfermeiro e dos objetos e ambiente virtual para a ausculta, usando procedimentos de simulação. Ao final do processo, concluiu-se que iniciativas dessa natureza, embora sejam permeadas de dificuldades, trazem contribuições importantes ao ensino-aprendizagem de conteúdos relativos à área da Enfermagem.En este estudio se tuvo como objetivo relatar la experiencia de la construcción de un software educativo sobre la auscultación de los sonidos respiratorios. En ese proceso, se aplicó el referencial pedagógico de Lev Semenovic Vygotsky y se delimitó el contenido de modo a abarcar el método de la auscultación paso a paso, las finalidades, la clasificación de los sonidos normales y casuales y las respectivas características estetoacústicas. Para el desarrollo del sistema, fue utilizada la tecnología 3D, incluyendo avatares (personificaciones virtuales del paciente, del enfermero y de los objetos y ambiente virtual para la auscultación, usando procedimientos de simulación. Al final del proceso, se concluyó que iniciativas de esa naturaleza, aún con dificultades presentes, traen contribuciones importantes para la enseñanza-aprendizaje de contenidos relativos al área de la Enfermería.The aim of this study was to discuss the experience of building an educational software about the auscultation of breathing sounds. In the process, Lev Semenovic Vygotsky's pedagogic theoretical framework was used, and the

  17. Nouvelles: KEK: B pour BELLE; NA48 mesure la violation directe de CP; LEL: le laser à électrons libres dépasse le kilowatt; Le LEP à 100 pour 100; Tour d'honneur au RHIC; Mesures de précision; Etude sur les modes de gestion du village planétaire; Conférence PANIC99 à Uppsala; Rencontre électron-noyau à HERA; LPP, Doubna célèbre une décennie; Les physiciens auscultent le photon; Aimants chauds venus du froid


    Nouvelles: KEK: B pour BELLE; NA48 mesure la violation directe de CP; LEL: le laser à électrons libres dépasse le kilowatt; Le LEP à 100 pour 100; Tour d'honneur au RHIC; Mesures de précision; Etude sur les modes de gestion du village planétaire; Conférence PANIC99 à Uppsala; Rencontre électron-noyau à HERA; LPP, Doubna célèbre une décennie; Les physiciens auscultent le photon; Aimants chauds venus du froid

  18. Application of Laser Doppler Vibrometery for human heart auscultation.

    Koegelenberg, S; Scheffer, C; Blanckenberg, M M; Doubell, A F


    In this study the potential of a Laser Doppler Vibrometer (LDV) was tested as a non-contact sensor for the classification of heart sounds. Of the twenty participants recorded using the LDV, five presented with Aortic Stenosis (AS), three were healthy and twelve presented with other pathologies. The recorded heart sounds were denoised and segmented using a combination of the Electrocardiogram (ECG) data and the complexity of the signal. Frequency domain features were extracted from the segmented heart sound cycles and used to train a K-nearest neighbor classifier. Due to the small number of participants, the classifier could not be trained to differentiate between normal and abnormal participants, but could successfully distinguish between participants who presented with AS and those who did not. A sensitivity of 80 % and a specificity of 100 % were achieved a test dataset. PMID:25570986

  19. Crackle analysis for chest auscultation and comparison with high-resolution CT findings

    The purpose of our study was to clarify the correlation between respiratory sounds and the high-resolution CT (HRCT) findings of lung diseases. Respiratory sounds were recorded using a stethoscope in 41 patients with crackles. All had undergone inspiratory and expiratory CT. Subjects included 18 patients with interstitial pneumonia and 23 without interstitial pneumonia. Two parameters, two-cycle duration (2CD) and initial deflection width (IDW) of the ''crackle,'' were induced by time-expanded waveform analysis. Two radiologists independently assessed 11 HRCT findings. An evaluation was carried out to determine whether there was a significant difference in the two parameters between the presence and absence of each HRCT finding. The two parameters of crackles were significantly shorter in the interstitial pneumonia group than the non-interstitial pneumonia group. Ground-glass opacity, honeycombing, lung volume reduction, traction bronchiectasis, centrilobular nodules, emphysematous change, and attenuation and volume change between inspiratory and expiratory CT were correlated with one or two parameters in all patients, whereas the other three findings were not. Among the interstitial pneumonia group, traction bronchiectasis, emphysematous change, and attenuation and volume change between inspiratory and expiratory CT were significantly correlated with one or two parameters. Abnormal respiratory sounds were correlated with some HRCT findings. (author)

  20. Use of tracheal auscultation for the assessment of bronchial responsiveness in asthmatic children

    Sprikkelman, AB; Grol, MH; Lourens, MS; Gerritsen, J; Heymans, HSA; vanAalderen, WMC


    Background - It can be difficult to assess bronchial responsiveness in children because of their inability to perform spirometric tests reliably. In bronchial challenges lung sounds could be used to detect the required 20% fall in the forced expiratory volume in one second (FEV(1)). A study was unde

  1. Agreement between spirometry and tracheal auscultation in assessing bronchial responsiveness in asthmatic children

    Sprikkelman, AB; Schouten, JP; Lourens, MS; Heymans, HSA; van Aalderen, WMC


    We have recently found that changes in lung sounds correspond well with a 20% fall in the forced expiratory volume in 1 s (FEV1) after methacholine challenge in asthmatic children. Up to now, little was known about the agreement between a 20% fall in FEV1 and a change in lung sounds after repeated b

  2. Auscultation des barrages en beton par ecoute microsismique: Detectabilite et localisation des evenements

    Giroux, Bernard

    The aging of dams leads to their degradation and is therefore a threat to normal operation, and is potentially dangerous. Ideally, a method continuously monitoring the majority of the structure would help considerably the management of operations. The feasibility of such a technique is the topic of this thesis. The principle underlying the proposed method is to listen to microseismic events generated by the cracking of the concrete dam. A method based on this principle is used to detect and attempt to predict rockbursts in the mining industry. The method procedure is the following: given a sensor network distributed over a dam, one wishes to detect the microseismic events emitted by structure cracking, to locate the source in space and time, and ultimately to characterize the stress field causing the emission. The seismic quality factor Q is usually used to quantify attenuation. Presented is a technique to reduce the noise bias in the calculation of the amplitude spectrum ratio. The results so obtained show a Q factor of order ranging from 5 to 10. A new method using genetic algorithms is presented to evaluate Q and the coupling jointly. According to our results, sensor coupling varies from 0,2 to 0,8. The corresponding Q factor attains a value of 60. Also, the ambient noise level must be known in order to establish from which distance the seismic energy can be measured. Reference RMS values of 10-5 m/s for velocity and 10-1 m/s 2 for acceleration are used as an upper limit for the computation of a so-called "critical detection radius". Thirdly, the seismic responses of circular cracks having areas of 0,01, 0,1 and 1,0 m2 were computed for a model equivalent to the Carillon Dam, for Q values varying from 5 to 100. Considering that an adequate coupling can be obtained (equivalent to Q = 50) and that a signal to noise ratio of 100 allows for the detection of the seismic signal, one can expect to detect an event caused by a 0,01 m 2 defect at a distance of 25 m. In the second part of this work, a method for locating the seismic sources based on the joint hypocenter-velocity inversion of traveltime data is presented. The inversion method relies on raytrace forward modeling. This method was tested and implemented in the inversion code. Finally, tests with synthetic data were conducted to assess the performance of the inversion program. The results show that an accurate location is achieved with about ten sensors, provided that some sensors are placed at the upstream base of the structure, the remainder being on the crest and downstream side of the dam. (Abstract shortened by UMI.)

  3. Contribution a l'auscultation des chaussees mixtes par methodes GPR et electrique

    Kaouane, Carole

    Quebec's infrastructures are ageing. A reliable, quick and economical assessment of the state of urban roads would help to plan civil engineering. This M.Sc. thesis aims to investigate and develop the potential of Ground Penetrating Radar (GPR) and electrical methods to assess pavement condition subject to wetting, freezing and drying cycles. The objectives are to display defects and estimate water content in the materials used for the mixed pavement construction; these consist in layers of asphalt (top), concrete (middle) and grade and sub-grade (bottom). Prior studies showed a valuable potential of joint application of GPR and electrical resistivity to assess mixed pavement condition. These studies were mainly based on numerical modeling and some site tests using both methods. It was concluded that a better evaluation of the potential of the coupled methods would come from the assessment of physical properties and validation from geotechnical evidences. At first, we characterized the context. Structural defects and water content implied modification of physical properties of road materials. After running numerical modeling, we carried out an experiment in one of the streets in Montreal (Canada) where pavement needed complete rehabilitation. GPR surveys were carried out before the pavement was destroyed and removed, and subsequently a resistivity imaging was carried out on the subgrade layer. We also sampled blocks of asphalt and concrete along the street from the demolition rubble in order to study their physical properties in the lab. Soil samples were taken from trenches to measure water content. The grade and sub-grade were mainly a mix of clayey-silt and gravel, as the embedding ground is grey clay. We measured the complex dielectric constants of asphalt and concrete in the range 50 MHz-900 MHz with a recently developed dielectric probe sampling a volume of 30 cm3. Resistivity measurements were also performed on large cores of asphalt and concrete using an inhouse system. Measurements were carried out on dry and wet samples, which provided a range of values encompassing the climatic conditions for the whole year. Finally the physical property and geotechnical data were used as input to numerical modeling and the modeled responses compared to the survey data. The predicted data fit nicely with the observed data. This work aims to provide further information for a better calibration of geophysical devices in pavement condition assessment. Moreover, it gives a wide range of information, which could become a base for further and more specific works.

  4. The Validation of an Interactive Videodisc as an Alternative to Traditional Teaching Techniques: Auscultation of the Heart.

    Branck, Charles E.; And Others


    This study of 87 veterinary medical students at Auburn University tests the effectiveness and student acceptance of interactive videodisc as an alternative to animal experimentation and other traditional teaching methods in analyzing canine cardiovascular sounds. Results of the questionnaire used are presented, and benefits of interactive video…

  5. Comment vieillissent les géofiltres ? Auscultation du dispositif expérimental de Roissard Geofilters ageing – Monitoring of Roissard expérimental draining trenches

    FAURE, Yves-Henri ; VERSTAEVEL, Matthieu ; MERIAUX, Patrice ; VEYLON, Guillaume ; BARTHE, Matthieu ; BERTRAND, Cécile


    Full Text Available Les risques liés au vieillissement des géotextiles-filtres utilisés dans les ouvrages de drainage sont un enjeu majeur pour l’ingénierie des glissements de terrain et des ouvrages hydrauliques. Le projet DrainAgeing vise à mieux comprendre les phénomènes de vieillissement par colmatage de ces matériaux afin de mieux les prévenir et de formuler des recommandations pour les concepteurs et gestionnaires d’ouvrages.Risks related to geofilters ageing used in drainage are very important in the context of landslides stabilization engineering and dams and dikes design. “DrainAgeing” research project aims to a better understanding and prevention of drains ageing and clogging. This paper is about the state of progress of the project and the results of 18 years monitoring of Roissard experimental draining trenches. We conclude about the excavation and the analysis of geotextiles and geomaterials recently performed within the context of the second phase of the project.

  6. The electronic stethoscope

    Leng, Shuang; Tan, Ru San; Chai, Kevin Tshun Chuan; Wang, Chao; Ghista, Dhanjoo; Zhong, Liang


    Most heart diseases are associated with and reflected by the sounds that the heart produces. Heart auscultation, defined as listening to the heart sound, has been a very important method for the early diagnosis of cardiac dysfunction. Traditional auscultation requires substantial clinical experience and good listening skills. The emergence of the electronic stethoscope has paved the way for a new field of computer-aided auscultation. This article provides an in-depth study of (1) the electron...

  7. Training auscultatory skills: computer simulated heart sounds or additional bedside training? A randomized trial on third-year medical students

    Solheim Svein


    Full Text Available Abstract Background The present study compares the value of additional use of computer simulated heart sounds, to conventional bedside auscultation training, on the cardiac auscultation skills of 3rd year medical students at Oslo University Medical School. Methods In addition to their usual curriculum courses, groups of seven students each were randomized to receive four hours of additional auscultation training either employing a computer simulator system or adding on more conventional bedside training. Cardiac auscultation skills were afterwards tested using live patients. Each student gave a written description of the auscultation findings in four selected patients, and was rewarded from 0-10 points for each patient. Differences between the two study groups were evaluated using student's t-test. Results At the auscultation test no significant difference in mean score was found between the students who had used additional computer based sound simulation compared to additional bedside training. Conclusions Students at an early stage of their cardiology training demonstrated equal performance of cardiac auscultation whether they had received an additional short auscultation course based on computer simulated training, or had had additional bedside training.

  8. Combination Of The Non-Destructive Methods For Evaluating The Quality Of Concrete Used In Structures In Reinforced Concrete

    Mr. R. OBAD


    Full Text Available The study is aboutthe use and comparison of three non-destructive methods (dynamic auscultation, sclerometric auscultation and auscultation by RADAR (Radio Detecting and Ranging to monitor and assess the quality of concrete. Samples of reinforced concrete panels, dimensions 200x100x30 cm of concrete dosed at 350 kg/m3 with diverse E/C ratio were achieved, conserved in the laboratory and subjected to various non-destructive test. The synthesis of the results obtained by auscultation RADAR shows a decrease in the propagation speed of the electromagnetic wave with an increase of the E/C ratio and a decrease in resistance of concrete values measured and confirmed by other non-destructive techniques (sclerometric and dynamic auscultations. This shows that more the dielectric constant is high, morethe concrete resistance is reduced, and conversely the opposite.

  9. Rene Theophile Hyacinthe Laënnec (1781–1826): The Man Behind the Stethoscope

    Roguin, Ariel


    Rene Theophile Hyacinthe Laënnec (1781–1826) was a French physician who, in 1816, invented the stethoscope. Using this new instrument, he investigated the sounds made by the heart and lungs and determined that his diagnoses were supported by the observations made during autopsies. Laënnec later published the first seminal work on the use of listening to body sounds, De L’auscultation Mediate (On Mediate Auscultation). Laënnec is considered the father of clinical auscultation and wrote the fir...

  10. Laser Stethoscope for Use in Noisy Spacecraft Environments Project

    National Aeronautics and Space Administration — Auscultation, or listening to internal sounds made by the body of a patient, is an important tool in medical diagnostics. Heart, lung, intestine, and circulatory...

  11. Breath sounds

    The lung sounds are best heard with a stethoscope. This is called auscultation. Normal lung sounds occur ... the bottom of the rib cage. Using a stethoscope, the doctor may hear normal breathing sounds, decreased ...

  12. The stethoscope: some preliminary investigations

    Welsby, P; Parry, G; Smith, D.


    Textbooks, clinicians, and medical teachers differ as to whether the stethoscope bell or diaphragm should be used for auscultating respiratory sounds at the chest wall. Logic and our results suggest that stethoscope diaphragms are more appropriate.

  13. Abdominal sounds

    ... sounds by listening to the abdomen with a stethoscope ( auscultation ). Most bowel sounds are normal. However, there ... sounds can sometimes be heard even without a stethoscope. Hyperactive bowel sounds mean there is an increase ...

  14. Echo-free renal masses on ultrasound: the stethoscope as an adjunct to their diagnosis.

    Suarez, R; Lynn, A. H.


    A patient with an intrarenal arteriovenous malformation is described. Ultrasound suggested this to be a renal cyst but auscultation revealed a loud bruit and, on the basis of this, arteriography rather than cyst puncture was carried out.

  15. A novel murmur-based heart sound feature extraction technique using envelope-morphological analysis

    Yao, Hao-Dong; Ma, Jia-Li; Fu, Bin-Bin; Wang, Hai-Yang; Dong, Ming-Chui


    Auscultation of heart sound (HS) signals serves as an important primary approach to diagnose cardiovascular diseases (CVDs) for centuries. Confronting the intrinsic drawbacks of traditional HS auscultation, computer-aided automatic HS auscultation based on feature extraction technique has witnessed explosive development. Yet, most existing HS feature extraction methods adopt acoustic or time-frequency features which exhibit poor relationship with diagnostic information, thus restricting the performance of further interpretation and analysis. Tackling such a bottleneck problem, this paper innovatively proposes a novel murmur-based HS feature extraction method since murmurs contain massive pathological information and are regarded as the first indications of pathological occurrences of heart valves. Adapting discrete wavelet transform (DWT) and Shannon envelope, the envelope-morphological characteristics of murmurs are obtained and three features are extracted accordingly. Validated by discriminating normal HS and 5 various abnormal HS signals with extracted features, the proposed method provides an attractive candidate in automatic HS auscultation.

  16. Instructional Multiple Binaural Stethoscope

    Catalina C. Platon


    The stethoscope is an acoustic medical device for auscultation where human ear plays significant part. Long before doctors practiced immediate auscultation meaning placing ear directly on patient’s body by Salinsky (1990), then monaural introduced by Laennec; later binaural, Comins’s invention and Cammann developed further. Several decades numerous innovations made predominantly over chestpiece some had drawbacks. Dr Littman introduced teaching stethoscope with two headset and ...

  17. A decision tree – based method for the differential diagnosis of Aortic Stenosis from Mitral Regurgitation using heart sounds

    Loukis Euripides N; Stasis Antonis CH; Pavlopoulos Sotiris A


    Abstract Background New technologies like echocardiography, color Doppler, CT, and MRI provide more direct and accurate evidence of heart disease than heart auscultation. However, these modalities are costly, large in size and operationally complex and therefore are not suitable for use in rural areas, in homecare and generally in primary healthcare set-ups. Furthermore the majority of internal medicine and cardiology training programs underestimate the value of cardiac auscultation and junio...

  18. Stethoscopes with hearing aid use: Case studies

    Jacob, Regina Tangerino de Souza


    Full Text Available Introduction: Description for using stethoscopes adapted to hearing aids. Aim: To describe the adaptation of HAs to stethoscopes used by 2 students in the health field with bilateral hearing impairment. Case reports: Two subjects with hearing loss had their stethoscopes coupled to HAs because of the individual requirements of their professions (healthcare to perform auscultation. Conclusion: The improvement was measured in situ, and satisfaction was evaluated using a subjective questionnaire. The use of a stethoscope coupled to an HA allowed students with hearing loss to perform auscultation.

  19. Phonocardiography Signal Processing

    Abbas, Abbas K


    The auscultation method is an important diagnostic indicator for hemodynamic anomalies. Heart sound classification and analysis play an important role in the auscultative diagnosis. The term phonocardiography refers to the tracing technique of heart sounds and the recording of cardiac acoustics vibration by means of a microphone-transducer. Therefore, understanding the nature and source of this signal is important to give us a tendency for developing a competent tool for further analysis and processing, in order to enhance and optimize cardiac clinical diagnostic approach. This book gives the

  20. Swallowing sounds in speech therapy practice: a critical analysis of the literature.

    Ferrucci, Juliana Lopes; Mangilli, Laura Davison; Sassi, Fernanda Chiarion; Limongi, Suelly Cecilia Olivan; Andrade, Claudia Regina Furquim de


    This study aimed to investigate international scientific papers published on the subject of cervical auscultation and its use in speech therapy. The study involved a qualitative review of the literature spanning the last 10 years. Articles were selected from the PubMed database using the following keywords: cervical auscultation, swallowing and swallowing disorders. Research was included that was conducted on adult humans (over 18 years of age) and was written in English. Each citation retrieved from the database was analyzed independently by each of the study researchers to ascertain its relevance for inclusion in the study. The methodology involved formulating the research question, locating and selecting studies and critically evaluating the articles according to the precepts of the Cochrane Handbook. As a result, 35 studies were identified; 13 articles were analyzed because they allowed access to the full text and were related directly to the subject. We found that the studies were performed with groups of healthy subjects and subjects with different types of base pathology. Some studies compared the patterns found in the different groups. Some of the research sought to study the pattern of swallowing sounds with different factors - evaluator experience, the specificity and sensitivity of the method and how to improve the technique of cervical auscultation through the use of instruments other than the stethoscope. The conclusion of this critical analysis is that cervical auscultation is an important tool to be used in conjunction with other assessment methods in the routine clinical evaluation of swallowing. PMID:24488399

  1. On the blind recovery of cardiac and respiratory sounds

    Shah, Ghafoor; Koch, Peter; Papadias, Constantinos B.


    We present a method for smart auscultation by proposing a novel blind recovery of the original cardiac and respiratory sounds from a single observation mixture, in the framework of non-negative matrix factorization (NMF). The method learns the basis spectra of the mixing sources in unsupervised or...

  2. Tongue diagnosis in the treatment of patients with schizophrenia: Differentiation of patterns and ideas for future research

    Bosch, M.P.C.; Scholten, M.; Groetelaers, L.; Küppenbender, N.; Noort, M.W.M.L. van den


    In TCM, the diagnostic process consists of inspection, auscultation and olfaction, inquiry and palpation. Part of this diagnostic process is the study of the tongue. After careful consideration of all diagnostic information, the treatment points are chosen. During a research project on TCM treatment

  3. Sports and Marfan Syndrome: Awareness and Early Diagnosis Can Prevent Sudden Death.

    Salim, Mubadda A.; Alpert, Bruce S.


    Physicians who work with athletes play an important role in preventing sudden death related to physical activity in people who have Marfan syndrome. Flagging those who have the physical stigmata and listening for certain cardiac auscultation sounds are early diagnostic keys that can help prevent deaths. People with Marfan syndrome should be…

  4. Vocal cord dysfunction diagnosis may be improved by a screening check list

    Lucia Helena Eduardo Pinto


    Conclusions: A finding of wheezing or stridor on auscultation of the cervical region is suggestive of vocal cord dysfunction, especially in elderly patients, and such dysfunction can be confirmed through laryngoscopy. Our VCD screening check list proved to be useful in the screening of VCD among patients with severe asthma.

  5. The electronic stethoscope.

    Leng, Shuang; Tan, Ru San; Chai, Kevin Tshun Chuan; Wang, Chao; Ghista, Dhanjoo; Zhong, Liang


    Most heart diseases are associated with and reflected by the sounds that the heart produces. Heart auscultation, defined as listening to the heart sound, has been a very important method for the early diagnosis of cardiac dysfunction. Traditional auscultation requires substantial clinical experience and good listening skills. The emergence of the electronic stethoscope has paved the way for a new field of computer-aided auscultation. This article provides an in-depth study of (1) the electronic stethoscope technology, and (2) the methodology for diagnosis of cardiac disorders based on computer-aided auscultation. The paper is based on a comprehensive review of (1) literature articles, (2) market (state-of-the-art) products, and (3) smartphone stethoscope apps. It covers in depth every key component of the computer-aided system with electronic stethoscope, from sensor design, front-end circuitry, denoising algorithm, heart sound segmentation, to the final machine learning techniques. Our intent is to provide an informative and illustrative presentation of the electronic stethoscope, which is valuable and beneficial to academics, researchers and engineers in the technical field, as well as to medical professionals to facilitate its use clinically. The paper provides the technological and medical basis for the development and commercialization of a real-time integrated heart sound detection, acquisition and quantification system. PMID:26159433

  6. Treatment of patent ductus arteriosus by the use of an Amplatz canine ductal occluder device.

    White, Pam


    A 7-month-old female, spayed border collie was referred to the Ontario Veterinary College due to a continuous murmur noted by the referring veterinarian prior to ovariohysterectomy. Auscultation confirmed a grade VI/VI continuous murmur. An echocardiogram confirmed patent ductus arteriosus (PDA). An Amplatz canine ductal occluder device was successfully placed for occlusion of blood flow though the ductus. PMID:19436449

  7. Factors Associated with Severe Leptospirosis, Martinique, 2010-2013.

    Hochedez, Patrick; Theodose, Rafaelle; Olive, Claude; Bourhy, Pascale; Hurtrel, Guillaume; Vignier, Nicolas; Mehdaoui, Hossein; Valentino, Ruddy; Martinez, Roland; Delord, Jean-Marie; Herrmann, Cécile; Lamaury, Isabelle; Césaire, Raymond; Picardeau, Mathieu; Cabié, André


    To identify factors associated with disease severity, we examined 102 patients with quantitative PCR-confirmed leptospirosis in Martinique during 2010-2013. Associated factors were hypotension, chest auscultation abnormalities, icterus, oligo/anuria, thrombocytopenia, prothrombin time <68%, high levels of leptospiremia, and infection with L. interrogans serovar Icterohaemorrhagiae/Copenhageni. PMID:26583702

  8. Development of a tele-stethoscope and its application in pediatric cardiology.

    Hedayioglu, F L; Mattos, S S; Moser, L; de Lima, M E


    Over the years, many attempts have been made to develop special stethoscopes for the teaching of auscultation. The objective of this article is to report on the experience with the development and implementation of an electronic stethoscope and a virtual library of cardiac sounds. There were four stages to this project: (1) the building of the prototype to acquire, filter and amplify the cardiac sounds, (2) the development of a software program to record, reproduce and visualize them, (3) the testing of the prototype in a clinical scenario, and (4) the development of an internet site, to store and display the sounds collected. The first two stages are now complete. The prototype underwent an initial evaluation in a clinical scenario within the Unit and during virtual out-patient clinical sessions. One hundred auscultations were recorded during these tests. They were reviewed and discussed on-line by a panel of experience cardiologists during the sessions. Although the sounds were considered "satisfactory" for diagnostic purposes by the cardiology team, they identified some qualitative differences in the electronic recorded auscultations, such as a higher pitch of the recorded sounds. Prospective clinical studies are now being conducted to further evaluate the interference of the electronic device in the physicians' capability to diagnose different cardiac conditions. An internet site ( auscultaped) was developed to host these cardiac auscultations. It is set as a library of cardiac sounds, catalogued by pathologies and already contains examples from auscultations of the majority of common congenital heart lesions, such as septal defects and valvar lesions. PMID:17249332

  9. Stethoscope vs. ultrasound probe - which is more reliable in children with suspected pneumonia?

    Jovan Lovrenski


    Full Text Available Objective. To compare lung ultrasound (LUS with auscultation findings in children with clinical suspicion of pneumonia. Patients and methods. A prospective study including 95 patients (age: from 2 months to 17.5 years; mean age: 5.1 y, SD 4.5 y with referral diagnosis of suspected pneumonia. In all patients LUS and auscultatory examinations were performed within an hour. These findings were compared separately in each hemithorax. The radiologist performing LUS was blinded to the patient’s clinical information. Positive auscultatory findings included: crackles and/or abnormal breath sounds (decreased, asymmetric, absent, or bronchial. For LUS examinations a combined transthoracic – transabdominal approach was used. A pneumonia-positive LUS finding included subpleural consolidation with air-bronchogram, or an adjacent area of interstitial edema. For each subpleural consolidation the cranio-caudal (CC diameter was measured, and 95% confidence intervals (CI of the sizes of subpleural consolidations for positive and negative auscultatory findings were compared. The p-value between LUS and auscultation was calculated using McNemar’s test. Results. LUS and auscultation showed pneumonia-positive findings in 98 and 64 hemithoraces, i.e. in 67 and 45 patients respectively. In positive auscultatory findings the CI for CC diameters of subpleural consolidations ranged from 32.46 to 54.14 mm, and in negative auscultatory findings the CI was between 16.52 and 29.83 mm, which showed a statistically significant difference. McNemar’s test showed a statistically significant difference between LUS and auscultation. Conclusions. LUS showed positive findings in more hemithoraces than auscultation in children with suspected pneumonia. A cranio-caudal size of subpleural consolidation of less than 30 mm significantly reduces the possibility of auscultatory detection.

  10. A Signal Processing Technique for Heart Murmur Extraction and Classification Using Fuzzy Logic Controller

    M.S. Ahmad


    Full Text Available The aim of this study is to present a system which uses a new signal processing technique for extracting and identifying different types of systolic and diastolic heart murmurs as well as normal heart sound, depending on their relevant energies and frequencies values. Heart auscultation is one of the most commonly method that cardiologists used to examine the heart murmurs. In order to overcome the deficiency of cardiologists for heart auscultation the numbers of signal processing techniques have been introduced, such as ECG (Electrocardiography, MRI (Magnetic Resonance Imaging and CT-Skin etc. The system uses the wav heart sound samples taking from Littman 3M electronic stethoscope and based on Fuzzy controller. The system reveals important information of cardiovascular disorders and can assist general physician to come up with more accurate and reliable diagnosis at early stages.

  11. Looking is not seeing and listening is not hearing: effect of an intervention to enhance auditory skills of graduate-entry nursing students.

    Pellico, Linda Honan; Duffy, Thomas C; Fennie, Kristopher P; Swan, Katharine A


    Inspection/observation and listening/auscultation are essential skills for health care providers. Given that observational and auditory skills take time to perfect, there is concern about accelerated students' ability to attain proficiency in a timely manner. This article describes the impact of music auditory training (MAT) for nursing students in an accelerated master's entry program on their competence in detecting heart, lung, and bowel sounds. During the first semester, a two-hour MAT session with focused attention on pitch, timbre, rhythm, and masking was held for the intervention group; a control group received traditional instruction only. Students in the music intervention group demonstrated significant improvement in hearing bowel, heart, and lung sounds (p effect of an adult-oriented, creative, yet practical method for teaching auscultation. PMID:22916626

  12. A study of heart sound and lung sound separation by independent component analysis technique.

    Chien, Jen-Chien; Huang, Ming-Chuan; Lin, Yue-Der; Chong, Fok-ching


    In the hospital, using percussion and auscultation are the most common ways for physical examination. Recently, in order to develop tele-medicine and home care system and to assist physician getting better auscultation results; electric stethoscope and computer analysis have become an inevitable trend. However, two important physical signals heart sound and lung sound recorded from chest overlap on spectrum chart. Therefore, in order to reduce human factor (ex. misplace or untrained of using) and minimize correlated effect in computer analysis; it's necessary for separated heart sound and lung sound. Independent component analysis can divide these sounds efficiency. In this paper, we use two microphones to collect signals from left and right chest. We have successfully divide heart and lung sounds by fast ICA algorithm. Therefore, it can assist physician examine and also using on tele-medicine and home care by this way. PMID:17945913

  13. Subcutaneous Emphysema and Pneumomediastinum after Inhaling Pepper Spray

    Woussen, Sofie; Lemmerling, Marc; Verstraeten, André


    A 25-year-old police officer presented to the emergency department with shortness of breath developed after multiple exposures to pepper spray during training exercises. Physical examination revealed crepitus on palpation and auscultation in the neck, face and thorax, consistent with subcutaneous emphysema. The patient was hemodynamically stable. Blood tests showed no abnormalities. The anteroposterior (AP) chest radiograph (Fig. A) demonstrated diffuse subcutaneous emphysema (solid white arr...

  14. Clinical - cardiologic data of 170 dogs - general aspects of diagnosis and therapy

    The paper presents an actual continuous cardiologic follow up study on 170 unselected dogs. Each proband underwent a complete cardiologic examination (history, auscultation, ECG, radiologic examination, in some cases also echocardiography). Data were grouped by age, sex, breed, congenital and acquired cardiac diseases, and by therapy. 81 (47.65 percent) of the 170 dogs were suffering from an acquired, 25 (14.70 percent) from a congenital cardiac disease. 64 dogs (37.65 percent) showedno clinical signs of heart disease

  15. Auditory Verbal Cues Alter the Perceived Flavor of Beverages and Ease of Swallowing: A Psychometric and Electrophysiological Analysis

    Aya Nakamura; Satoshi Imaizumi


    We investigated the possible effects of auditory verbal cues on flavor perception and swallow physiology for younger and elder participants. Apple juice, aojiru (grass) juice, and water were ingested with or without auditory verbal cues. Flavor perception and ease of swallowing were measured using a visual analog scale and swallow physiology by surface electromyography and cervical auscultation. The auditory verbal cues had significant positive effects on flavor and ease of swallowing as well...

  16. Myxoid liposarcoma of the mediastinum: a case report and review of the literature; Lipossarcoma mixoide de mediastino: relato de caso e revisao da literatura

    Escuissato, Dante L. [Parana Univ., Curitiba, PR (Brazil). Dept. de Clinica Medica]. E-mail:; Adam, Guilherme P.; Gasparetto, Emerson L.; Urban, Linei A.B.D. [Parana Univ., Curitiba, PR (Brazil). Hospital de Clinicas. Servico de Radiologia Medica e Diagnostico por Imagem; Benites Filho, Paulo R. [Parana Univ., Curitiba, PR (Brazil). Faculdade de Medicina; Sakamoto, Daniele [Parana Univ., Curitiba, PR (Brazil). Hospital de Clinicas. Servico de Anatomia Patologica; Marchiori, Edson [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Inst. Biomedico. Dept. de Radiologia


    Mediastinal neoplasms of mesenchymal origin are rare, accounting for less than 6% of these tumors. Most of these tumors are liposarcomas, although cystic lesions are uncommon. The authors present a case of a 58-year-old woman with progressively worsening dyspnoea since she was 52-years-old. Laryngeal stridor was auscultable and a chest CT scan showed a cystic lesion in the posterior mediastinum. The tumor was resected and the histological examination revealed myxoid liposarcoma. (author)

  17. Monitorování stavu plodu během porodu porodní asistentkou

    Svobodová, Jana


    This bachelor thesis deals with the fetal health monitoring performed by a midwife during childbirth. The thesis is divided into two parts: theoretical and practical application. In the theoretical part I study the history of the fetal monitoring, compare the methods of the monitoring that were used in the past and I also present the development of the methods that are applied these days. The next chapter is focused on the auscultation of the heart sound, using stethoscope. Despite its limita...

  18. Abnormal movement of the arytenoid region as a cause of upper airway obstruction.

    Nagai, A.; Kanemura, T; Konno, K.


    A 75 year old woman presented with a three week history of severe dyspnoea and cough. Auscultation and spirometry suggested extrathoracic inspiratory airway obstruction, and bronchoscopy showed abnormal motion of the arytenoid region (supraglottic area), causing upper airway obstruction only during forced inspiratory efforts. Sedatives improved the symptoms within a week. It is suggested that reversible malfunction of the arytenoid region can be responsible for upper airway obstruction.

  19. Serum marker KL-6/MUC1 for the diagnosis and management of interstitial pneumonitis

    Kohno, Nobuoki


    Interstitial pneumonitis includes more than a hundred diseases in which alveolitis is the main manifestation of the affected lung. Symptoms such as dry cough and exertional dyspnea, fine crackles on chest auscultation, interstitial infiltrates on chest X-ray films and CT scans, respiratory function tests, and Ga-67 scintigraphy have been used for the diagnosis and the evaluation of disease activity. However, the poor prognosis of some types of interstitial pneumonitis has not been improved . ...

  20. Heart murmurs recorded by a sensor based electronic stethoscope and e-mailed for remote assessment

    Wren, C; Dahl, L.; Hasvold, P; Arild, E; Hasvold, T.


    Background: Heart murmurs are common in children, and they are often referred to a specialist for examination. A clinically innocent murmur does not need further investigation. The referral area of the University Hospital is large and sparsely populated. A new service for remote auscultation (telemedicine) of heart murmurs in children was established where heart sounds and short texts were sent as an attachment to e-mails.


    Güraksin, Gür Emre


    Listening with stethoscope is a preferential method that the doctors use in order to differentiate normal cardiac systems from the abnormal ones that come out. On the other hand, listening with stethoscope has a number of constraints. The interpretation of these various heart sounds depends on doctor's ability of hearing, experience and skill. Because of the problems that can be faced, listening process with stethoscope, that is auscultation, falls behind in the search of the heart abnormalit...

  2. Comparison of Two Digital Stethoscopes with the Traditional Stethoscope Used on International Space Station

    Rasbury, Jack; Bascal, Kira; Ownby, Matt; McCulley, Phyllis; Paul, Bonnie


    A traditional stethoscope is currently flown on the International Space Station (ISS). The background noise on the ISS is much higher than a normal exam room, and the literature shows that traditional stethoscopes are unable to function effectively in high noise environments. Digital stethoscopes provide amplification which improves the audibility in a quiet environment. This study is designed to determine if digital stethoscopes offer any advantage over traditional stethoscopes in being able to identify normal and abnormal sounds in the ISS noise environment. Methods: An ISS noise simulation facility was created to reproduce ISS noise profiles by modifying pink noise with a software-based graphic equalizer. The files were played in a continuous loop on a computer, amplified through a high-end stereo system and adjusted using a sound level meter. Nine caregiver analogues were given the same auscultation lesson received by astronauts. They began testing by becoming familiar with normal and abnormal sounds on a Student Auscultation Manikin . They then used two digital stethoscopes and a traditional stethoscope identical to the one flown on the ISS to auscultate the manikin sounds in the noise facility. They identified the sounds on a questionnaire and picked which of the three stethoscopes they preferred. Results: Evaluators displayed equivalent accuracy in sound identification when using either the 3M model 4000 digital stethoscope or traditional stethoscope. However, the 3M was preferred 2 to 1 by the evaluators, primarily because of additional amplification of the sounds. Discussion: Although our results show that the current ISS stethoscope and the "best-of-breed" digital stethoscope provide essentially the same auscultation utility, the latter has the advantage of recording and transmitting sounds to a remote physician. Since the astronaut caregivers are non-physiCians, this capability may be worth the additional expense and effort needed to certify the digital

  3. Examining Interrater Reliability and Validity of a Paediatric Cardiopulmonary Physiotherapy Discharge Tool

    Lati, Jamil; Pellow, Vanessa; Sproule, Jeannine; Brooks, Dina; Ellerton, Cindy


    Purpose: To determine the interrater reliability (IRR) of the individual items in the Paediatric Cardiopulmonary Physiotherapy (CPT) Discharge Tool. This tool identifies six critical items that physiotherapists should consider when determining a paediatric patient's readiness for discharge from CPT after upper-abdominal, cardiac, or thoracic surgery: oxygen saturation, mobility, secretion retention, discharge planning, auscultation, and signs of respiratory distress. Methods: A total of 33 pa...

  4. Arteriovenous Fistula in the Orbit of a Calf

    Lamb, Christopher R.; Naylor, Jonathan M.


    An Ayrshire calf with a protruding left eye and a fluctuant swelling dorsal to the orbit was examined. A diagnosis of arteriovenous fistula was made based on the findings of pulsation, a palpable thrill and a machinery-like bruit on auscultation over the swelling. Arteriography failed to outline the full extent of the fistula. The calf was euthanized and the fistula dissected. An enlarged superficial temporal artery communicated with a branch of the maxillary vein by way of a tortuous mass of...

  5. Detection of Heart Diseases by Mathematical Artificial Intelligence Algorithm Using Phonocardiogram Signals

    D. Prakash; T. Uma Mageshwari; K. Prabakaran; A. Suguna


    An artificial intelligence (AI) algorithm has been developed using Mathematical formula to diagnose heart disease from Phonocardiogram (PCG) signals. Auscultation, the technique of listening to heart sounds with a stethoscope can be used as a primary detection technique for detecting heart disorders for the past years. But now the Phonocardiogram, the digital recording of heart sounds is becoming very popular technique as it is relatively inexpensive. Four amplitude parameters of the PCG sign...

  6. Nonlinear phonocardiographic Signal Processing

    Ahlström, Christer


    The aim of this thesis work has been to develop signal analysis methods for a computerized cardiac auscultation system, the intelligent stethoscope. In particular, the work focuses on classification and interpretation of features derived from the phonocardiographic (PCG) signal by using advanced signal processing techniques. The PCG signal is traditionally analyzed and characterized by morphological properties in the time domain, by spectral properties in the frequency domain or by nonstation...

  7. 028. Migratory pneumonia—cryptogenic organizing pneumonia (COP)

    Lagoudi, Kalliopi; Ioannidou, Despoina; Papadaki, Elena; Organtzis, Ioannis; Kostanta, Soultana; Papaioannou, Antonis; Moumtzi, Despoina; Porpodis, Konstantinos; Fouka, Evaggelia


    In this study were presented the clinical and laboratory findings of eight patients with migratory pneumonia, who were hospitalised in our clinic. It is about eight women with average age of 58±13 years with fever, weakness, dry cough, shortness of breath and who already had received antibiotics. Crackles were the most frequent evidence by the auscultation. All patients showed consolidation in chest radiography which resolved completely from the initial area and migrated in different areas. T...

  8. Mounier-Kuhn Syndrome

    Schiettecatte, E.; Hedent, E Van; Van Herreweghe, R; Verstraete, K


    Background: A 38-year-old male with no medical history complains about hemoptysis, chest pain, dyspnea on exertion and a cough. He has a history of occasional smoking, but had quitted smoking 1 year previously. There is a normal saturation and normal spirometry. Clinical examination and auscultation are also normal. Because of these complaints CT scan of the thorax was performed. For further diagnostic workup bronchoscopy was performed afterwards.

  9. Popliteal Artery Pseudoaneurysm Following Primary Total Knee Arthroplasty

    Shin, Young-Soo; Hwang, Yeok-Gu; Savale, Abhijit Prakash; Han, Seung-Beom


    An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty. The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation. In the present report, we describe popliteal artery pseudo...

  10. Prehospital determination of tracheal tube placement in severe head injury

    Grmec, S; Mally, S


    Methods: All adult patients (>18 years) with severe head injury, maxillofacial injury with need of protection of airway, or polytrauma were intubated by an emergency physician in the field. Tube position was initially evaluated by auscultation. Then, capnometry and capnography was performed (infrared method). Emergency physicians evaluated capnogram and partial pressure of end tidal carbon dioxide (EtCO2) in millimetres of mercury. Determination of final tube placement was performed by a seco...

  11. Tissue-Informative Mechanism for Wearable Non-invasive Continuous Blood Pressure Monitoring

    Woo, Sung Hun; Choi, Yun Young; Kim, Dae Jung; Bien, Franklin; Kim, Jae Joon


    Accurate continuous direct measurement of the blood pressure is currently available thru direct invasive methods via intravascular needles, and is mostly limited to use during surgical procedures or in the intensive care unit (ICU). Non-invasive methods that are mostly based on auscultation or cuff oscillometric principles do provide relatively accurate measurement of blood pressure. However, they mostly involve physical inconveniences such as pressure or stress on the human body. Here, we in...

  12. Bronchospasm in obese patients undergoing elective laparoscopic surgery under general anesthesia

    Tassoudis, Vassilios; Ieropoulos, Hronis; Karanikolas, Menelaos; Vretzakis, George; Bouzia, Aik; Mantoudis, Elias; Petsiti, Argyro


    Background Existing data suggest that obesity correlates with airway hyper-reactivity. However, the incidence of bronchospasm during bariatric surgery in obese patients has not been well studied. Methods This was a prospective observational study comparing 50 obese versus 50 non obese patients undergoing elective laparoscopic surgery over a 2 year period. Bronchospasm was detected clinically by auscultation and was confirmed by measuring peak airway pressure during mechanical ventilation. Blo...

  13. Frequency shifting approach towards textual transcription of heartbeat sounds

    Safar Khorasani Ehsan; Doraisamy Shyamala; Arvin Farshad


    Abstract Auscultation is an approach for diagnosing many cardiovascular problems. Automatic analysis of heartbeat sounds and extraction of its audio features can assist physicians towards diagnosing diseases. Textual transcription allows recording a continuous heart sound stream using a text format which can be stored in very small memory in comparison with other audio formats. In addition, a text-based data allows applying indexing and searching techniques to access to the critical events. H...

  14. Cardiac abnormalities in the fragile X syndrome.

    Sreeram, N.; WREN, C.; Bhate, M; Robertson, P.; Hunter, S


    Twenty three patients with fragile X syndrome underwent cardiovascular assessment. Echocardiography showed dilatation of the aortic root in 12 (52%) and mitral valve prolapse in five (22%), four of whom had an apical mid-systolic click on auscultation. Patients with fragile X syndrome have cardiac defects similar to those seen in other disorders of connective tissue such as Marfan's syndrome and Ehlers-Danlos syndrome. These, and other somatic features, suggest an underlying connective tissue...

  15. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by Emergency Department Ultrasound

    Wendler, Carlan; Shoenberger, Jan Marie; Mailhot, Thomas; Perera, Phillips


    A 57-year-old man presented to our emergency department with altered mental status. He had a past medical history significant for cirrhosis and previous placement of a transjugular intrahepatic portosystemic shunt (TIPS). On cardiac auscultation, a new heart murmur and an unexpected degree of cardiac ectopy were noted. On the 12-lead electrocardiogram, the patient was noted to have multiple premature atrial contractions, corroborating the irregular heart rhythm on physicalexam. A focused beds...

  16. Visualization of Heart Sounds and Motion Using Multichannel Sensor

    Nogata, Fumio; Yokota, Yasunari; Kawamura, Yoko


    As there are various difficulties associated with auscultation techniques, we have devised a technique for visualizing heart motion in order to assist in the understanding of heartbeat for both doctors and patients. Auscultatory sounds were first visualized using FFT and Wavelet analysis to visualize heart sounds. Next, to show global and simultaneous heart motions, a new technique for visualization was established. The visualization system consists of a 64-channel unit (63 acceleration sensors and one ECG sensor) and a signal/image analysis unit. The acceleration sensors were arranged in a square array (8×8) with a 20-mm pitch interval, which was adhered to the chest surface. The heart motion of one cycle was visualized at a sampling frequency of 3 kHz and quantization of 12 bits. The visualized results showed a typical waveform motion of the strong pressure shock due to closing tricuspid valve and mitral valve of the cardiac apex (first sound), and the closing aortic and pulmonic valve (second sound) in sequence. To overcome difficulties in auscultation, the system can be applied to the detection of heart disease and to the digital database management of the auscultation examination in medical areas.

  17. Consumer information on fetal heart rate monitoring during labor: a content analysis: a content analysis.

    Torres, Jennifer; De Vries, Raymond; Low, Lisa Kane


    Electronic fetal monitoring (EFM) is used for the majority of births that occur in the United States. While there are indications for use of EFM for women with high-risk pregnancies, its use in low-risk pregnancies is less evidence-based. In low-risk women, the use of EFM is associated with an increased risk for cesarean birth compared with the use of intermittent auscultation of the fetal heart rate. The purpose of this investigation was to evaluate the existence of evidence-based information on fetal heart rate monitoring in popular consumer-focused maternity books and Web sites. Content analysis of information in consumer-oriented Web sites and books was completed using the NVivo software (QRSinternational, Melbourne, Australia). Themes identified included lack of clear terminology when discussing fetal monitoring, use of broad categories such as low risk and high risk, limited presentation of information about intermittent auscultation, and presentation of EFM as the standard of care, particularly upon admission into the labor unit. More than one-third of the sources did not mention auscultation, and conflicting information about monitoring methods was presented. The availability of accurate, publically accessible information offers consumers the opportunity to translate knowledge into the power to seek evidence-based care practices during their maternity care experience. PMID:24781772




    Full Text Available AIM This study evaluates the usefulness of intrapartum cardiotocography in patients with post-dated pregnancy compared to intermittent auscultation. MATERIALS AND METHODS 100 patients with pregnancies beyond EDD and with no other risk factors were included in the study; 50 patients who underwent CTG on admission into labour ward formed the study group and 50 patients who underwent intermittent auscultation formed the control group. Antenatal foetal monitoring namely daily foetal movement count, twice-weekly non-stress test with amniotic fluid assessment and Doppler velocimetry using ultrasound were done in all patients until the onset of labour. Labour was induced whenever NST was non-reassuring or ultrasound showed oligohydramnios. Partogram was used to monitor the course of labour. RESULTS The foetal outcome was better in the study group than in the control group with fewer depressed babies. Cardiotocography had a positive predictive value of 36 36% and a negative predictive value of 94.04% with a P value of 0.010. CONCLUSION Cardiotocography is definitely superior to intermittent auscultation in intrapartum foetal monitoring. Despite the high number of false positives, CTG predicts the outcome of labour in every patient and especially in cases with prolonged pregnancy it serves as a valuable screening tool to pick up those cases that may be compromised by the events of labour.

  19. An open real-time tele-stethoscopy system

    Foche-Perez Ignacio


    Full Text Available Abstract Background Acute respiratory infections are the leading cause of childhood mortality. The lack of physicians in rural areas of developing countries makes difficult their correct diagnosis and treatment. The staff of rural health facilities (health-care technicians may not be qualified to distinguish respiratory diseases by auscultation. For this reason, the goal of this project is the development of a tele-stethoscopy system that allows a physician to receive real-time cardio-respiratory sounds from a remote auscultation, as well as video images showing where the technician is placing the stethoscope on the patient’s body. Methods A real-time wireless stethoscopy system was designed. The initial requirements were: 1 The system must send audio and video synchronously over IP networks, not requiring an Internet connection; 2 It must preserve the quality of cardiorespiratory sounds, allowing to adapt the binaural pieces and the chestpiece of standard stethoscopes, and; 3 Cardiorespiratory sounds should be recordable at both sides of the communication. In order to verify the diagnostic capacity of the system, a clinical validation with eight specialists has been designed. In a preliminary test, twelve patients have been auscultated by all the physicians using the tele-stethoscopy system, versus a local auscultation using traditional stethoscope. The system must allow listen the cardiac (systolic and diastolic murmurs, gallop sound, arrhythmias and respiratory (rhonchi, rales and crepitations, wheeze, diminished and bronchial breath sounds, pleural friction rub sounds. Results The design, development and initial validation of the real-time wireless tele-stethoscopy system are described in detail. The system was conceived from scratch as open-source, low-cost and designed in such a way that many universities and small local companies in developing countries may manufacture it. Only free open-source software has been used in order to

  20. Má percepção da limitação aos fluxos aéreos em pacientes com asma moderada a grave Poor perception of airflow limitation in patients with moderate to severe asthma



    Full Text Available Introdução: Este estudo avaliou a percepção da obstrução das vias aéreas em pacientes ambulatoriais com asma moderada a grave e a capacidade da ausculta torácica em identificar a limitação aos fluxos aéreos. Métodos: Trinta e três pacientes foram avaliados em sete visitas semanais usando escores de sintomas por meio de escala visual analógica de sintomas (EVAS, 0-100mm, índice clínico de hiper-reatividade brônquica (1-10, a classificação clínica de gravidade da asma (GINA, 1-4 e um escore de ausculta torácica (EAT, 0-5, espirometria e pico de fluxo expiratório (PFE, que foram correlacionados por meio do coeficiente de Spearman. Os pacientes foram classificados como percebedores (--1 £ r Background: This study evaluated the perception of airway obstruction in moderate to severely asthmatic outpatients and the efficiency of chest auscultation in identifying airflow limitation. Methods: 33 subjects were evaluated at seven weekly visits by using symptoms scores determined by visual analogue scales (VAS, 0-100 mm, a clinical index of bronchial hyperreactivity (1-10, the clinical classification of asthma severity (GINA, 1-4 and a thoracic auscultation score (TAS, 0-5, spirometry and peak expiratory flow (PEF, which were correlated by the coefficient of Spearman. Patients were classified as perceivers (--1 <= r < 0 or nonperceivers (0 <= r <= 1 by correlations between VAS for dyspnoea and FEV1. A correlation between auscultation and bronchial obstruction was considered accurate when a r <= --0.5 (TAS vs. FEV1 was found. Results: Seventeen asthmatic patients (51.5% did not accurately perceive the degree of their airways obstruction (nonperceivers. No clinical characteristics distinguished the groups. Only 39.4% of the individual correlations between TAS and FEV1 indicated accurate discrimination by auscultation. Severe asthma was not associated with inaccurate auscultation nor with malperception in this study. Conclusions: A

  1. Comparing the auscultatory accuracy of health care professionals using three different brands of stethoscopes on a simulator

    Mehmood M


    Full Text Available Mansoor Mehmood,1 Hazem L Abu Grara,1 Joshua S Stewart,2 Faisal A Khasawneh3 1Department of Internal Medicine, Texas Tech University Health Sciences Center, 2Surgical Intensive Care Unit, Northwest Texas Hospital, 3Section of Infectious Diseases, Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA Background: It is considered standard practice to use disposable or patient-dedicated stethoscopes to prevent cross-contamination between patients in contact precautions and others in their vicinity. The literature offers very little information regarding the quality of currently used stethoscopes. This study assessed the fidelity with which acoustics were perceived by a broad range of health care professionals using three brands of stethoscopes. Methods: This prospective study used a simulation center and volunteer health care professionals to test the sound quality offered by three brands of commonly used stethoscopes. The volunteer's proficiency in identifying five basic ausculatory sounds (wheezing, stridor, crackles, holosystolic murmur, and hyperdynamic bowel sounds was tested, as well. Results: A total of 84 health care professionals (ten attending physicians, 35 resident physicians, and 39 intensive care unit [ICU] nurses participated in the study. The higher-end stethoscope was more reliable than lower-end stethoscopes in facilitating the diagnosis of the auscultatory sounds, especially stridor and crackles. Our volunteers detected all tested sounds correctly in about 69% of cases. As expected, attending physicians performed the best, followed by resident physicians and subsequently ICU nurses. Neither years of experience nor background noise seemed to affect performance. Postgraduate training continues to offer very little to improve our trainees' auscultation skills. Conclusion: The results of this study indicate that using low-end stethoscopes to care for patients in contact precautions could

  2. CT pulmonay angiography features of a hepatopulmonary syndrome

    Chawla, Ashish; Gaikwad, Vishai; Dubey, Niraj; Bosco, Jerome [Dept. of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore (Singapore)


    A 59-year-old man presented a six-month history of worsening dyspnea and dry cough, and not responding to medication. There was no history of fever, hematemesis, loss of appetite, or chest pain. Physical examination revealed peripheral cyanosis and clubbing. Bibasilar crepitations were present but no murmur was auscultated. Platypnea (worsening of dyspnea in a standing position) was present. Arterial gas analysis showed a PaO2 of 52 mm when breathing ambient room air. Laboratory findings were significant for a mildly abnormal liver function test.

  3. Severe IgG4-Related Disease in a Young Child: A Diagnosis Challenge

    Susana Corujeira; Catarina Ferraz; Teresa Nunes; Elsa Fonseca; Luísa Guedes Vaz


    Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized syndrome that can appear with multiple organ involvement, typically with tumor-like swelling, lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, and elevated serum IgG4 concentrations. We report the case of a 22-month-old female child with failure to thrive and recurrent respiratory tract infections since 8 months of age. Physical examination was normal except for pulmonary auscultation with bilateral crac...

  4. [Sonography in pleural effusion of horses].

    Stadtbäumer, G


    Pleural effusion in the horse can be caused by diseases such as pneumonia, trauma, pulmonary abscesses and thoracic neoplasms. Besides clinical (auscultation, percussion) and radiographic diagnostic procedures, the ultrasonic examination represents a method that supplies detailed information on quantity and location of fluid in the pleural space. By means of ultrasonic examination the most favourable position for a thoracentesis can be determined. Control of thoracentesis' efficiency as well as exact supervision of the disease's course are made feasible by repeated sonographic examinations. PMID:2694447

  5. Dispne Etyolojisinde Nadiren Karşılaşılan Bir Etken: TİMİK KİST



    A are etiologic factor for dyspnea: thymic cyst l/ A 55 year old woman was admitted our emergency service with dyspneic respiration. She had a complaint of dyspnea for 3 years and it was increased during the last week. On physical examination there was cyanosis around mouth and on the tongue, tachypnea with 44 respiration counts per minute, by auscultation a stridor on the tracheal area, 100 heart rate per minute. On PA thorax roentgenogram an opacity was seen in the upper mediastinum whic...

  6. Pre-term Spontaneous Unscarred Uterine Rupture; A Case Report and Review

    Shima Sheybani


    Case:The case we intend to present is a multigravid woman (G3L2 in 28th week of gestation with an unscarred uterus. She had cardiac surgery six months earlier Atrial Septal Defect (ASD device closure with Percutaneous Coronary Intervention (PCI. She presented with severe dyspnea, diminished lung sounds in the right lower zone, chest pain at rest, and radiating pain to her right shoulder from 12 hours earlier. No FHR was detected by auscultation with Doppler. She had generalized abdominal tenderness and rebound tenderness.

  7. Opphavet til og distribusjonen av normale lungelyder


    The intension of this work was to investigate what conclusions we can make from a normal lung auscultation; where has the normal lung sound its origin and what anatomic and mechanic factors affect its transport from its site of origin to the chest wall? To do this I extracted the essence in a selection of articles found by a search in Medline on the keywords “lung sound”, “respiratory sounds” and “auscultation”. The text includes a mechanical understanding of sound production and transport, ...

  8. Complete atrio-ventricular septal defect and Wolf-Parkinson-White syndrome

    Gudrun Björkhem


    Full Text Available A full term female infant was born after 41 weeks of gestation, with a birth weight of 3815g and normal Apgar scores (9-10-10. Immediately after birth tachycardia was noted. An electrocardiogram (ECG showed a heart rate of 300 beats per minute (bpm and narrow QRS complexes. The newborn was clinically stable. She was admitted to the neonatal intensive care unite and an intravenous line was inserted for treatment with Adenosine. While preparing for Adenosine infusion her heart rate spontaneously decreased. Her ECG at presentation with normal heart rate is shown in figure1a. On auscultation, a soft systolic murmur was heard.

  9. Transient mitral regurgitation: An adjunctive sign of myocardial ischemia during dipyridamole-thallium imaging

    Lette, J.; Gagnon, A.; Lapointe, J.; Cerino, M.


    A patient developed transient exacerbation of a mitral insufficiency murmur and a reversible posterior wall perfusion defect during dipyridamole-thallium imaging. Coronary angiography showed significant stenoses of both the right and the circumflex coronary arteries that supply the posterior papillary muscle. Cardiac auscultation for transient mitral incompetence, a sign of reversible papillary muscle dysfunction, is a simple and practical adjunctive test for myocardial ischemia during dipyridamole-thallium imaging. It may confirm that an isolated reversible posterior wall myocardial perfusion defect is truly ischemic in nature as opposed to an artifact resulting from attenuation by the diaphragm.

  10. Transient mitral regurgitation: An adjunctive sign of myocardial ischemia during dipyridamole-thallium imaging

    A patient developed transient exacerbation of a mitral insufficiency murmur and a reversible posterior wall perfusion defect during dipyridamole-thallium imaging. Coronary angiography showed significant stenoses of both the right and the circumflex coronary arteries that supply the posterior papillary muscle. Cardiac auscultation for transient mitral incompetence, a sign of reversible papillary muscle dysfunction, is a simple and practical adjunctive test for myocardial ischemia during dipyridamole-thallium imaging. It may confirm that an isolated reversible posterior wall myocardial perfusion defect is truly ischemic in nature as opposed to an artifact resulting from attenuation by the diaphragm

  11. Tele-cardiology.

    Molefi, M; Fortuin, J; Wynchank, S


    After defining tele-medicine, we describe its situation in the public health service of South Africa and its application to cardiology. Methods of communication relevant to tele-cardiology are outlined, together with their bearing on primary healthcare. The range of tele-cardiological applications to electrocardiology, echocardiology, auscultation, imaging and pathology are indicated. Tele-cardiology's contributions to a range of cardiological problems and types of management are described briefly. Finally, a mention is made of the relevance of tele-medicine to education and the costs related to cardiology, with an indication of some future needs for tele-cardiology. PMID:16547558

  12. Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration

    de Medeiros, Gisele Chagas; Sassi, Fernanda Chiarion; Zambom, Lucas Santos; de Andrade, Claudia Regina Furquim


    Objective: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. Methods: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). Results: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. Conclusions: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment.

  13. The Generation and Propagation of Arterial Murmurs from a Stenosed Artery: A Computational Study

    Zhu, Chi; Seo, Jung-Hee; Bakhshaee, Hani; Mittal, Rajat


    Cardiac auscultation - the procedure of diagnosing cardiovascular conditions using the stethoscope - has been used effectively for over a hundred years but still, the flow mechanism(s) responsible for the generation of these murmurs, as well as the effect of intervening tissue on the propagation of these murmurs, is not well understood. In this study, a one-way coupled, hybrid approach is used to investigate the propagation of murmurs generated from the flow in a stenosed artery. Specifically, the flow in the modeled artery is solved by an incompressible Navier-Stokes solver with the immersed-boundary method. The structural wave propagation in the tissue is resolved by a high-order, linear viscoelastic wave solver, and a mathematical decomposition is applied to separate the compressional and shear component of the acoustic wave propagating through the tissue. The simulations suggest, somewhat counterintuitively, that the shear wave contributes a significant component to the signal picked up by a stethoscope, and that this component carries much of the information that characterizes the source of the murmur. The implications of this for cardiac auscultation and further modeling of hemoacoustics are discussed. The effect of the stenosis severity and the flow pulsatility will also be investigated. The authors would like to acknowledge the SCH for funding this project.

  14. Fluid Dynamics of the Generation and Transmission of Heart Sounds: (2): Direct Simulation using a Coupled Hemo-Elastodynamic Method

    Seo, Jung-Hee; Bakhshaee, Hani; Zhu, Chi; Mittal, Rajat


    Patterns of blood flow associated with abnormal heart conditions generate characteristic sounds that can be measured on the chest surface using a stethoscope. This technique of `cardiac auscultation' has been used effectively for over a hundred years to diagnose heart conditions, but the mechanisms that generate heart sounds, as well as the physics of sound transmission through the thorax, are not well understood. Here we present a new computational method for simulating the physics of heart murmur generation and transmission and use it to simulate the murmurs associated with a modeled aortic stenosis. The flow in the model aorta is simulated by the incompressible Navier-Stokes equations and the three-dimensional elastic wave generation and propagation on the surrounding viscoelastic structure are solved with a high-order finite difference method in the time domain. The simulation results are compared with experimental measurements and show good agreement. The present study confirms that the pressure fluctuations on the vessel wall are the source of these heart murmurs, and both compression and shear waves likely plan an important role in cardiac auscultation. Supported by the NSF Grants IOS-1124804 and IIS-1344772, Computational resource by XSEDE NSF grant TG-CTS100002.

  15. Perception of binary acoustic events associated with the first heart sound

    Spodick, D. H.


    The resolving power of the auditory apparatus permits discrete vibrations associated with cardiac activity to be perceived as one or more events. Irrespective of the vibratory combinations recorded by conventional phonocardiography, in normal adults and in most adult patients auscultators tend to discriminate only two discrete events associated with the first heart sound S1. It is stressed that the heart sound S4 may be present when a binary acoustic event associated with S1 occurs in the sequence 'low pitched sound preceding high pitched sound', i.e., its components are perceived by auscultation as 'dull-sharp'. The question of S4 audibility arises in those individuals, normal and diseased, in whom the major components of S1 ought to be, at least clinically, at their customary high pitch and indeed on the PCG appear as high frequency oscillations. It is revealed that the apparent audibility of recorded S4 is not related to P-R interval, P-S4 interval, or relative amplitude of S4. The significant S4-LFC (low frequency component of S1) differences can be related to acoustic modification of the early component of S1.

  16. Instructional Multiple Binaural Stethoscope

    Catalina C. Platon


    Full Text Available The stethoscope is an acoustic medical device for auscultation where human ear plays significant part. Long before doctors practiced immediate auscultation meaning placing ear directly on patient’s body by Salinsky (1990, then monaural introduced by Laennec; later binaural, Comins’s invention and Cammann developed further. Several decades numerous innovations made predominantly over chestpiece some had drawbacks. Dr Littman introduced teaching stethoscope with two headset and researcher utilized as prior art.Experimental research method used and the study aimed to determine accuracy and measurement of speed of the device in terms of systolic and diastolic blood pressure and acceptability of user. The subjects were 19 clients and 27 nursing students, government /private registered nurses. The device are comparable to single binaural stethoscope in accuracy performance; speed of sound, former is slightly higher than the latter but still considered as normal; the device are acceptable to users; the utility model have no significant difference in accuracy performance and speed measurements of systolic and diastolic. The utility model may be tried in any acoustic activities and may be pilot tested to the Universities animal science courses, veterinary medicine other Colleges of Nursing and all health allied courses.

  17. Adaptive neuro-fuzzy inference system for acoustic analysis of 4-channel phonocardiograms using empirical mode decomposition.

    Becerra, Miguel A; Orrego, Diana A; Delgado-Trejos, Edilson


    The heart's mechanical activity can be appraised by auscultation recordings, taken from the 4-Standard Auscultation Areas (4-SAA), one for each cardiac valve, as there are invisible murmurs when a single area is examined. This paper presents an effective approach for cardiac murmur detection based on adaptive neuro-fuzzy inference systems (ANFIS) over acoustic representations derived from Empirical Mode Decomposition (EMD) and Hilbert-Huang Transform (HHT) of 4-channel phonocardiograms (4-PCG). The 4-PCG database belongs to the National University of Colombia. Mel-Frequency Cepstral Coefficients (MFCC) and statistical moments of HHT were estimated on the combination of different intrinsic mode functions (IMFs). A fuzzy-rough feature selection (FRFS) was applied in order to reduce complexity. An ANFIS network was implemented on the feature space, randomly initialized, adjusted using heuristic rules and trained using a hybrid learning algorithm made up by least squares and gradient descent. Global classification for 4-SAA was around 98.9% with satisfactory sensitivity and specificity, using a 50-fold cross-validation procedure (70/30 split). The representation capability of the EMD technique applied to 4-PCG and the neuro-fuzzy inference of acoustic features offered a high performance to detect cardiac murmurs. PMID:24109851

  18. Risks of Using Bedside Tests to Verify Nasogastric Tube Position in Adult Patients

    Melody Ni


    Full Text Available Nasogastric (NG tubes are commonly used for enteral feeding. Complications of feeding tube misplacement include malnutrition, pulmonary aspiration, and even death. We built a Bayesian network (BN to analyse the risks associated with available bedside tests to verify tube position. Evidence on test validity (sensitivity and specificity was retrieved from a systematic review. Likelihood ratios were used to select the best tests for detecting tubes misplaced in the lung or oesophagus. Five bedside tests were analysed including magnetic guidance, aspirate pH, auscultation, aspirate appearance, and capnography/colourimetry. Among these, auscultation and appearance are non-diagnostic towards lung or oesophagus placements. Capnography/ colourimetry can confirm but cannot rule out lung placement. Magnetic guidance can rule out both lung and oesophageal placement. However, as a relatively new technology, further validation studies are needed. The pH test with a cut-off at 5.5 or lower can rule out lung intubation. Lowering the cut-off to 4 not only minimises oesophageal intubation but also provides extra safety as the sensitivity of pH measurement is reduced by feeding, antacid medication, or the use of less accurate pH paper. BN is an effective tool for representing and analysing multi-layered uncertainties in test validity and reliability for the verification of NG tube position. Aspirate pH with a cut-off of 4 is the safest bedside method to minimise lung and oesophageal misplacement.

  19. Acoustic cardiac signals analysis: a Kalman filter–based approach

    Salleh SH


    Full Text Available Sheik Hussain Salleh,1 Hadrina Sheik Hussain,2 Tan Tian Swee,2 Chee-Ming Ting,2 Alias Mohd Noor,2 Surasak Pipatsart,3 Jalil Ali,4 Preecha P Yupapin31Department of Biomedical Instrumentation and Signal Processing, Universiti Teknologi Malaysia, Skudai, Malaysia; 2Centre for Biomedical Engineering Transportation Research Alliance, Universiti Teknologi Malaysia, Johor Bahru, Malaysia; 3Nanoscale Science and Engineering Research Alliance, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand; 4Institute of Advanced Photonics Science, Universiti Teknologi Malaysia, Johor Bahru, MalaysiaAbstract: Auscultation of the heart is accompanied by both electrical activity and sound. Heart auscultation provides clues to diagnose many cardiac abnormalities. Unfortunately, detection of relevant symptoms and diagnosis based on heart sound through a stethoscope is difficult. The reason GPs find this difficult is that the heart sounds are of short duration and separated from one another by less than 30 ms. In addition, the cost of false positives constitutes wasted time and emotional anxiety for both patient and GP. Many heart diseases cause changes in heart sound, waveform, and additional murmurs before other signs and symptoms appear. Heart-sound auscultation is the primary test conducted by GPs. These sounds are generated primarily by turbulent flow of blood in the heart. Analysis of heart sounds requires a quiet environment with minimum ambient noise. In order to address such issues, the technique of denoising and estimating the biomedical heart signal is proposed in this investigation. Normally, the performance of the filter naturally depends on prior information related to the statistical properties of the signal and the background noise. This paper proposes Kalman filtering for denoising statistical heart sound. The cycles of heart sounds are certain to follow first-order Gauss–Markov process. These cycles are observed with additional noise

  20. Exploration of nurses' knowledge regarding correct way of blood pressure measurement

    Paraskeui Gourni


    Full Text Available Blood pressure (BP measurement by the use of sphygmomanometer and auscultation of brachial artery by stethoscope is the most widespread way of measurement in daily clinical practice. The aim of the present study was to explore nurses' knowledge regarding correct way of measurement of blood pressure by the use of a sphygmomanometer. Method and material: The sample –studied consisted of individuals from all levels of nursing personnel. Data were collected by the use the completion of a specially designed questionnaire which apart from demographic variables, it included items concerning knowledge about the correct way of blood pressure measurement. Results: From the 360 participants, 88% (316 were women, while the mean age of the sample-studied was 36,1 years old. 51,4% of the sample-studied was of tertiary education. In terms of the knowledge of participants, 79,6% knew the correct preparation, 98,6% knew that arm position for blood pressure measurement should be on a pillow or a side table and the 94,8% knew the back should be supported on a chair back. 60,9% of the sample-studied knew that at first time, blood pressure (BP should be measured in both arms, while 45,9% didn't know that BP should be measured in arm with higher measurement. 78,2% of the participants knew that the correct measurement includes the use of sphygmomanometer and auscultation of brachial artery by stethoscope. 67,9% knew that body and arm position should be in ankle of 45o degrees and that the cuff should be placed around the upper arm at the same vertical height as the heart. 59,8% knew that the cuff should be placed 2-3 cm above the point of auscultation of brachial artery. 45,1% considered that the arm cuff should be inflated manually until when the height of the column of mercury approaches 200 mmHg. 52,3% knew the correct rhythm (2-3 mmHg/sec that the pressure in the cuff should be released. 88,4% knew the sounds corresponding to the measurement of Systolic blood

  1. La tecnología DGPS en la construcción: control de movimientos en grandes estructuras

    Marchamalo, M.


    Full Text Available The joint development of auscultation and communications technologies is enabling the development of Automated Monitoring Systems for structures. In this paper, we analyze the viability of the application of DGPS (Differential GPS technique to monitoring in construction. We can affirm DGPS is accurate and useful for the auscultation of large structures, such as dams, reflecting properly their movements and deformations, compared to geotechnical sensors. The use of DGPS technology in large structures can provide information on the dynamic characteristics of their movements and deformations. All this can be analyzed in real time, with automated measurement systems and alarms programmed for different thresholds. Therefore DGPS is considered a complementary technique for auscultation of large structures that can integrate with other geotechnical or topographical methods, both in the construction and monitoring phases.

    La evolución conjunta de las tecnologías de auscultación y las telecomunicaciones está permitiendo el desarrollo de Sistemas de Auscultación Automática de estructuras. En este trabajo se analiza la viabilidad de la aplicación de la técnica DGPS a la auscultación en construcción. Se puede afirmar que el GPS diferencial es preciso y útil en la auscultación de grandes estructuras, como las presas, al reflejar adecuadamente el movimiento de las mismas, en comparación con los sensores geotécnicos. El empleo de DGPS en grandes estructuras puede proporcionar información sobre sus movimientos y deformaciones. Esta información puede estar disponible en tiempo real, con sistemas automáticos de medición y alarmas programadas para distintos umbrales de movimientos. Por todo ello, se considera que el DGPS es una tecnología complementaria para la auscultación de grandes estructuras, que puede integrarse con otros métodos geotécnicos o topográficos, tanto en la fase constructiva como en el seguimiento de las obras.

  2. Acute Psychosis as Major Clinical Presentation of Legionnaires’ Disease

    Ricardo Coentre


    Full Text Available We report a case of a 61-year-old woman who presented with acute psychosis as a major manifestation of Legionnaires’ disease in the absence of other neuropsychiatric symptoms. Clinical history revealed dry cough and nausea. Observation showed fever and auscultation crackles in the lower lobe of the right lung. Laboratory testing demonstrated elevated C-reactive protein and lung chest radiograph showed patchy peribronchial and right lower lobe consolidation. Soon after admission, she started producing purulent sputum. Epidemiological data suggested Legionella pneumophila as possible cause of the clinical picture that was confirmed by urinary antigen detection and polymerase chain reaction of the sputum. She was treated with levofloxacin 750 mg/day for 10 days with complete remission of pulmonary and psychiatric symptoms. She has not had further psychotic symptoms.

  3. Design of Wireless Electronic Stethoscope Based on Zigbee

    Kadam Patil D.D


    Full Text Available Heart sound stethoscope is primary stage to access diseases. In this paper design of an electronic stethoscope with the functions of wireless transmission is discussed. This electronic stethoscope based on embedded processor. The data can be transmitted through wireless transmission using Zigbee module. A microphone is used to pick up the sound of the heart beat. Acoustic stethoscope can be changed into a digital stethoscope by inserting an electric capacity microphone into its head. The signal is processed and amplified to play with or without earphone. Heart sounds are processed, sampled and sent wirelessly using Zigbee module so that multiple doctors can do auscultation. PC connectivity is provided through serial port where from audio and video can be made available through LAN and internet for telemedicine consultation. Heart beat signals are sensed, sent, displayed, monitored, stored, reviewed, and analysed with ease.

  4. A stethoscope with wavelet separation of cardiac and respiratory sounds for real time telemedicine implemented on field-programmable gate array

    Castro, Víctor M.; Muñoz, Nestor A.; Salazar, Antonio J.


    Auscultation is one of the most utilized physical examination procedures for listening to lung, heart and intestinal sounds during routine consults and emergencies. Heart and lung sounds overlap in the thorax. An algorithm was used to separate them based on the discrete wavelet transform with multi-resolution analysis, which decomposes the signal into approximations and details. The algorithm was implemented in software and in hardware to achieve real-time signal separation. The heart signal was found in detail eight and the lung signal in approximation six. The hardware was used to separate the signals with a delay of 256 ms. Sending wavelet decomposition data - instead of the separated full signa - allows telemedicine applications to function in real time over low-bandwidth communication channels.

  5. Development of digital stethoscope for telemedicine.

    Lakhe, Aparna; Sodhi, Isha; Warrier, Jyothi; Sinha, Vineet


    The stethoscope is a medical acoustic device which is used to auscultate internal body sounds, mainly the heart and lungs. A digital stethoscope overcomes the limitations of a conventional stethoscope as the sound data is transformed into electrical signals which can be amplified, stored, replayed and, more importantly, sent for an expert opinion, making it very useful in telemedicine. With the above in view, a low cost digital stethoscope has been developed which is interfaceble with mobile communication devices. In this instrument sounds from various locations can be captured with the help of an electret condenser microphone. Captured sound is filtered, amplified and processed digitally using an adaptive line enhancement technique to obtain audible and distinct heart sounds. PMID:26728637

  6. Egophony: is this classic semeiological sign still helpful?

    Domenico Viviani


    Full Text Available BACKGROUND Egophony, also known as “E to A change”, is a classical, clinical sign detected by chest auscultation, consisting into a change in timbre, but not pitch or volume, produced by solid interposed between the resonator and the stethoscope head. Egophony was first described in 1916 by R.T.H. Laënnec, but today it is almost unknown. Yet it is a powerful tool to detect pleural effusion as well as other pathological conditions associated with lung compression or consolidation, such as hemothorax or atelectasis of the lung. AIM OF THE STUDY The aim of this paper is to remember the value of this frequently neglected clinical sign and to stress the importance of physical examination, that should always precede – and could often replace – instrumental tests, which are quite expensive and sometimes unnecessary.

  7. Dynamic monitoring equipment for earthworks and sub grades; Euipos de auscultacion dinamica para obras de tierra

    Alvarez de Sotomayor, R.


    This paper take into account some dynamic auscultation equipment s that currently are available in Spain for compaction quality control on earthworks and sub grades. Closed to the equipment description, a deformation modulus calculus approximation has been developed for each of them. A standards checking has been made from national and European point of view. some important research works that have been developed in our country about dynamic monitoring equipment s for quality control in earthworks has been mentioned. In addition to this, some variables are analyzed which have an influence on deformation modulus calculi and a possibility for comparing the equipment modulus calculated with a reference laboratory test has been offered. (Author) 18 refs.

  8. Severe Unilateral Atelectasis after Induction of General Anesthesia: Due to Aspiration of Oropharyngeal Secretion?

    Myoung Jin Ko


    Full Text Available A 27-year-old man underwent general anesthesia for arthroscopic Bankart repair surgery. Glycopyrrolate was administered for premedication and anesthesia was induced with propofol and rocuronium. After tracheal intubation, the patient’s position was changed to right lateral position for operation. Gradual elevation of airway pressure and decrease of oxygen saturation occurred, and was suspected to be due to endobrochial intubation. Nonetheless, the endotracheal tube was drawn to 22 cm at the upper incisor and breathing sound was not auscultated overthe right lung field. Bronchoscopy was performed for diagnosis, right main bronchus was filled withclear mucus secretion. After suction of the secretion, ventilation was improved. After finishing the operation, a chest X-ray showed aspiration pneumonia overthe right lung. The patient was treated with antibiotics and discharged uneventfully 5 days postoperatively.

  9. Auscultatory versus oscillometric measurement of blood pressure in octogenarians

    Pedersen, Sidsel Arnspang


    Abstract Background. Auscultatory measurement using a sphygmomanometer has been the predominant method for clinical estimation of blood pressure, but it is now rapidly being replaced by oscillometric measurement. Objective. To compare blood pressure by auscultatory and oscillometric measurements in...... patients 80 years. Method. 100 patients had blood pressure measured by auscultation with a sphygmomanometer and by an electronic device using the oscillometric method. For each patient the mean of two blood pressures with each method measured within 15 min were compared. Results. The mean age of...... participants was 85.8 years; 55.8% were women. The correlation coeffi cient for systolic blood pressure was 0.88 and for diastolic 0.79. Differences between auscultatory and oscillometric values were less than 10 mmHg in 70.6% of systolic blood pressures and in 83.2% for diastolic. Arrhythmia and hypertension...

  10. Thoracic and abdominal blastomycosis in a horse.

    Toribio, R E; Kohn, C W; Lawrence, A E; Hardy, J; Hutt, J A


    A 5-year-old Quarter Horse mare was examined because of lethargy, fever, and weight loss of 1 month's duration. Thoracic auscultation revealed decreased lung sounds cranioventrally. Thoracic ultrasonography revealed bilateral anechoic areas with hyperechoic strands, consistent with pleural effusion and fibrin tags. A large amount of free fluid was evident during abdominal ultrasonography. Abnormalities included anemia, hyperproteinemia, hyperglobulinemia, hyperfibrinogenemia, and hypoalbuminemia. Thoracic radiography revealed alveolar infiltrates in the cranial and caudoventral lung fields. A cavitary mass, consistent with an abscess, could be seen caudodorsal to the crura of the diaphragm. Ultrasonographic evaluation of this area revealed a hypoechoic mass with septations. Bilateral thoracocentesis was performed. Bacterial culture of the pleural fluid did not yield growth, but Blastomyces dermatitidis was isolated from pleural fluid, abdominal fluid, and an aspirate of the abscess. The mare was euthanatized, and a diagnosis of thoracic and abdominal blastomycosis was confirmed at necropsy. PMID:10319179

  11. Design of wireless electronic stethoscope based on zigbee

    Patil, D D Kadam


    Heart sound stethoscope is primary stage to access diseases. In this paper design of an electronic stethoscope with the functions of wireless transmission is discussed. This electronic stethoscope based on embedded processor. The data can be transmitted through wireless transmission using Zigbee module. A microphone is used to pick up the sound of the heart beat. Acoustic stethoscope can be changed into a digital stethoscope by inserting an electric capacity microphone into its head. The signal is processed and amplified to play with or without earphone. Heart sounds are processed, sampled and sent wirelessly using Zigbee module so that multiple doctors can do auscultation. PC connectivity is provided through serial port where from audio and video can be made available through LAN and internet for telemedicine consultation. Heart beat signals are sensed, sent, displayed, monitored, stored, reviewed, and analysed with ease.

  12. A diagnostic challenge of an unusual presentation of pneumomediastinum

    Hatamabadi Hamid Reza


    Full Text Available 【Abstract】A 77-year-old man who had underwent orthopedic surgery 17 days ago due to his left femur fracture caused by a pedestrian-car accident came to our emer- gency department with the chief complaint of a 2 days history of sore throat and cough and also swelling of eyelids. He had no respiratory distress or any other life-threatening symptoms. Subsequent physical examination revealed remarkable edema and crepitus over the whole face, neck, proximal upper limbs and the anterior and posterior chest regions, and also bilateral hyperresonance was detected in pulmonary auscultation. The imaging studies showed pneumomediastinum and bilateral subcutaneous emphysema. The diagnosis of pneumomediastinum and mild left pneumothorax and massive subcutaneous emphysema was definitely made. He underwent bilateral tube thoracostomy by using a 32 French chest tube under local anesthesia in the fifth in- tercostal space on the anterior axillary line. The patient was discharged with no complications 10 days postoperatively.

  13. Lethal Aorto-Right Ventricular Defect After Transcatheter Aortic Valve Implantation in a Patient With Radiation-Induced Porcelain Aorta: Notes of Caution.

    Leroux, Lionel; Dijos, Marina; Peltan, Julien; Casassus, Frederic; Seguy, Benjamin; Natsumeda, Makoto; Lafitte, Stephane; Labrousse, Louis; Dos Santos, Pierre


    A 47-year-old man with severe radiation-induced aortic stenosis was rejected for cardiac surgery because of porcelain aorta. We successfully implanted an Edwards SAPIEN valve (Edwards Lifesciences, Irvine, CA), but the patient was readmitted 3 weeks later for heart failure with a continuous murmur on auscultation. Echocardiography showed a small defect between the aorta and the infundibulum of the right ventricle, which was also confirmed with aortography and computed tomography. Medical therapy was optimized; however, he died unexpectedly a few weeks later. We concluded that irradiated tissues are particularly fragile and require specific attention during transcatheter aortic valve implantation. Furthermore, this case suggests that a more aggressive closure should have been applied. PMID:26342846

  14. A novel communications network for the provision of medical care in disaster and emergency situations.

    Dembeyiotis, S; Konnis, G; Koutsouris, D


    We have designed and developed a novel data communications network targeted at the provision of Emergency Medical Care in disaster situations over wide areas. The network nodes can transmit essential biosignals and in addition, support video and diagnostic quality sound (auscultation) broadcasting for teleconsultation purposes, by using a variety of wireless transports. The medical data acquisition stations are networked dynamically and on demand, with no requirement for an existing communications infrastructure at the disaster sites. The network design allows for limited transmitting station mobility and support for software-based Voice over IP during station roaming. Initial test results, following the hardware and software integration, indicate that the chosen network design meets specifications, and a full-scale field test, utilizing a large number of wireless stations operating under realistic conditions is to take place. PMID:17271008

  15. Etude en laboratoire de l'anisotropie des roches par méthode ultrasonique : Application au gneiss de Valabres (Alpes-Maritimes)

    Gasc Barbier, Muriel; Wassermann, Jérôme


    Parmi les essais non destructifs, l'auscultation des roches par méthode ultrasonore est un moyen couramment utilisé pour caractériser l'état initial d'un spécimen au laboratoire. S'il est courant de faire ces mesures pour caractériser l'état de fracturation d'une roche, ce type de mesure est moins utilisé pour caractériser l'état d'anisotropie. Des essais de compression uniaxiale avec mesure des vitesses des ondes élastiques ont été réalisés sur des gneiss carottés parallèlement et perpendicu...

  16. French school of neurology in the 19 th and first half of the 20th century, and its influence in Brazil

    Marleide da Mota Gomes


    Full Text Available French medicine was of the utmost importance for the birth of modern medicine and neurology in the 19 th century. Innovative approaches, such as examination at the bedside, the use of the stethoscope, techniques of auscultation, palpation, and close patient examination, besides emphasis on anatomical-clinical correlation and observation of the outcome of the disease, were put into practice. French medicine offered professional training and incentives for the beginnings of Brazilian neurology and psychiatry. Returning from France, many Brazilian physicians implemented what they had learned, mainly in Paris. The most important pupils of the French neurology schools in Brazil during the 19 th century and first half of the 20 th century include names like Antonio Austregesilo, Aloysio de Castro, Enjolras Vampré, and Deolindo Couto, founders of the leading Brazilian neurological schools, directly influenced by Dejerine, Pierre Marie, Guillain and Babinski.

  17. Pain in the chest in a user of cocaine

    A 21-year-old man presented with pleuritic substernal chest pain of one hour's duration. The pain was exacerbated in a supine position and did not radiate. Questioning revealed that he was a recreational user of cocaine and had inhaled free-based cocaine via a pipe the previous evening and as recently as two hours before admission to the hospital. Physical examination demonstrated an anxious young man with a respiratory rate of 26 breaths per minute and shallow. He was afebrile with normal heart rate and blood pressure. His sternum was tender to palpation, and auscultation revealed precordial crepitus synchronous with systole. His electrocardiogram showed sinus rhythm at a rate of 62 beats per minute. Posteroanterior and lateral roentgenograms of the chest were obtained. A diagnosis of spontaneous pneumomediastinum was made

  18. Lymphoma and broncho-pneumonia in a calf

    A one and a half month old Holstein calf was presented with a chronic respiratory condition. Clinical examination revealed cachexia and lymphadenopathy and wheezes and crepitations on auscultation. Blood cell count indicated a non-regenerative microcytic anaemia and marked lymphopenia. Broncho-pneumonia due to Mycoplasma bovis was diagnosed after radiography and cytobacteriology of transtracheal lavage. A large cell lymphoma was suspected after finding a high proportion of large lymphocytes in a lymph node puncture aspirate. Serology for bovine leukosis was negative. A diagnosis of juvenile lymphoma associated with M. bovis broncho-pneumonia was established. The diagnosis was confirmed on post-mortem. Juvenile lymphoma is rare. Affected animals are aged between two and six months and systematically present generalised lymphadenopathy. This disease is always fatal. When an animal is presented with generalised lymphadenopathy, this condition should be eliminated by lymph node puncture of a moderately hypertrophied lymph node before other tests are performed

  19. Subclinical high altitude pulmonary edema:A clinical observation of 12 cases in Yushu

    Li Shuzhi; Zheng Bihai; Wu Tianyi; Chen Huixing; Zhang Ming


    During the Yushu Earthquake on April 14,2010,a high incidence of acute high altitude illness was observed in the mountain rescuers,and 0.73 % of these patients suffered from high altitude pulmonary edema,of which 12 patients developed subclinical pulmonary edema and concomitantly contracted acute mountain sickness.Symptoms and signs were atypically high heart rate with high respiratory rate,striking cyanosis,and significantly low oxygen saturation,whereas no moist rates were heard on auscultation,and Chest X-ray showed peripheral with a patchy distribution of mottled infiltrations in one or both lung fields.We believe that subclinical high altitude pulmonary edema is an earliest stage of pulmonary edema at high altitude.The possible pathogenesis and the diagnosis were discussed.

  20. Tissue-Informative Mechanism for Wearable Non-invasive Continuous Blood Pressure Monitoring

    Woo, Sung Hun; Choi, Yun Young; Kim, Dae Jung; Bien, Franklin; Kim, Jae Joon


    Accurate continuous direct measurement of the blood pressure is currently available thru direct invasive methods via intravascular needles, and is mostly limited to use during surgical procedures or in the intensive care unit (ICU). Non-invasive methods that are mostly based on auscultation or cuff oscillometric principles do provide relatively accurate measurement of blood pressure. However, they mostly involve physical inconveniences such as pressure or stress on the human body. Here, we introduce a new non-invasive mechanism of tissue-informative measurement, where an experimental phenomenon called subcutaneous tissue pressure equilibrium is revealed and related for application in detection of absolute blood pressure. A prototype was experimentally verified to provide an absolute blood pressure measurement by wearing a watch-type measurement module that does not cause any discomfort. This work is supposed to contribute remarkably to the advancement of continuous non-invasive mobile devices for 24-7 daily-life ambulatory blood-pressure monitoring.

  1. Remote auscultatory patient monitoring during magnetic resonance imaging

    Henneberg, S; Hök, B; Wiklund, L;


    A system for patient monitoring during magnetic resonance imaging (MRI) is described. The system is based on remote auscultation of heart sounds and respiratory sounds using specially developed pickup heads that are positioned on the precordium or at the nostrils and connected to microphones via...... polymer tubing. The microphones operate in a differential mode outside the strong magnetic field to reduce various sources of interference from the MRI equipment. After amplification, the signal is transmitted as infrared light to a small, battery-operated receiver and a headphone set. Thus, the patient...... tubing having a diameter of approximately 2 mm can be used for efficient sound transmission. Recordings in situ show satisfactory detection of both heart sounds and respiratory sounds, although the signal is somewhat masked by noise during imaging. A clinical test incorporating 17 sedated or anesthetized...

  2. Fast Fourier transform analysis of sounds made while swallowing various foods.

    Taniwaki, Mitsuru; Kohyama, Kaoru


    The cervical auscultation method was applied to investigate sounds generated while swallowing various foods with unique physical properties, including liquid (water), semiliquid (yogurt), and solid (konjac jelly). To study the differences among swallowing sounds for various foods, fast Fourier transform (FFT) analysis was applied to signals that were attributed to the flow of a food bolus, which is a swallowable soft mass of chewed food. An FFT program was developed that enabled the calculation of a spectrum for a specified region of time domain swallowing sound signals. The intensity of spectra in the frequency range between 400 and 1000 Hz significantly differed: liquid > semiliquid > solid. The FFT spectrum in this range was suggested to represent the frequency characteristics of the swallowing sounds of various foods. PMID:23039442

  3. A large un-ruptured abdominal aortic aneurysm causing pulmonary embolism.

    Sajjad, Jahangir; Ahmed, Abubakr; Coveney, Andrew; Fulton, Gregory


    A 79 years old woman presented in a peripheral hospital with dyspnea, right-sided pleuritic chest pain and cough for 3 days. On examination, she was tachycardiac and tachypneic. She had reduced air entry bilaterally on auscultation. Computed tomography-pulmonary angiogram, performed in peripheral Hospital, confirmed the diagnosis of pulmonary embolism, and she was commenced on warfarin. Ultrasonography showed no evidence of deep venous thrombosis in legs; however, ultrasound of the abdomen revealed an aortic aneurysm. She was hemodynamically stable on transfer to vascular surgery department, and her complete clinical examination revealed a pulsatile mass in the central abdomen. Computed tomography angiogram of aorta showed 8.7-cm abdominal aortic aneurysm. Venogram performed during inferior vena cava (IVC) filter insertion showed that IVC was displaced and compressed due to this large aortic aneurysm, causing thromboembolism. An open repair of the aneurysm was performed with uneventful recovery. PMID:26205717

  4. Frequency shifting approach towards textual transcription of heartbeat sounds

    Safar Khorasani Ehsan


    Full Text Available Abstract Auscultation is an approach for diagnosing many cardiovascular problems. Automatic analysis of heartbeat sounds and extraction of its audio features can assist physicians towards diagnosing diseases. Textual transcription allows recording a continuous heart sound stream using a text format which can be stored in very small memory in comparison with other audio formats. In addition, a text-based data allows applying indexing and searching techniques to access to the critical events. Hence, the transcribed heartbeat sounds provides useful information to monitor the behavior of a patient for the long duration of time. This paper proposes a frequency shifting method in order to improve the performance of the transcription. The main objective of this study is to transfer the heartbeat sounds to the music domain. The proposed technique is tested with 100 samples which were recorded from different heart diseases categories. The observed results show that, the proposed shifting method significantly improves the performance of the transcription.

  5. Frequency shifting approach towards textual transcription of heartbeat sounds.

    Arvin, Farshad; Doraisamy, Shyamala; Safar Khorasani, Ehsan


    Auscultation is an approach for diagnosing many cardiovascular problems. Automatic analysis of heartbeat sounds and extraction of its audio features can assist physicians towards diagnosing diseases. Textual transcription allows recording a continuous heart sound stream using a text format which can be stored in very small memory in comparison with other audio formats. In addition, a text-based data allows applying indexing and searching techniques to access to the critical events. Hence, the transcribed heartbeat sounds provides useful information to monitor the behavior of a patient for the long duration of time. This paper proposes a frequency shifting method in order to improve the performance of the transcription. The main objective of this study is to transfer the heartbeat sounds to the music domain. The proposed technique is tested with 100 samples which were recorded from different heart diseases categories. The observed results show that, the proposed shifting method significantly improves the performance of the transcription. PMID:21970368

  6. Pulmonary ventilation and perfusion scintigraphy in patients with bronchial asthma

    Pulmonary ventilation and perfusion scan using Xe-133 gas and Tc-99m MAA were performed in 18 patients with bronchial asthma to evaluate the regional pulmonary function. The scintigraphic findings were compared with the results of the auscultation and the conventional pulmonary functioning examination (%FVC, %FEV1.0). Ventilation image showed abnormality in 12 (70.6%) out of the asymptomatic 17 patients and perfusion image showed abnormality in 7 (41.2%) out of 17 patients. These 7 patients with abnormality on perfusion image all showed abnormality on ventilation image. The grade of abnormality in scintigraphic findings was compatible with the values of %FVC and %FEV1.0. In conclusion Xe-133 ventilation and Tc-99m MAA perfusion scan were useful procedures to estimate the pulmonary function of patients with bronchial asthma. (author)

  7. Retrospective study of pre-anesthetic electrocardiogram examination of 700 dogs conducted at the Veterinary Hospital of UFMG (2013-2014

    Ana Flávia Machado Botelho


    Full Text Available Abstract: Pre-operative electrocardiograms performed in 700 dogs were analyzed in order to establish correlation between sex, age, indication for surgery, body condition score, breed and weight. Initially a clinical questionnaire was filled out from each owner, including age, breed, sex, weight, clinical history and surgical indication. Dogs above 6 years of age or those showing any kind of cardiac auscultation disturbances were referred to electrocardiogram (ECG evaluation. All ECG were performed and analyzed by the same veterinary specialist. Abnormalities at ECG were founnd in 364 of 700 (52% evaluated dogs, and the most frequent variation was sinus arrhythmia, observed in 293 dogs (25.4%. No significant correlation was found between the electrocardiographic alterations with weight, sex and age of the animals. Therefore ECG should be conducted routinely regardless of age, sex, breed or surgical indication, highlighting its value for determining a safe anesthetic protocol that promotes minimal cardiopulmonary depression and allows rapid post-surgical recovery.

  8. Acoustic heart. Interpretation of Phonocardiograms by computer

    In the field of Cardiology have been identified several heart pathologies associated with problems in valves and narrowing in veins. Each case is associated with a specific sound emitted by the heart, detected in cardiac auscultation. On the Phonocardiogram, sound is visualized as a peak in the wave. In the Optics Laboratory of the Universidad Autonoma Metropolitana – Azcapotzalco, we have developed a simulation of the Phonocardiograms of heart sounds associated with the main pathologies and a computer program of recognition of images that allows you to quickly identify the respective diseases. This is a novel way to analyze Phonocardiograms and the foundation for building a portable non-invasive cardiac diagnostic computerized analyzer system

  9. Off-Pump CABG in a Patient with Dextrocardia Totalis: A Case Report

    Ali Dabbagh


    Full Text Available Coronary revascularization in patients with dextrocardia is not a common clinical condition. There are very few cases of off-pump coronary artery bypass. A 64-year-old woman was admitted to a university hospital due to exertional chest pain. Her primary diagnosis was coronary artery disease superimposed on dextrocardia, which was first suspected on physical examination, with the patient having right-sided heart sounds on auscultation. It was corroborated by chest X-ray. After diagnostic evaluations, including coronary angiography, she underwent off-pump coronary artery bypass grafting due to a significant left main coronary artery stenosis associated with dextrocardia. Two years later, multi-slice CT angiography revealed patent grafts, demonstrating good clinical results.

  10. Infective endocarditis of the aortic valve in a Border collie dog with patent ductus arteriosus.

    Aoki, Takuma; Sunahara, Hiroshi; Sugimoto, Keisuke; Ito, Tetsuro; Kanai, Eiichi; Fujii, Yoko


    Infective endocarditis (IE) in dogs with cardiac shunts has not been reported previously. However, we encountered a dog with concurrent patent ductus arteriosus (PDA) and IE. The dog was a 1-year-old, 13.9-kg female Border collie and presented with anorexia, weight loss, pyrexia (40.4 °C) and lameness. A continuous murmur with maximal intensity over the left heart base (Levine 5/6) was detected on auscultation. Echocardiography revealed a PDA and severe aortic stenosis (AS) caused by aortic-valve vegetative lesions. Corynebacterium spp. and Bacillus subtilis were isolated from blood cultures. The dog responded to aggressive antibiotic therapy, and the PDA was subsequently surgically corrected. After a series of treatments, the dog showed long-term improvement in clinical status. PMID:25391395

  11. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by Emergency Department Ultrasound.

    Wendler, Carlan; Shoenberger, Jan Marie; Mailhot, Thomas; Perera, Phillips


    A 57-year-old man presented to our emergency department with altered mental status. He had a past medical history significant for cirrhosis and previous placement of a transjugular intrahepatic portosystemic shunt (TIPS). On cardiac auscultation, a new heart murmur and an unexpected degree of cardiac ectopy were noted. On the 12-lead electrocardiogram, the patient was noted to have multiple premature atrial contractions, corroborating the irregular heart rhythm on physical exam. A focused bedside emergency ultrasound of the heart was then performed. This exam revealed an apparent foreign body in the right atrium. It appeared as if the patient's TIPS had migrated from the heart into the right atrium. This case, as well as the literature describing this unusual complication of TIPS placement, is reviewed in this case report. PMID:23358693

  12. Transjugular Intrahepatic Portosystemic Shunt (TIPS Migration to the Heart Diagnosed by Emergency Department Ultrasound

    Carlan Wendler


    Full Text Available A 57-year-old man presented to our emergency department with altered mental status. He had a past medical history significant for cirrhosis and previous placement of a transjugular intrahepatic portosystemic shunt (TIPS. On cardiac auscultation, a new heart murmur and an unexpected degree of cardiac ectopy were noted. On the 12-lead electrocardiogram, the patient was noted to have multiple premature atrial contractions, corroborating the irregular heart rhythm on physical exam. A focused bedside emergency ultrasound of the heart was then performed. This exam revealed an apparent foreign body in the right atrium. It appeared as if the patient’s TIPS had migrated from the heart into the right atrium. This case, as well as the literature describing thisunusual complication of TIPS placement, is reviewed in this case report

  13. Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment

    Objective: To describe the clinical manifestations and bronchoscopic treatment of foreign body aspiration in children under 14 years of age, correlating the clinical aspects with the bronchoscopic findings. Methods: A retrospective, descriptive study analyzing data related to children under 14 years of age undergoing bronchoscopy due to clinical suspicion of foreign body aspiration at the State University at Campinas Hospital das Clinicas from January of 2000 to December of 2005. Results: The sample consisted of 69 patients, ranging in age from 8 months to 12 years/7 months (75.4% under 3 years of age), 62.3% of whom were male. The principal complaint was sudden-onset cough (75.4%), auscultation was abnormal in 74%, and dyspnea was observed in 29%. Radiological abnormalities were seen in 88% of the cases. Aspirations were primarily into the right lung (54.8%), and 30.7% of the foreign bodies were of vegetal origin (principally beans and peanuts). In the follow-up period, 29% presented complications (most commonly pneumonia), which were found to be associated with longer aspiration time (p = 0.03). Mechanical ventilation was required in 7 children (10.1%), and multiple bronchoscopies were performed in 5 (7.2%). Conclusions: A history of sudden-onset choking and cough, plus abnormal auscultation and radiological findings, characterizes the profile of foreign body aspiration. In such cases, bronchoscopy is indicated. Longer aspiration time translates to a higher risk of complications. The high prevalence of foreign bodies of vegetal origin underscores the relevance of prevention at children younger than three years of age. (author)

  14. Direct Signal-to-Noise Quality Comparison between an Electronic and Conventional Stethoscope aboard the International Space Station

    Marshburn, Thomas; Cole, Richard; Ebert, Doug; Bauer, Pete


    Introduction: Evaluation of heart, lung, and bowel sounds is routinely performed with the use of a stethoscope to help detect a broad range of medical conditions. Stethoscope acquired information is even more valuable in a resource limited environments such as the International Space Station (ISS) where additional testing is not available. The high ambient noise level aboard the ISS poses a specific challenge to auscultation by stethoscope. An electronic stethoscope's ambient noise-reduction, greater sound amplification, recording capabilities, and sound visualization software may be an advantage to a conventional stethoscope in this environment. Methods: A single operator rated signal-to-noise quality from a conventional stethoscope (Littman 2218BE) and an electronic stethoscope (Litmann 3200). Borborygmi, pulmonic, and cardiac sound quality was ranked with both stethoscopes. Signal-to-noise rankings were preformed on a 1 to 10 subjective scale with 1 being inaudible, 6 the expected quality in an emergency department, 8 the expected quality in a clinic, and 10 the clearest possible quality. Testing took place in the Japanese Pressurized Module (JPM), Unity (Node 2), Destiny (US Lab), Tranquility (Node 3), and the Cupola of the International Space Station. All examinations were conducted at a single point in time. Results: The electronic stethoscope's performance ranked higher than the conventional stethoscope for each body sound in all modules tested. The electronic stethoscope's sound quality was rated between 7 and 10 in all modules tested. In comparison, the traditional stethoscope's sound quality was rated between 4 and 7. The signal to noise ratio of borborygmi showed the biggest difference between stethoscopes. In the modules tested, the auscultation of borborygmi was rated between 5 and 7 by the conventional stethoscope and consistently 10 by the electronic stethoscope. Discussion: This stethoscope comparison was limited to a single operator. However, we

  15. 慢性肾衰竭的四诊客观化研究进展%Objectification Progress of Four Diagnostic Methods of Chronic Renal Failure(CRF)

    张宇; 金亚明; 王忆勤


    Traditional Chinese Medicine ( TCM ) four diagnostic methods (inspection, auscultation - olfaction, interrogation and palpation) ,are the basis of syndrome differentiation and treatment, and the objectification of four diagnostic methods is an effective approach to develop the TCM. Nowadays,researchers have observed and summarized significant a-mount of four diagnostic methods information against different types of diseases, and then objectified the four diagnostic methods through the analysis and research by using modern information technology. CRF is one of the late - stage clinical disorders of various types of chronic kidney diseases. This paper summarized the current situation of inspection, auscultation - olfaction, interrogation and palpation objectification researches about chronic renal failure within last two decades, proved the four diagnostic methods objectification development of CRF, which is meaningful for syndrome differentiation and prognosis of chronic renal failure.%中医四诊信息——“望、闻、问、切”是辨证论治的基础,而四诊客观化更是发展中医的一种有效途径.目前,学者们对大量疾病四诊信息进行观察总结,并利用现代信息技术进行分析研究,实现四诊客观化.慢性肾衰竭是各种慢性肾脏疾病后期的一种临床病症,综述了近20年来慢性肾衰竭在中医望闻问切四方面的客观化研究现状,发现慢性肾衰竭的四诊客观化取得了很大的进展,对慢性肾衰竭的辨证及预后产生了一定的意义.

  16. Auscultatory and electrocardiographic characteristics of Crioulo horses

    Jackson Schade


    Full Text Available In order to determine auscultatory and electrocardiographic characteristics of Crioulo horses, one hundred animals ranging between one and twenty-six years of age (21 stallions, nine geldings, 27 pregnant mares e 43 not pregnant mares were evaluated. The cardiac auscultation was performed during the clinical examination of the cardiovascular system, evaluating frequency, rate, normal and abnormal heart sounds (heart murmurs. The electrocardiographic examination followed the bipolar base-apex derivative system with animals at rest, by using an ECG-PC TEB equipment. The cardiac frequency, heart rate, morphology, duration, wave and complex amplitudes and interval durations were determined. The results were submitted to ANOVA and Tukey tests with an error probability of 5%. The cardiac auscultation revealed presence of functional systolic and diastolic murmur (10.00% and systolic murmur compatible with tricuspid regurgitation besides normal heart sounds S1 (100.0%, S2 (100.0%, S3 (19.0% and S4 (34.0%. The cardiac frequency obtained the average of 43.64 bpm, observing significative differences in relation to sexual and age factors and training level. The sinus rhythm was the most frequent (57.00%, followed by sinus tachycardia (38.00% and sinus arrhythmia (5.00%, being observed rhythm disturbances in 16% of tracings. The P and T waves were observed more frequently in their forms P bifida positive (95.00% and biphasic T (91.00%, being variable at tracing. There were also observed Q waves in 12.00% of the tracings. Thus, it was concluded that the auscultatory characteristics of Crioulo horses are according to the described in the literature for the species and the sexual factor, category, age factor and training level can influence some electrocardiographic parameters.

  17. Doppler sonar analysis of swallowing sounds in normal pediatric individuals Análise dos sons da deglutição pelo sonar Doppler em indivíduos normais na faixa etária pediátrica

    Cibele Fontoura Cagliari


    Full Text Available Among the methods for assessing swallowing sounds - videofluoroscopy modified barium study, fiberoptic swallowing endoscopy, neck auscultation through a microphone, accelerometer and, more recently, the Doppler sonar - we have chosen the latter. AIM: to analyze swallowing sounds by cervical auscultation using Doppler sonar, in a population between 2 and 15 years without oro-pharyngeal dysfunction. STUDY DESIGN: cross-sectional historical cohort. MATERIALS AND METHODS: we investigated 90 individuals in Curitiba (2006/2007. The population was separated by age into 3 groups: from 2 to 5 years, from 5 to 10 years of age and from 10 to 15 years of age. We obtained the average values for frequency, intensity and swallowing duration for saliva, liquid and pasty foods. RESULTS: objective and measurable data were obtained. Significance related to gender was found in certain age groups and consistencies, under all the studied variables, except swallowing time. CONCLUSION: neck auscultation using Doppler sonar is a sensitive method to detect swallowing sounds. There was swallowing interference associated with saliva and the other tested food types and with the biological development of the age range being studied. It is an easy to apply method, not expensive and non-invasive.Dentre a variabilidade de métodos para o estudo da deglutição temos a videofluoroscopia dinâmica da deglutição, a endoscopia da deglutição e a ausculta cervical através do microfone, acelerômetro e mais recentemente pelo sonar Doppler. OBJETIVO: Analisar os sons da deglutição em indivíduos entre mais de dois e 15 anos de idade sem disfagia orofaríngea obtidos na ausculta cervical pelo sonar Doppler. FORMA DE ESTUDO: Estudo de coorte histórica com corte transversal. MATERIAL E MÉTODO: estudaram-se 90 indivíduos em Curitiba (2006/2007. Aplicaram-se as subfaixas mais de dois a cinco, mais de cinco a 10 e mais de 10 a 15 anos de idade. Estabeleceram-se as médias nas vari

  18. Evaluation of Diagnostic Methods in the Differentiation of Heart Murmurs in Children

    Begic, Zijo; Dinarevic, Senka Mesihovic; Pesto, Senad; Begic, Edin; Dobraca, Amra; Masic, Izet


    Introduction: The most common clinical sign in pediatric cardiology is a heart murmur (organic and inorganic). Organic are sign of heart disease, while inorganic (basically divided into accidental and functional) murmurs occur on anatomically healthy heart. Aim: To determine the justification of the application of the methods of cardiac treatment. Patients and methods: Study included 116 children aged from 1 to 15 years, who were referred due to cardiac treatment to Pediatric Clinic, of Sarajevo University Clinical Center. Results: The first group consisted of children with innocent heart murmur, 97 (53 males). The second group consisted of patients with organic murmur, 19 (13 males). The average age of the first group was 7.69 (1.01–15.01) years old, and of the second group 3.15 (1.01- 8.06) years old, and there is a significant difference between these two groups (p <0.001). Medical history questions about potentially harmful habits of mother in pregnancy, found significant differences in the frequency of the existence of habits between the first and second groups of subjects (14.44% vs. 85.1%, p = 0.013). The values of the pulse of patients showed statistically significant difference (p = 0.012). The most common place of the murmurs’ appearance is the second left intercostal space. In the first group, the most common were vibratory (32.3%) and ejection (31.9%) and in the second the most common were holosystolic (73.7%) murmur. Analyzing the R/S ratio of V1, a significant difference among the two groups was found (mean 0.78 vs. the values for 1.45, p = 0.003). There is a significance in terms of developed hypertrophy of the heart cavities (BVH) between the two groups. The most common accidental murmur was classic vibratory Still’s murmurs (55.43%) and the most common congenital heart defects was ASD (36.8%). Conclusions: A heart murmur itself, should not be the purpose of auscultation. One of the tasks of pediatricians, pediatric cardiologists in particular

  19. Severe hypertension and pulmonary edema associated with systemic absorption of topical phenylephrine in a child during retinal surgery

    Ashraf A Abdelhalim


    Full Text Available Topical phenylephrine solutions are widely used in eye procedures to promote pupil dilation without cycloplegia. We report a case of intraoperative severe hypertension and acute pulmonary edema occurring in a child during retinal surgery after possible systemic absorption of topical phenylephrine eyedrops. Our objective is to discuss the proper treatment and preventive strategies for such a complication. A 4-year-old, male patient, 18.4 kg in weight, physical status ASA I was admitted for right retinal detachment surgery. Anesthesia was induced with sevoflurane in oxygen, followed by glycopyrrolate (5.0 μg/kg, propofol 25 mg, fentanyl 50 μg and cisatracurium 0.15 mg/kg given intravenously. Anesthesia was maintained with sevoflurane 2-2.5% in a mixture of nitrous oxide and oxygen (60%:40%. After incision, two drops of 10% aqueous phenylephrine were administered topically by the surgeon to the right eye for further pupil dilation. Few minutes later, the noninvasive blood pressure rose to 220/120 mmHg and the heart rate increased to 140 beats/min. Oxygen saturation (SpO 2 dropped from 99% (with an inspired oxygen concentration (FiO 2 of 0.4 to 82%. Auscultation revealed crepitations throughout the chest and a blood-stained frothy fluid was aspirated from the trachea with possible development of acute pulmonary edema. Hydralazine (5 mg and furosemide (10 mg were administered intravenously. Seven minutes later, the blood pressure returned to normal and the SpO 2 increased to 92% on FiO 2 of 1.0, with decreased intratracheal secretions. After approximately 20 minutes, the SpO 2 had improved to 99%, with a FiO 2 of 1.0 and the blood pressure was 109/63 mmHg and heart rate was 121 beats/min. The FiO 2 gradually reduced back to 0.4 over 30 min with no further desaturation. The patient was discharged from the post anesthesia care unit 5 h after surgery with adequate spontaneous breathing, SpO 2 99% on room air, normal blood pressure and pulmonary

  20. Discussion on effective vibratory sputum ejection machine for patients with extremely severe burn and inhalation injury%振动排痰机用于特重度烧伤伴吸入性损伤患者有效排痰的探讨



    Objective:to study the vibratory sputum ejection machine's prevention effect of the pulmonary infection for patients with extremely severe burn and inhalation injury: a clinical observation of human nature.Methods:70 patients with extremely severe burn and inhalation injury were randomly divided into 35 in the experimental group and 35 in a control group. G5 vibratory sputum ejection machine is used in the experimental group for sputum excretion while handcuff is used in the control group.The effects are drawn and compared via chest auscultation, SpO2 and arterial partial pressure of oxygen (PaO2), the amount of excreted sputum and the sucted sputum.Results: the sputum expectoration effect of the experimental group is much better than that of the control group because the indexes of the chest auscultation, oxygen saturation and blood gas analysis indices are signiifcantly higher than those in the control group (P < 0.05).Conclusion: vibratory sputum ejection machine has ramarkable effect for patients with extremely severe burn and inhalation injury patients in sputum expectoration. What's more, it also helps to prevent the pulmonary infection for patients with extremely severe burn.%目的 探讨振动排痰机用于特重度烧伤伴吸人性损伤患者预防肺部感染的疗效观察.方法 70例特重度烧伤伴有吸入性损伤患者随机分成实验组35和对照组35例.实验组应用G5振动排痰机排痰,对照组采用手扣法对患者进行排痰治疗,在胸部听诊、SpO2、动脉血氧分压(PaO2)、咳痰或吸痰量的多少等方面进行比较.结果 实验组排痰效果明显优于对照组,胸部听诊、氧饱和度和血气分析指标也明显高于对照组(P<0.05).结论 振动排痰机对特重度烧伤伴有吸入性损伤患者协助排痰效果显著,有利特重度烧伤患者肺部感染的控制.

  1. Resistencia del hormigón en estructuras terminadas

    Tobío, J. M.


    Full Text Available This paper deals, in a highly practical manner, with the question of determining the true strength of concrete in its final functional state, and it also contains recommendations on safety, and on the dispersal of results. Some testing methods are mentioned and discussed, which are applicable to working site use, and detailed information is given on the precautions that should be taken so that a non destructive auscultation should give reliable data on the actual strength of the concrete.Desde un punto de vista eminentemente práctico, se aborda el problema de la verdadera resistencia del hormigón terminado, con ciertas indicaciones respecto a la seguridad y las dispersiones. Se citan y comentan algunos métodos de ensayo, de especial aplicación en obra, y se muestran, con bastante detalle, las precauciones que es preciso tomar para que una auscultación no destructiva responda fielmente al estado resistente actual del hormigón.

  2. Hypertrophic osteopathy characterized by nuclear scintigraphy in a horse

    A five year old American Saddlebred gelding was admitted to the University of Illinois Veterinary Medical Teaching Hospital with a history of multiple leg lameness, depression and intermittent fever for a duration of six months. Physical examination revealed the horse to be underweight, depressed and a febrile. No abnormalities were detected during auscultation of the heart and lungs. All limbs possessed multiple hard swellings of the distal long bones and digits. The horse walked witha stiff gait and was reluctant to trot. Nuclear scintigraphy of the distal limbs revealed multiple areas of focally increased uptake in all limbs. Radiographs of several sites on the distal limbs showed evidence of periosteal new bone production corresponding to the areas of abnormal uptake. The horse was euthanized and at necropsy chronic, multifocal, fibrous pericarditis and epicarditis were observed grossly. The left atrial myocardium contained areas of osseous metaplasia. Histological evaluation of the distal long bones revealed proliferative periosteal new bone formation consistent with a diagnosis of hypertrophic osteopathy

  3. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia

    Nusbaumer Charly


    Full Text Available Abstract Background Community-acquired pneumonia (CAP is the most frequent infection-related cause of death. The reference standard to diagnose CAP is a new infiltrate on chest radiograph in the presence of recently acquired respiratory signs and symptoms. This study aims to evaluate the diagnostic and prognostic accuracy of clinical signs and symptoms and laboratory biomarkers for CAP. Methods 545 patients with suspected lower respiratory tract infection, admitted to the emergency department of a university hospital were included in a pre-planned post-hoc analysis of two controlled intervention trials. Baseline assessment included history, clinical examination, radiography and measurements of procalcitonin (PCT, highly sensitive C-reactive protein (hsCRP and leukocyte count. Results Of the 545 patients, 373 had CAP, 132 other respiratory tract infections, and 40 other final diagnoses. The AUC of a clinical model including standard clinical signs and symptoms (i.e. fever, cough, sputum production, abnormal chest auscultation and dyspnea to diagnose CAP was 0.79 [95% CI, 0.75–0.83]. This AUC was significantly improved by including PCT and hsCRP (0.92 [0.89–0.94]; p Conclusion PCT, and to a lesser degree hsCRP, improve the accuracy of currently recommended approaches for the diagnosis of CAP, thereby complementing clinical signs and symptoms. PCT is useful in the severity assessment of CAP.

  4. Primary neuroendocrine tumour of the right ventricle presenting with heart failure and cyanosis.

    Naqvi, Syed Yaseen; Henry, David; Furukawa, Satoshi; Haber, Howard


    A 68-year-old woman presented to the emergency department owing to exertional dyspnoea and bilateral leg oedema for 3 weeks. Her vital signs included the following: heart rate of 95 bpm, respiratory rate of 24 breaths/min, oxygen saturation of 73% on room air and a blood pressure of 184/108 mm Hg. Physical examination revealed tachypnoea with clear lungs to auscultation, elevated jugular veins, cyanosis and bilateral pitting oedema. A chest X-ray demonstrated cardiomegaly without obvious pulmonary oedema. A CT of the chest was negative for pulmonary embolus; however, the scan did reveal a large right ventricular (RV) mass. An echocardiogram with bubble study confirmed a patent foramen ovale with significant right-to-left shunting and a large RV mass that significantly obstructed the pulmonary outflow tract. A cardiac biopsy revealed a low-grade neuroendocrine tumour. The patient underwent successful debridement and adjuvant chemotherapy. She improved greatly and was asymptomatic at a 9-month follow-up visit. PMID:26969366

  5. Hazards of the ‘Hard Cash’: Hypersensitivity Pneumonitis

    Elif Kupeli


    Full Text Available Hypersensitivity pneumonitis (HP is a nonimmunoglobulin E-related immune-mediated parenchymal lung disease. A 45-year-old woman who was a lifelong nonsmoker with a six-month history of frequent episodes of cough and dyspnea was admitted to hospital. She had been working as a money counter for 20 years at a central bank. Bibasilar crackles on lung auscultation, ground-glass opacities and a mosaic pattern on high-resolution computed tomography, restrictive abnormality on pulmonary function tests and mild hypoxemia were the prominent findings. Bronchoalveolar lavage fluid analysis revealed a predominance of CD4-positive T cells, and she tested positive on her natural challenge test. She was diagnosed with subacute HP based on established criteria. She was advised to discontinue counting fresh banknotes. Prednisolone was commenced, then tapered to discontinue in the ensuing six months. Clinical and radiological improvement was achieved within two months. To the authors’ knowledge, the present report is the first to describe ‘hard cash HP’, possibly caused by chipping dust or printing dye.

  6. Traumatic arteriovenous fistula. Apropos of a case

    Manuel Otero Reyes


    Full Text Available The traumatisms that affect the extremities represent 80% of all the vascular traumatisms approximately. The inadequate handling of these it contributes to fateful consequences as the loss of the life or of the function of the extremity. The vascular lesions for firearm constitute one of the main causes with the appearance of arteriovenous fistula. We present the case of a 36 year old masculine patient with antecedents of having hurt 1 year ago by firearm in the root of the left thigh goes to present increase of volume of the extremity and difficulty to the march with sensation of fatigue and gravity. To the physical exam increase of volume of the limb more marked affection was verified in the root of the thigh, in the area related with the bullet impact thrill is felt and blow holosistólico is auscultated. The echo doppler and the tomography with contrast use evidenced the presence of a arteriovenous fistula. With this diagnosis was carried out surgical exploration and repair by means of veins bond for exclusion and interference of ilio-femoral arterial implant of politetrafluoroethylene (PTFE. The postoperative evolution was satisfactory with regression of all the clinical signs.

  7. An Intelligent Phonocardiography for Automated Screening of Pediatric Heart Diseases.

    Sepehri, Amir A; Kocharian, Armen; Janani, Azin; Gharehbaghi, Arash


    This paper presents a robust device for automated screening of pediatric heart diseases based on our unique processing method in murmur characterization; the Arash-Band method. The present study modifies the Arash-Band method and employs output of the modified method in conjunction with the two other original techniques to extract indicative feature vectors for the screening. The extracted feature vectors are classified by using the support vector machine method. Results show that the proposed modifications significantly enhances performance of the Arash-Band in terms of the both accuracy and sensitivity as the corresponding effect sizes are sufficiently large. The proposed algorithm has been incorporated into an Android-based tablet to constitute an intelligent phonocardiogram with the automatic screening capability. In order to obtain confidence interval of the accuracy and sensitivity, an inferable statistical test is applied on our database containing the phonocardiogram signals recorded from 263 of the referrals to a hospital. The expected value of the accuracy/sensitivity is estimated to be 87.45 % / 87.29 % with a 95 % confidence interval of (80.19 % - 92.47 %) / (76.01 % - 95.78 %) exhibiting superior performance than a pediatric cardiologist who relies on conventional or even computer-assisted auscultation. PMID:26573653

  8. Detection of Heart Diseases by Mathematical Artificial Intelligence Algorithm Using Phonocardiogram Signals

    D. Prakash


    Full Text Available An artificial intelligence (AI algorithm has been developed using Mathematical formula to diagnose heart disease from Phonocardiogram (PCG signals. Auscultation, the technique of listening to heart sounds with a stethoscope can be used as a primary detection technique for detecting heart disorders for the past years. But now the Phonocardiogram, the digital recording of heart sounds is becoming very popular technique as it is relatively inexpensive. Four amplitude parameters of the PCG signal are extracted by using filter technique and are used as input. PCG signals for three types of heart diseases such as Tachycardia, Bradycardia and Atrial fibrillation were used in this paper to test the accuracy. These disease types that affect the electrical system of heart are known as arrhythmias, cause the heart to beat very fast (Tachycardia or very slow (Bradycardia, or unexpectedly (Atrial fibrillation. After the signals are filtered and the parameters are extracted, the parameters are fed to the AI algorithm. Classifications of heart diseases are carried using the AI algorithm by comparing the extracted parameters. Here comparison is done using Min Max method. The developed mathematical artificial intelligence algorithm is implemented in MATLab using Simulink and the simulation results proved that the developed algorithm has been shown to be a powerful technique in detection of heart diseases using PCG signals.

  9. Can joint sound assess soft and hard endpoints of the Lachman test?: A preliminary study.

    Hattori, Koji; Ogawa, Munehiro; Tanaka, Kazunori; Matsuya, Ayako; Uematsu, Kota; Tanaka, Yasuhito


    The Lachman test is considered to be a reliable physical examination for anterior cruciate ligament (ACL) injury. Patients with a damaged ACL demonstrate a soft endpoint feeling. However, examiners judge the soft and hard endpoints subjectively. The purpose of our study was to confirm objective performance of the Lachman test using joint auscultation. Human and porcine knee joints were examined. Knee joint sound during the Lachman test (Lachman sound) was analyzed by fast Fourier transformation. As quantitative indices of Lachman sound, the peak sound as the maximum relative amplitude (acoustic pressure) and its frequency were used. The mean Lachman peak sound for healthy volunteer knees was 86.9 ± 12.9 Hz in frequency and -40 ± 2.5 dB in acoustic pressure. The mean Lachman peak sound for intact porcine knees was 84.1 ± 9.4 Hz and -40.5 ± 1.7 dB. Porcine knees with ACL deficiency had a soft endpoint feeling during the Lachman test. The Lachman peak sounds of porcine knees with ACL deficiency were dispersed into four distinct groups, with center frequencies of around 40, 160, 450, and 1600. The Lachman peak sound was capable of assessing soft and hard endpoints of the Lachman test objectively. PMID:27175472

  10. Computed Tomography Following Body Stuffing Heroin

    Sean P. Nordt


    Full Text Available A 37-year-old male presented to the emergency department (ED in police custody for “medical clearance” before being taken to jail. The patient was approached by police officers for suspicion of selling illicit drugs. When approached by police he ran away and was witnessed to swallow several small plastic baggies suspected to contain heroin. He was apprehended and brought to the ED. On arrival, he was asymptomatic with a blood pressure 144/83mmHg, heart rate 67bpm, respiratory rate of 19bpm, oxygen saturation of 99% on room air and afebrile. A Glasgow coma score was 15 and he was alert and oriented to person, place and time. Patient had a negative review of systems. On physical examination pupils were 4mm and reactive to light, lungs clear to auscultation and had normal respiratory rate with normal cardiovascular exam. Abdomen was soft, non-tender and non-distended with present bowel sounds. The patient admitted to ingesting approximately 20 packets of heroin to avoid being charged with possession. The patient declined activated charcoal and whole bowel irrigation (WBI with polyethylene glycol-electrolyte solution (PEG-ELS. The patient declined a urine toxicology immunoassay screen. A computed tomography (CT of his abdomen with contrast was obtained and read as normal except for a cluster of foreign bodies within the distal stomach likely contained within a plastic bag.

  11. Development of an Amplifier for Electronic Stethoscope System and Heart Sound Analysis

    Kim, D. J.; Kang, D. K. [Chongju University, Chongju (Korea)


    The conventional stethoscope can not store its stethoscopic sounds. Therefore a doctor diagnoses a patient with instantaneous stethoscopic sounds at that time, and he can not remember the state of the patient's stethoscopic sounds on the next. This prevent accurate and objective diagnosis. If the electronic stethoscope, which can store the stethoscopic sound, is developed, the auscultation will be greatly improved. This study describes an amplifier for electronic stethoscope system that can extract heart sounds of fetus as well as adult and allow us hear and record the sounds. Using the developed stethoscopic amplifier, clean heart sounds of fetus and adult can be heard in noisy environment, such as a consultation room of a university hospital, a laboratory of a university. Surprisingly, the heart sound of a 22-week fetus was heard through the developed electronic stethoscope. Pitch detection experiments using the detected heart sounds showed that the signal represents distinct periodicity. It can be expected that the developed electronic stethoscope can substitute for conventional stethoscopes and if proper analysis method for the stethoscopic signal is developed, a good electronic stethoscope system can be produced. (author). 17 refs., 6 figs.

  12. Complicated Varicella Infection at 8-year-old Boy with Pulmonary Agenesis

    Hadzovic–Cengic, Meliha; Baljic, Rusmir; Hadzic, Amir; Lukovac, Enra; Mehanic, Snjezana; Ahmetspahic-Begic, Aida


    SUMMARY CONFLICT OF INTEREST: none declared. Introduction Varicella or chickenpox is highly contagious, childhood infectious disease caused by primary infection with varicella – zoster virus from the herpes family of viruses. Usually it has a mild clinical course, rarely with described complication, mostly affecting respiratory tract and rarely the central nervous system. Case report The case present 8 year old boy hospitalized eighth day of disease with clinical pictures of varicella complication. Upon receipt tachydyspnea, high fever, tachycardia, hypotensive with positive findings on lung auscultation in the sense of pneumonia. Extremely high values of non-specific inflammatory parameters are implied on bacterial infection which is treated using triple antimicrobial therapy and antiviral. A detailed clinical, laboratory and radiological evaluation is determined of clinical disease complication under a picture of MODS that required prolonged multidisciplinary treatment in ICU. Conclusion The disease had a favorable clinical outcome in terms of training completely without consequences but, with the detected congenital absence lower lobe of right lung and transposition of the brachiocephalic trunk. PMID:24493991

  13. Role of fetal monitoring in high risk pregnancy by fetal electrocardiogram

    Somya Girish Goyal


    Full Text Available Background: Non-stress test is an external monitoring of fetal heart rate by electrocardiograph. Although intermittent auscultation of fetal heart rate is equivalent to continuous electronic fetal monitoring in detecting fetal compromise1 but continuous electronic fetal monitoring is indicated in high risk patients women whose foetuses are at high risk for neonatal encephalopathy or cerebral palsy.2 Objective of current study was to study the efficacy and diagnostic value of non-stress Test for surveillance and its usefulness to detect fetal distress at early stage which help to decide further management in mode of delivery. Methods: Design: prospective study. NST was done in 50 high risk patients for minimum of 20 minutes and in patients with non-reactive non stress test it was continued for 40 minutes. Maternal age, parity, complications during labour, and delivery, mode of delivery, indications of caesarean section and perinatal outcome were noted. Results: Out of total 50 cases studied patient delivered vaginally were 24 and Caesarean was done in 26 cases. Most LSCS were performed due to PIH (35% and related complications like IUGR, eclampsia (10%, fetal distress, previous caesarean pregnancy, IUGR, oligohydraminos and meconium stained liquor. 52% patients were delivered by caesarean and 48% by normal delivery. Conclusions: Routine use of electronic fetal heart monitoring helped in reduction of neonatal morbidity and mortality with increased rate of caesarean section. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 893-897

  14. Sensitivity and specificity of on-farm scoring systems and nasal culture to detect bovine respiratory disease complex in preweaned dairy calves.

    Love, William J; Lehenbauer, Terry W; Van Eenennaam, Alison L; Drake, Christiana M; Kass, Philip H; Farver, Thomas B; Aly, Sharif S


    The California (CA) and Wisconsin (WI) clinical scoring systems have been proposed for bovine respiratory disease complex (BRDC) detection in preweaned dairy calves. The screening sensitivity (SSe), for estimating BRDC prevalence in a cohort of calves, diagnostic sensitivity (DSe), for confirming BRDC in ill calves, and specificity (Sp) were estimated for each of the scoring systems, as well as for nasal swab cultures for aerobic bacteria and mycoplasma species. Thoracic ultrasound and auscultation were used as the reference standard tests interpreted in parallel. A total of 536 calves (221 with BRDC and 315 healthy) were sampled from 5 premises in California. The SSe of 46.8%, DSe of 72.6%, and Sp of 87.4% was determined for the CA system. The SSe of 46.0%, DSe of 71.1%, and Sp of 91.2% was determined for the WI system. For aerobic culture, the SSe was 43.4%, DSe was 52.6%, and Sp was 71.3%; for Mycoplasma spp. culture, the SSe was 57.5%, DSe was 68.9%, and Sp was 59.7%. The screening and diagnostic sensitivities of the scoring systems were not significantly different but the Sp of the WI system was greater by 3.8%. Scoring systems can serve as rapid on-farm tools to determine the burden of BRDC in preweaned dairy calves. However, users may expect the SSe to be less than the DSe when confirming BRDC in an ill calf. PMID:26796957

  15. A training session in a clinical simulation laboratory for the acquisition of clinical skills by newly recruited medical interns.

    Yoshimura, Akinobu; Shimura, Toshiro; Kim, Chol; Ishikawa, Gen; Haraguchi, Shuji; Ohno, Tadaaki; Hayashi, Hiroki; Nakano, Hiroshi; Nitta, Takashi; Takaoka, Masako


    In organized orientation programs for newly recruited medical interns of the Nippon Medical School Hospital, the working committee of the clinical simulation laboratory introduced a laboratory training session that was designed to improve the clinical skills of the medical interns. The session consisted of 6 training courses, comprising internal examination, tracheal intubation, auscultation of heart sounds, bandaging and the collection of samples of venous and arterial blood. Medical interns rotated to a new course every 30 minutes and did practical trainings in each of the 6 skills. A total of 36 newly recruited medical interns participated in the training session. The majority of medical interns took part in the practical training actively and positively. The session was efficiently carried out from the standpoints of human resources and the teaching hours involved. A post training questionnaire survey, completed by the medical interns, revealed that many of them valued the sessions for comprehensibility of the instructions, the descriptions in the manual and the content of the training; however, only 21% thought that they had successfully acquired the clinical skills. Medical interns must continually engage in self-training to steadily acquire basic clinical skills. The convenience of a clinical simulation laboratory, together with the reinforcement of the education of clinical skills during internship, is necessary to strengthen the educational benefits of the training session. PMID:20818139

  16. Auditory Verbal Cues Alter the Perceived Flavor of Beverages and Ease of Swallowing: A Psychometric and Electrophysiological Analysis

    Aya Nakamura


    Full Text Available We investigated the possible effects of auditory verbal cues on flavor perception and swallow physiology for younger and elder participants. Apple juice, aojiru (grass juice, and water were ingested with or without auditory verbal cues. Flavor perception and ease of swallowing were measured using a visual analog scale and swallow physiology by surface electromyography and cervical auscultation. The auditory verbal cues had significant positive effects on flavor and ease of swallowing as well as on swallow physiology. The taste score and the ease of swallowing score significantly increased when the participant’s anticipation was primed by accurate auditory verbal cues. There was no significant effect of auditory verbal cues on distaste score. Regardless of age, the maximum suprahyoid muscle activity significantly decreased when a beverage was ingested without auditory verbal cues. The interval between the onset of swallowing sounds and the peak timing point of the infrahyoid muscle activity significantly shortened when the anticipation induced by the cue was contradicted in the elderly participant group. These results suggest that auditory verbal cues can improve the perceived flavor of beverages and swallow physiology.

  17. Low frequency arterial wall movements for indirect blood pressure measurement in man. Validation of a method for non-invasive assessment of blood pressure under the influence of isoprenaline and angiotensin.

    Dietz, U; Belz, G G


    In order to measure blood pressure noninvasively, the second derivative of the low frequency wall movements of the brachial artery were registered with a piezo-electric pressure probe during deflation of a Riva-Rocci cuff along with the actual cuff pressure. Two characteristic phenomena of this signal have been suggested to reflect systolic and diastolic blood pressure. Appearance of a positive spike phenomenon (S) was suggested to indicate systolic blood pressure and disappearance of a negative preanacrotic notch (D) to indicate diastolic blood pressure. To prove the validity of these suggestions, these phenomena were assessed in 10 young healthy males during isoprenaline and angiotensin induced changes of blood pressure. Intraarterial (A. radialis) and auscultatory (A. brachialis) blood pressures were recorded simultaneously. Determination of systolic blood pressure with the S phenomenon agreed well with invasive and auscultatory results. Invasive diastolic values agreed well with the cuff pressure at the last signal before disappearance of the preanacrotic notch (D1). Data from auscultation agreed less well with the D1 phenomenon. With increasing doses of isoprenaline, the diastolic measurements (D1) tended to be lower than the invasive ones. However, this discrepancy was far discreeter than that seen with ordinary auscultatory blood pressure measurement. We therefore conclude that registrations of low frequency arterial wall movements yield distinct characteristic spike phenomena useful for measurement of blood pressure in good agreement with the invasive method. In addition, the method provides clearly documented records and should be useful in situations which rely on a valid indirect method. PMID:1898428

  18. A Distinguishing Arterial Pulse Waves Approach by Using Image Processing and Feature Extraction Technique.

    Chen, Hsing-Chung; Kuo, Shyi-Shiun; Sun, Shen-Ching; Chang, Chia-Hui


    Traditional Chinese Medicine (TCM) is based on five main types of diagnoses methods consisting of inspection, auscultation, olfaction, inquiry, and palpation. The most important one is palpation also called pulse diagnosis which is to measure wrist artery pulse by doctor's fingers for detecting patient's health state. In this paper, it is carried out by using a specialized pulse measuring instrument to classify one's pulse type. The measured pulse waves (MPWs) were segmented into the arterial pulse wave curve (APWC) by image proposing method. The slopes and periods among four specific points on the APWC were taken to be the pulse features. Three algorithms are proposed in this paper, which could extract these features from the APWCs and compared their differences between each of them to the average feature matrix, individually. These results show that the method proposed in this study is superior and more accurate than the previous studies. The proposed method could significantly save doctors a large amount of time, increase accuracy and decrease data volume. PMID:27562483

  19. Do Simulation-Based Skill Exercises and Post-Encounter Notes Add Additional Value to a Standardized Patient-Based Clinical Skills Examination?

    Michael D. Prislin


    Full Text Available Background. Standardized patient (SP clinical assessments have limited utility in assessing higher-level clinical competencies. This study explores the value of including simulation exercises and postencounter notes in an SP clinical skills examination. Methods. Two exercises involving cardiac auscultation and ophthalmic funduscopy simulations along with written post encounter notes were added to an SP-based performance examination. Descriptive analyses of students' performance and correlations with SP-based performance measures were obtained. Results. Students' abilities to detect abnormalities on physical exam were highly variable. There were no correlations between SP-based and simulation-derived measures of physical examination competency. Limited correlations were found between students' abilities to perform and document physical examinations and their formulation of appropriate differential diagnoses. Conclusions. Clinical simulation exercises add depth to SP-based assessments of performance. Evaluating the content of post encounter notes offers some insight into students' integrative abilities, and this appears to be improved by the addition of simulation-based post encounter skill exercises. However, further refinement of this methodology is needed.

  20. 冠心病中医四诊客观化研究现状%Research Situation of Four Diagnosis Objectification of Coronary Heart Disease

    董梦青; 李福凤


    中医诊断精髓在于“辨证论治”,而中医辨证以“望、闻、问、切”四诊为依据,通过四诊合参,综合各类临床信息,对疾病进行确切诊断.对近10年来冠心病的中医四诊客观化研究情况进行整理,系统地总结归纳了目前中医界专家学者对冠心病病因病机、舌象、脉象、面诊、闻诊和问诊的客观化研究进展,并对冠心病客观化的未来发展趋势进行展望.%The essence of traditional Chinese medicine diagnosis is the diagnosis and treatment based on syndrome differentiation,while TCM syndrome differentiation is based on TCM four diagnosis methods,through the combination of all comprehensive clinical information to diagnose the disease.The author summarized the researches on TCM four diagnosis objectification in the past 10 years,and systematically summarized the research development of pathogenesis,etiology,tongue inspection,pulse inspection,face inspection,auscultation and inquiry of coronary heart disease of the experts and scholars of Chinese medicine,prospecting the development trends of TCM objectification.

  1. Five Vessel Coronary Arter Bypass Graft Surgery in a Case with Familial Hypercholesterolemia

    Sureyya Talay


    Full Text Available We report a case of a rare and sypmtomatic familyal hypercholesterolemia case with an end-point of coronary artery bypass surgery at the age of 16. Patient was evaluated at the emergency department with chest pain and discomfort. Physical examination were within normal limits. The electrocardiogram showed a normal sinus rhythm for 108/ min. Arterial blood pressure was 90/60 mmHg. Lungs and heart were clear to auscultation. Patient was under treatment with a prior diagnosis of familial hypercholesterolemia (FH for one year by daily 40 mgs rosuvastatine. A coronary artery angiography was performed for chest pain. Multivessel coronary artery disease was diagnosed with a total occlusion of left anterior descending artery. Transthoracic echocardiography presented a left ventricular (LV ejection fraction 50%, LV diameters 44/26 mm, aneurysm formation at interatrial septum and mild dyskinesia of anterior wall. Thus, a five vessel emergent coronary artery graft bypass surgery was performed at this early age. FH is with a severe elevation in total cholesterol (TC and low density lipoprotein cholesterol (LDL in an autosomal dominant characteristic disorder that approximately occurs in 1 per 500 persons by its heterozygous form. FH is most certainly associated with premature coronary artery disease (CAD with catasthrophic early age results. [Cukurova Med J 2014; 39(4.000: 872-875

  2. Antibiotics for coughing in general practice: a questionnaire study to quantify and condense the reasons for prescribing

    Van Royen Paul


    Full Text Available Abstract Background Antibiotics are being overprescribed in ambulant care, especially for respiratory tract infections (RTIs. Gaining insight into the actual reasons for prescribing remains important for the design of effective strategies to optimise antibiotic prescribing. We aimed to determine items of importance for the antibiotic prescribing decision and to make them operational for an intervention trial. Methods A postal questionnaire based upon focus group findings was sent to 316 Flemish general practitioners (GPs. On a verbal rating scale the GPs scored to what extent they consider the questionnaire items in decision making in case of suspected RTI in a coughing patient and how strongly the items support or counter antibiotic treatment. Factor analysis was used to condense the data. The relative importance of the yielded operational factors was assessed using Wilcoxon Matched Pairs test. Results 59.5% completed the study. Response group characteristics (mean age: 42.8 years; 65.9% men approximated that of all Flemish GPs. Participants considered all the items included in the questionnaire: always the operational factor 'lung auscultation', often 'whether or not there is something unusual happening' – both medical reasons – and to a lesser extent 'non-medical reasons' (P Conclusion This study quantified, condensed and confirmed the findings of previous focus group research. Practice guidelines and interventions to optimise antibiotic prescribing have to take non-medical reasons into account.

  3. [Fever and lung abscesses in anorexia nervosa after infusion therapy].

    Hoffmann, J; Herzum, M; Maisch, B


    A 26 year old female patient was admitted to our hospital because of septic temperatures and chills. In the patient's history renal insufficiency has been known for several years due to agenesia of the right and pyelonephritic renal congestion of the left kidney. Long lasting anorexia nervosa had been treated by psychotherapeutical interventions for years and when failing it necessitated repeated intravenous nutrition by central venous lines. The prominent symptom of the intravenously treated young woman was fever up to 39.7 degrees C and pneumonia, which was considered by the first treating clinic to be caused directly by diminished immunoreactivity in malnutrition and preuremia. The chest X-ray confirmed pneumonia and revealed multiple abscesses in both lungs (Figure 1). After being transferred to our intensive care unit the pathophysiological context became obvious. From inspection (positive jugular pulsation), from auscultation (holosystolic murmur at the left parasternal border) tricuspid incompetence due to infective endocarditis was suspected. This was confirmed immediately by TM and two-dimensional transthoracic echocardiography, which showed a large vegetation on the anterior tricuspid valve leaflet (Figures 2a and 2b). Tricuspid regurgitation was also ascertained by color flow echocardiography (Figure 2c). Several blood cultures were positive for staphylococcus aureus. Clinical and laboratory recovery was achieved by antibiotic therapy with vancomycin and cephtazidim for 3 months.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7927123

  4. A color spectrographic phonocardiography (CSP applied to the detection and characterization of heart murmurs: preliminary results

    Hassani Kamran


    Full Text Available Abstract Background Although cardiac auscultation remains important to detect abnormal sounds and murmurs indicative of cardiac pathology, the application of electronic methods remains seldom used in everyday clinical practice. In this report we provide preliminary data showing how the phonocardiogram can be analyzed using color spectrographic techniques and discuss how such information may be of future value for noninvasive cardiac monitoring. Methods We digitally recorded the phonocardiogram using a high-speed USB interface and the program Gold Wave in 55 infants and adults with cardiac structural disease as well as from normal individuals and individuals with innocent murmurs. Color spectrographic analysis of the signal was performed using Spectrogram (Version 16 as a well as custom MATLAB code. Results Our preliminary data is presented as a series of seven cases. Conclusions We expect the application of spectrographic techniques to phonocardiography to grow substantially as ongoing research demonstrates its utility in various clinical settings. Our evaluation of a simple, low-cost phonocardiographic recording and analysis system to assist in determining the characteristic features of heart murmurs shows promise in helping distinguish innocent systolic murmurs from pathological murmurs in children and is expected to useful in other clinical settings as well.

  5. Morbidity of Chagas heart disease in the microregion of Rio Negro, Amazonian Brazil: a case-control study

    Jose Rodrigues Coura


    Full Text Available A case-control study on the morbidity of Chagas heart disease was carried out in the municipality of Barcelos in the microregion of the Rio Negro, state of Amazonas. One hundred and six individuals, who were serologically positive for Trypanosoma cruzi infection, as confirmed by at least two techniques with different principles, were matched according to age and sex with an equal number of seronegative individuals. The cases and controls were evaluated using an epidemiological questionnaire and clinical, electrocardiograph and echocardiograph examinations. In the seroepidemiological evaluation, 62% of the interviewees recognised triatomines and most of them confirmed that they had seen these insects in the piassava plantations of the riverside communities of the Negro River tributaries. Of the seropositive patients, 25.8% affirmed that they had been stung by the triatomines and 11.7% denied having been stung. The principal clinical manifestations of the seropositive individuals were palpitations, chest pain and dyspnoea upon effort. Cardiac auscultation revealed extrasystoles, bradycardia and systolic murmurs. The electrocardiographic alterations were ventricular extrasystoles, left and right bundle branch block, atrioventricular block and primary T wave alterations. The echocardiogram was altered in 22.6% of the seropositive individuals and in 8.5% of the seronegative individuals.

  6. Age alters the cardiovascular response to direct passive heating

    Minson, C. T.; Wladkowski, S. L.; Cardell, A. F.; Pawelczyk, J. A.; Kenney, W. L.


    During direct passive heating in young men, a dramatic increase in skin blood flow is achieved by a rise in cardiac output (Qc) and redistribution of flow from the splanchnic and renal vascular beds. To examine the effect of age on these responses, seven young (Y; 23 +/- 1 yr) and seven older (O; 70 +/- 3 yr) men were passively heated with water-perfused suits to their individual limit of thermal tolerance. Measurements included heart rate (HR), Qc (by acetylene rebreathing), central venous pressure (via peripherally inserted central catheter), blood pressures (by brachial auscultation), skin blood flow (from increases in forearm blood flow by venous occlusion plethysmography), splanchnic blood flow (by indocyanine green clearance), renal blood flow (by p-aminohippurate clearance), and esophageal and mean skin temperatures. Qc was significantly lower in the older than in the young men (11.1 +/- 0.7 and 7.4 +/- 0.2 l/min in Y and O, respectively, at the limit of thermal tolerance; P blood flow from the combined splanchnic and renal circulations at the limit of thermal tolerance (960 +/- 80 and 720 +/- 100 ml/min in Y and O, respectively, P blood flow directed to the skin.

  7. Re-evaluation of normal splitting of the second heart sound in patients with classical left bundle branch block.

    Xiao, H B; Faiek, A H; Gibson, D G


    To study the mechanism of normal splitting of the second heart sound in patients with classical left bundle branch block, we investigated 43 such patients and 15 normal controls, using electro-, phono- and echo-cardiography and comparing the relative timing of mechanical activity in the two ventricles. The splitting of the second heart sound is reversed in only two-thirds of the patients and normal in remaining one-third. Comparing patients with and without reversed splitting, there are no significant differences in left ventricular cavity size, heart rate, pre-ejection period and the distribution of age, gender, or aetiology. QRS duration is longer (P < 0.01) in patients with reversed splitting. Diastolic events of the left ventricle do not differ between groups. The onset of the left ventricular free wall motion is delayed compared with normal by a similar extent in the two groups. In patients with normal splitting, the onset of the right ventricular wall motion is also delayed, both with respect to normal and to those with reversed splitting to an extent similar to that seen in classical right bundle branch block. Normal splitting of the second heart sound associated with an electrocardiographic pattern of left bundle branch block therefore suggests bilateral block. This combination can be documented from the precise timing of the movement of the two ventricles by M-mode echocardiography and identified by simple auscultation. PMID:7960260

  8. August 2015 pulmonary case of the month: holy sheep

    Hall JM


    Full Text Available No abstract available. Article truncated after 150 words. History of Present Illness: A 42-year-old woman presented to the emergency department with chest pain and dyspnea. The onset of symptoms was acute, initially endorsing left-sided sharp chest pain which then progressed with dyspnea. Chest radiograph was read as normal. Laboratory evaluation was notable for an elevated D-Dimer which prompted a thoracic CT scan to be obtained. Past Medical History, Family History, Social History: She had well-controlled rheumatoid arthritis (on no medical therapy and was diagnosed with emphysema by her PCP two years earlier. Her mother died from pulmonary embolism secondary to underlying lung cancer. She quit smoking 2 years ago with a total of 20-pack-years. Physical Examination: Patient was in mild distress with heart rate of 105, respiratory rate of 22, but otherwise stable, SpO2 was 95% while breathing ambient air. She had diminished breath sounds in both bases, but otherwise her chest was clear to auscultation. The remainder ...

  9. A Rare Case of Jejunal Arterio-Venous Fistula: Treatment with Superselective Catheter Embolization with a Tracker-18 Catheter and Microcoils

    Arterio-venous fistulas may develop spontaneously, following trauma or infection, or be iatrogenic in nature. We present a rare case of a jejunal arterio- venous fistula in a 35-year-old man with a history of pancreatic head resection that had been performed two years previously because of chronic pancreatitis. The patient was admitted with acute upper abdominal pain, vomiting and an abdominal machinery-type bruit. The diagnosis of a jejunal arterio-venous fistula was established by MR imaging. Transfemoral angiography was performed to assess the possibility of catheter embolization. The angiographic study revealed a small aneurysm of the third jejunal artery, abnormal early filling of dilated jejunal veins and marked filling of the slightly dilated portal vein (13-14 mm). We considered the presence of segmental portal hypertension. The patient was treated with coil embolization in the same angiographic session. This case report demonstrates the importance of auscultation of the abdomen in the initial clinical examination. MR imaging and color Doppler ultrasound are excellent noninvasive tools in establishing the diagnosis. The role of interventional radiological techniques in the treatment of early portal hypertension secondary to jejunal arterio-venous fistula is discussed at a time when this condition is still asymptomatic. A review of the current literature is included

  10. Spontaneous pneumomediastinum with a rare presentation.

    Bolvardi, Ehsan; Pishbin, Elham; Ebrahimi, Mohsen; Mahmoudi Gharaee, Azadeh; Bagherian, Farhad


    Spontaneous pneumomediastinum is an unusual and benign condition in which air is present in mediastinum. A 20-year-old male patient presented to ED with complaint of hoarseness and odynophagia from the day before, after weightlifting. The patient was nonsmoker and denied history of other diseases. On physical examination he had no dyspnea with normal vital signs. Throat examination and pulmonary auscultation were normal and no crepitation was palpable. We could not find subcutaneous emphysema in neck and chest examination. In neck and chest X-ray we found that air is present around the trachea. There was no apparent pneumothorax in CXR. In cervical and chest CT free air was present around trachea and in mediastinum. Subcutaneous emphysema was also evident. But there was no pneumothorax. The patient was admitted and went under close observation, oxygen therapy, and analgesic. The pneumomediastinum and subcutaneous emphysema gradually resolved within a week by conservative therapy and he was discharged without any complication. Many different conditions could be trigged because of pneumomediastinum but it is rarely seen in intense physical exertion such as weightlifting and bodybuilding. Two most common symptoms are retrosternal chest pain and dyspnea. But the patient here complained of hoarseness and odynophagia. PMID:24963422

  11. Spontaneous Pneumomediastinum with a Rare Presentation

    Ehsan Bolvardi


    Full Text Available Spontaneous pneumomediastinum is an unusual and benign condition in which air is present in mediastinum. A 20-year-old male patient presented to ED with complaint of hoarseness and odynophagia from the day before, after weightlifting. The patient was nonsmoker and denied history of other diseases. On physical examination he had no dyspnea with normal vital signs. Throat examination and pulmonary auscultation were normal and no crepitation was palpable. We could not find subcutaneous emphysema in neck and chest examination. In neck and chest X-ray we found that air is present around the trachea. There was no apparent pneumothorax in CXR. In cervical and chest CT free air was present around trachea and in mediastinum. Subcutaneous emphysema was also evident. But there was no pneumothorax. The patient was admitted and went under close observation, oxygen therapy, and analgesic. The pneumomediastinum and subcutaneous emphysema gradually resolved within a week by conservative therapy and he was discharged without any complication. Many different conditions could be trigged because of pneumomediastinum but it is rarely seen in intense physical exertion such as weightlifting and bodybuilding. Two most common symptoms are retrosternal chest pain and dyspnea. But the patient here complained of hoarseness and odynophagia.

  12. Rumenolith formation in a Bapedi ram

    Rhoda Leask


    Full Text Available During a routine flock visit, a farmer observed that one of the eight tooth Bapedi rams had been losing body condition despite being separated from the flock and fed supplementary feed. The ram’s body condition score was assessed as 2 out of 5 (one point less than the average of the rest of the rams and the teeth appeared normal with no excessive wear. The rumen was assessed by auscultation, palpation and ballottement where a foreign body (approximately 20 cm × 5 cm – 10 cm was clearly palpated and ballotted. A rumenotomy was performed and a large mass of tightly compacted foreign matter and plant material was removed. The mass consisted of synthetic fibre, plant material and calcium phosphate (50.5%. It appeared to have formed as the result of the ingestion of a synthetic fibre which formed the nidus of a concretion. This was probably the result of deficient nutrition, with the rams eating the synthetic fibre in an attempt to increase feed intake. The ram recovered uneventfully after the rumenotomy was performed and supplementary feeding.

  13. January 2015 pulmonary case of the month: more red wine, every time

    Ghori U


    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: A 41-year-old man travelling from Texas to Las Vegas, Nevada presents to the Emergency Room in Albuquerque, New Mexico with petechial rash, photophobia and headache of 2 weeks duration. The patient complains of general malaise, arthralgia, trouble sleeping, shortness of breath associated with cough and intermittent bilateral lower extremity swelling of 3 weeks duration. PMH, SH & FH: The patient was prescribed lisinopril and metformin for hypertension and diabetes mellitus, respectively. He admitted occasional drinking, smoking a variable quantity for 30 years but currently not smoking. He denied any illicit drug use. Physical Exam: Vitals: Heart Rate-92, Blood Pressure-116/45 mm Hg, Respiratory Rate-44 breaths/min, Temperature- 37.2ºC, SpO2-98% on non-rebreather mask. General: His mental status was not altered. HEENT: No papilledema was appreciated on eye exam. Neck: JVP not appreciated. Lungs: he had diminished breath sounds bilaterally on auscultation. Heart: His heart had a regular rate and ...

  14. Pericardial Mesothelioma in a Yellow-naped Amazon Parrot (Amazona auropalliata).

    McCleery, Brynn; Jones, Michael P; Manasse, Jorden; Johns, Sara; Gompf, Rebecca E; Newman, Shelley


    A 37-year-old female yellow-naped Amazon parrot (Amazona auropalliata) was presented with a history of lethargy, inappetence, and decreased vocalizations. On examination, the coelom was moderately distended and palpated fluctuant, and the heart was muffled on auscultation. Coelomic ultrasound, coelomocentesis, and radiographs were performed and revealed an enlarged cardiac silhouette and marked coelomic effusion. Pericardial effusion was confirmed by echocardiography. A well-circumscribed, hyperechoic soft tissue density was observed at the level of the right atrium on initial echocardiography; however, a cardiac mass was not identified by computed tomography scan or repeat echocardiograms. Ultrasound-guided pericardiocentesis was performed under anesthesia, and cytology results were consistent with hemorrhage; no neoplastic cells were identified. A repeat echocardiogram 4 days after pericardiocentesis revealed recurrence of the pericardial effusion. Due to the grave prognosis, the owners declined endoscopic pericardiectomy, and the patient died the following day. On postmortem examination, the pericardial surface of the heart was covered in a white to yellow, multinodular mass layer. Histologic analysis revealed a multinodular mass extending from the atria, running along the epicardium distally, and often extending into the myocardium. Neoplastic cells present in the heart mass and pericardium did not stain with a Churukian-Schenk stain, and thyroglobulin immunohistochemistry was negative. Cytokeratin and vimentin stains showed positive expression in the neoplastic cells within the mass. These results are consistent with a diagnosis of mesothelioma. This is the first report of mesothelioma in a psittacine bird. PMID:25867668

  15. Value of renal scintigraphy with captopril test in the exploration of renovascular hypertension: Case report

    Introduction Dynamic renal scintigraphy with 99mTc-DTPA and captopril test is a non-invasive functional method for the diagnosis of renovascular hypertension. It allows differentiating between hypertension induced by renal arterial stenosis from primary arterial hypertension with an incidental stenosis. Case report A 14-year-old girl, without previous medical history, developed a severe arterial hypertension with cephalalgia and ears buzzing. Auscultation revealed a murmur in the left lumbar pit. Renal angiography objectified a stenosis of the infra renal aorta due to a circumferential parietal thickening associated to renal arteries stenosis more marked in the left side. Dynamic renal scintigraphy after administration of captopril highlighted a marked collapse of the rate of tracer uptake exceeding 40% on the left side with an increase in the time of collecting on the right side testifying a frankly positive test prevailing on the left. A transluminal angioplasty of the left renal artery and a revascularization surgery on the right side were carried out. The evolution was marked by an improvement of blood pressure figures. Discussion Dynamic renal scintigraphy using 99mTc-DTPA with captopril test constitutes a non-invasive process with a low dosimetry for the patients. Its principal goal is to affirm the role of renovascular stenosis in the origin of arterial hypertension and to determine which hypertensive patients with renal arterial stenosis can be treated successfully by surgical or endoscopic revascularization of the kidney. (authors)

  16. The reliability of lung crackle characteristics in cystic fibrosis and bronchiectasis patients in a clinical setting

    Lung sounds provide useful information for assessing and monitoring respiratory patients, but standard auscultation is subjective. Computer aided lung sound analysis (CALSA) enables the quantification and characterisation of added lung sounds (e.g. crackles). At present, little is known about the reliability of these sound characteristics. Therefore, the aim of this study was to explore the reliability of crackle initial deflection width (IDW) and two-cycle deflection (2CD) in a clinical population. Fifty-four subjects (37 bronchiectasis, 17 cystic fibrosis) were recruited from out-patient clinics. Three repeated lung sound recordings were taken at seven anatomical sites with a digital stethoscope connected to a laptop computer. The intra-subject reliability of crackle IDW and 2CD was found to be 'good' to 'excellent', estimated by the analysis of variance, intraclass correlation coefficient (IDW 0.76;0.85, 2CD 0.83;0.94), Bland and Altman 95% limits of agreement (IDW −0.50;0.47 ms, 2CD −2.12;1.87 ms) and smallest real difference (IDW 0.30;0.66 ms, 2CD 1.57;2.42 ms). Crackle 2CD was found to be more reliable than IDW. It is concluded that crackle IDW and 2CD characterized by CALSA have good test–retest reliability. This technique requires further evaluation since CALSA has potential to diagnose or monitor respiratory conditions, and provide an objective physiological measure for respiratory interventions

  17. Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery.

    Kalava, Arun; Clark, Kirpal; McIntyre, John; Yarmush, Joel M; Lizardo, Teresita


    A 64-year-old male had an awake right nasal fiber-optic intubation with an endotracheal tube for open reduction and internal fixation of bilateral displaced mandibular fractures. After induction of anesthesia, an 18 Fr nasogastric tube (NGT) was inserted through the left nostril and was secured. The patient required high flow rates to deliver adequate tidal volumes with the ventilator. A chest x-ray done in the postanesthesia care unit revealed a malpositioned NGT in the left lower lobe bronchus, which was immediately removed. The patient was extubated on postoperative day 2. Various traditional methods, such as aspiration of gastric contents, auscultation of gastric insufflations, and chest x-ray are in use to detect or prevent the misplacement of an NGT. These methods can be unreliable or impractical. Use of capnography to detect an improperly placed NGT should be considered in the operating room as a simple, cost-effective method with high sensitivity to prevent possibly serious sequelae of an NGT placed within the bronchial tree. PMID:26398128

  18. [Intraoperative risk management during thoracic procedures].

    Tsuzaki, Koichi


    Risk management in clinical practice is an impor part of medical audit. Although, medical audit consists of monitoring, data collection, peer review and establishing standards, these four steps should be regarded as a series of cyclical process. As a general rule, this concept should be applied to any field of clinical medicine and will contribute to the development of sound quality control scheme. Several complications are known to occur in thoracic anesthesia, especially in one-lung ventilation. For example, malposition of double-lumen endotracheal tube, severe hypoxia and higher airway pressure are relatively common problems, and it would be better for us to prepare for these adverse events beforehand. Auscultation, fiber-optic visualization and proper ventilatory management (eg. lower tidal volume with dependent lung PEEP, alveolar recruitment maneuver, application of CPAP to non-dependent lung) are the recommended technique required to correct these abnormalities. When life-threatening hypoxia is imminent, we should convert to two-lung ventilation without any delay. In this regard, verbal communication between surgical teams should be kept on even ground, each playing key roles in the management of such a critical situation. PMID:19462793

  19. Care in a birth center according to the recommendations of the World Health Organization

    Flora Maria Barbosa da Silva


    Full Text Available Birth centers are maternal care models that use appropriate technology when providing care to birthing women. This descriptive study aimed to characterize intrapartum care in a freestanding birth center, in light of the practices recommended by the World Health Organization (WHO, with 1,079 assisted births from 2006 to 2009 in the Sapopemba Birth Center, São Paulo, Brazil. Results included the use of intermittent auscultation (mean=7 controls; maternal positions during delivery: semi-sitting (82.3%, side-lying (16.0%, other positions (1.7%, oral intake (95.6%; companionship (93.3%; exposure to up to three vaginal examinations (85.4%, shower bathing (84.0%, walking (68.0%, massage (60.1%, exercising with a Swiss ball (51.7%; amniotomy (53.4%, oxytocin use during the first (31.0% and second stages of labor (25.8%, bath immersion (29.3% and episiotomy (14.1%. In this birth center, care providers used practices recommended by the WHO, although some practices might have been applied less frequently.

  20. The HADES demonstration and pilot project on radioactive waste disposal in a clay formation

    The overall objective of the HADES programme is the evaluation of the technical feasibility and safety of the disposal of radwaste in a deep clay formation. The pilot phase is aimed at demonstrating the system behaviour for those components of the system and those operations and issues which can be demonstrated directly. The time period considered covers a first phase of the development programme of the pilot project which includes: -The construction of a concrete lined tests drift of about 30 m length with a useful inner diameter of 3.5 m. In the lining, a number of openings or ports are foreseen for emplacing the various tests and sensors for the general auscultation in the host rock; - Mine-by test for the investigation of the response of the surrounding clay on the excavating; - CERBERUS test, a combined heating-irradiation test aiming at evaluating by simulation (electrical heaters and Co-60 radiation source) the impact of a HLW canister on its immediate near field; - Design of a gallery heating test for the demonstration by simulation of the behaviour of a concrete lined gallery structure and of the surrounding clay mass in a temperature field (TEMPPRES code for temperature and pressure evolution simulation). 21 refs

  1. Identification of Velcro rales based on Hilbert-Huang transform

    Chen, Xue; Shao, Jie; Long, Yingjiao; Que, Chengli; Zhang, Jue; Fang, Jing


    Velcro rales, as a kind of crackles, are relatively specific for lung fibrosis and usually the first clinical clue of interstitial lung disease (ILD). We proposed an automatic analytic tool based on Hilbert-Huang transform (HHT) for the computerized identification of Velcro rales. In particular, HHT was utilized to extract the energy weight in various frequency bands (EW) of crackles and to calculate the portion of crackles during late inspiration. Support vector machine (SVM) based on the HHT-derived measures was used to differentiate Velcro rales from other crackles. We found that there were significant differences in the extracted parameters between Velcro rales and other crackles, including EW, EW and the proportion of crackles that appeared during the late inspiration. The discrimination results obtained from SVM achieved a concordance rate up to 92.20%±1.80% as confirmed by the diagnosis from experienced physicians. For practical purpose, the proposed approach may have potential applications to improve the sensitivity and accuracy of auscultation and conduct automatic ILD diagnose system.

  2. Soplos cardíacos fisiológicos y patológicos en el caballo de deporte. Su diagnóstico diferencial Physiological and pathological cardiac murmurs in the sport of horse. Its differential diagnosis

    G Pidal


    Full Text Available Los autores describen las pautas utilizadas para mejorar el diagnóstico diferencial entre los soplos patológicos y los soplos fisiológicos en el caballo, particularmente en los utilizados en deportes ecuestres. Asimismo, presentan la incidencia encontrada en la población estudiada de los soplos funcionales según válvula afectada y uso del caballo. Finalmente hace referencia al "error diagnóstico" en la clasificación de los soplos (patológicos / fisiológicos cuando son estudiados por medio de la semiología clásica (auscultación y luego de la utilización de exploraciones complementarias como la ecocardiografía bidimensional y el Doppler cardíaco.The authors describe the guidelines used to improve the differential diagnosis between physiological and pathological murmurs in horses, particularly those used in equestrian sports. They also present the incidence of functional murmurs, valve affected and use of the horse found in the population studied. Finally refer to "diagnostic error" in the classification of murmurs (pathological / physiological when studied by clinical evaluation (auscultation and after the use of complementary studies as bidimensional echocardiography and cardiac Doppler.

  3. A 15-Year-Old Boy with Anterior Chest Pain, Progressive Dyspnea, and Subcutaneous Emphysema of the Neck

    Nicola Scichilone


    Full Text Available We describe the case of an adolescent who was admitted to the hospital because of sudden occurrence of chest pain, dyspnea and subcutaneous emphysema. On admission, physical examination revealed subcutaneous crepitations in the superior part of the rib cage, and auscultation of the chest showed widespread wheezing. The radiological assessment confirmed the diagnosis of pneumomediastinum and pneumothorax. A follow-up CT scan performed one week after the admission showed almost complete resolution of the radiological alterations. At the following visits, the patient was asymptomatic, but reported to have suffered from frequent episodes of rhinorrea, sneezing, nasal blockage, and sometimes, chest tightness, especially during exposure to pets and/or windy weather. Skin prick testing showed sensitivities to dermatophagoides pteronyssinus and farinae, grass pollen and dog dander. Spirometry documented significant improvement in lung function after short-acting bronchodilator, allowing for the diagnosis of asthma to be made. Although pneumomediastinum may be a complication of various respiratory diseases, including asthma, it has never been reported as the first presentation of underlying bronchial asthma. Herein, the physiopathological mechanisms, the diagnostic procedures and treatment of pneumomediastinum in asthma are discussed. We suggest that the diagnosis of asthma should be considered in the differential diagnosis of pneumomediastinum in adolescence.

  4. Causes of gastrointestinal colic at an equine referral hospital in South Africa (1998 - 2007

    A. Voigt


    Full Text Available The most common causes of gastrointestinal colic at an equine referral hospital in South Africa were determined following retrieval of the medical records of horses admitted during a 10-year study period. The study included 935 horses of which 28 % were admitted after hours. Most horses were Thoroughbreds (54 %, male (57 %, with a mean age of 8.2 years and originated from the Gauteng Province (81 %. Heart rate (98 %, mucous membrane colour (95 % and auscultation of the abdomen (91 % were the clinical data commonly obtained at admission. Packed cell volume, total serum protein and white cell count were recorded in 78 %, 75 % and 44 % of horses respectively. Transrectal palpation (93 %, nasogastric intubation (84 %, intravenous catheterisation (74 % and abdominocentesis (53 % were the most frequently performed procedures. Medical intervention was performed in 558 horses (60 %. The common causes of medical colic were impactions (39 %, tympany (7 % and displacement of the large colon (6 %. An exploratory laparotomy was performed in 331 horses (36 %. The common causes of surgical colic were displacement (29 %, impaction (22 % and small intestinal strangulating lesions (18 %. Death occurred in 3 % of horses, while euthanasia before medical intervention was performed in 4 %. Overall, medical intervention was successful in 93 % of horses and 67 % in horses managed surgically. In conclusion, 55 % of all the equine admissions responded to medical intervention and the recovery rate for horses receiving both medical and surgical intervention was comparable to that reported in other studies.

  5. Toxic Effects of Peracetic Acid Used as a Chemical Weapon During Workers Riots

    Peracetic acid (PAA) is a mixture of acetic acid and hydrogen peroxide, often used as antimicrobial agent on food processing equipment. It may explosively decompose on shock, friction or concussion. PAA is a strong oxidant, corrosive to the eyes, skin, respiratory and digestive tract. Depending on concentration, contact may cause severe burns of the skin or the eyes, and inhalation may cause lung edema. We report toxic effects of PAA used as a chemical weapon in workers riots. Group of workers attacked the security guards in beverage plant, throwing out beer bottles filled with PAA. Bottles exploded, producing irritant mists and fumes, and splashing some of the guards with acid. After about 20 minutes of exposure in the closed space, 30 persons were transported to the emergency room; 22 of them were transferred to the hospital. After the initial treatment, 10 patients were admitted for further treatment. The symptoms of exposure included burning sensation and pain of the eyes, throat and skin, cough and shortness of breath. Effects on the eyes included redness and corneal erosions. Pulmonary disturbances were prolonged expirium and wheezing by auscultation, and hypoxemia. Skin burns were ranged as grade I-III. Treatment included rinse of eyes and skin, systemic therapy with corticosteroids, beta adrenergic drugs and theophylline. Surgical treatment was necessary in grade III skin burns. A variety of common industrial chemicals may be misused as a chemical weapon. We point out the hazards of serious toxic effects of PAA if used in riots or terrorists attacks. (author)

  6. Hypertension and its association with overweight and obesity among adolescents: a school-based survey

    Rafael Vieira Martins


    Full Text Available This study aimed to investigate the association of overweight and obesity with hypertension in adolescents from public schools in Curitiba, southern Brazil.The sample comprised 1,549 randomly selected adolescents aged 12 to 18 years (744 males. Body mass index (BMI was calculated and classified according to Conde and Monteiro (2006. Blood pressure was measured by the auscultation method on two occasions (different days and was classified according to the fourth report of the National High Blood Pressure Education Program (NHBPEP. Prevalence ratio was used as a measure of association. Overweight and obesity were observed in 23% and 5.8% of boys, respectively. Among girls, 18.8% were overweight and 5.6% were obese. After two measurements, 7% of boys had prehypertension and 10.5% had hypertension. Pre hypertension and hypertension were observed in 5.2% and 9.9% of girls, respectively. Obesity was significantly associated with high blood pressure among boys (PR = 1.19, 95% CI= 1.07-1.32. Overweight (PR = 1.11, 95% CI = 1.04-1.17 and obese (PR = 1.26,95% CI = 1.13-1.40 girls were more likely to have high blood pressure levelsin comparison to normal weight adolescents. These results showed alarming estimates of hypertension among young people and that the reduction of obesity during adolescence should be focused on public policies for hypertensionprevention in the population.

  7. [A Case of Bacteremia Caused by Ochrobacterium intermedium].

    Hirai, Jun; Yamagishi, Yuka; Sakanashi, Daisuke; Koizumi, Yusuke; Suematsu, Hiroyuki; Mikamo, Hiroshige


    We report herein on a case of bacteremia caused by Ochrobactrum intermedium (O. intermedium) identified with biotyper matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). An 86-year-old man was admitted to our hospital with paralysis of the right side of the body and dysphagia. He was diagnosed as having a pontine infarction based on the brain MRI findings and was admitted to hospital to have anti-platelet therapy. Three days after admission, he had a fever. Although he had redness and swelling at the peripheral venous catheter insertion site, he was diagnosed as having aspiration pneumonia, since he had fine crackles on auscultation. Soon after taking two sets of blood cultures and removal of the peripheral venous catheter, sulbactam/ampicillin (SBT/ABPC) was administrated. Fifty three hours after incubation, gram-negative bacilli was detected from an aerobic bottle and identified as O. intermedium with MALDI-TOF MS (Bruker MS). Antimicrobial chemotherapy was changed to meropenem (MEPM). He was treated for a total of seven days, and recovered without relapse. Infection caused by O. intermedium has been very uncommon, however, O. intermedium has been recognized as an emerging pathogen in immunodeficient and immunocompetent patients. Since identification of Ochrobactrum species by biochemical methods could be difficult, MALDI-TOF MS might be helpful to clarify Ochrobactrum species just as in the present case. PMID:27197440

  8. A mathematical modeling proposal for a Multiple Tasks Periodic Capacitated Arc Routing Problem

    Cleverson Gonçalves dos Santos


    Full Text Available The countless accidents and incidents occurred at dams at the last years, propelled the development of politics related with dams safety. One of the strategies is related to the plan for instrumentation and monitoring of dams. The monitoring demands from the technical team the reading of the auscultation data, in order to periodically monitor the dam. The monitoring plan of the dam can be modeled as a problem of mathematical program of the periodical capacitated arcs routing program (PCARP. The PCARP is considered as a generalization of the classic problem of routing in capacitated arcs (CARP due to two characteristics: 1 Planning period larger than a time unity, as that vehicle make several travels and; 2 frequency of associated visits to the arcs to be serviced over the planning horizon. For the dam's monitoring problem studied in this work, the frequent visits, along the time horizon, it is not associated to the arc, but to the instrument with which is intended to collect the data. Shows a new problem of Multiple tasks Periodic Capacitated Arc Routing Problem and its elaboration as an exact mathematical model. The new main characteristics presented are: multiple tasks to be performed on each edge or edges; different frequencies to accomplish each of the tasks; heterogeneous fleet; and flexibility for more than one vehicle passing through the same edge at the same day. The mathematical model was implemented and examples were generated randomly for the proposed model's validation.

  9. Hippocrates: the forefather of neurology.

    Breitenfeld, T; Jurasic, M J; Breitenfeld, D


    Hippocrates is one of the most influential medical doctors of all times. He started observing and experimenting in times of mysticism and magic. He carried a holistic and humanitarian approach to the patient with examination as the principal approach-inspection, palpation and auscultation are still the most important tools in diagnosing algorithms of today. He had immense experience with the human body most likely due to numerous wound treatments he had performed; some even believe he performed autopsies despite the negative trend at the time. Hippocrates identified the brain as the analyst of the outside world, the interpreter of consciousness and the center of intelligence and willpower. Interestingly, Hippocrates was aware of many valid concepts in neurology; his treatise On the Sacred Disease was the most important for understanding neurology and epilepsy. His other ideas pioneered modern day neurology mentioning neurological diseases like apoplexy, spondylitis, hemiplegia, and paraplegia. Today, 10 % of neurological Pubmed and 7 % of neuroscience Scopus reviews mention Corpus Hippocraticum as one of the sources. Therefore, Hippocrates may be considered as the forefather of neurology. PMID:25027011

  10. Medical image of the week: Boerhaave's syndrome during colonoscopy

    Meenakshisundaram C


    Full Text Available No abstract available. Article truncated at 150 words. A 76-year-old woman with no significant past medical history underwent outpatient screening colonoscopy. The procedure was difficult due to a tortuous colon and only multiple diverticula were visualized. She vomited once during the procedure. In the immediate postoperative period, she complained of neck swelling. Her vital signs were stable. On examination, right sided neck and facial swelling with palpable crepitations were noticed as well as coarse breath sounds heard on auscultation of both lung fields. Immediate chest X-ray (Figure 1 was obtained which showed bilateral subcutaneous emphysema extending from the supraclavicular area and above to the neck. Subsequent thoracic CT scan showed extensive subcutaneous air within the soft tissues of the neck bilaterally, extending into the mediastinum and along the anterior chest wall (Figure 2. An esophagram (Figure 3 revealed a focus of oral contrast actively extravasating approximately at 2.5 cm above the gastro-esophageal junction consistent with a small perforation ...


    Seema Khanna


    Full Text Available An unusual cause of vaginal beeding after total abdominal hysterectomy is being reported. Histopathology revealed adenomyosis uteri and bilateral ovarian cyst. On examination there was a single lump in the hypogastrium and left iliac fossa. Auscultation revealed a faint continuous hum. On digital rectal examination, a bulge was felt, while per vaginum examination revealed mucosal congestion and bulging of mucosa. Ultrasound revealed a mass posterior to the urinary bladder. Duplex study demonstrated the yin-yang sign suggestive of a pseudo-aneurysm .CT Angiography was confirmatory and demonstrated a pseudoaneurysm arising from the left internal iliac artery. Patient underwent surgery.Postoperative period was uneventful . The commonest cause of IIA aneurysm is atherosclerosis. Other causes are arteritis ,collagen vascular disease, infection, trauma. An important subgroup is young females, who have undergone difficult delivery, forceps delivery or caesarian section or abdominal hysterectomy IIA aneurysms are usually discovered incidentally on pelvic imaging for any other indication. Surgery is the mainstay of treatment but endovascular procedures are gaining ground . [Natl J Med Res 2014; 4(2.000: 181-182

  12. Bilateral tension pneumothorax following equipment improvisation.

    Zambricki, Christine; Schmidt, Carol; Vos, Karen


    This case report describes an unexpected event that took place as a result of using improvised equipment. The patient, a 16-year-old female undergoing complex oral surgery, suffered bilateral pneumothorax following the improper use of an airway support device. During the immediate postoperative period with the patient still intubated, oxygen tubing was attached to a right angle elbow connector with the port closed and 10 L/minute oxygen flow was administered to the patient in a manner that did not allow the patient to exhale. Within seconds, pneumothorax was apparent as the patient's vital signs deteriorated, visible swelling was noted in the shoulders and neck, and there was an absence of breath sounds on auscultation. This case study has application beyond the immediate discussion of bilateral pneumothorax, serving as a caution about the unintended consequences of equipment improvisation. In addition to highlighting the hazards of providing patient care with a non-standard device, this study also provides a powerful example of the human factors that can contribute to medical errors in the healthcare setting. PMID:24654348

  13. Pneumothorax complicating pulmonary embolism after combined spinal epidural anesthesia in a chronic smoker with open femur fracture

    Shivendu Bansal


    Full Text Available Pulmonary embolism during or after regional anaesthesia is although very rare, it has been reported in cases undergoing lower limb orthopedic procedures. We presenting a 48 years old male, a known smoker since 25 years, with history of road traffic accident and open fracture right femur for external fixation. Combined spinal epidural anaesthesia was given. After 35 minutes patient complained dyspnea and chest pain. SpO2 decreased to 82% from 100%. Continuous positive airway pressure with 100% oxygen was given. SpO2 increased from 82% to 96%. Suddenly he had bouts of cough and SpO2 became 79-80% with unstable haemodynamics. On chest auscultation there was decreased breath sounds on right side with limited expansion. Trachea was intubated after inducing anaesthesia with fentanyl 70 μg and thiopental 300 mg. Chest radiograph showed right sided pneumothorax. Intercostal drain with a water seal was put. After 5 minutes HR was 80/min, BP was 110/69 mmHg and SpO2 was 97%. Pulmonary thromboembolism secondary to deep vein thrombosis was suspected and was confirmed by D-dimer Elisa and color Doppler of lower limbs. Patient was shifted to intensive care unit after completion of surgery. Anticoagulant therapy was started. He was weaned from the ventilator on 3rd day and trachea was extubated. Chest drain was removed after 9 days and he was discharged from hospital on 15th post operative day

  14. Clinical study of urokinase-bound fibrocollagenous tubes.

    Senatore, F; Bernath, F; Meisner, K


    Dacron-reinforced fibrocollagenous tubes (FCT) were synthesized from canine mongrels using the mandril-rod technique in order to develop a small diameter (i.e., 4 mm i.d.) vascular graft. They were rendered fibrinolytic by immobilizing urokinase on to the inner surface of the tubes. Urokinase-bound fibrocollagenous tubes (UK-FCT), control FCTs (i.e., no bound enzyme), Perloff grafts (Dr. Perloff, Department of Surgery, University Medical Center, Sidney Australia, has developed a mandril-derived collagenous tube from goats. Samples were implanted for comparative purposes.) and autogeneous saphenous veins, were interposed in the carotid or femoral artery in chronic studies involving 21 canine mongrels. On the basis of Doppler auscultation and palpation, the UK-FCTs were statistically more patent than other candidate prostheses. Fibrin degradation product (FDP) increased in the dogs' systemic circulation with a postoperative peak of 5 days. The host's increase in fibrinolytic activity was shown to be local to the anastamosis. A carotid arterial extracorporeal shunt was designed to evaluate acute patency. Results indicated a rapid thrombosis but no platlet or fibrin adherence to the graft surface was observed, as evidenced by scanning electron microscopy. PMID:2937788

  15. Time-shared channel identification for adaptive noise cancellation in breath sound extraction

    Zheng HAN; Hong WANG; Leyi WANG; Gang George YIN


    Noise artifacts are one of the key obstacles in applying continuous monitoring and computer-assisted analysis of lung sounds.Traditional adaptive noise cancellation (ANC) methodologies work reasonably well when signal and noise are stationary and independent.Clinical lung sound auscultation encounters an acoustic environment in which breath sounds are not stationary and often correlate with noise.Consequently,capability of ANC becomes significantly compromised.This paper introduces a new methodology for extracting authentic lung sounds from noise-corrupted measurements.Unlike traditional noise cancellation methods that rely on either frequency band separation or signal/noise independence to achieve noise reduction,this methodology combines the traditional noise canceling methods with the unique feature of time-split stages in breathing sounds.By employing a multi-sensor system,the method first employs a high-pass filter to eliminate the off-band noise,and then performs time-shared blind identification and noise cancellation with recursion from breathing cycle to cycle.Since no frequency separation or signal/noise independence is required,this method potentially has a robust and reliable capability of noise reduction,complementing the traditional methods.

  16. A Comparative Study of Cuffed Pharyngeal Tube (CPR with Endotracheal Tube in Airway Management and Ventilation of Spontaneously Breathing Patients Undergoing General Anesthesia

    F Mir Mohammad Sadeghi


    Full Text Available Background: Cuffed pharyngeal tube is a device designed for ventilation of anesthetized patients. CPT has advantages over face mask including: maintaining of face mask can be difficult and boring after several minutes and mobility of the practitioner is reduced due to involvement of hands. Mask pressure can cause soft tissue and nerve damage around the nose. Anesthetic gas leakage from the mask adds to the operation room pollution. In difficult intubation CPT can be life-saving. Materials and Methods: In our study CPT was compared with endotracheal tube (ET in anesthetized patients. A scoring system for evaluating ventilation of patients was designed using symmetric chest wall motion during ventilation with anesthesia bag and sensing lung compliance through it, auscultation of breathing sounds, oscilation of bag with breathing and peripheral oxygen saturation by pulse oxymetry. Respiratory complications (pulmonary aspiration, Iaryngospasm and bronchospasm, nausea and vomiting were looked for during anesthesia. Results: The results showed that CPT was successful as ET in ventilation of spontaneously breathing patients and incidence of respiratory complications with CPT was no more than ET. Airway resistance was significantly greater with CPT than ET (P<0.05. Patients with ET had significantly greater incidence of sore throat than with CPT (P<0.05. Conclusion: Thus we concluded that CPT can be used for ventilation of anesthetized patients not predisposed to pulmonary aspiration and whose peak airway pressure does not exceed 20-25 CmH2O.

  17. Pulmonary hantavirus syndrome: case report and brief review

    VanHook CJ


    Full Text Available No abstract available. Article truncated after 150 words. A 31-year-old white man presented to the emergency department complaining of fever, headache, mild confusion, and muscle aches. Approximately three days earlier he had developed non-quantified fever and diffuse muscle aches and pains. He was employed as a feedlot worker. He had visited an urgent care center one day earlier and had been advised to increase his oral fluid intake and to use non-steroidal anti-inflammatory agents as needed. Upon arrival to the emergency department he was found to have a temperature of 103.6º Fahrenheit, blood pressure of 125/72 mm Hg, respiratory rate of 40 breaths per minute, and room-air oxygen saturation of 84% by pulse oximetry. Auscultation of the chest disclosed diffuse rales. Heart sounds were rapid and regular. Abdominal exam was benign. There was no skin rash. Central nervous exam demonstrated agitation and confusion, but was otherwise non-focal. Laboratory examination revealed a white blood count of 11.7 K/uL, hemoglobin ...

  18. Diffuse Pulmonary Arteriovenous Fistulas With Pulmonary Arterial Hypertension: Case Report and Review.

    Jiang, Rong; Gong, Su-Gang; Pudasaini, Bigyan; Zhao, Qin-Hua; Wang, Lan; He, Jing; Liu, Jin-Ming


    Pulmonary arteriovenous fistulas (PAVFs) are rare. Diffuse type PAVFs with pulmonary arterial hypertension (PAH) are even rarer and can elude anatomy imaging like a plain chest film or a computed tomography. The rapid blood flow that ensues due to lack of a capillary bed leads to various degrees of ischemia depending on the number and size of the PAVF. This is a case report of diffuse PAVF in a patient with PAH.This case report describes a patient with recurrent hemoptysis and chest pain. Systemic examination was unremarkable except for P2 attenuation on auscultation. Echocardiograghy showed confirmed pulmonary hypertension with mild dilation of right atrium and ventricle and a tricuspid regurgitation pressure gradient of 40 mm Hg and ruled out congenital heart diseases. Right heart catheterization revealed precapillary PAH with mean pulmonary arterial pressure of 88 mm Hg. Pulmonary angiography showed enlarged pulmonary arterial trunk and diffuse spiral tortuous pulmonary arterial branches indicting diffuse PAVFs. The patient was diagnosed as PAH and began treatment of 25 mg tid of sildenafil.The case highlights a rare and unique presentation of PAH. PMID:27057843

  19. Multi-point accelerometric detection and principal component analysis of heart sounds

    Heart sounds are a fundamental physiological variable that provide a unique insight into cardiac semiotics. However a deterministic and unambiguous association between noises in cardiac dynamics is far from being accomplished yet due to many and different overlapping events which contribute to the acoustic emission. The current computer-based capacities in terms of signal detection and processing allow one to move from the standard cardiac auscultation, even in its improved forms like electronic stethoscopes or hi-tech phonocardiography, to the extraction of information on the cardiac activity previously unexplored. In this report, we present a new equipment for the detection of heart sounds, based on a set of accelerometric sensors placed in contact with the chest skin on the precordial area, and are able to measure simultaneously the vibration induced on the chest surface by the heart's mechanical activity. By utilizing advanced algorithms for the data treatment, such as wavelet decomposition and principal component analysis, we are able to condense the spatially extended acoustic information and to provide a synthetical representation of the heart activity. We applied our approach to 30 adults, mixed per gender, age and healthiness, and correlated our results with standard echocardiographic examinations. We obtained a 93% concordance rate with echocardiography between healthy and unhealthy hearts, including minor abnormalities such as mitral valve prolapse. (fast track communication)

  20. Coronary Arteriovenous Fistula Causing Hydrops Fetalis

    Nilüfer Çetiner


    Full Text Available Fetal heart failure and hydrops fetalis may occur due to systemic arteriovenous fistula because of increased cardiac output. Arteriovenous fistula of the central nervous system, liver, bone or vascular tumors such as sacrococcygeal teratoma were previously reported to be causes of intrauterine heart failure. However, coronary arteriovenous fistula was not reported as a cause of fetal heart failure previously. It is a rare pathology comprising 0.2–0.4% of all congenital heart diseases even during postnatal life. Some may remain asymptomatic for many years and diagnosed by auscultation of a continuous murmur during a routine examination, while a larger fistulous coronary artery opening to a low pressure cardiac chamber may cause ischemia of the affected myocardial region due to steal phenomenon and may present with cardiomyopathy or congestive heart failure during childhood. We herein report a neonate with coronary arteriovenous fistula between the left main coronary artery and the right ventricular apex, who presented with hydrops fetalis during the third trimester of pregnancy.

  1. Physical therapy for post coronary artery bypass grafting complications -A Case Report

    Anitha Kumari Abbina


    Full Text Available Background:This case report describes about the female patient who came with cough, breathlessness and neck pain after one month following coronary artery bypass grafting to the cardiology department. Chest radiograph was taken and diagnosed it as pleural effusion with atelectasis of left lower lobe. Later therapeutic thoracentesis was done to aspirate the fluid and referred the case to physiotherapy. Thorough physical examination showed reduced neck mobility due to trigger points and spasm of the neck muscles which are causing pain, and also breathlessness on walking, on percussion dull note on left lower lobe, on auscultation crackles are heard with diminished breath sounds over the left lower lobe, altered chest symmetry reduced chest expansion of the lower chest. To reduce neck pain and improve neck mobility she was treated with cryostretches,trigger point release technique, myofascial release and muscle energy techniques. She was treated with positioning, chest percussion, vibration and shaking, deep breathing exercises, thoracic expansion exercises, segmental breathing to lower lobes, incentive spirometry every one hour ten times, trunk and thoracic mobilityexercises were done twice in a day to reduce breathlessness. After 15 days again x-ray was taken where lung was re-expanded and also there are free movements of the neck without pain.

  2. Pneumomediastinum, pneumothorax and pneumoretroperitoneum following endoscopic retrieval of a tracheal foreign body from a cat : clinical communication

    A.B. Zambelli


    Full Text Available 6-year-old entire male cat was presented with a 1-week history of severe dyspnoea without coughing. Upon auscultation, an inspiratory and particularly pronounced expiratory wheeze was noted, with severe dyspnoea. The minimum database was normal. Plain thoracic radiographs showed signs of a mural or intraluminal intrathoracic (1-T4 tracheal narrowing. A dynamic collapsing trachea was ruled out using fluoroscopy. Bronchoscopy was performed and a dark green and brown spiculated foreign object was found just cranial to the carina. Following removal, the cat rapidly developed extensive truncal subcutaneous emphysema and oxygen-responsive dyspnoea and cyanosis. Follow-up radiographs demonstrated unilateral pneumothorax and lung collapse, marked pneumomediastinum and dissection of air through the tracheal wall. A thoracic drain was placed and the pneumothorax resolved rapidly. Follow-up radiographs demonstrated resolution of pneumothorax and development of extensive retroperitoneal air. The cat made an uneventful recovery. The foreign object was the calyx and stem of a flower. This article emphasises the importance of diagnostic imaging in the dyspnoeic patient, both for confirming initial suspicions of respiratory tract disease, and in managing and charting post-therapy resolution or complications.

  3. Placebo controlled trial of zinc supplementation on duration of hospital stay in children with pneumonia

    Background: Pneumonia is one of the leading causes of morbidity and mortality in children younger than 5 years of age. Zinc may have an important protective role in cases of childhood pneumonia. Objectives: To study the effect of zinc supplementation on duration of hospital stay in children (6 months to 5 years) with pneumonia. Methodology: This Randomized control trial was conducted in the Department of Paediatrics Unit - I, King Edward Medical University / Mayo Hospital, Lahore from January to December 2011. After consent, 150 children from 6 months to 5 years of age with pneumonia consistent with WHO ARI definition along with crepitations on auscultation were registered by non-probability purposive sampling and were randomized into treatment group (Group A) and placebo group (Group B). Seventy five children supplemented with zinc for 14 days while 75 children were supplemented with placebo. Outcome measure was duration of hospital stay. T-test was used to compare the groups. Results: Out of total study population of 150, majority (35%) of children were below 2 years. There was male predominance (64%). Mean duration of hospital stay was significantly reduced in treatment group (p value < 0.05). Conclusion: Zinc supplementation results in statistically significant reduction in the duration of hospital stay in children (6 months to 5 years) with pneumonia. (author)

  4. [Analytical study and physiological consequences of a model of respiration].

    Guillez, A


    The author, starting from the pattern established by Brocas and Cherruault (1973), develops new equations by considering the dynamics of breathing. He distinguishes space without exhanges, called 'blower' and space with exchanges, called 'exchanger'. The equations are studied and explicit solutions are found by an original method. The necessity for a neutral gas is proved. The author develops periodic functions for ventilation, for gas pressures in the air and in the blood and control functions such as differences of pressure between aerial- and blood-dissolved gas at the bottom of the alveola, consumption of O2 and excretion of CO2 and remaining CO2 in blood. The control functions oscillate around zero for the differences and around constants for the others. Examining the effects of frequency of breathing, blood flow, variations of transerval diffusivities, atmospheric pressure, variation of the dimensions connected with fever, infections, altitude and depth, sclerosis and even emotions, he again determines the pathologies, their auscultation symptoms and other aspects. PMID:478687

  5. Neck circumference as a new anthropometric indicator for prediction of insulin resistance and components of metabolic syndrome in adolescents: Brazilian Metabolic Syndrome Study

    Cleliani de Cassia da Silva


    Full Text Available OBJECTIVE: To evaluate the correlation between neck circumference and insulin resistance and components of metabolic syndrome in adolescents with different adiposity levels and pubertal stages, as well as to determine the usefulness of neck circumference to predict insulin resistance in adolescents.METHODS:Cross-sectional study with 388 adolescents of both genders from ten to 19 years old. The adolescents underwent anthropometric and body composition assessment, including neck and waist circumferences, and biochemical evaluation. The pubertal stage was obtained by self-assessment, and the blood pressure, by auscultation. Insulin resistance was evaluated by the Homeostasis Model Assessment-Insulin Resistance. The correlation between two variables was evaluated by partial correlation coefficient adjusted for the percentage of body fat and pubertal stage. The performance of neck circumference to identify insulin resistance was tested by Receiver Operating Characteristic Curve.RESULTS: After the adjustment for percentage body fat and pubertal stage, neck circumference correlated with waist circumference, blood pressure, triglycerides and markers of insulin resistance in both genders.CONCLUSIONS: The results showed that the neck circumference is a useful tool for the detection of insulin resistance and changes in the indicators of metabolic syndrome in adolescents. The easiness of application and low cost of this measure may allow its use in Public Health services.

  6. Predicción clínica de aspiración en pacientes con patología neurológica aguda CLINICAL PREDICTION OF ASPIRATION IN ACUTE NEUROLOGICAL PATIENTS

    Iván Caviedes S


    Full Text Available La disfunción glótica es una entidad prevalente en enfermos con patología neurológica aguda: compromete aproximadamente entre el 45 al 51% de los pacientes que padecen un ataque cerebrovascular, incrementando su mortalidad en una relación de 3/1. Su complicación principal es el síndrome aspirativo, que involucra diversas especialidades, entre ellas enfermedades respiratorias y neurología. El propósito de este estudio ha sido evaluar la fonación húmeda, el test del vaso de agua y la auscultación cervical como indicadores clínicos de aspiración frente a la certificación nasolaringoscópica, considerada patrón estándar de evaluación al lado de la cama del enfermo. Evaluamos prospectivamente durante un año a pacientes neurológicos agudos hospitalizados en una unidad de tratamiento intensivo. La fonación húmeda, el test del vaso de agua y la auscultación cervical demostraron sensibilidades de 66,7, 88,9 y 77,8%, con una especificidad respectiva de 85,2, 59,3 y 77,8%. Los valores predictivos positivo fueron de 60, 42,1 y 53,8%, con valores predictivos negativo de 88,5, 94,1 y 91,3% respectivamente. Nuestros resultados permiten afirmar que el monitoreo clínico de aspiración es un instrumento sencillo y valioso, que puede ser realizado al lado de la cama del enfermoGlottic dysfunction is a frequent condition in patients with acute neurological diseases: the incidence in stroke patients is between 45 - 51% increasing mortality three times. The principal complication is aspiration, which demands the involvement of pulmonary physicians and neurologists. The purpose of this study is to evaluate wet voice, water swallow test and cervical auscultation as clinical predictors of aspiration using endoscopical observation as a gold standard. During a period of one year we have prospectively evaluated these tests in acute neurological patients hospitalized in an intensive care unit. Wet voice, 3 oz water swallow test and cervical

  7. Estetoscópio digital como ferramenta inovadora no ensino da ausculta cardíaca Digital stethoscope as an innovative tool on the teaching of auscultatory skills

    Claudio Tinoco Mesquita


    Full Text Available O exame físico cardiovascular, em particular a ausculta cardíaca, é uma das habilidades clínicas mais difíceis para os alunos durante seu treinamento médico. Estudos sugerem que o uso de tecnologias, como o estetoscópio digital, aumente a acurácia do exame clínico, entretanto, seu impacto no ensino da propedêutica da ausculta cardíaca em alunos de graduação de Medicina não é conhecido. O objetivo é demonstrar a utilidade do estetoscópio digital, em comparação com métodos tradicionais, como instrumento de ensino da ausculta cardíaca. Estudo de intervenção, longitudinal, controlado, unicêntrico e randomizado. Foram inscritos 38 alunos de medicina para um curso de semiologia cardiovascular com duração de oito semanas. Definiu-se um programa com aulas expositivas e à beira do leito nas enfermarias de Cardiologia. Nas aulas práticas, os alunos foram randomizados em dois grupos: 1 (n = 21 estetoscópio digital (Littmann® modelo 3200, 3M; e 2 (n = 17 estetoscópios convencionais. Foi realizada uma avaliação pré-treinamento, através de um teste utilizando o software Heart Sounds®, que foi repetida ao final do curso. As médias das avaliações foram comparadas pelo teste T pareado e não pareado. Observa-se que, ao final do curso, houve uma melhora significativamente maior no grupo que utilizou o estetoscópio digital (51,9% quando comparado ao grupo que utilizou o estetoscópio convencional (29,5%. Intervenções de curta duração para o ensino de semiologia cardíaca são capazes de contribuir de modo significativo para melhora da proficiência da identificação dos sons cardíacos. O uso do estetoscópio digital demonstrou ser um fator positivo no ensino dessas habilidades.Physical cardiovascular examination, particularly cardiac auscultation, is one of the most difficult clinical skills for students during their medical training. Studies suggest that the use of technologies such as digital stethoscope increase the

  8. Aspiração de corpo estranho em crianças: aspectos clínicos, radiológicos e tratamento broncoscópico Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment

    Andrea de Melo Alexandre Fraga


    years of age undergoing bronchoscopy due to clinical suspicion of foreign body aspiration at the State University at Campinas Hospital das Clinicas from January of 2000 to December of 2005. RESULTS: The sample consisted of 69 patients, ranging in age from 8 months to 12 years/7 months (75.4% under 3 years of age, 62.3% of whom were male. The principal complaint was sudden-onset cough (75.4%, auscultation was abnormal in 74%, and dyspnea was observed in 29%. Radiological abnormalities were seen in 88% of the cases. Aspirations were primarily into the right lung (54.8%, and 30.7% of the foreign bodies were of vegetal origin (principally beans and peanuts. In the follow-up period, 29% presented complications (most commonly pneumonia, which were found to be associated with longer aspiration time (p = 0.03. Mechanical ventilation was required in 7 children (10.1%, and multiple bronchoscopies were performed in 5 (7.2%. CONCLUSION: A history of sudden-onset choking and cough, plus abnormal auscultation and radiological findings, characterizes the profile of foreign body aspiration. In such cases, bronchoscopy is indicated. Longer aspiration time translates to a higher the risk of complications. The high prevalence of foreign bodies of vegetal origin underscores the relevance of prevention programs aimed at children younger than 3 years of age.

  9. A decision tree – based method for the differential diagnosis of Aortic Stenosis from Mitral Regurgitation using heart sounds

    Loukis Euripides N


    Full Text Available Abstract Background New technologies like echocardiography, color Doppler, CT, and MRI provide more direct and accurate evidence of heart disease than heart auscultation. However, these modalities are costly, large in size and operationally complex and therefore are not suitable for use in rural areas, in homecare and generally in primary healthcare set-ups. Furthermore the majority of internal medicine and cardiology training programs underestimate the value of cardiac auscultation and junior clinicians are not adequately trained in this field. Therefore efficient decision support systems would be very useful for supporting clinicians to make better heart sound diagnosis. In this study a rule-based method, based on decision trees, has been developed for differential diagnosis between "clear" Aortic Stenosis (AS and "clear" Mitral Regurgitation (MR using heart sounds. Methods For the purposes of our experiment we used a collection of 84 heart sound signals including 41 heart sound signals with "clear" AS systolic murmur and 43 with "clear" MR systolic murmur. Signals were initially preprocessed to detect 1st and 2nd heart sounds. Next a total of 100 features were determined for every heart sound signal and relevance to the differentiation between AS and MR was estimated. The performance of fully expanded decision tree classifiers and Pruned decision tree classifiers were studied based on various training and test datasets. Similarly, pruned decision tree classifiers were used to examine their differentiation capabilities. In order to build a generalized decision support system for heart sound diagnosis, we have divided the problem into sub problems, dealing with either one morphological characteristic of the heart-sound waveform or with difficult to distinguish cases. Results Relevance analysis on the different heart sound features demonstrated that the most relevant features are the frequency features and the morphological features that


    D. V. Bestaev


    Full Text Available Subjects and methods. The study enrolled 61 inpatients diagnosed with RA (according to the 1987 American College of Rheumatology criteria who were treated at the V.A. Nasonova Research Institute of Rheumatology; in so doing, high-resolution computed tomography revealed lung changes as a ground glass pattern in 15 patients, reticular striation, traction bronchoectases, and lung tissue changes as honeycomb ones in 25 patients; no lung abnormalities were found in 21 patients. DAS28 was applied to determine the inflammatory activity of RA. The RA patients underwent X-ray studies of the hand, foot, and chest, by using accordingly X-Ray unit and spiral computed tomography scanner (section thickness, 0.65 mm. External respiration function (ERF indicators were studied with plethysmograph. IgM rheumatoid factor was measured using an immune nephelometer. Serum anti-cyclic citrullinated peptide antibodies were assayed by immunochemiluminescence technique on a Cobas e411 analyzer. The xMAP technology using a BioPlex200 analyzer was employed to determine the serum concentrations of 27 cytokines in 15 patients with subclinical IPI and in 25 with clinical IPI. Results and discussion. The major respiratory signs in patients with IPI proved to be cough (24 %, expectoration (20 %, dyspnea (16 %, and crepitation (64 % on auscultation. Three patients with subclinical IPI were found to have crepitation on auscultation. Respiratory symptoms were absent in the RA patients without IPI. It should be noted that there are a larger number of RA patients with a high smoking index among the RA patients with IPI than among those without IPI (p < 0.05. Investigation of ERF indicators revealed a statistically significantly lower lung diffusing capacity (LDC in the RA patients with subclinical IPI than in those without IPI (p < 0.05. Other ERF indicators showed no significant deviations of the reference values. LDC and total lung capacity appeared to be statistically

  11. Traumatic arteriovenous fistula. Apropos of a case Fístula arteriovenosa postraumática. A propósito de un caso

    María Victoria Gordis Aguilera.


    Full Text Available The traumatisms that affect the extremities represent 80% of all the vascular traumatisms approximately. The inadequate handling of these it contributes to fateful consequences as the loss of the life or of the function of the extremity. The vascular lesions for firearm constitute one of the main causes with the appearance of arteriovenous fistula. We present the case of a 36 year old masculine patient with antecedents of having hurt 1 year ago by firearm in the root of the left thigh goes to present increase of volume of the extremity and difficulty to the march with sensation of fatigue and gravity. To the physical exam increase of volume of the limb more marked affection was verified in the root of the thigh, in the area related with the bullet impact thrill is felt and blow holosistólico is auscultated. The echo doppler and the tomography with contrast use evidenced the presence of a arteriovenous fistula. With this diagnosis was carried out surgical exploration and repair by means of veins bond for exclusion and interference of ilio-femoral arterial implant of politetrafluoroethylene (PTFE. The postoperative evolution was satisfactory with regression of all the clinical signs.Los traumatismos vasculares representan aproximadamente el 80 % de todos los traumatismos que afectan a las extremidades. El manejo inadecuado de estos ocasiona consecuencias funestas como la pérdida de la vida o de la función de la extremidad. Las lesiones vasculares por arma de fuego constituyen una de las principales causas de la aparición de fístulas arteriovenosas. Se presenta el caso de un paciente de sexo masculino de 36 años de edad, con antecedentes de herida por arma de fuego en la raíz del muslo izquierdo, este paciente acudió a la consulta del servicio de Angiología, por presentar aumento de volumen en la extremidad y se le dificultaba la marcha, además sentía sensación de cansancio. Al realizar el examen físico se constató aumento de volumen

  12. Pediatric Cardiology Boot Camp: Description and Evaluation of a Novel Intensive Training Program for Pediatric Cardiology Trainees.

    Ceresnak, Scott R; Axelrod, David M; Motonaga, Kara S; Johnson, Emily R; Krawczeski, Catherine D


    The transition from residency to subspecialty fellowship in a procedurally driven field such as pediatric cardiology is challenging for trainees. We describe and assess the educational value of a pediatric cardiology "boot camp" educational tool designed to help prepare trainees for cardiology fellowship. A two-day intensive training program was provided for pediatric cardiology fellows in July 2015 at a large fellowship training program. Hands-on experiences and simulations were provided in: anatomy, auscultation, echocardiography, catheterization, cardiovascular intensive care (CVICU), electrophysiology (EP), heart failure, and cardiac surgery. Knowledge-based exams as well as surveys were completed by each participant pre-training and post-training. Pre- and post-exam results were compared via paired t tests, and survey results were compared via Wilcoxon rank sum. A total of eight participants were included. After boot camp, there was a significant improvement between pre- and post-exam scores (PRE 54 ± 9 % vs. POST 85 ± 8 %; p ≤ 0.001). On pre-training survey, the most common concerns about starting fellowship included: CVICU emergencies, technical aspects of the catheterization/EP labs, using temporary and permanent pacemakers/implantable cardiac defibrillators (ICDs), and ECG interpretation. Comparing pre- and post-surveys, there was a statistically significant improvement in the participants comfort level in 33 of 36 (92 %) areas of assessment. All participants (8/8, 100 %) strongly agreed that the boot camp was a valuable learning experience and helped to alleviate anxieties about the start of fellowship. A pediatric cardiology boot camp experience at the start of cardiology fellowship can provide a strong foundation and serve as an educational springboard for pediatric cardiology fellows. PMID:26961569

  13. High-Resolution Computed Tomography and Chest X-Ray Findings of Interstitial Lung Disease Related to Systemic Sclerosis

    V. Sheikh


    Full Text Available Introduction & Objective: Interstitial lung disease is the leading cause of mortality and morbidity in patients with scleroderma. For this reason an early diagnosis of lung involvement is warranted. The best approach to detect pulmonary disease particularly alveolitis (inflammatory NSIP as a reversible phase is controversial. The aim of this study is estimating the advantage of HRCT as a noninvasive screening test to detect the pattern of ILD related to systemic sclerosis.Materials & Methods: In this cross sectional study, 52 patients with scleroderma who referred to rheumatologic medical center from 2010 to 2011 were evaluated for ILD by the use of history, physical examination, CXR and HRCT. Finally, all the data were analyzed using SPSS13 software.Results: HRCT was normal in 21 patients (40.4%, and NSIP in 19 patients (36.5% and UIP in 12 patients (23.1% were reported. CXR was normal in 19 (36.5% and mild reticular pattern in 15 (28.8%, overt reticular pattern in 14 (26.9% and honey combing in 4 (7.7% were seen. HRCT findings were abnormal in 6(11.5% patients without dyspnea, 22(42.3% without cough, 20(38.4% without crackle in lung auscultation and 26(50% without clubbing in physical examination. In 2(3.8% patients no pulmonary signs and symptoms UIP were reported.Conclusion: HRCT is a noninvasive method to detect lung involvement in early phases independent of presence or absence of pulmonary signs and symptoms.(Sci J Hamadan Univ Med Sci 2012;19(2:16-22

  14. Echocardiographic diagnosis and necropsy findings of a congenital ventricular septal defect in a stranded harbor porpoise.

    Szatmári, Viktor; Bunskoek, Paulien; Kuiken, Thijs; van den Berg, Annemarie; van Elk, Cornelis


    A live-stranded harbor porpoise Phocoena phocoena was found on the west coast of the Dutch island Texel (North Sea) and transported to a rehabilitation center for small cetaceans, where it underwent a veterinary health check. Cardiac auscultation revealed a systolic cardiac murmur with the point of maximal intensity in the right hemithorax with an intensity of IV out of VI. Transthoracic echocardiography revealed a congenital ventricular septal defect with left-to-right shunting. Because the left atrium was not dilated according to the reference range of canine left atrium to aortic ratio, the presence of congestive heart failure was considered very unlikely. Therefore, this congenital cardiac anomaly was thought to be a clinically non-relevant incidental finding and would not explain the weakness, coughing, anorexia, vomiting, and diarrhea. Because the animal was still unable to swim or eat by itself after 2 wk of supportive care, it was euthanized. Post-mortem examination confirmed the presence of a ventricular septal defect. The weight of the heart relative to the animal's length was greater than expected, using linear regression analysis on the lengths and cardiac weights of 71 other stranded wild harbor porpoises without macroscopic cardiac pathologic changes. This finding suggests that the left ventricle had an eccentric hypertrophy because of volume overload resulting from the intracardiac shunt. This is the first report of a congenital cardiac anomaly and its ante-mortem diagnosis in this species. Data presented for the other 71 harbor porpoises may provide reference values for this species. PMID:27025305

  15. Successful balloon dilatation of both orifices in a case of double-orifice mitral valve with severe rheumatic stenosis.

    Nath, Ranjit Kumar; Soni, Dheeraj Kumar


    A 24-year-old female patient presented to us with progressive dyspnea on exertion for last three year. She was not a known case of rheumatic heart disease. Her physical examination showed regular pulse and her blood pressure was 100/76 mm Hg. Cardiac palpation showed grade 3 parasternal heave and auscultation revelled an accentuated first heart sound, loud P2 and mid-diastolic long rumbling murmur at apex and pansystolic murmur of tricuspid regurgitation at lower left sterna border. Chest X-ray showed evidence of grade 3 pulmonary venous congestion. Transthoracic and transesophageal two-dimensional echocardiography revealed a double-orifice mitral valve of complete bridge type at the leaflet level. Both orifice sizes were unequal, with the anterolateral orifice being smaller than its counterpart. There was moderate subvalvular fusion and both commisures were fused. Color doppler examination showed two separate mitral diastolic flows with mean gradients of 22 mm and 20 mm of Hg, respectively. There was no mitral regurgitation and no left atrial or appendage clot was seen by transesophageal echocardiography. Transseptal puncture was done by the modified fluoroscopic method. Posteromedial orifice was crossed with a 24 mm Inoue balloon and dilated using the stepwise dilation technique. Anterolateral orifice was not crossed by Inuoe balloon after multiple attempts. A TYSHAK (NuMAD Canada Inc.) balloon (16 × 40mm) was taken over the wire and inflated successfully across the anterolateral orifice with the help of transthoracic echocardiography guidance. Mean gradient become 9 and 8 mm across the medial and lateral orifice. Patient was discharged in stable condition after two day. © 2015 Wiley Periodicals, Inc. PMID:26389694

  16. Epidemiology, Seasonality and Treatment of Hospitalized Adults and Adolescents with Influenza in Jingzhou, China, 2010-2012.

    Jiandong Zheng

    Full Text Available After the 2009 influenza A (H1N1 pandemic, we conducted hospital-based severe acute respiratory infection (SARI surveillance in one central Chinese city to assess disease burden attributable to influenza among adults and adolescents.We defined an adult SARI case as a hospitalized patient aged ≥ 15 years with temperature ≥38.0°C and at least one of the following: cough, sore throat, tachypnea, difficulty breathing, abnormal breath sounds on auscultation, sputum production, hemoptysis, chest pain, or chest radiograph consistent with pneumonia. For each enrolled SARI case-patient, we completed a standardized case report form, and collected a nasopharyngeal swab within 24 hours of admission. Specimens were tested for influenza viruses by real-time reverse transcription polymerase chain reaction (rRT-PCR. We analyzed data from adult SARI cases in four hospitals in Jingzhou, China from April 2010 to April 2012.Of 1,790 adult SARI patients enrolled, 40% were aged ≥ 65 years old. The median duration of hospitalization was 9 days. Nearly all were prescribed antibiotics during their hospitalization, less than 1% were prescribed oseltamivir, and 28% were prescribed corticosteroids. Only 0.1% reported receiving influenza vaccination in the past year. Of 1,704 samples tested, 16% were positive for influenza. Influenza activity in all age groups showed winter-spring and summer peaks. Influenza-positive patients had a longer duration from illness onset to hospitalization and a shorter duration from hospital admission to discharge or death compared to influenza negative SARI patients.There is substantial burden of influenza-associated SARI hospitalizations in Jingzhou, China, especially among older adults. More effective promotion of annual seasonal influenza vaccination and timely oseltamivir treatment among high risk groups may improve influenza prevention and control in China.

  17. Exploring Ideational Metafunction in Helon Habila’s Oil on Water: A re-evaluation and redefinition of African Women’s Personality and Identity through Literature

    Léonard A. Koussouhon


    Full Text Available This article aims at applying some of the principles guiding Systemic Functional Grammar (SFG to Helon Habila’s Oil On Water (2011. One of the major principles of Systemic Linguistics is that the exploration of the Transitivity properties (processes, participants, and circumstances in/of a text can give a full insight into how the writer encodes experiential meaning therein (Koussouhon & Allagbe, 2013 and Koussouhon & Dossoumou, 2014. This implies that the analysis in/of a text can reveal how its language is organized to express the speaker’s or narrator’s personal experience, views, etc., thereby contributing to the meaning of personal and interpersonal interaction. Given the importance of social role played by language in any societal situation, the experiential meaning of a structural choice is not determined only by Lexico-grammar, but also by contextual factors (Gledhill, 2011. By applying the theory of the grammar of experiential meaning to Helon Habila’s Oil On Water (2011, this article attempts to auscultate African society’s emerging perception of gender identity as it affects and re-presents women. By borrowing the way the writer encodes his experience (or fictional reality via the medium of language to affirm male writers’ support to the trend, this article is proving the propriety and relevance of womanist theory by re-evaluating and re-defining African women’s identity and personality through the novel under study.    Keywords: systemic functional grammar (SFG, experiential meaning, re-evaluation, redefinition, Womanism, women’s identity

  18. Clinical report on the improvement of the symptoms of pneumonia by the aqueous extract of Platycodon grandiflorum

    Kim, Sook-Kyeng


    Full Text Available Objective: The purpose of this report is to prove the clinical effect of Platycodon grandiflorum aqueous extract on pneumoniae patients. Methods: We used the aqueous extract of Platycodon grandiflorum to treat two pneumoniae patients. It was injected into five acupuncture points, which was Chondol(天突:CV22 1 point, Pyesu(肺兪 : BL13 2 point, and Kworumsu(厥陰兪: BL14 2 point. Results & conclusions: We have used the aqueous extract of 24-year-old JK for treating the patients suffering from lung diseases, and have experienced the actual effects. Of the treated, two pneumonia-involved patients showed apparent improvement in simple chest X-ray and clinical symptoms. The patients were treated with JK (Jang-saeng platycodon aqueous extract 25 and 22 times individually. The results were as follows. 1. The symptoms including coughing, phlegm, and fever were improved in two cases. 2. The lung infiltration in simple chest X-ray decreased and the WBC count was kept within normal range in two cases. 3. Side effect such as itching was not found in the process of JK aqueous extract treatment. 4. The criteria for pneumonia are fever, coughing with purulent phlegm, pleural chest pain, the evidence of new infiltration in simple chest X-ray, sign of lung sclerosis in auscultation, increase of WBC count, etc. But they may not be the proper objective diagnostic standards. So we had trouble in statistic process and numerical interpretation. Putting these results together, the JK aqueous extract is considered to be effective in treating patients for pneumonia, and the continuous research and accumulation of data is needed.

  19. Embedded Stethoscope for Heart Sounds

    Mr.Ashish Harsola


    Full Text Available In India significant percentage of the people who die due to cardiovascular diseases belong to rural part. The major reasons are lack of awareness, lifestyle, and the cost factor. While the first two reasons are more applicable in urban India, the third is a pain point for rural areas where there are no cost-effective ways available for an early diagnosis of heart diseases. There are different tests and investigations used to diagnose heart disease. The tests doctor chooses depending upon risk of heart disease, history of heart problems and the symptoms one might have but the initial diagnosis can be done using the stethoscope used for auscultation.For many years healthcare professionals would listen quietly to patients internal organs so they could diagnose from specific sounds of these organs. But it requires lot of expertise for such diagnosis, which is not available in the rural part. The objective is to develop a Digital Stethoscope for early initial diagnosis of cardiac disorders without any high end test which the patients can be referred to, if required. The proposed design consists of a Peripheral Interface Controller (PIC based system which consists of following stages: Front end pick-up circuitry, PIC18F4550 controller, graphic LCD display or high resolution TFT display, a memory device, USB and Bluetooth connectivity. Recorded data on memory device helps professionals to analyze later on at far distances. Bluetooth facilitates professionals to use portable devices along with its Bluetooth connectivity to capture these transmitted recordings and then analyzing these waveforms in time and frequency domain by using software such as LabVIEW.




    Full Text Available A male patient, D. Sanjeev Rao, aged 50 years, lorry driver by occupation, residing at Vijayawada, AP, presented with Rt. sided chest pain, cough, severe breathlessness, low-grade fever since one day. He was admitted in the casualty under emergency condition and was resuscitated with oxygen inhalation. On inspection, trachea was deviated to right side. Chest was bilaterally asymmetrical. Intercostal tube with underwater seal drainage on right side was found. Right side of chest shows loss of lung volume with wasting of muscles, drooping of shoulder, narrowing of intercostal spaces with crowding of ribs. Apical impulse appears to be shifted to right side. On palpation respiratory movements diminished all over the right chest with increased vocal fremitus over the middle of chest and decreased in base. On percussion dull note was present in base, resonant in middle of the chest. On auscultation, amphoric breathing with metallic quality were heard on right side. CVS-S1, S2 present. On percussion, heart borders were in normal limits. ICD tube column moving continuously. CX-Ray PA view with right pneumothorax encysted with thickened pleural margins with right upper lobe collapse. Patient underwent right decortication on 30th June 2015. Since then lung was not expanded, but landed into continuous air leakage with bronchopleural fistula with persistent right pneumothorax pocket. Patient was diagnosed as hydropneumothorax. 1 on 1-6-15, treated with intercostal tube. 2 drainage, but was failed with occurrence of bronchopleural fistula.3 Later, he underwent decortication. 1 and presented with persistent pneumothorax. 4 Patient is a known case of type-2 diabetic, on medication with Human Mixtard insulin for the past 5years. Diabetes was under control. Pus from ICD bag sent for culture for AFB- not detected by culture, confirmed by “MycoReal” real time PCR by SRL diagnostic test.

  1. Establishment of Stereo Multi-sensor Network for Giant Landslide Monitoring and its Deploy in Xishan landslide, Sichuan, China.

    Liu, C.; Lu, P.; WU, H.


    Landslide is one of the most destructive natural disasters, which severely affects human lives as well as the safety of personal properties and public infrastructures. Monitoring and predicting landslide movements can keep an adequate safety level for human beings in those situations. This paper indicated a newly developed Stereo Multi-sensor Landslide Monitoring Network (SMSLMN) based on a uniform temporal geo-reference. Actually, early in 2003, SAMOA (Surveillance et Auscultation des Mouvements de Terrain Alpins, French) project was put forwarded as a plan for landslide movements monitoring. However, SAMOA project did not establish a stereo observation network to fully cover the surface and internal part of landslide. SMSLMN integrated various sensors, including space-borne, airborne, in-situ and underground sensors, which can quantitatively monitor the slide-body and obtain portent information of movement in high frequency with high resolution. The whole network has been deployed at the Xishan landslide, Sichuan, P.R.China. According to various characteristic of stereo monitoring sensors, observation capabilities indicators for different sensors were proposed in order to obtain the optimal sensors combination groups and observation strategy. Meanwhile, adaptive networking and reliable data communication methods were developed to apply intelligent observation and sensor data transmission. Some key technologies, such as signal amplification and intelligence extraction technology, data access frequency adaptive adjustment technology, different sensor synchronization control technology were developed to overcome the problems in complex observation environment. The collaboratively observation data have been transferred to the remote data center where is thousands miles away from the giant landslide spot. These data were introduced into the landslide stability analysis model, and some primary conclusion will be achieved at the end of paper.

  2. Auditory characteristics of individuals with temporomandibular dysfunctions and dentofacial deformities

    Tatiane Totta


    Full Text Available OBJECTIVE: To investigate whether there is any relationship between otological as well as vestibular symptoms, audiological findings and type of temporomandibular disorder (articular, muscular and mixed; and to check the distribution of the temporomandibular disorders (TMD dysfunction degree in the research population. METHODS: A retrospective study involving 30 patients of both sexes, aged between 18 and 49 years old, diagnosed with TMD and dentofacial deformities, who were subject to clinical evaluation (muscle palpation, auscultation of temporomandibular joint during mandibular motion and measurement of jaw movement, audiological testing (pure tone audiometry and immittance testing and two questionnaires, one on otological and vestibular symptoms and the other on TMD anamnesis. Based on both the anamnesis questionnaire and the clinical assessment, the subjects were divided according to the type and degree of TMD dysfunction (mild, moderate and severe, and compared regarding the occurrence of auditory signs and symptoms, vestibular symptoms and audiological findings according to TMD type. RESULTS: The anamnesis questionnaire demonstrated higher prevalence (83.33% of severe TMD. Subjects with mixed TMD had more complaints about hypoacusis than those with muscular TMD (p < 0.05. The results showed no change in either audiological and immittance testing for all assessed individuals. CONCLUSION: Otological symptoms are present in subjects with TMD and dentofacial deformities, regardless of the classification of TMD (articular, muscular or mixed. Those with mixed TMD may have higher incidence of complaints about hypoacusis than subjects with muscular TMD. Further studies are needed to investigate the relationship between otological symptoms and the different types of TMD.

  3. Comparison of ultrasound-guided thrombin injection and compression repair in treatment of iatrogenic femoral arterial pseudoaneurysms

    QIN Jun; GAO Yun-hua; ZHUO Zhong-xiong; HUANG Lan; LI Ai-min; SONG Yao-ming; JIN Jun; YU Xue-jun; GENG Zhao-hua; ZHOU Xia-bo; LIN Chun-mei


    Objective:To retrospectively compare the efficacy and safety of ultrasound-guided thrombin injection (UGTI) with ultrasound-guided compression repair (UGCR) in patients with postcatheterizational femoral arterial pseudoaneurysms (PSA). Methods: Thirty patients of this iatrogenic PSA [8males, 22 females, average age (66.5± 5.2) years] in our nstitution from 1997 to 2004 were retrospectively analyzed. Among them, 11 patients were treated with UGCR, 2 under continuous ultrasonographic (US) guidance and 9 under the guidance of femoral arterial bruit auscultation and dorsalis pedis artery palpation. Because UGCR was failed in 5 patients, consecutively 24 patients were treated with UGTI. Wine thrombin solution at a concentration of 200 U/ml was injected percutaneously using 22-25 gauge needles under color Doppler US. Demographics, clinical variables, pseudoaneurysm characteristics, and results of the 2 groups were compared by using Fisher's exact test and Student's t test. Results: The initial success rate of UGCR was 36.4% (4/11) nd the overall success rate was 45.5% (5/11). Ten of 11 patients suffered from local pain during the compression, but there was no any complication in UGTI group. The average dose of injected thrombin was (180±82) U for PSA of a single loculus and (315±150) U for multiloculated PSA. The initial success rate of UGTI was 89.5% (17/19) and the verall uccess rate was 100% (24/24). Conclusion:UGTI offers a safe, quick and effective means of definitively treating femoral pseudoaneurysms and seems superior to UGCR. The amount of thrombin applied on our people seems smaller compared with others' work.

  4. Age alters the cardiovascular response to direct passive heating.

    Minson, C T; Wladkowski, S L; Cardell, A F; Pawelczyk, J A; Kenney, W L


    During direct passive heating in young men, a dramatic increase in skin blood flow is achieved by a rise in cardiac output (Qc) and redistribution of flow from the splanchnic and renal vascular beds. To examine the effect of age on these responses, seven young (Y; 23 +/- 1 yr) and seven older (O; 70 +/- 3 yr) men were passively heated with water-perfused suits to their individual limit of thermal tolerance. Measurements included heart rate (HR), Qc (by acetylene rebreathing), central venous pressure (via peripherally inserted central catheter), blood pressures (by brachial auscultation), skin blood flow (from increases in forearm blood flow by venous occlusion plethysmography), splanchnic blood flow (by indocyanine green clearance), renal blood flow (by p-aminohippurate clearance), and esophageal and mean skin temperatures. Qc was significantly lower in the older than in the young men (11.1 +/- 0.7 and 7.4 +/- 0.2 l/min in Y and O, respectively, at the limit of thermal tolerance; P skin temperatures and time to reach the limit of thermal tolerance. A lower stroke volume (99 +/- 7 and 68 +/- 4 ml/beat in Y and O, respectively, P heating, was the primary factor for the lower Qc observed in the older men. Increases in HR were similar in the young and older men; however, when expressed as a percentage of maximal HR, the older men relied on a greater proportion of their chronotropic reserve to obtain the same HR response (62 +/- 3 and 75 +/- 4% maximal HR in Y and O, respectively, P skin. PMID:9516200

  5. Impaired hemodynamic response to mental stress in subjects with prehypertension is improved after a single bout of maximal dynamic exercise

    Renata Frauches Medeiros


    Full Text Available INTRODUCTION: High blood pressure during mental stress in subjects with prehypertension is associated with blunted vasodilation in skeletal muscles, which might be improved by an acute bout of exercise. OBJECTIVE: To investigate the hemodynamic responses to mental stress before and after a bout of exercise in subjects with prehypertension. METHOD: Eighteen subjects with prehypertension and 16 with normotension underwent a mental stress test before and after a maximal cardiopulmonary exercise test on a treadmill. Blood pressure was measured by auscultation, and forearm blood flow was measured by venous occlusion plethysmography; from these measurements, the vascular conductance was calculated. RESULTS: Subjects with prehypertension had a higher mean blood pressure during mental stress (prehypertension 112±2 vs. normotension 101±3 mm Hg, p<0.05, and their vascular conductance did not increase (baseline 0.025±0.004 vs. mental stress 0.022±0.003 a.u., p.0.05. After the exercise bout, the mean blood pressure during mental stress was lower in subjects with prehypertension (before exercise 112±2 vs. after exercise 107±2 mm Hg, p<0.05, and vascular conductance increased (baseline 0.011±0.001 vs. mental stress 0.024±0.004 a.u., p<0.05. CONCLUSION: Subjects with prehypertension had elevated blood pressure and a blunted vasodilator response during mental stress, but their blood pressure was attenuated and their vasodilator response was normalized after a single bout of maximal dynamic exercise.

  6. Sound component duration of healthy human pharyngoesophageal swallowing: a gender comparison study.

    Morinière, Sylvain; Beutter, Patrice; Boiron, Michèle


    Cervical auscultation is a noninvasive technique for studying swallowing that was first used in the 1960s. The aim of our study was to use the numeric acoustic recording technique for analyzing swallowing sound signals in healthy subjects while they ingested a defined volume and consistency of a specific substance. Twenty males and ten females were included in the study and given 10 ml of a barium suspension to swallow. A microphone was placed on the skin overlying the lateral border of the trachea, directly under the inferior border of the cricoid, and connected to a computer. For each sound recording, the total duration of the sound (td), the number (n) of sound components (SC), the duration of each SC (c1, c2, c3,...), and the intervals (i1, i2,...) between the SCs were measured. For all the recordings, the mean durations of acoustic parameters (TDm, C1m, C2m, C3m, I1m, I2m) were calculated and compared by using Student's t test. In the 20 male subjects, the mean acoustic parameters were calculated (MTDm, MC1m, MC2m, MC3m, MI1m, MI2m) and compared with the mean acoustic parameters (FTDm, FC1m, FC2m, FC3m, FI1m, FI2m) in the ten females by using a Wilcoxon nonparametric statistical test. We were able to interpret 80% of the recordings. The TDm was 710 +/- 28 ms. Three main SCs were detected: C1m = 100 +/- 56, C2m = 150 +/- 90, C3m = 80 +/- 54 ms; I1m = 100 +/- 66, I2m = 190 +/- 120 ms. No significant difference in these parameters was observed with respect to gender. This study enabled us to decompose the swallowing sounds into three main SCs and to quantify their normal durations. These results should prove useful for the assessment of sound variations in pathologic conditions. PMID:16897324

  7. Phono-spectrographic analysis of heart murmur in children

    Angerla Anna


    Full Text Available Abstract Background More than 90% of heart murmurs in children are innocent. Frequently the skills of the first examiner are not adequate to differentiate between innocent and pathological murmurs. Our goal was to evaluate the value of a simple and low-cost phonocardiographic recording and analysis system in determining the characteristic features of heart murmurs in children and in distinguishing innocent systolic murmurs from pathological. Methods The system consisting of an electronic stethoscope and a multimedia laptop computer was used for the recording, monitoring and analysis of auscultation findings. The recorded sounds were examined graphically and numerically using combined phono-spectrograms. The data consisted of heart sound recordings from 807 pediatric patients, including 88 normal cases without any murmur, 447 innocent murmurs and 272 pathological murmurs. The phono-spectrographic features of heart murmurs were examined visually and numerically. From this database, 50 innocent vibratory murmurs, 25 innocent ejection murmurs and 50 easily confusable, mildly pathological systolic murmurs were selected to test whether quantitative phono-spectrographic analysis could be used as an accurate screening tool for systolic heart murmurs in children. Results The phono-spectrograms of the most common innocent and pathological murmurs were presented as examples of the whole data set. Typically, innocent murmurs had lower frequencies (below 200 Hz and a frequency spectrum with a more harmonic structure than pathological cases. Quantitative analysis revealed no significant differences in the duration of S1 and S2 or loudness of systolic murmurs between the pathological and physiological systolic murmurs. However, the pathological murmurs included both lower and higher frequencies than the physiological ones (p Conclusion Phono-spectrographic analysis improves the accuracy of primary heart murmur evaluation and educates inexperienced listener

  8. TRALI in the perioperative period

    Berdai MA


    Full Text Available Mohamed Adnane Berdai, Smael Labib, Mustapha HarandouChild and Mother Intensive Care Unit, University Hospital Hassan II, Fes, MoroccoBackground: Transfusion-related acute lung injury (TRALI is one of the leading causes of transfusion-related morbidity and mortality. Although it is a serious complication of blood transfusion, it is still underestimated because of underrecognition and misdiagnosis, which can lead to inappropriate management.Case report: We report the case of a 34-year-old female, who presented with hemorrhagic shock during cesarean section and was transfused with packed red blood cells and fresh frozen plasma. Three hours after the end of transfusion, while still intubated, the patient developed acute respiratory failure, with diffuse crackles at auscultation and bilateral lung infiltrations on chest radiography. The ratio of the arterial partial pressure of O2 and the fraction of inspired O2 (PaO2/FiO2 was 51. The diagnosis of TRALI was made after excluding other possible causes of acute lung injury. She was managed symptomatically with ventilatory support and vasopressors. The patient later died secondary to multiple organ failure.Conclusion: The diagnosis of TRALI relies on the exclusion of other causes of acute pulmonary edema following transfusion. All plasma-containing blood products have been involved in the genesis of this syndrome. This is a relatively common and serious adverse transfusion reaction that requires prompt diagnosis and management. Challenges are ahead as preventive strategies have reduced but not eliminated the onset of TRALI.Keywords: acute lung injury, transfusion related acute lung injury, anti-human leukocyte antigen antibody, pulmonary edema, transfusion accident

  9. Prevalence and risk factors for obstructive respiratory conditions among textile industry workers in Zimbabwe, 2006

    Gerald Shambira


    Full Text Available INTRODUCTION: Workers in the cotton processing industries risk developing obstructive respiratory conditions due to prolonged exposure to cotton dust. We noted a tenfold increase in asthma among workers in a Textile Manufacturing Company. We determined the prevalence of respiratory obstructive conditions among workers in various sections. METHODS: We conducted a cross sectional analytic study. Workers were randomly sampled and data was collected using interviewer-administered questionnaires. Respiratory function was assessed using spirometry and chest auscultation. A walk through survey was conducted and a checklist was used to capture hazards and control measures in the work place. RESULTS: A total of 194 workers participated. The prevalence of severe respiratory obstruction was 27.8%. It was 50.0% among the blowers, 35.3% in waste recovery, 32.5% in carders, 15.0% in spinners and 7.5% among weavers. The mean years of exposure between the affected and the non-affected were significantly different (T =2.20; p less than 0.05. Working in the blowing department was significantly associated with developing respiratory obstruction (OR=3.53; 95% CI= 1.61- 7.79 but working in the weaving department was significantly protective (OR 0.16; CI 0.04-0.59.Working in a department for less than 10 years was protective (OR =0.94; 95% CI= 0.48- 1.85, but not significant. CONCLUSION: Obstructive respiratory conditions are common among textile workers, with those in blowing and waste recovery sections being the most affected. We recommended worker rotation every six months, regular spirometric screening employment of a medical officer.

  10. Prognostic value of clinical and Doppler echocardiographic findings in children and adolescents with significant rheumatic valvular disease

    The diagnosis of acute rheumatic fever (RF) is based on clinical findings. However, during the chronic phase of the disease, the clinical approach is not sufficient for the follow-up of the patients and the Doppler echocardiography is a tool for the diagnosis of cardiac involvement. Prognostic variables that influence long-term outcomes are not well known. 462 patients with RF according to Jones criteria were studied, and followed-up from the initial attack to 13.6 ± 4.6 years. All patients underwent clinical assessment and Doppler echocardiography for the detection of heart valve involvement in the acute and chronic phases. Multivariate logistic regression analysis was used to identify the factors influencing long-term heart valve disease. Carditis occurred in 55.8% and subclinical valvulitis in 35.3% patients. In the chronic phase, 33% of the patients had significant valvular heart disease. No normal Doppler echocardiography exam was observed on patients who had severe valvulitis, although heart auscultation had become normal in 13% of these. In the multivariate analysis, only the severity of carditis and the mitral and/or aortic valvulitis were associated with significant valvular heart disease. Chorea or arthritis were protective factors for significant valvular heart disease, odds ratio 0.41 (95% C.I. 0.22 – 0.77) and 0.43 (95% C.I. 0.23 – 0.82), respectively. Our study suggests that the use of Doppler echocardiography during RF helps to identify prognostic factors regarding the development of significant valvular heart disease. Initial severe carditis is an important factor in the long-term prognosis of chronic RHD, whereas arthritis and chore during the initial episode of RF appears to be protective. Strict secondary prophylaxis should be mandatory in high risk patients