Sample records for auscultation

  1. Physicians' Abdominal Auscultation

    DEFF Research Database (Denmark)

    John, Gade; Peter, Kruse; Andersen, Ole Trier


    Background: Abdominal auscultation has an important position in the physical examination of the abdomen. Little is known about rater agreement. The aim of this study was to describe rater agreement and thus, indirectly, the value of the examination. Methods: In a semi-virtual setup 12 recordings...... of the intestinal sounds from 8 patients with acute abdominal pain and 4 healthy volunteers were presented to 100 physicians. The physicians were asked to characterize the intestinal sounds as normal or pathologic. Fisher's exact test was used for comparison between groups of physicians. Results: Overall, 72......% of the answers with regard to healthy volunteers concluded that the sounds were normal (equalling agreement), whereas 64% of answers with regard to intestinal obstruction concluded that the sounds were pathologic (but agreement was higher due to agreement on wrong diagnosis in one case). Bowel sounds from...

  2. Hybrid High-Fidelity Auscultation Scope Project (United States)

    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...

  3. Auscultation of the Chest and Abdomen by Athletic Trainers. (United States)

    McChesney, John A.; McChesney, John W.


    OBJECTIVE: To present a practical overview of the methods and techniques of auscultation of the chest and abdomen for use during the physical examination of athletes. Our intent is to provide information on this clinical technique to assist athletic trainers in recognizing and referring athletes presenting with potentially serious internal organ conditions. BACKGROUND: Use of the stethoscope is a clinical skill increasingly necessary for athletic trainers. Given the expanding breadth of both the assessment techniques used by athletic trainers and the populations they care for and the fact that clinical instruction guidelines have changed in the newly adopted National Athletic Trainers' Association Educational Competencies, our goal is to provide a framework upon which future instruction can be based. DESCRIPTION: This review covers the use of a stethoscope for auscultation of the chest and abdomen. Auscultation of the heart is covered first, followed by techniques for auscultating the breath sounds. Lastly, auscultation of the abdomen describes techniques for listening for bowel sounds and arterial bruits. CLINICAL ADVANTAGES: During the assessment of injuries to and illnesses of athletes, knowledge of auscultatory techniques is valuable and of increasing importance to athletic trainers. Athletic trainers who do not know how to perform auscultation may fail to recognize, and therefore fail to refer for further evaluation, athletes with potentially serious pathologic conditions.

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

    DEFF Research Database (Denmark)

    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....

  5. Small Steps in Impacting Clinical Auscultation of Medical Students

    Directory of Open Access Journals (Sweden)

    Edem K. Binka MD


    Full Text Available The objective of this study was to determine if a training module improves the auscultation skills of medical students at the University of Maryland School of Medicine. Second-year medical students completed pretests on 12 heart sounds followed by a 45-minute training module on clinical auscultation, with retesting immediately after the intervention and during their third-year pediatrics clerkship. The control group consisted of third-year medical students who did not have the intervention. There was a 23% improvement in the identification of heart sounds postintervention (P < .001. Diastolic and valvular murmurs were poorly identified pre- and post intervention. There was a 6% decline in accuracy of the intervention group in the following academic year. The intervention group was superior to the control group at identifying the tested heart sounds (49% vs 43%, P = .04. The accuracy of second-year medical students in identifying heart sounds improved after a brief training module.

  6. Technology for enhancing chest auscultation in clinical simulation. (United States)

    Ward, Jeffrey J; Wattier, Bryan A


    The ability to use an acoustic stethoscope to detect lung and/or heart sounds, and then to then communicate one's interpretation of those sounds is an essential skill for many medical professionals. Interpretation of lung and heart sounds, in the context of history and other examination findings, often aids the differential diagnosis. Bedside assessment of changing auscultation findings may also guide treatment. Learning lung and heart auscultation skills typically involves listening to pre-recorded normal and adventitious sounds, often followed by laboratory instruction to guide stethoscope placement, and finally correlating the sounds with the associated pathophysiology and pathology. Recently, medical simulation has become an important tool for teaching prior to clinical practice, and for evaluating bedside auscultation skills. When simulating cardiovascular or pulmonary problems, high-quality lung and heart sounds should be able to accurately corroborate other findings such as vital signs, arterial blood gas values, or imaging. Digital audio technology, the Internet, and high-fidelity simulators have increased opportunities for educators and learners. We review the application of these technologies and describe options for reproducing lung and heart sounds, as well as their advantages and potential limitations.

  7. Manipulation of Cognitive Load Variables and Impact on Auscultation Test Performance (United States)

    Chen, Ruth; Grierson, Lawrence; Norman, Geoffrey


    Health profession educators have identified auscultation skill as a learning need for health professional students. This article explores the application of cognitive load theory (CLT) to designing cardiac and respiratory auscultation skill instruction for senior-level undergraduate nursing students. Three experiments assessed student auscultation…

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

    DEFF Research Database (Denmark)

    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 wit...

  9. A High Performance Approach to Improving Auscultation Capability in Noisy Environments Project (United States)

    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 have...

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

    DEFF Research Database (Denmark)

    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 capnography for verifying endotracheal intubation in obese patients....

  11. A quality assessment of respiratory auscultation material on YouTube. (United States)

    Sunderland, Nicholas; Camm, Christian F; Glover, Katie; Watts, Anna; Warwick, Geoffrey


    YouTube contains a large volume of medical educational material. This study assessed the quality of respiratory auscultation videos contained in YouTube. Videos were searched for using the terms 'breath sounds', 'respiratory sounds', 'respiratory auscultation' and/or 'lung sounds'. In total, 6,022 videos were located, 36 of which were considered suitable for scoring for video accuracy, comprehensiveness and quality. The average score was 3.32/6 (55.3% ± 1.30). Video score correlated with time-adjusted YouTube metadata: hits per day (0.496, p=0.002) and likes per day (0.534, p=0.001). Video score also correlated with the first search page on which the video was located in the 'breath sounds' and 'lung sounds' searches (-0.571, p=0.001; -0.445, p=0.014, respectively). The quality of videos was variable. Correlation between video score and some metadata values suggests that there is value for their use in judging video quality. However, the large number of videos found and inability to filter these results quickly makes locating educational content difficult.


    Directory of Open Access Journals (Sweden)

    Velimala Ratna


    Full Text Available EFM was introduced into widespread clinical practice in the 1970s to 1980s on the premise that it would facilitate early detection of abnormal FHR patterns thought to be associated with hypoxia thus allowing earlier intervention to prevent foetal neurological damage and/or death. There is a lack of evidence of benefit supporting the use of the admission CTG in low-risk pregnancy. In this study we the aim to evaluate the effects of Cardiotocograph Foetal Monitoring on perinatal outcome in low risk Obstetric population and determine the cost effective and reliable method of fetal monitoring that is applicable to low-risk population. METHODOLOGY A prospective randomized study conducted on 200 low risk pregnant women in labour divided into 2 groups of 100 each. Group A includes those monitored with admission CTG and Group B includes those monitored with intermittent auscultation (IA. OBSERVATION AND RESULTS The demographic features, parity and gestational age in both the groups were comparable; 10 out of the 100 in CTG group had meconium stained liquor whereas 15 of them had meconium in IA group; 71% of the patients in CTG group had normal delivery, whereas it was 84% in IA group. Incidence of LSCS was 23% in CTG group as against 9% in IA group. A ‘P’ value of 0.02, RR of 2 5 for operative deliveries in CTG group was observed which was significant. Incidence of AVD was 6% in CTG group and 7% in IA group with a p value of <0.05, which is statistically significant. The incidence of MSL, APGAR scores at 1, 5 and 10 minutes and NICU admissions were comparable in both the groups. There was no significant difference in babies with low APGAR <7 at 5 min and NICU admissions in both the groups. In our study the sensitivity of CTG was 63.63%, specificity 80.35%, positive predictive value 33.3%, negative predictive value 94.93%. The low sensitivity and high false positives led to the intervention in delivery and increase in operative delivery with no

  13. Lung sounds auscultation technology based on ANC-ICA algorithm in high battlefield noise environment

    Institute of Scientific and Technical Information of China (English)

    牛海军; 冯安吉; 万明习; 白培瑞


    AIM:To explore the more accurate lung sounds auscultation technology in high battlefield noise environment.METHODS: In this study, we restrain high background noise using a new method-adaptive noise canceling based on independent component analysis (ANC-ICA), the method, by incorporating both second-order and higher-order statistics can remove noise components of the primary input signal based on statistical independence.RESULTS:The algorithm retained the local feature of lung sounds while eliminating high background noise, and performed more effectively than the conventional LMS algorithm.CONCLUSION:This method can cancel high battlefield noise of lung sounds effectively thus can help diagnose lung disease more accurately.

  14. The Auscultation of a Carbon Dioxide Embolization Event during Endoscopic Vein Harvest

    Directory of Open Access Journals (Sweden)

    Erik Strauss


    Full Text Available Endoscopic vein harvest in preparation for coronary artery bypass surgery has become a preferred method of procuring saphenous vein. Several case reports have documented carbon dioxide (CO2 embolization with this procedure as well as CO2 embolization during other laparoscopic surgeries (Markar et al., 2010. Although uncommon, the potential for CO2 entrainment through an open vein or through absorption by vascular structures exists and should be recognized (Lin et al., 2003. We report a case of CO2 embolization during EVH for a 77-year-old patient who underwent CABG that was identified early by the cardiac surgeon through the indirect auscultation of a mill-wheel murmur after the pericardium was opened. This may be the first reported case of a murmur related to air emboli identified without the use of a precordial Doppler probe or a stethoscope. This diagnosis was further supported by TEE before systemic hypotension or cardiovascular collapse occurred.

  15. Rolling ball sifting algorithm for the augmented visual inspection of carotid bruit auscultation (United States)

    Huang, Adam; Lee, Chung-Wei; Liu, Hon-Man


    Carotid bruits are systolic sounds associated with turbulent blood flow through atherosclerotic stenosis in the neck. They are audible intermittent high-frequency (above 200 Hz) sounds mixed with background noise and transmitted low-frequency (below 100 Hz) heart sounds that wax and wane periodically. It is a nontrivial task to extract both bruits and heart sounds with high fidelity for further computer-aided auscultation and diagnosis. In this paper we propose a rolling ball sifting algorithm that is capable to filter signals with a sharper frequency selectivity mechanism in the time domain. By rolling two balls (one above and one below the signal) of a suitable radius, the balls are large enough to roll over bruits and yet small enough to ride on heart sound waveforms. The high-frequency bruits can then be extracted according to a tangibility criterion by using the local extrema touched by the balls. Similarly, the low-frequency heart sounds can be acquired by a larger radius. By visualizing the periodicity information of both the extracted heart sounds and bruits, the proposed visual inspection method can potentially improve carotid bruit diagnosis accuracy.

  16. La shearographie une méthode optique plein champ pour l'auscultation des ouvrages d'art


    TAILLADE, F; Y. Goyat; Muzet, V.; GUILLARD, Y


    Ce papier présente une technique d'interférométrie de speckle, appelée shearographie, permettant de mesurer en quasi-temps réel un champ de déformation. Après un rappel du principe de la shearographie, nous présentons plusieurs résultats de mesures de déformation sur la surface d'une dalle en béton fissurée soumise à une sollicitation thermique ou mécanique. Une simulation de la mesure par shearographie permet d'évaluer les possibilités d'auscultation des ouvrages d'art.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Utilisation des méthodes géophysiques pour l'auscultation des digues en eau : Etude de cas sur le canal du Centre (France)




    Diférentes méthodes d'auscultation géophysiques non destructives ont été testées sur un corps de digue (canal du Centre, France) où des fuites existent en pied de digue. Le canal est ici construit en profil mixte (déblai côté vallée et remblai côté coteau). Une étude géologique détaillé du secteur, préalable aux mesures géophysiques, indique que la structuration locale du site, composé de formations jurassiques carbonatées de plateforme assez fortement fracturées et organisées en lanières étr...

  19. 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

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    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

  20. 用“望、闻、问、切”法点检诊断液压设备故障%Hydraulic Equipment Fault Diagnosis by "Auscultation, Olfaction, Interrogation, and Palpation"

    Institute of Scientific and Technical Information of China (English)



    The hydraulic equipment faults are diagnosed at the spot inspection by the "Chinese medical techniques of auscultation, olfaction, interrogation and palpation". This fault diagnosis method is feasible and practicable, and plays positive roles in the equipment management.%介绍了用中医诊断病症的“望、闻、问、切”方法点检诊断液压设备故障,具有很好的可行性和实用性,在设备管理中发挥了积极的作用。

  1. 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

    Directory of Open Access Journals (Sweden)

    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

  2. Congenital Heart Disease Screening by Ultrasonic Cardiogram for Cerebral Palsy Children with Cardiac Souffle in Cardiac Auscultation%超声心动图对心脏听诊有杂音的脑瘫儿童先天性心脏病筛查

    Institute of Scientific and Technical Information of China (English)

    刘朝辉; 冯国军; 梁坤; 张佼


    目的:探讨超声心动图对心脏听诊有杂音脑瘫儿童的先天性心脏病临床筛查的应用价值.方法:选择笔者所在医院2012年 11月-2014年9月收治的200例心脏听诊有Ⅱ级以上杂音的脑瘫儿童作为研究对象,对其临床资料进行回顾性分析,所有患儿均进行超声心动图检查.结果:通过心脏彩超检查出先天性心脏病46例,占23.0%,其中单纯房缺13例,单纯室缺12例,动脉导管未闭合6例(其中合并小室缺 3例),完全性心内膜垫缺损伴肺动脉狭窄3例,单纯肺动脉狭窄2例,法洛氏四联症2例,法洛氏五联症2例,主动脉瓣狭窄2例,肺动脉瓣上狭窄伴房缺1例,右位心伴永存动脉干1例,永存动脉干1例,三尖瓣下移畸形1例.结论:应用超声心电图检查对心脏听诊有杂音脑瘫儿童进行筛查先天性心脏病,具有无创、可靠、价格便宜等优点,有效提高CHD诊断率,具有较大的临床推广价值.%Objective:To investigate the application value of ultrasonic cardiogram in clinical screening for congenital heart disease of cerebral palsy children with cardiac souffle in cardiac auscultation.Method:200 cases with cerebral palsy who manifested cardiac souffle above level Ⅱ in heart auscultation in our hospital from November 2012 to September 2014 were selected as research objects,the clinical data were retrospectively analyzed and all of the patients underwent ultrasonic cardiogram examination.Result:46 cases of congenital heart disease were diagnosed in the cardiac color ultrasound examination and accounted for 23.0%,of which only 13 cases of simple atrial septal defect,12 cases of simple ventricular septal defect,6 cases of patent ductus arteriosus(3 cases combined with small VSD),3 cases of complete endocardial cushion defect combined with pulmonary artery stenosis,2 cases of simple pulmonary artery stenosis, 2 cases of Fallot tetralogy,2 cases of Fallot pentalogy,2 cases of aortic stenosis,1 case of upper

  3. 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

    CERN Multimedia


    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

  4. Les moyens d'auscultation et de surveillance : Applications au viaduc de Merlebach


    Tessier, C.; Gaillet, L.; BRUHAT, D; Michel, R.; NOBLET, S; Barbier, V


    Les câbles sont souvent des éléments fondamentaux pour la tenue des structures, et la sécurité des usagers dépend étroitement de leur état. Cette sécurité est directement liée à la qualité des matériaux employés et de l'exécution des travaux, mais aussi, tout au long de la vie des ouvrages, à la capacité de surveiller et de détecter des dégradations. Le cas du viaduc de Merlebach (Moselle) donne un exemple des moyens mis en oeurvre pour assurer cette surveillance, notamment en matière de surv...

  5. Look4MySounds: a remote monitoring platform for auscultation


    Sapata, Tiago Filipe Teixeira


    As doenças cardiovasculares são a epidemia do Século XXI. O envelhecimento populacional, a obesidade, os estilos de vida sedentários e diversos outros factores contribuem para o seu crescimento, com um impacto económico e social devastador. A auscultação cardíaca é um dos mais antigos métodos para avaliação da função cardíaca. É um método barato e não invasivo, que permite observar com precisão fenómenos cardíacos mecânicos e hemodinâmicos. Recentemente, as tecnologias de monitorização ...

  6. Contribution a l'auscultation des chaussees mixtes par methodes GPR et electrique (United States)

    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.

  7. Mise au point d'une méthodologie pour l'auscultation par acousto-ultrasons de défauts




    Les ponts suspendus comme le pont de Tancarville ou les ponts à haubans comme le pont de Normandie sont deux types de ponts où la sécurité est liée à l'état de leurs câbles, plus particulièrement au niveau de l'ancrage. C'est l'endroit où le câble subit les deux principaux types d'endommagements. La corrosion (accumulation de l'eau de pluie au niveau de l'ancrage) et la fatigue sont les deux grandes catégories d'endommagement sur les câbles. Pour détecter les fils endommagés, les contrôles pa...

  8. 五音闻诊体系探析%Probe and analysis on System of Five-sound Auscultation and Olfaction

    Institute of Scientific and Technical Information of China (English)




  9. Fault diagnosis of transformers by inspection, auscultation-olfaction, interrogation and palpation method%望闻问切法诊断变压器故障

    Institute of Scientific and Technical Information of China (English)

    潘明九; 王颖



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

    Directory of Open Access Journals (Sweden)

    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.

  11. Safety and exploitation of dams: the inspection equipments (part.1); an international facility: the hydroelectric facility of Emosson. Dams life. Activities of the control services; Securite et exploitation des barrages: les materiels d'auscultation (1. partie); un amenagement international: l'amenagement hydroelectrique d'Emosson. La vie des barrages. Activites des services du controle

    Energy Technology Data Exchange (ETDEWEB)



    This issue of Barrages newsletter comprises 4 articles. The first article deals with the instruments used for the inspection of dams and the detection of any drift of dams stability. This article is the first of a series. It presents some general considerations about dams sounding and the apparatuses used. Two types of instruments are presented: the pendulums and the planimeters. The second article presents the conclusions of the decennial and annual inspections of French dams. Only the observations requiring a special follow-up are reported. The third article treats of trans-border facilities which require an international agreement. This is the case of the French-Swiss Emosson dam. The article describes the preliminary negotiations and the main points of the convention signed by both countries. The last article summarizes the activities of the control services for the second quarter of 2004: important facts, administrative instructions, studies, projects and works, services organisation of the different regional directions of industry, research and environment (DRIRE), of the technical service of electric power and big dams (STEEGB) and of the office of technical study and control of big dams (BETCGB). (J.S.)

  12. Laser Stethoscope for Use in Noisy Spacecraft Environments Project (United States)

    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...

  13. Improving auscultatory proficiency using computer simulated heart sounds

    Directory of Open Access Journals (Sweden)

    Hanan Salah EL-Deen Mohamed EL-Halawany


    Full Text Available This study aimed to examine the effects of 'Heart Sounds', a web-based program on improving fifth-year medical students' auscultation skill in a medical school in Egypt. This program was designed for medical students to master cardiac auscultation skills in addition to their usual clinical medical courses. Pre- and post-tests were performed to assess students' auscultation skill improvement. Upon completing the training, students were required to complete a questionnaire to reflect on the learning experience they developed through 'Heart Sounds' program. Results from pre- and post-tests revealed a significant improvement in students' auscultation skills. In examining male and female students' pre- and post-test results, we found that both of male and female students had achieved a remarkable improvement in their auscultation skills. On the other hand, students stated clearly that the learning experience they had with 'Heart Sounds' program was different than any other traditional ways of teaching. They stressed that the program had significantly improved their auscultation skills and enhanced their self-confidence in their ability to practice those skills. It is also recommended that 'Heart Sounds' program learning experience should be extended by assessing students' practical improvement in real life situations.

  14. DGPS technology in construction: movement control in large structures; La tecnologia DGPS en la construccion: control de movimientos en grandes estructuras

    Energy Technology Data Exchange (ETDEWEB)

    Marchamalo, M.; Galan, D.; Sanchez, J. a.; Martinez, R.


    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. (Author)

  15. Differential diagnostic algorithm for diseases manifested with heart murmurs syndrome. (United States)

    Naumov, Leonid B


    Diagnostic interpretation at auscultation of heart murmurs is accompanied by frequent errors. It creates serious clinical, pedagogical, organizational and social problems. The standard nosological principle of a clinical information description from the diagnosis (a disease name) to the description of symptoms/signs contradicts to real clinical practice from revealing of symptoms through differential diagnostics to a diagnosis establishment. The differential diagnostic algorithm or diagnostic algorithm developed by the author, is based on the opposite syndromic principle of thinking - from the signs to the diagnosis. It completely corresponds to the practical purposes of reliable diagnostics of 35 illnesses, manifested by heart murmurs at a heart auscultation.

  16. Phonocardiography Signal Processing

    CERN Document Server

    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

  17. Esophageal rupture due to Sengstaken-Blakemore tube misplacement

    Institute of Scientific and Technical Information of China (English)

    Chee-Fah Chong


    The author presents three cases of esophageal rupture during the treatment of massive esophageal variceal bleeding with Sengstaken-Blakemore (SB) tube. In each case, simple auscultation was used to guide SB tube insertion, with chest radiograph obtained only after complete inflation of the gastric balloon. Two patients died of hemorrhagic shock and one died of mediastinitis.The author suggests that confirmation of SB tube placement by auscultation alone may not be adequate.Routine chest radiographs should be obtained before and after full inflation of the gastric balloon to confirm tube position and to detect tube dislocation.

  18. [Normal and Adventitious Breath Sounds]. (United States)

    Koehler, U; Hildebrandt, O; Kerzel, S; Urban, C; Hoehle, L; Weissflog, A; Nikolaizik, W; Koehler, J; Sohrabi, K; Gross, V


    Auscultation of the lung is an inexpensive, noninvasive and easy-to-perform tool. It is an important part of the physical examination and is help ful to distinguish physiological respiratory sounds from pathophysiological events. Computerized lung sound analysis is a powerful tool for optimizing and quantifying electronic auscultation based on the specific lung sound spectral characteristics. The automatic analysis of respiratory sounds assumes that physiological and pathological sounds are reliably analyzed based on special algorithms. The development of automated long-term lungsound monitors enables objective assessment of different respiratory symptoms.

  19. US Army Medical Department Journal, April-June 2005 (United States)


    Matulionis DH. Ultrastructur changes in rat peripheral nerve flow based on Doppler auscultation on both upper and lower following pneumatic tourniquet...Orthopedic 1 2-4 Central Venous Pressure +/- + Neurosurgeon -+/- Echocardiography + Urology -1 Vital Signs/EKG + + ENT - Urine Output + + OMFS - 1-2 Chest X

  20. Sports and Marfan Syndrome: Awareness and Early Diagnosis Can Prevent Sudden Death. (United States)

    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…

  1. [Biatrial myxomas--a diagnostic challenge]. (United States)

    Dittmann, H; Marschall, H U; Jacksch, R; Konz, K H; Huth, C; Karsch, K R; Hoffmeister, H E; Seipel, L


    Like isolated cardiac myxoma, biatrial myxoma may manifest itself only by extracardiac symptoms over a prolonged period. A 24-year-old patient presented over seven years a history of repeated arthalgia with concomitant anaemia, elevated blood sedimentation rate, positive antistreptolysin test and electrophoretic signs of inflammation. A discrete systolic sound on auscultation gave rise to an echocardiographic examination which revealed a biatrial myxoma.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. On the blind recovery of cardiac and respiratory sounds

    DEFF Research Database (Denmark)

    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...

  4. A System Approach to Navy Medical Education and Training. Appendix 29. Competency Curriculum for Advanced General Duty Corpsman. (United States)


    kidneys, spleen , bladder for: dullness, distension, shifting dullness Auscultation for: peristaltic sounds, bruits Palpation of liver, spleen , kidneys for...venipuncture sites Proper preservation procedures, e.g., immediate cooling for ammonia or acid phosphatase Principles and use of anticoagulants Use of

  5. Breeding Restrictions Decrease the Prevalence of Myxomatous Mitral Valve Disease in Cavalier King Charles Spaniels over an 8-to 10-Year Period

    DEFF Research Database (Denmark)

    Birkegård, Anna Camilla; Reimann, M. J.; Martinussen, T.;


    compared with dogs in 2002-2003, reflecting a 73% decreased risk (P Importance: A mandatory breeding scheme based on auscultation...... and echocardiography findings significantly decreased the prevalence of MMVD over the 8- to 10-year period. Such a breeding scheme therefore is recommended for CKCS....

  6. Sensitivity of bronchial responsiveness measurements in young infants

    DEFF Research Database (Denmark)

    Loland, Lotte; Buchvald, Frederik F; Halkjaer, Liselotte Brydensholt


    of 402 infants (median age, 6 weeks). Forced flow-volume measurements were obtained by the raised volume rapid thoracoabdominal compression technique and were compared with indexes of tidal breathing, measurements of transcutaneous oxygen (Ptco(2)), and auscultation during methacholine challenge testing...

  7. Laser metrology applied to the nuclear maintenance; Metrologia laser aplicada al mantenimiento nuclear

    Energy Technology Data Exchange (ETDEWEB)

    Garrido Garcia, J.; Sarti Fernandez, F.


    The development of this paper focuses on providing an overview of the state of the art about laser metrology. This type of equipment combines the measurement philosophy of laser scanning with the great precision of the robotic equipment of auscultation. Getting micron.

  8. The electronic stethoscope. (United States)

    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.

  9. Comparison of three clinical techniques for evaluating joint sounds. (United States)

    Hardison, J D; Okeson, J P


    Two-hundred two consecutive adult patients presenting to the University of Kentucky for general dental care screening were examined for temporomandibular joint sounds by three techniques: (1) lateral pole surface palpation, (2) digital palpation in the external auditory canal, (3) auscultation by a stethoscope. Sixty-nine patients reported joint sounds, but only 32 had sounds diagnosed by auscultation resulting in a 54% false-negative reporting rate. Stethoscopic auscultation was used as the standard to which the other two techniques were compared. The false-negative rate for auditory canal digital palpation was 71% and 77% for lateral pole surface palpation. Surface palpation had only a 2% false-positive incidence while auditory canal digital palpation had a 51% false-positive rate. There was poor agreement between the patients' subjective reporting and clinical exam by any technique. Using stethoscopic auscultation as the standard, both auditory canal and surface palpation had a very high false-negative rate, but only the auditory canal palpation had a poor false-positive incidence. Auditory canal palpation often produces TMJ sounds that are not heard with a stethoscope during normal opening and closure.

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

    NARCIS (Netherlands)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  12. The effectiveness of ultrasonography in verifying the placement of a nasogastric tube in patients with low consciousness at an emergency center

    Directory of Open Access Journals (Sweden)

    Kim Hyung


    Full Text Available Abstract Background This study was designed to compare the effectiveness of using auscultation, pH measurements of gastric aspirates, and ultrasonography as physical examination methods to verify nasogastric tube(NGT placement in emergency room patients with low consciousness who require NGT insertion. Methods The study included 47 patients who were all over 18 years of age. In all patients, tube placement was verified by chest X-rays. Auscultation, pH analysis of gastric aspirates, and ultrasonography were conducted on each patient in random order. The mean patient age was 57.62 ± 17.24 years, and 28 males (59.6% and 19 females (40.4% were included. The NGT was inserted by an emergency room resident. For pH testing, gastric aspirates were dropped onto litmus paper, and the resulting color of the paper was compared with a reference table. Ultrasonography was performed by an emergency medicine specialist, and the chest X-ray examination was interpreted by a different emergency medicine specialist who did not conduct the ultrasonography test. The results of the auscultation, gastric aspirate pH, and ultrasonography examinations were compared with the results of the chest x-ray examination. Results The sensitivity and specificity were 100% and 33.3%, respectively, for auscultation and 86.4% and 66.7%, respectively, for ultrasonography. Kappa values were the highest for auscultation at 0.484 compared to chest x-rays, followed by 0.299 for ultrasonography and 0.444 for pH analysis of the gastric aspirate. The ultrasonography has a positive predictive value of 97.4% and a negative predictive value of 25%. Conclusions Ultrasonography is useful for confirming the results of auscultation after NGT insertion among patients with low consciousness at an emergency center. When ultrasound findings suggest that the NGT placement is not gastric, additional chest X-ray should be performed.

  13. Remote auscultatory patient monitoring during magnetic resonance imaging

    DEFF Research Database (Denmark)

    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...... can be simultaneously auscultated both inside and outside the shielded MRI room by infrared transmission through a metal mesh window. Bench tests of the system show that common mode acoustic noise is suppressed by approximately 30 dB in the frequency region of interest (100-1,000 Hz), and that polymer...... 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...

  14. Testing of Dhoulath's method to speed up diagnose by separating up crying sound of a baby from normal heart beats – ‘An innovative time saving technique’

    Directory of Open Access Journals (Sweden)

    J. Dhoulath Beegum


    Full Text Available Medical world offers unforeseen ways and techniques in diagnosis of the rarest of rare diseases, of early detection, of prompt and speedy aid and treatment but, many are the hurdles to be overcome by doctors. The case undertaken precedes one such problem doctors confront during auscultation. The baby crying sound necessitates a pause – a pause to distract the baby and stop its cry without which diagnosis becomes impossible and erratic too, leading to time delay. An innovative time saving facility was pondered upon as the way out to gear up doctors to facilitate auscultation even when the baby continues to cry. Dhoulath's method is utilized for separation of the baby cry and normal heart beats. This time saving facility is highly effective during cardiac failures. The diagnosing time and the death rate is considered, while organizing the concept.

  15. Heart sounds: are you listening? Part 1. (United States)

    Reimer-Kent, Jocelyn


    All nurses should have an understanding of heart sounds and be proficient in cardiac auscultation. Unfortunately, this skill is not part of many nursing school curricula, nor is it necessarily a required skillfor employment. Yet, being able to listen and accurately describe heart sounds has tangible benefits to the patient, as it is an integral part of a complete cardiac assessment. In this two-part article, I will review the fundamentals of cardiac auscultation, how cardiac anatomy and physiology relate to heart sounds, and describe the various heart sounds. Whether you are a beginner or a seasoned nurse, it is never too early or too late to add this important diagnostic skill to your assessment tool kit.

  16. Patent ductus arteriosus in an adult amur leopard (Panthera pardus orientalis). (United States)

    Douay, Guillaume; Drut, Amandine; Ribas, Thibault; Gomis, David; Graille, Mélanie; Lemberger, Karin; Bublot, Isabelle


    A clinically healthy 16-yr-old female leopard (Panthera pardus orientalis) was diagnosed with a patent ductus arteriosus on echocardiography and later confirmed on necropsy A murmur was heard on auscultation during a routine examination, and the congenital defect was an incidental finding. The animal had been asymptomatic its entire life. This deformity is rarely observed in nondomestic felids and may be asymptomatic, as has been described in domestic cats.




    A 60 year old male patient presented with hoarseness of voice lasting for 2 months. First he was examined by the otorhinolaryngologist of our hospital, who noticed absence of movements of the left vocal cord. Chest X-ray showed a large opacity in the left upper zone and the patient was referred to the pulmonologist. His general physical examination was unremarkable not having any stigmata of Marfan's or Ehler Danlos syndrome. On chest auscultation, a systolic flow murmur was ...

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  19. First report of multinodular pulmonary fibrosis associated with equine herpesvirus 5 in Belgium


    Verryken, Kirsten; Saey, Veronique; S.; Maes; Borchers, K; Van de Walle, Gerlinde; Ducatelle, Richard; Deprez, Piet


    A 20-year-old horse was evaluated for symptoms of weight loss, anorexia, fever and lethargy. Clinical examination revealed tachypnea, poor body condition and increased breath sounds on auscultation. Ultrasound showed multiple consolidations on the lungs. Thoracic radiography revealed a severe nodular pattern. The horse was treated with antibiotics, corticoids and supportive medication. Since no improvement was observed, the horse was euthanized. At necropsy, numerous coalescing fibrous nod...

  20. Контузія легень у постраждалих із політравмою


    Тrutyak, І.R.


    Objective. To pay attention to the timely diagnosis and adequate treatment of lung contusion in polytrauma patients.Materials and Methods. 208 (52.6 %) out of 392 polytrauma patients had chest trauma. 68.9 % patients were younger than 39 years old. Lung contusion were in 86 (41.3 %). External respiration we estimate for respiratory rate, costosternal condition, percussion, auscultation data and blood oxygen saturation index.Results and Discussion. Pulmonary contusion is characterized by hemor...

  1. Celebrating Two Centuries since the Invention of the Stethoscope. René Théophile Hyacinthe Laënnec (1781-1826). (United States)

    Tomos, Ioannis; Karakatsani, Anna; Manali, Effrosyni D; Papiris, Spyros A


    René Théophile Hyacinthe Laënnec (1781-1826), a French physician, is considered one of the pioneers of respiratory medicine. His contribution to the invention of the stethoscope and to the development of clinical auscultation played a key role in the progress of the diagnosis of chest diseases. Almost two centuries after his invention of the stethoscope, his achievements continue to be widely appreciated and used by modern physicians in current pulmonology.

  2. Construction of the enemy in the Colombian armed conflict 1998-2010

    Directory of Open Access Journals (Sweden)

    Julio González Z


    should be taken as a toolbox or as a lens, which are used if they allow a better view and leaving aside whether or disturb the look muddy work. I think the construction of the enemy in the Colombian armed conflict 1998-2010, is that: a good toolbox or good lenses that allow us auscultate some phenomena and raises some concerns?

  3. Feedback promotes learning success! Which kind of feedback for the faculty is given by an interdisciplinary OSCE with focus on decision-making?


    Stibane, Tina; Sitter, Helmut; Neuhof, Despina; Wiechens, Helena; Schönbauer, Andrea; Bösner, Stefan; Baum, Erika


    Clinical skills such as history taking, diagnostic reasoning, therapy planning, and giving advice are even more complex than practical skills like lung auscultation and have to be applied in complex clinical situations. We judged this competence in an interdisciplinary formative OSCE conducted with students of Marburg University. Results of 218 students passing 643 OSCE stations composed of 37 different scenarios were analyzed. As a competence based examination that reflects the practical ski...

  4. Acoustic cardiac signals analysis: a Kalman filter-based approach. (United States)

    Salleh, Sheik Hussain; Hussain, Hadrina Sheik; Swee, Tan Tian; Ting, Chee-Ming; Noor, Alias Mohd; Pipatsart, Surasak; Ali, Jalil; Yupapin, Preecha P


    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 for the given measurement. The model is formulated into state-space form to enable use of a Kalman filter to estimate the clean cycles of heart sounds. The estimates obtained by Kalman filtering are optimal in mean squared sense.


    Directory of Open Access Journals (Sweden)



    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.

  6. Hemodynamics of the Aortic Jet and Implications for Detection of Aortic Stenosis Murmurs (United States)

    Zhu, Chi; Seo, Junghee; Bakhshaee, Hani; Mittal, Rajat


    Cardiac auscultation with a stethoscope has served as the primary method for qualitative screening of cardiovascular conditions for over a hundred years. However, a lack of quantitative understanding of the flow mechanism(s) responsible for the generation of the murmurs, as well as the effect of intervening tissue on the propagation of these murmurs has been a significant limiting factor in the advancement of automated cardiac auscultation. In this study, a multiphysics computational modeling approach is used to investigate these issues. Direct numerical simulation (DNS) is used to explore the fluid dynamics of the jets formed at the aortic valve and the pressure fluctuations generated by the interaction of this jet with the aortic wall. Subsequently, structural wave propagation in the tissue is resolved by a high-order, linear viscoelastic wave solver in order to explore the propagation of the murmurs through a tissue-like material. The implications of these results for cardiac auscultation are discussed. The authors would like to acknowledge the financial support from NSF Grants IIS-1344772, CBET-1511200, and computational resource by XSEDE NSF Grant TG-CTS100002.

  7. Doppler echocardiography imaging in detecting multi-valvular lesions: a clinical evaluation in children with acute rheumatic fever.

    Directory of Open Access Journals (Sweden)

    Pushpa Shivaram

    Full Text Available RATIONALE: Doppler echocardiography has been demonstrated to be accurate in diagnosing valvular lesions in rheumatic heart disease (RHD when compared to clinical evaluation alone. OBJECTIVE: To perform Doppler echocardiography in children clinically diagnosed by the Jones criteria to have acute rheumatic fever (ARF, and to then compare the effectiveness of echo in detecting single/multi-valvular lesions with that of the initial clinical evaluation. METHODS AND RESULTS: We enrolled 93 children who were previously diagnosed with ARF by clinical examination. Presence of valvular lesions were enlisted, first by clinical auscultation, and then by performing Doppler echocardiography. We found that Doppler echocardiography was a sensitive technique, capable of detecting valvular lesions that were missed by clinical auscultation alone. Echocardiography of patients with carditis revealed mitral regurgitation to be the most common lesion present (53 patients, 56.98%, followed by aortic regurgitation in 21 patients (22.6%. The difference between clinical and echocardiographic diagnosis in ARF children with carditis was statistically significant for mitral regurgitation, aortic regurgitation and tricuspid regurgitation. Clinical auscultation alone revealed 4 cases of mitral stenosis, 39 mitral regurgitation, 14 aortic regurgitation, 9 tricuspid regurgitation; in contrast, echo revealed 5 cases of mitral stenosis, 53 mitral regurgitation, 21 aortic regurgitation, 18 tricuspid regurgitation. CONCLUSION: Doppler echocardiography is a more sensitive technique for detecting valvular lesions. In the setting of ARF, echo enables a 46.9% higher detection level of carditis, as compared to the clinical examination alone. Echo was very significant in detecting regurgitation lesions, especially for cases of tricuspid regurgitation in the setting of multivalvular involvement. The results of our study are in accordance with previous clinical studies, all of which clearly

  8. Durabilité structurelle des chaussées : pathologie et entretien - Sujet 2 "méthodes de diagnostic"




    Dans le cadre de la réflexion sur le volet "auscultation diagnostic des structures semi-rigides", le LR d'Autun a fait la synthèse de son expérience d'utilisation du paramètre "rayon de courbure" (regroupement entre valeurs de rayon mesurées et défauts constatés par carottages) et approfondi le sujet en étudiant par modélisation de défauts l'incidence sur ce paramètre "rayon de courbure". COMPTE RENDU DE RECHERCHE

  9. Infective Endocarditis Due To Haemophilus Aphrophilus: A Case Report


    Pereira,Ricardo M.; Bucaretchi,Fabio; Tresoldi,Antonia T.


    Objective: To report the case of a child with infective endocarditis caused by Haemophilus aphrophilus. Description: Boy with 20 days of fever and chills. On admission, he was febrile, pale and with no signs of hemodynamic instability; on cardiac auscultation, a mitral-related holosystolic murmur was observed. Laboratory examination identified anemia (hemoglobin = 9.14 g/dL), total leukocytes of 11,920 mm3, platelets of 250,000 mm3, elevated sedimentation velocity of red cells and elevated C-...

  10. Multiple pulmonary rheumatoid nodules. (United States)

    Sargin, Gokhan; Senturk, Taskin


    We present a case of 45-year-old female patient with the diagnosis of seropositive rheumatoid arthritis, who was admitted to our rheumatology department with exacerbation of the disease. The patient's disease activity score (DAS 28) was 6.9. Physical examination revealed changes in the lung auscultation as a rough breathing sound at the middle and lower lobe of the right lung. Chest X-ray revealed multiple nodular densities in both lungs. Lung biopsy was performed for the diagnosis and revealed necrotizing granulomas with central fibrinoid necrosis surrounded by epithelioid cells. Such a histopathological picture is typical for rheumatoid nodules. Finally the patient was treated with rituximab, with significant improvement.

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

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    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.


    Shin, Jinho


    Arterial pulsation which had long been studied for estimation of blood pressure or mean blood pressure was replaced by the measurement of systolic and diastolic blood pressure using Korotkoff sound detected by stethoscope in the beginning of the previous century. In the meantime, vast of modern knowledge of human hypertension from epidemiology to randomized clinical trial had been built on the Korotkoff sound and stethoscope methodology. Hypertension is very special clinical entity in terms of the diagnosis is solely dependent on the manual blood pressure measurement by a physician or nurse. The observer related error was mentioned frequently but the source of the error is numerous and the noncompliance with the standard measurement protocol is not only confined to the observer related factor but also, practically more important, to the other factors such as resting period, environment, exposure to drugs, behavioral factors, and etc. After emerging of automated device using oscillometric algorithm, gradually auscultation methods has been replaced by automated device. Even with the environmental hazard issue by mercury manometer, the reason to be replaced does not seem to be accuracy issue but feasibility issue because, in general, standardization of the auscultation method costs more. Fortunately, since 1990 s, most randomized clinical trial has been using automated device to measure blood pressure even though validation data for each trial were scarce. Moreover clinician should have attention on the blood pressure measurement protocol for each trial before applying the result to practice. Mercury seems be replaced at any time because the accuracy of electronic manometer is very high. Stethoscope as another part of the conventional technique seems to be useful to measure blood pressure in special situation such as arrhythmia, pregnancy, or patient driven needs. As reported in several studies, in some patient group, the error of automated device can be

  13. [Synchronous playing and acquiring of heart sounds and electrocardiogram based on labVIEW]. (United States)

    Dan, Chunmei; He, Wei; Zhou, Jing; Que, Xiaosheng


    In this paper is described a comprehensive system, which can acquire heart sounds and electrocardiogram (ECG) in parallel, synchronize the display; and play of heart sound and make auscultation and check phonocardiogram to tie in. The hardware system with C8051F340 as the core acquires the heart sound and ECG synchronously, and then sends them to indicators, respectively. Heart sounds are displayed and played simultaneously by controlling the moment of writing to indicator and sound output device. In clinical testing, heart sounds can be successfully located with ECG and real-time played.

  14. Acute Pulmonary Edema Caused by a Giant Atrial Myxoma

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    Andrea Fisicaro


    Full Text Available Atrial myxoma is the most common primary cardiac tumor. Its clinical presentation spreads from asymptomatic incidental mass to serious life-threatening cardiovascular complications. We report the case of a 44-year-old man with evening fever and worsening dyspnea in the last weeks, admitted to our hospital for acute pulmonary edema. The cardiac auscultation was very suspicious for mitral valve stenosis, but the echocardiography revealed a huge atrial mass with a diastolic prolapse into mitral valve orifice causing an extremely high transmitral gradient pressure. Awareness of this uncommon acute presentation of atrial myxoma is necessary for timely diagnosis and prompt surgical intervention.

  15. Feedback promotes learning success! Which kind of feedback for the faculty is given by an interdisciplinary OSCE with focus on decision-making?

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    Stibane, Tina


    Full Text Available Clinical skills such as history taking, diagnostic reasoning, therapy planning, and giving advice are even more complex than practical skills like lung auscultation and have to be applied in complex clinical situations. We judged this competence in an interdisciplinary formative OSCE conducted with students of Marburg University. Results of 218 students passing 643 OSCE stations composed of 37 different scenarios were analyzed. As a competence based examination that reflects the practical skills gained during clinical training, the here presented analysis serves also as a feedback instrument for clinical teachers, their respective disciplines and the medical faculty as a whole.

  16. Feedback promotes learning success! Which kind of feedback for the faculty is given by an interdisciplinary OSCE with focus on decision-making? (United States)

    Stibane, Tina; Sitter, Helmut; Neuhof, Despina; Wiechens, Helena; Schönbauer, Andrea; Bösner, Stefan; Baum, Erika


    Clinical skills such as history taking, diagnostic reasoning, therapy planning, and giving advice are even more complex than practical skills like lung auscultation and have to be applied in complex clinical situations. We judged this competence in an interdisciplinary formative OSCE conducted with students of Marburg University. Results of 218 students passing 643 OSCE stations composed of 37 different scenarios were analyzed. As a competence based examination that reflects the practical skills gained during clinical training, the here presented analysis serves also as a feedback instrument for clinical teachers, their respective disciplines and the medical faculty as a whole.

  17. Feedback promotes learning success! Which kind of feedback for the faculty is given by an interdisciplinary OSCE with focus on decision-making? (United States)

    Stibane, Tina; Sitter, Helmut; Neuhof, Despina; Wiechens, Helena; Schönbauer, Andrea; Bösner, Stefan; Baum, Erika


    Clinical skills such as history taking, diagnostic reasoning, therapy planning, and giving advice are even more complex than practical skills like lung auscultation and have to be applied in complex clinical situations. We judged this competence in an interdisciplinary formative OSCE conducted with students of Marburg University. Results of 218 students passing 643 OSCE stations composed of 37 different scenarios were analyzed. As a competence based examination that reflects the practical skills gained during clinical training, the here presented analysis serves also as a feedback instrument for clinical teachers, their respective disciplines and the medical faculty as a whole. PMID:27579353

  18. Best evidence: nasogastric tube placement verification. (United States)

    Longo, M Anne


    Further research on cost-effective techniques to verify enteral tube placement is warranted using a variety of pediatric populations with differing conditions that may impact gastric pH. It is imperative that clinical facilities review current policies and procedures to ensure that evidence-based findings are guiding nursing practice. Many nurses continue to rely on auscultation to verify NGT placement. Education and competency validation can assist with current practices for NGT placement being consistently incorporated by all personnel in the health care setting. Continuing to search for evidence related to nursing care will guide the direct care RN in providing best practice.

  19. Chronic hypersensitivity pneumonitis (United States)

    Pereira, Carlos AC; Gimenez, Andréa; Kuranishi, Lilian; Storrer, Karin


    Hypersensitivity pneumonitis (HSP) is a common interstitial lung disease resulting from inhalation of a large variety of antigens by susceptible individuals. The disease is best classified as acute and chronic. Chronic HSP can be fibrosing or not. Fibrotic HSP has a large differential diagnosis and has a worse prognosis. The most common etiologies for HSP are reviewed. Diagnostic criteria are proposed for both chronic forms based on exposure, lung auscultation, lung function tests, HRCT findings, bronchoalveolar lavage, and biopsies. Treatment options are limited, but lung transplantation results in greater survival in comparison to idiopathic pulmonary fibrosis. Randomized trials with new antifibrotic agents are necessary. PMID:27703382

  20. CT pulmonay angiography features of a hepatopulmonary syndrome

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    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.

  1. A computational model of cardiovascular physiology and heart sound generation. (United States)

    Watrous, Raymond L


    A computational model of the cardiovascular system is described which provides a framework for implementing and testing quantitative physiological models of heart sound generation. The lumped-parameter cardiovascular model can be solved for the hemodynamic variables on which the heart sound generation process is built. Parameters of the cardiovascular model can be adjusted to represent various normal and pathological conditions, and the acoustic consequences of those adjustments can be explored. The combined model of the physiology of cardiovascular circulation and heart sound generation has promise for application in teaching, training and algorithm development in computer-aided auscultation of the heart.

  2. Quadricuspid pulmonary valve associated with atrial septal defects and pulmonary stenosis (United States)

    Aboitiz-Rivera, Carlos Manuel; Blachman-Braun, Ruben; Ferrer-Arellano, Laura Graciela


    A 1-month-old Hispanic female was referred to the cardiology service. During physical examination, a systolic ejection murmur at the pulmonic area was auscultated. The echocardiography evaluation of the pulmonary valve demonstrated a quadricuspid pulmonary valve (QPV) with slightly thickened leaflets, associated atrial septal defects and mild pulmonary stenosis. QPV is a rare congenital anomaly variant that can remain asymptomatic with few or non-hemodynamic alterations. Associations with structural or functional alterations have been reported. This is the first case of QPV that was diagnosed in a Hispanic newborn. PMID:26138189

  3. Applying cybernetic technology to diagnose human pulmonary sounds. (United States)

    Chen, Mei-Yung; Chou, Cheng-Han


    Chest auscultation is a crucial and efficient method for diagnosing lung disease; however, it is a subjective process that relies on physician experience and the ability to differentiate between various sound patterns. Because the physiological signals composed of heart sounds and pulmonary sounds (PSs) are greater than 120 Hz and the human ear is not sensitive to low frequencies, successfully making diagnostic classifications is difficult. To solve this problem, we constructed various PS recognition systems for classifying six PS classes: vesicular breath sounds, bronchial breath sounds, tracheal breath sounds, crackles, wheezes, and stridor sounds. First, we used a piezoelectric microphone and data acquisition card to acquire PS signals and perform signal preprocessing. A wavelet transform was used for feature extraction, and the PS signals were decomposed into frequency subbands. Using a statistical method, we extracted 17 features that were used as the input vectors of a neural network. We proposed a 2-stage classifier combined with a back-propagation (BP) neural network and learning vector quantization (LVQ) neural network, which improves classification accuracy by using a haploid neural network. The receiver operating characteristic (ROC) curve verifies the high performance level of the neural network. To expand traditional auscultation methods, we constructed various PS diagnostic systems that can correctly classify the six common PSs. The proposed device overcomes the lack of human sensitivity to low-frequency sounds and various PS waves, characteristic values, and a spectral analysis charts are provided to elucidate the design of the human-machine interface.

  4. Neglected evidence in idiopathic pulmonary fibrosis and the importance of early diagnosis and treatment

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    Vincent Cottin


    Full Text Available In idiopathic pulmonary fibrosis (IPF, some facts or concepts based on substantial evidence, whilst implicit for learned subspecialists, have previously been neglected and/or not explicitly formulated or made accessible to a wider audience. IPF is strongly associated with cigarette smoking and is predominantly a disease of ageing. However, its cause(s remain elusive and, thus, it is one of the most challenging diseases for the development of novel effective and safe therapies. With the approval of pirfenidone for patients with mild-to-moderate IPF, an earlier diagnosis of IPF is a prerequisite for earlier treatment and, potentially, improvement of the long-term clinical outcome of this progressive and ultimately fatal disease. An earlier diagnosis may be achieved in IPF by promoting thin-slice chest high-resolution computed tomography screening of interstitial lung disease as a “by-product” of large-scale lung cancer screening strategies in smokers, but other techniques, which have been neglected in the past, are now available. Lung auscultation and early identification of “velcro” crackles has been proposed as a key component of early diagnosis of IPF. An ongoing study is exploring correlations between lung sounds on auscultation obtained using electronic stethoscopes and high-resolution computed tomography patterns.

  5. Effectiveness of current teaching methods in Cardiology: the SKILLS (medical Students Knowledge Integration of Lower Level clinical Skills) study (United States)

    Lavranos, G; Koliaki, C; Briasoulis, A; Nikolaou, A; Stefanadis, C


    Introduction: The aim of the study is to assess reported changes in medical students’ capacity to attain five basic cardiological clinical skills, following a one-month intensive cardiology course provisioned in the core curriculum. Materials and Methods: An anonymous questionnaire comprising self reported performance in the five skills, namely 1) arterial blood pressure measurement, 2) cardiac auscultation, 3) electrocardiogram (ECG) carry out, 4) ECG interpretation and 5) defibrillation, was distributed to 177 fifth year students of the Athens Medical School upon initiating the cardiology course (pre-training group) and to 59 students matched for sex, age, year of study and training centre, following completion of the course (post training group). Comparison of pre- and post- training performance was evaluated using the χ2 test. Results: No change was noted with regards to blood pressure measurement, cardiac auscultation or defibrillation. By contrast, a statistically significant improvement was reported for ECG execution (54.3 versus 81.4%; p<0.001) and interpretation (from 33.1 to 89.8%; p<0.001). Conclusions: Improvement in the execution and interpretation of ECGs seems to be among the strengths of the cardiology training program. Further studies including larger samples from multiple medical schools and objective assessment of skill execution might facilitate accurate training evaluation and define opportunities for improvement. PMID:23935341


    Institute of Scientific and Technical Information of China (English)

    Qing-bo Fan; Ming-ying Gai; Jian-qiu Yang; Fei-fei Xing


    Objective To explore fetal arrhythmia clinical significance and its correlation with fetal prognosis.Methods Twenty-six cases of fetal arrhythmia detected among 12 799 pregnant women recorded over a ten-year period in Peking Uinon Medical College (PUMC) Hospital were reviewed retrospectively. Fetal arrhythmia was diagnosed by fetal auscultation, ultrasonography, electric fetal heart monitoring, and fetal echocardiography.Results Twenty-six fetuses were documented with fetal arrhythmia (3 tachycardia, 4 bradycardia, 19 normal heart rate with irregular fetal cardiac rhythm). The incidence of fetal arrhythmia in our hospital was 0.2%. They were diagnosed at the average of 35 weeks' gestation (15 to 41 weeks). Twenty-two cases were diagnosed by antenatal fetal auscultation, 1 case was diagnosed by ultrasonography, and 3 cases were diagnosed by electric fetal heart monitoring. Fetal echocardiograms were performed on 17 fetuses, 6 cases (35.3%) of which showed that ventricular premature beats with normal structure of fetal heart.All neonates survived postnatally and 24 of them (92.3%) were followed up. Echocardiograms were performed for 16 neonates and 2 of them were identified as atrial septal defects with normal heart rhythms. The results of follow-up showed that the two patients had no apparent clinical manifestation. The echocardiogram showed that atrial septal defect obliterated already.Conclusion The prognosis is well for most of the fetuses with arrhythmias, with low incidence of heart deformation.

  7. Digital stethoscope as an innovative tool on the teaching of auscultatory skills. (United States)

    Mesquita, Claudio Tinoco; Reis, Jader Costa dos; Simões, Luciana Silveira; Moura, Eduardo Cardoso de; Rodrigues, Gustavo Amarante; Athayde, Carolina Cunto de; Machado, Hugo Lima; Lanzieri, Pedro Gemal


    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 accuracy of clinical examination, however, its impact on the teaching of cardiac auscultation for undergraduate students of medicine is not known. The objective is to demonstrate the usefulness of the digital stethoscope compared to traditional methods as a tool in the teaching of auscultatory skills. nterventional, longitudinal, controlled, unicenter and randomized study. Thirty-eight medicine students were enrolled for a cardiovascular semiology course lasting eight weeks. The course program included lectures and bedside practice in Cardiology wards. In the practical lessons, the students were randomized into two groups: 1) (n = 21) digital stethoscope (Littmann® Model 3200, 3M); and 2) (n = 17) conventional stethoscopes. A pre-training evaluation was conducted through a test using the software Heart Sounds®, which was repeated after the course. The average scores were compared by paired T test and unpaired T test. It is observed that, at the end of the course, there was a significantly greater improvement in the group that used the digital stethoscope (51.9%) compared to the group using the conventional stethoscope (29.5%). Short-term interventions for cardiac semiology teaching are able to contribute significantly to improving proficiency in the identification of heart sounds. The use of digital stethoscope proved to be a positive factor in teaching these skills.

  8. Instructional Multiple Binaural Stethoscope

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    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.

  9. Determining the Effect of Early Feeding after Cesarean section Compared with Regular Diet on the Gastrointestinal Function of Women Referred to Tajrish Hospital, Iran

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    M Amiri-Siavoshani


    Full Text Available Background & aim: Early feeding after cesarean section can have beneficial effects, however, no sufficient study has been conducted in this area. The aim of this study was to determine the effects of early feeding on the gastrointestinal complications in women after cesarean section and comparing it with a regular diet.   Methods: The present randomized-clinical-trial study was conducted on 160 women who admitted to Shohada hospital and underwent cesarean section in 2011-2012. The inclusion criteria included women with gestational age more than 37 weeks, singleton pregnancy, having at least 8 hours of fasting, and regional anesthesia (spinal cord, respectively. After registration of demographic characteristics and pregnancy, women were randomly divided into two groups: Early feeding (2 hours after completion of the operation, 250 ml filtered juice, tea and biscuits style regime in the next 2 hours and 2 hours after the usual diet and the usual power (8 hours of operation clear liquid diet the day after the usual diet groups. Presence of gastrointestinal symptoms in 2, 4, 8 and 12 hours after surgery, time to the bowel sounds auscultation, passage of flatus and stool were recorded. Data were analyzed by SPSS software version13.The significance level of p-value was considered 0.05.   Conclusion: Early feeding caused the acceleration of gastrointestinal symptoms, earlier bowel sounds auscultation and earlier utilization of gas. It is recommended to investigate the different diets and examined the level of compliance and satisfaction.  

  10. Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration (United States)

    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. PMID:27167432

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

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    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.

  12. Analysis of phonocardiogram signals using wavelet transform. (United States)

    Meziani, F; Debbal, S M; Atbi, A


    Phonocardiograms (PCG) are recordings of the acoustic waves produced by the mechanical action of the heart. They generally consist of two kinds of acoustic vibrations: heart sounds and heart murmurs. Heart murmurs are often the first signs of pathological changes of the heart valves, and are usually found during auscultation in primary health care. Heart auscultation has been recognized for a long time as an important tool for the diagnosis of heart disease, although its accuracy is still insufficient to diagnose some heart diseases. It does not enable the analyst to obtain both qualitative and quantitative characteristics of the PCG signals. The efficiency of diagnosis can be improved considerably by using modern digital signal processing techniques. Therefore, these last can provide useful and valuable information on these signals. The aim of this study is to analyse PCG signals using wavelet transform. This analysis is based on an algorithm for the detection of heart sounds (the first and second sounds, S1 and S2) and heart murmurs using the PCG signal as the only source. The segmentation algorithm, which separates the components of the heart signal, is based on denoising by wavelet transform (DWT). This algorithm makes it possible to isolate individual sounds (S1 or S2) and murmurs. Thus, the analysis of various PCGs signals using wavelet transform can provide a wide range of statistical parameters related to the phonocardiogram signal.

  13. Cervical accelerometry in preterm infants. (United States)

    Reynolds, Eric W; Vice, Frank L; Bosma, James F; Gewolb, Ira H


    The objective of this study was to develop a method to use digital signal processing (DSP) technology to describe quantitatively and statistically swallow-associated sounds in preterm infants and to use this method to analyze changes as infants mature. Twelve recordings of accelerometric and physiological data on bottle-feeding preterm infants between 32 and 39 weeks' postmenstrual age (PMA) were analyzed. Cervical auscultation was performed using an accelerometer attached over the larynx. Acoustic data were recorded and graphically displayed using DSP software. Initial discrete sounds (IDSs) were identified and used to construct an average waveform from which a 'variance index' (VI) was calculated for each infant. The shape of the IDS waveforms became progressively more uniform with advancing PMA, as indicated by a significant inverse correlation between VI and PMA (r=0.739; p=0.006). DSP technology facilitated the development of a new method to quantitatively analyze feeding in preterm infants. This method provides an elegant tool to track maturation of infant feeding and assessing feeding readiness. This technique makes the interpretation of cervical auscultation data less subjective by replacing the verbal description of the sounds of feeding with quantitative numeric values. It is anticipated that this method can be automated to facilitate further the analysis of cervical accelerometry data.

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

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    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

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

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    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.

  16. Design of wireless electronic stethoscope based on zigbee

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    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.

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

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    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

  18. Temporomandibular joint sounds: a critique of techniques for recording and analysis. (United States)

    Widmer, C G


    Sonography, or the graphic recording of sounds, has been proposed as an objective measure of various pathological conditions in the temporomandibular joint. Various electronic devices have been developed to enhance our ability to auscultate the joint, monitor the timing of the sounds with jaw movement, and analyze the characteristics of the sound; the intent of these devices is to diagnose the intracapsular condition "objectively." This review paper critically evaluates the advantages and limitations of this technique. Based on the existing literature, these instruments can record sounds; however, the origin of these sounds is uncertain, since room noise, skin and hair sounds, respiration, arterial blood flow, and cross-over noises from the opposite TMJ have not been excluded as possible artifacts of the recording. More important, the diagnostic specificity, as an indicator of each type of TMJ disease, has not been clearly and consistently demonstrated with the sonographic technique.

  19. Guidelines for screening, prophylaxis and critical information prior to initiating anti-TNF-alpha treatment

    DEFF Research Database (Denmark)

    Lassen, Inge Nordgaard; Dahlerup, Jens Frederik; Belard, Erika


    These national clinical guidelines outlining the screening, prophylaxis and critical information required prior to initiating anti-TNF-alpha treatment have been approved by the Danish Society for Gastroenterology. Anti-TNF-alpha therapy is widely used in gastroenterology (for inflammatory bowel...... disease), rheumatology (for rheumatoid arthritis, psoriatic arthritis and spondyloarthropathies) and dermatology (for psoriasis). With this background, the Danish Society for Gastroenterology established a group of experts to assess evidence for actions recommended before treatment with anti...... a history of previous malignancies (cases of malignant disease within 5 years of anti-TNF-alpha treatment should be carefully considered). The physical examination should include lung/heart auscultation and lymph node examination, and the paraclinical investigations should include chest X...

  20. French influence on the development of medicine in Louisiana. (United States)

    Duffy, J


    The paper presents a brief survey of the state of medicine in the 18th century with an emphasis upon developments in France. In the early nineteenth century the emergence of the Paris Clinical School made France pre-eminent in medicine. Its leaders emphasized localism, correlated symptoms with postmortem reports, and introduced clinical statistics. They also introduced the stethoscope and the techniques of auscultation and palpation and were the first to recognize that excessive bloodletting, purging and other depletory measures were harmful. The French population in Louisiana continued to look to France for educational and intellectual leadership well into the nineteenth century, and the findings of the Paris Clinical School had an immediate impact upon Louisiana medicine, leading to a clash between the French-speaking physicians who emphasized moderation and good nursing and the English-speaking practitioners who believed in drastic intervention.

  1. A multi-spot exploration of the topological structures of the reconstructed phase-space for the detection of cardiac murmurs. (United States)

    Oliveira, Jorge; Oliveira, Cristina; Cardoso, Bruna; Sultan, Malik Saad; Tavares Coimbra, Miguel


    Acoustic heart signals are generated by a turbulence effect created when the heart valves snap shut, and therefore carrying significant information of the underlying functionality of the cardiovascular system. In this paper, we present a method for heart murmur classification divided into three major steps: a) features are extracted from the heart sound; b) features are selected using a Backward Feature Selection algorithm; c) signals are classified using a K-nearest neighbor's classifier. A new set of fractal features are proposed, which are based on the distinct signatures of complexity and self-similarity registered on the normal and pathogenic cases. The experimental results show that fractal features are the most capable of describing the non-linear structure and the underlying dynamics of heart sounds among the all feature families tested. The classification results achieved for the mitral auscultation spot (88% of accuracy) are in agreement with the current state of the art methods for heart murmur classification.

  2. Eosinophilic mastitis masquerading as breast carcinoma. (United States)

    Garg, M; Kumar, S; Neogi, S


    We report the sixth case of Eosinophilic Mastitis, presenting similarly enough to be confused with breast carcinoma. A 50 year old lady presented with a six month history of progressively enlarging asymptomatic breast lump, cough and breathlessness. Clinical examination, mammography and axillary lymphadenopathy suggested malignant disease. Ronchi were heard on chest auscultation. Needle cytology was twice inconclusive and Tru-cut biopsy showed acute on chronic inflammation. Blood investigations revealed significant peripheral eosinophilia. Open biopsy reported eosinophilic mastits, correlating with peripheral eosinophilia and pulmonary symptoms. The patient responded to conservative management. Eosinophilic infiltration of the breast is a rare manifestation of tissue involvement in peripheral eosinophilia. Asthma, Churgh-Strauss Syndrome and hyper-eosinophilic syndromes are associated. Importantly, if a clinically and radiologically malignant breast lump in asthmatic ladies with peripheral eosinophilia is not confirmed on cytology, this entity could be a diagnosis, potentially saving the patient from surgery.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.


    Franzen, Dana; Lamberski, Nadine; Zuba, Jeffery; Richardson, G Lynn; Fischer, A T; Rantanen, Norman W


    A 10-yr-old female okapi (Okapia johnstoni) at the San Diego Zoo Safari Park was evaluated for intermittent malaise, inappetence, occasional cough, abdominal splinting, and licking at both flanks. Physical examination revealed tachypnea, tachycardia, and fluid sounds on thoracic auscultation. Transthoracic ultrasound showed multiple uniform, anechoic filled structures in the right and left pleural space. Surgical exploration of the thoracic cavity revealed bilateral, mature, fibrous, compartmentalizing adhesions between the visceral and parietal pleura, confirming a diagnosis of chronic, infectious, fibrinous pleuritis. The suspected etiology was occult aspiration pneumonia secondary to historical episodes of regurgitation associated with general anesthesia. Culture of the pleural fluid and fibrous adhesions grew Trueperella (Arcanobacterium) pyogenes, Arcanobacterium haemolyticum, and few Fusobacterium species. Treatment consisted of chest-tube placement to establish drainage, thoracic lavage, unilateral surgical debridement, and long-term antibiotics. The animal made a complete clinical recovery over 7 mo.

  5. "Vanishing" pulmonary valve stenosis

    Directory of Open Access Journals (Sweden)

    Nofil I Arain


    Full Text Available Objective: Both spontaneous resolution and progression of mild pulmonary valve stenosis (PS have been reported. We reviewed characteristics of the pulmonary valve (PV to determine factors that could influence resolution of mild PS. Methods: Fifteen asymptomatic pediatric patients with spontaneous resolution of isolated mild PS were retrospectively reviewed. Results: There was no correlation between the PV gradient, clinical presentation, age at diagnosis, or PV morphology. The PV annulus was small at initial presentation, which normalized at follow up. When corrected for the body surface area (z-score, the PV annulus was normal in all patients, including at initial evaluation. Conclusions: Based on our observation, neither age at diagnosis, nor PV-morphology-influenced resolution of mild PS. The variable clinical presentation makes it difficult to categorize and observe mild PS by auscultation alone. The PV annulus z-score could be a useful adjunct to determine the course and serial observation of mild PS.

  6. A diagnostic challenge of an unusual presentation of pneumomediastinum

    Institute of Scientific and Technical Information of China (English)

    Hamid Reza Hatamabadi; Shaghayegh Sadat Esmailnejad; Ahmad Reza Khazayi; Betsabeh Masjoudi


    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 emergency 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 intercostal space on the anterior axillary line.The patient was discharged with no complications 10 days postoperatively.

  7. Management of a Patient With Faciocervical Burns and Inhalational Injury Due to Hydrofluoric Acid Exposure. (United States)

    Yuanhai, Zhang; Xingang, Wang; Liangfang, Ni; Chunmao, Han


    Hydrofluoric acid, a highly dangerous substance, can cause tissue damage and systemic toxicity by its unique mechanisms. Many cases of severe faciocervical burns due to hydrofluoric acid exposure are lethal. Herein, we present a case of 37-year-old man who suffered from hydrofluoric acid burns to his face, anterior neck, lips, and nasal cavity. On admission, this patient coughed with much sputum, and the chest auscultation detected rough breath sounds, wheezes, and very weak heart sounds, indicating possible inhalation injury. This case highlights the extreme complexity of managing this kind of injury. Timely and accurate wound treatment and respiratory tract care, as well as active systematic support treatment, played vital roles in the management of this patient.

  8. Frequency shifting approach towards textual transcription of heartbeat sounds

    Directory of Open Access Journals (Sweden)

    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.

  9. Electronic stethoscope with frequency shaping and infrasonic recording capabilities. (United States)

    Gordon, E S; Lagerwerff, J M


    A small electronic stethoscope with variable frequency response characteristics has been developed for aerospace and research applications. The system includes a specially designed piezoelectric pickup and amplifier with an overall frequency response from 0.7 to 5,000 HZ (-3 dB points) and selective bass and treble boost or cut of up to 15 dB. A steep slope, high pass filter can be switched in for ordinary clinical auscultation without overload distortion from strong infrasonic signal inputs. A commercial stethoscope-type headset, selected for best overall response, is used which can adequately handle up to 100 mW of audio power delivered from the amplifier. The active components of the amplifier consist of only four opamp-type integrated circuits.

  10. Advanced multimodality imaging of an anomalous vessel between the ascending aorta and main pulmonary artery in a dog. (United States)

    Markovic, Lauren E; Kellihan, Heidi B; Roldán-Alzate, Alejandro; Drees, Randi; Bjorling, Dale E; Francois, Chris J


    A 1-year-old male German shorthaired pointer was referred for evaluation of tachypnea and hemoptysis. A grade VI/VI left basilar continuous murmur was ausculted. Multimodality imaging consisting of thoracic radiographs, transthoracic and transesophageal echocardiography, fluoroscopy-guided selective angiography, computed tomography angiogram (CTA) and magnetic resonance angiogram (MRA), was performed on this patient. The defect included a left-to-right shunting anomalous vessel between the ascending aorta and main pulmonary artery, along with a dissecting aneurysm of the main and right pulmonary artery. An MRA post-processing technique (PC VIPR) was used to allow for high resolution angiographic images and further assessment of the patient's hemodynamics prior to surgical correction. This case report describes the clinical course of a canine patient with a rare form of congenital cardiac disease, and the multiple imaging modalities that were used to aid in diagnosis and treatment.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  12. Modélisation par éléments finis de type solide-coque de structures piézoélectriques


    KPEKY, Fessal; Boudaoud, Hakim; ABED-MERAIM, Farid; Daya, El Mostafa


    Dans les dernières décennies, les structures à parois minces intégrant des couches ou patchs de matériaux piézoélectriques ont eu un essor. Ils sont utilisés pour le contrôle des vibrations et de forme, le contrôle acoustique, l’auscultation d'ouvrage de génie civil et aussi dans le domaine de la santé, entre autres. La prédiction du comportement de tels matériaux devient donc indispensable pour leur bonne mise en œuvre. L’un des moyens les moins onéreux pour ce faire est la modélisation numé...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Breath sound changes associated with malpositioned endotracheal tubes. (United States)

    Mansy, H A; O'Connor, C J; Balk, R A; Sandler, R H


    Endotracheal tubes (ETTs) are used to establish airway access in patients with ventilatory failure and during general anaesthesia. Tube malpositioning can compromise respiratory function and can be associated with increased morbidity and mortality. Clinical assessment of ETT position normally involves chest auscultation, which is highly skill-dependent and can be misleading. The objective of this pilot study was to investigate breath sound changes associated with ETT malpositioning. Breath sounds were acquired in six human subjects over each hemithorax and over the epigastrium for tracheal, bronchial and oesophageal intubations. When the ETT was in the oesophagus, the acoustic energy ratio between epigastrium and chest surface increased in all subjects (p sounds may be useful for assessment of ETT positioning. More studies are needed to test the feasibility of this approach further.

  16. Guidelines for screening, prophylaxis and critical information prior to initiating anti-TNF-alpha treatment

    DEFF Research Database (Denmark)

    Nordgaard-Lassen, Inge; Dahlerup, Jens Frederik; Belard, Erika


    a history of previous malignancies (cases of malignant disease within 5 years of anti-TNF-alpha treatment should be carefully considered). The physical examination should include lung/heart auscultation and lymph node examination, and the paraclinical investigations should include chest X-rays......These national clinical guidelines outlining the screening, prophylaxis and critical information required prior to initiating anti-TNF-alpha treatment have been approved by the Danish Society for Gastroenterology. Anti-TNF-alpha therapy is widely used in gastroenterology (for inflammatory bowel...... disease), rheumatology (for rheumatoid arthritis, psoriatic arthritis and spondyloarthropathies) and dermatology (for psoriasis). With this background, the Danish Society for Gastroenterology established a group of experts to assess evidence for actions recommended before treatment with anti-TNF-alpha...


    Greene, Rebecca; Van Bonn, William G; Dennison, Sophie E; Greig, Denise J; Gulland, Frances M D


    A female northern elephant seal (Mirounga angustirostris) weaned pup presented with malnutrition. During rehabilitation, the seal developed regurgitation and reduced lung sounds on auscultation. Radiographs and endoscopy performed under sedation suggested a diaphragmatic hernia. A Type I (or sliding) hiatal hernia was confirmed with a positive contrast upper gastrointestinal study, revealing varying degrees of herniation of the gastric fundus through the diaphragm into the caudal thorax as well as esophageal reflux. The animal was treated preoperatively with an H2 antagonist and antinausea medication. A laparoscopic gastropexy was performed under general anesthesia. The animal recovered well postoperatively and resolution of clinical signs was achieved. The animal was released back into the wild 21 kg above admit weight. To our knowledge, we report here the first surgical correction of a hiatal hernia in a marine mammal.

  18. Cysticercal encephalitis presenting with a "Starry Sky" appearance on neuroimaging

    Directory of Open Access Journals (Sweden)

    Tushar B Patil


    Full Text Available A lady in her early forties was brought to our hospital in an unconscious state with history of generalized tonic-clonic seizures for last 6 h. She had multiple episodes of seizures in last 4 months, but did not receive any treatment. Relatives also gave a history of fever, headache, and vomiting for last 1 week. Her seizures were controlled with intravenous lorazepam and valproate. Clinical examination revealed a delirious patient with bilateral papilledema, brisk deep tendon reflexes, and extensor plantars. She had aspirated and had bilateral coarse crepitations on chest auscultation. Computed tomography (CT of brain showed multiple small hyperdense calcific lesions extending throughout both the cerebral hemispheres leading to a "starry sky" appearance, suggestive of cysticercal encephalitis. The patient succumbed to progressive aspiration pneumonitis on the 6 th day after hospitalization.

  19. Gonzalez-Quijano Yves, Arabités numériques, le printemps du web arabe, Paris, Sindbad, 2012, 187p.

    Directory of Open Access Journals (Sweden)

    Catherine Miller


    Full Text Available Ce petit ouvrage paru en 2012 revient dans un style alerte sur le rôle qu’ont joué les réseaux sociaux comme catalyseurs de la révolte et de la mobilisation pendant le « Printemps arabe » de 2011. L’auteur est un spécialiste des médias arabes qu’il ausculte depuis des années et dont il livre de nombreuses analyses à travers son blog Culture et politiques arabes (http// :cpa.hypothè Un des grands mérites de cet ouvrage est de dépasser l’actualité immédiate pour fournir un panorama syn...

  20. Chronic hypersensitivity pneumonitis

    Directory of Open Access Journals (Sweden)

    Pereira CA


    Full Text Available Carlos AC Pereira,1 Andréa Gimenez,2 Lilian Kuranishi,2 Karin Storrer 2 1Interstitial Lung Diseases Program, 2Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil Abstract: Hypersensitivity pneumonitis (HSP is a common interstitial lung disease resulting from inhalation of a large variety of antigens by susceptible individuals. The disease is best classified as acute and chronic. Chronic HSP can be fibrosing or not. Fibrotic HSP has a large differential diagnosis and has a worse prognosis. The most common etiologies for HSP are reviewed. Diagnostic criteria are proposed for both chronic forms based on exposure, lung auscultation, lung function tests, HRCT findings, bronchoalveolar lavage, and biopsies. Treatment options are limited, but lung transplantation results in greater survival in comparison to idiopathic pulmonary fibrosis. Randomized trials with new antifibrotic agents are necessary. Keywords: interstitial lung diseases, extrinsic allergic alveolitis, diffuse lung disease, lung immune response, HRCT, farmers lung

  1. Frequency shifting approach towards textual transcription of heartbeat sounds. (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Shone's complex with dextrocardia and situs inversus totalis: a case report. (United States)

    Ekici, Berkay; Erkan, Aycan Fahri; Sökmen, Yeliz; Tüfekçioğlu, Omaç


    Parachute mitral valve complex is an unusual congenital anomaly that has been described by Shone et al. It is characterized by a parachute deformity of the mitral valve associated with additional forms of left heart anomalies, such as aortic valvular stenosis and coarctation of the aorta. A 21-year-old female who was referred to our department because of progressive dyspnea on effort and at rest and minimal cyanosis is presented in this case report. On cardiac auscultation, the patient had a grade III/VI pansystolic murmur best heard at the lower left sternal border. The chest X-ray demonstrated dextrocardia and mild cardiomegaly. Echocardiographic evaluation revealed Shone's complex, including parachute mitral valve anomaly.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Lung herniation: an uncommon presentation of Poland's syndrome in a neonate at birth. (United States)

    Chandran, Suresh; Revanna, Krishna Gopagondanahalli; Ari, Dinesh; Rana, Aftab Ahmed


    A term male infant was admitted to the neonatal intensive care unit with an asymmetric chest wall and a herniating mass through the left fourth intercostal space. While crying, the left fourth intercostal space revealed a mass which herniated on expiration and receded on inspiration. On auscultation, the heart sounds were audible on the right side of the chest. Systemic examination was otherwise unremarkable. A roentgenogram of the chest revealed dextrocardia and hyperlucent left lung fields. Echocardiogram showed dextrocardia with a structurally normal heart. A clinical diagnosis of Poland's syndrome was made based on the hypoplasia of the left pectoral muscles, ribs and nipple, dextrocardia and lung herniation. He was thriving well when reviewed at 2 years of age.

  6. Off-Pump CABG in a Patient with Dextrocardia Totalis: a Case Report. (United States)

    Dabbagh, Ali; Bolourian, Ali Asghar


    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.

  7. [The Use of a Tracheal Tube for Guiding Nasogastric Tube Insertion]. (United States)

    Saima, Shunsuke; Asai, Takashi; Okuda, Yasuhisa


    An obese patient was scheduled for shoulder joint surgery under general anesthesia. After induction of anesthesia and tracheal intubation, insertion of a gastric tube was difficult. A new tracheal tube was prepared, the connecter was removed, and the tube was cut longitudinally. The tube was inserted orally into the esophagus. A gastric tube was passed through the nose, and its tip was taken out of the mouth. The tip of the gastric tube was passed through the tracheal tube, and its correct position in the stomach was confirmed by auscultation of the epigastrium. The tracheal tube was carefully taken out from the esophagus leaving the gastric tube in the stomach. The cut tracheal tube was peeled off from the gastric tube. Correct positioning of the gastric tube was re-confirmed.

  8. Applications of Sensor Technology Boost Chinese Medicine Research%运用传感器技术促进中医药研究

    Institute of Scientific and Technical Information of China (English)

    王光耀; 王兴华; 盛良; 汪宇; Te Kian Keong; The Siew Hoon


    Sensor technology has been introduced into the field of Chinese medicine research for increasing advantages in a wide range of areas such as pulse diagnosis,auscultation and olfaction, syndrome differentiation,disease diagnosis,Chinese medicine identification,four properties and five tastes,integrative use of Chinese and western medicine,etc. Therefore, sensor technology has the broad application prospect and great development potential.%传感器技术已被引入中医药研究领域,在脉诊、闻诊、辨证、疾病诊断、中药鉴别、四气五味、中西药汇通、中西医结合等方面显现出优势,并有广阔的应用前景和发展潜力.

  9. Combined pulmonary fibrosis and emphysema in hypersensitivity pneumonitis. (United States)

    Soumagne, Thibaud; Pana-Katatali, Héloïse; Degano, Bruno; Dalphin, Jean-Charles


    Combined pulmonary fibrosis and emphysema is a distinct syndrome reported in patients who smoke. A 72-year-old, never-smoking female dairy farmer was referred for progressive dyspnoea on exertion, basal crackles on auscultation, normal spirometry and normal lung volumes but decreased diffusing capacity of the lung for carbon monoxide, centrilobular emphysema in the upper zones of the lungs and diffuse infiltrative lung disease in the lower zones on high-resolution CT scan. Bronchoalveolar lavage differential cell count showed 35% lymphocytosis, and precipitating antibodies for Wallemia sebi, Trichoderma species and Cladosporium sphaerospermum were identified. The diagnosis of farmer's lung disease with combined pulmonary fibrosis and emphysema was retained. This case highlights for the first time that hypersensitivity pneumonitis should be suspected in the setting of combined pulmonary fibrosis and emphysema in non-smoking patients.

  10. An interesting case of cor pulmonale

    Directory of Open Access Journals (Sweden)

    Bagrecha Manish V, Kunkulol Rahul R


    Full Text Available A 14 yrs old boy presented with a history of breathlessness since 1 yr which had increased from 2 days, cough with expectoration and pedal edema since 7 days. In the past patient had history of kyphoscoliosissince birth and had a history of repeated URTI. On examination he had tachycardia, tachypnea, raised JVP, kyphoscoliosis, bilateral pitting edema. Respiratory auscultation revealed bilateral fine crepitations and wheezes. On investigation haemoglobin: 14.6, T.L.C: 20,000,chest X-ray: kyphoscoliosis with cardiomegaly. Clinical diagnosis of corpulmonale due to kyphoscoliosis was achieved and was confirmed with 2D echo. ECG showed RVH. The patient was treated with oxygen, diuretics, antibiotics, bronchodilators. Patient improved and was discharged on bronchodilators and was asymptomatic on follow up.

  11. 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)

    Institute of Scientific and Technical Information of China (English)

    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.

  12. Are physicians in primary health care able to recognize pulmonary fibrosis? (United States)

    Purokivi, Minna; Hodgson, Ulla; Myllärniemi, Marjukka; Salomaa, Eija-Riitta; Kaarteenaho, Riitta


    ABSTRACT Background: The early diagnosis of idiopathic pulmonary fibrosis (IPF) has become increasingly important due to evolving treatment options. IPF patients experience a significant delay in receiving an accurate diagnosis, thus delayed access to tertiary care is associated with higher mortality independently from disease severity. Objective: The aims were to evaluate whether there had been a delay in the referral process, and to determine whether the referring doctors had suspected IPF or other interstitial lung disease (ILD) already during the time of referral. Methods: Ninety-five referral letters of patients with IPF identified from the FinnishIPF registry were evaluated with respect to time of referral, referring unit, grounds for referral, symptoms, smoking status, occupational history, clinical examinations, co-morbidities, medication, radiological findings and lung function. Results: Fifty-nine percent of referral letters originated from primary public health care. The time from symptom onset to referral was reported in 60% of cases, mean time being 1.5 (0.8–2.3) (95%CI) years. The main reason for referral was a suspicion of interstitial lung disease (ILD) (63%); changes in chest X-ray were one reason for referring in 53% of cases. Lung auscultation was reported in 70% and inspiratory crackles in 52% of referral letters. Conclusions: Primary care doctors suspected lung fibrosis early in the course of disease. Lung auscultation and chest X-rays were the most common investigational abnormalities in the referrals. Providing general practitioners with more information of ILDs might shorten the delay from symptom onset to referral. PMID:28326180

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

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    Fraga, Andrea de Melo Alexandre; Reis, Marcelo Conrado dos; Zambon, Mariana Porto [Universidade Estadual de Campinas (UNICAMP), Campinas, SP (Brazil). Pediatric Emergency Room]. E-mail:; Toro, Ivan Contrera [Universidade Estadual de Campinas (UNICAMP), Campinas, SP (Brazil). Dept. of Thoracic Surgery; Ribeiro, Jose Dirceu; Baracat, Emilio Carlos Elias [Universidade Estadual de Campinas (UNICAMP), Campinas, SP (Brazil). Dept. of Pediatric Pulmonology


    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. Auscultatory and electrocardiographic characteristics of Crioulo horses

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    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.

  15. Use of a respiratory clinical score among different providers. (United States)

    Liu, Lenna L; Gallaher, Margaret M; Davis, Robert L; Rutter, Carolyn M; Lewis, Toby C; Marcuse, Edgar K


    Respiratory assessment of children with asthma or bronchiolitis is problematic because both the components of the assessment and their relative importance vary among care providers. Use of a systematic standard assessment process and clinical score may reduce interobserver variation. Our objective was to determine observer agreement among physicians (MD), nurses (RN), and respiratory therapists (RT), using a standard respiratory clinical score. A clinical score was developed incorporating four physiologic parameters: respiratory rate, retractions, dyspnea, and auscultation. One hundred and sixty-five provider pairs (e.g., MD-MD, RN-RT) independently assessed a total of 55 patients admitted for asthma, bronchiolitis, or wheezing at an urban tertiary-care hospital. A weighted kappa statistic measured agreement beyond chance. Rater pairs had high observed agreement on total score of 82-88% and weighted kappas ranging from 0.52 (MD-RN; 95% CI, 0.19, 0.79) to 0.65 (RN-RN; 95% CI, 0.46, 0.87). Observed agreement on individual components of the score ranged from 58% (auscultation) to 74% (dyspnea), with unweighted kappas of 0.36 (respiratory rate; 95% CI, 0.26, 0.46) to 0.53 (dyspnea; 95% CI, 0.41, 0.65). In conclusion, this respiratory clinical score demonstrates good interobserver agreement between MDs, RNs, and RTs. Future research is needed to examine validity and responsiveness in clinical settings. By standardizing respiratory assessments, use of a clinical score may facilitate care coordination by physicians, nurses, and respiratory therapists and thereby improve care of children hospitalized with asthma and bronchiolitis.

  16. A relative value method for measuring and evaluating cardiac reserve

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    Sun Xiaobo


    Full Text Available Abstract Background Although a very close relationship between the amplitude of the first heart sound (S1 and the cardiac contractility have been proven by previous studies, the absolute value of S1 can not be applied for evaluating cardiac contractility. However, we were able to devise some indicators with relative values for evaluating cardiac function. Methods Tests were carried out on a varied group of volunteers. Four indicators were devised: (1 the increase of the amplitude of the first heart sound after accomplishing different exercise workloads, with respect to the amplitude of the first heart sound (S1recorded at rest was defined as cardiac contractility change trend (CCCT. When the subjects completed the entire designed exercise workload (7000 J, the resulting CCCT was defined as CCCT(1; when only 1/4 of the designed exercise workload was completed, the result was defined as CCCT(1/4. (2 The ratio of S1 amplitude to S2 amplitude (S1/S2. (3 The ratio of S1 amplitude at tricuspid valve auscultation area to that at mitral auscultation area T1/M1 (4 the ratio of diastolic to systolic duration (D/S. Data were expressed as mean ± SD. Results CCCT(1/4 was 6.36 ± 3.01 (n = 67, CCCT(1 was 10.36 ± 4.2 (n = 33, S1/S2 was1.89 ± 0.94 (n = 140, T1/M1 was 1.44 ± 0.99 (n = 144, and D/S was 1.68 ± 0.27 (n = 172. Conclusions Using indicators CCCT(1/4 and CCCT(1 may be beneficial for evaluating cardiac contractility and cardiac reserve mobilization level, S1/S2 for considering the factor for hypotension, T1/M1 for evaluating the right heart load, and D/S for evaluating diastolic cardiac blood perfusion time.

  17. Changes in the distance between carina and orotracheal tube during open or videolaparoscopic bariatric surgery

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    Giovani de Figueiredo Locks


    Full Text Available ABSTRACTOBJECTIVE: To examine whether there are changes in the distance between the orotracheal tube and carina induced by orthostatic retractor placement or by pneumoperitoneum insufflation in obese patients undergoing gastroplasty.METHODS: 60 patients undergoing bariatric surgery by two techniques: open (G1 or videolaparoscopic (G2 gastroplasty were studied. After tracheal intubation, adequate ventilation of both hemitoraxes was confirmed by lung auscultation. The distance orotracheal tube-carina was estimated with the use of a fiber bronchoscope before and after installation of orthostatic retractors in G1 or before and after insufflation of pneumoperitoneum in patients in G2.RESULTS: G1 was composed of 22 and G2 of 38 patients. No cases of endobronchial intubation were detected in either group. The mean orotracheal tube-carina distance variation was estimated in -0.03 cm (95% CI 0.06 to -0.13 in the group of patients undergoing open gastroplasty and in -0.42 cm (95% CI -0.56 to -1.4 in the group of patients undergoing videolaparoscopic gastroplasty. The extremes of variation in each group were: 0.5 cm to -1.6 cm in patients undergoing open surgery and 0.1 cm to -2.2 cm in patients undergoing videolaparoscopic surgery.CONCLUSIONS: There was no significant change in orotracheal tube-CA distance after placement of orthostatic retractors in patients undergoing open gastroplasty. There was a reduction in orotracheal tube-CA distance after insufflation of pneumoperitoneum in patients undergoing videolaparoscopic gastroplasty. We recommend attention to lung auscultation and to signals of ventilation monitoring and reevaluation of orotracheal tube placement after peritoneal insufflation.

  18. Computer-aided diagnosis of knee-joint disorders via vibroarthrographic signal analysis: a review. (United States)

    Wu, Yunfeng; Krishnan, Sridhar; Rangayyan, Rangaraj M


    The knee is the lower-extremity joint that supports nearly the entire weight of the human body. It is susceptible to osteoarthritis and other knee-joint disorders caused by degeneration or loss of articular cartilage. The detection of a knee-joint abnormality at an early stage is important, because it helps increase therapeutic options that may slow down the degenerative process. Imaging-based arthrographic modalities can provide anatomical images of the joint cartilage surfaces, but fail to demonstrate the functional integrity of the cartilage. Knee-joint auscultation, by means of recording the vibroarthrographic (VAG) signal during bending motion of a knee, could be used to develop a noninvasive diagnostic tool. Computer-aided analysis of VAG signals could provide quantitative indices for screening of degenerative conditions of the cartilage surface and staging of osteoarthritis. In addition, the diagnosis of knee-joint pathology by means of VAG signal analysis may reduce the number of semi-invasive diagnostic arthroscopic examinations. This article reviews studies related to VAG signal analysis, first summarizing the pilot studies that demonstrated the diagnostic potential of knee-joint auscultation for the detection of degenerative diseases, and then describing the details of recent progress in analysis of VAG signals using temporal analysis, frequency-domain analysis, time-frequency analysis, and statistical modeling. The decision-making methods used in the related studies are summarized, followed by a comparison of the diagnostic performance achieved by different pattern classifiers. The final section is a perspective on the future and further development of VAG signal analysis.

  19. Statistical validation of strategies for Zang-Fu single pattern differentiation%一种单脏腑辨证方法的统计学验证

    Institute of Scientific and Technical Information of China (English)

    Arthur de Sá Ferreira


    目的:提出一种能帮助中医临床医师进行单脏腑辨证的方法,并对其进行验证.方法:收集患者的四诊资料,然后在中医诊断知识数据库中进行检索,获取不同的备选辨证结果(证型).根据其能够解释四诊所得临床表现的多少进行排序,形成假设诊断列表,从中确定最终诊断结果.利用从中医诊断知识数据库中获取的96 600种模拟证候群对该诊断方法进行验证.利用基于混淆矩阵的统计学方法评估望、闻、问、切等单个诊断手段、二诊(望诊和闻诊)或三诊(望诊、闻诊和问诊)结合及四诊合参的准确性.结果:问诊的准确度(89.7%)最高.其次为望诊(70.7%)、闻诊(59.9%)和切诊(56.1%).敏感度和阴性预测值的排序相同.各单个诊断方法的特异度和阳性预测值均相近且较高(>99%).四诊合参的准确度(93.2 9/6)、敏感度(86.5%)和阴性预测值(88.1%)最高,同样,四诊合参亦具有较高的特异度(99.9%)和阳性预测值(99.8%).与望、闻、问、切等单个诊断手段以及二诊或三诊结合诊断方法相比,四诊合参的诊断性能更高.结论:该证候诊断方法获得了统计学证据支持,可用于帮助中医临床医师依据脏腑理论进行单脏腑辨证诊断.%Objective:To propose and validate a method to aid traditionaI Chinese medicine(TCM)physicians in differentiation of Zang-Fu single patterns.Methods:The procedu re started with data collection and search on a knowledge database.Candidatepatterns were selected and ranked accordi ng tO fhe relative amount of explai ned exam's manifestaliOns.Diagnosis identification was performed on a Iist of diagnostic hypotheses.VaIidation was conducted with96 600 simulations of manifestation profiles obtained from database.Statistical performance based on confusion matrices was assessed for individua J methods incIudmg inspection,auscultation and olfaction.inquiry,and palpation.Combined methods(inspection+auscultation and

  20. 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

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    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

  1. Omission of postoperative nasogastric tube in esophagectomy: a randomized clinical trial

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    Daryaei P.


    Full Text Available Background: Nasogastric tube (NG tube usage was first described in 1921 by Levin. Surgeons routinely use NG tube in most esophageal resections. Considering the numerous complications caused by this tube, the uncertainty about its usefulness and the scarcity of studies conducted on the subject, particularly in esophageal cancer patients, we investigated the necessity of the NG tube in these cases.Methods: This clinical trial was performed at the Cancer Institute of Imam Khomeini Hospital. Esophageal cancer patients were randomized into groups either with or without postoperative NG tube; the latter group was also prescribed metoclopramide. Postoperative obstruction was the exclusion criteria. The operation was done by a team of surgeons using the surgical techniques of McKeown or Orringer. All patients received ranitidine, heparin and antibiotics postoperatively. All patients received postoperative chest X-ray and chest physiotherapy. The NG tube was inserted or reinserted for those with abdominal distention and/or repeated vomiting. The NG tube was pulled out after return of bowel movements. The variables recorded for each patient included the first day of flatus, the first day of defecation, the first day of bowel sound (BS upon auscultation, duration of post-operative hospitalization, nausea and vomiting, abdominal distension, pulmonary complications, wound complications, anastomotic leakage and the need for placing/replacing the NG tube. Statistical analysis was performed using SPSS, v. 11.5.Results: After randomization, the NG tube was inserted for 22 patients, and 18 patients had no NG tube. The incidence of anastomotic leakage was significantly higher in the NG-tube group. No significant differences between the two groups were found for other complications. The mean times until first passage of flatus, defecation and BS upon auscultation and the duration of post-operative hospitalization were not significantly different. The need for

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

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    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

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

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    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 ...

  4. Symptoms and signs in pulmonary medicine: old observations and new interpretations. (United States)

    Sharma, O P


    Andre Gide wrote, "Everything has been said before, but since nobody listens we have to keep going back and beginning all over again." To a certain extent, that statement applies to the importance of accurate and systematic history taking and physical examination in clinical practice. Although we are trained in habits of comprehension and accuracy in history taking and examination of patients, periodic reminders are required to develop a diagnostic framework based on observation (inspection), palpation, percussion, and auscultation. This monograph reemphasizes the method to be pursued in the treatment of a patient with pulmonary symptoms. It consists of three parts: (1) questioning the patient about his or her medical history; (2) performing the physical examination of the respiratory system; and (3) examining the extrapulmonary signs and symptoms. Once a strong clinical framework has been constructed, its further development and refinement depend on the clinician's experience, power of observation, and systematic reading of the medical literature. Good physicians must continue to learn throughout their careers; this is the most essential element of a physician's development. Be patient, however; as Cowper said, "Knowledge, to become wisdom, needs experience."

  5. The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. (United States)

    Daskalopoulou, Stella S; Rabi, Doreen M; Zarnke, Kelly B; Dasgupta, Kaberi; Nerenberg, Kara; Cloutier, Lyne; Gelfer, Mark; Lamarre-Cliche, Maxime; Milot, Alain; Bolli, Peter; McKay, Donald W; Tremblay, Guy; McLean, Donna; Tobe, Sheldon W; Ruzicka, Marcel; Burns, Kevin D; Vallée, Michel; Ramesh Prasad, G V; Lebel, Marcel; Feldman, Ross D; Selby, Peter; Pipe, Andrew; Schiffrin, Ernesto L; McFarlane, Philip A; Oh, Paul; Hegele, Robert A; Khara, Milan; Wilson, Thomas W; Brian Penner, S; Burgess, Ellen; Herman, Robert J; Bacon, Simon L; Rabkin, Simon W; Gilbert, Richard E; Campbell, Tavis S; Grover, Steven; Honos, George; Lindsay, Patrice; Hill, Michael D; Coutts, Shelagh B; Gubitz, Gord; Campbell, Norman R C; Moe, Gordon W; Howlett, Jonathan G; Boulanger, Jean-Martin; Prebtani, Ally; Larochelle, Pierre; Leiter, Lawrence A; Jones, Charlotte; Ogilvie, Richard I; Woo, Vincent; Kaczorowski, Janusz; Trudeau, Luc; Petrella, Robert J; Hiremath, Swapnil; Stone, James A; Drouin, Denis; Lavoie, Kim L; Hamet, Pavel; Fodor, George; Grégoire, Jean C; Fournier, Anne; Lewanczuk, Richard; Dresser, George K; Sharma, Mukul; Reid, Debra; Benoit, Geneviève; Feber, Janusz; Harris, Kevin C; Poirier, Luc; Padwal, Raj S


    The Canadian Hypertension Education Program reviews the hypertension literature annually and provides detailed recommendations regarding hypertension diagnosis, assessment, prevention, and treatment. This report provides the updated evidence-based recommendations for 2015. This year, 4 new recommendations were added and 2 existing recommendations were modified. A revised algorithm for the diagnosis of hypertension is presented. Two major changes are proposed: (1) measurement using validated electronic (oscillometric) upper arm devices is preferred over auscultation for accurate office blood pressure measurement; (2) if the visit 1 mean blood pressure is increased but blood pressure measurements using ambulatory blood pressure monitoring (preferably) or home blood pressure monitoring should be performed before visit 2 to rule out white coat hypertension, for which pharmacologic treatment is not recommended. A standardized ambulatory blood pressure monitoring protocol and an update on automated office blood pressure are also presented. Several other recommendations on accurate measurement of blood pressure and criteria for diagnosis of hypertension have been reorganized. Two other new recommendations refer to smoking cessation: (1) tobacco use status should be updated regularly and advice to quit smoking should be provided; and (2) advice in combination with pharmacotherapy for smoking cessation should be offered to all smokers. The following recommendations were modified: (1) renal artery stenosis should be primarily managed medically; and (2) renal artery angioplasty and stenting could be considered for patients with renal artery stenosis and complicated, uncontrolled hypertension. The rationale for these recommendation changes is discussed.

  6. Diffuse Pulmonary Arteriovenous Fistulas With Pulmonary Arterial Hypertension: Case Report and Review. (United States)

    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.

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

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    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 ...


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    Full Text Available A 60 year old male patient presented with hoarseness of voice lasting for 2 months. First he was examined by the otorhinolaryngologist of our hospital, who noticed absence of movements of the left vocal cord. Chest X-ray showed a large opacity in the left upper zone and the patient was referred to the pulmonologist. His general physical examination was unremarkable not having any stigmata of Marfan's or Ehler Danlos syndrome. On chest auscultation, a systolic flow murmur was audible and there was decreased breath sound in the left infraclavicular area. Bronchoscopy revealed absence of movement of left vocal cord. His trans-thoracic echocardiography revealed degenerative aortic and mitral valve disease with mild aortic regurgitation and mild mitral regurgitation with dilated aortic aneurysm. A contrast enhanced CT scan of thorax and CT Angio Aortogram revealed fusiform aneurysmal dilatation of the arch of aorta with diameter of 6.2 cm over a length of 12.3 cm showing intraluminal partial thrombus with wall calcification. The patient was advised to undergo surgery. However, after detailed discussion with him and his family, they decided for medical management in view of his advanced age

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

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    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.

  10. 自动化设备故障检测及维修方法的探讨%Discussing on the Fault Detection and Repairing Method for the Automatic Machine

    Institute of Scientific and Technical Information of China (English)



    In this paper, in order to find out an effective method of equipment fault detection and maintenance, based on years of experience,combined with the theory of traditional Chinese medicine,summed up a set of the equipment fault detection basic methods of inspection, auscultation and olfaction, inquiry, pulse-taking and palpation. And through the analysis of actual case, expounds how to apply this method. According to this method, can basically find out the cause of the equipment problem smoothly, handling equipment failure in time. In today when automation equipment is more and more popular,it has certain significance.%为了找出一套行之有效的设备故障检测及维修方法,从多年的工作经验出发,结合中医理论,总结出一套设备故障检测维修的望、闻、问、切的基本方法,并通过实际案例分析,阐述了如何应用此方法。按照此法,基本能顺利找出设备的故障原因,及时处理设备故障。这对自动化设备越来越普及的今天,有一定的意义。

  11. TDS中医经络检测仪的原理与功用%Mechanism and Function of TDS TCM Meridian Detector

    Institute of Scientific and Technical Information of China (English)

    朱亮; 骆文斌; 吴承玉


    目的:探讨TDS中医经络检测仪的原理以及功用.方法:通过利用感应器测定人体12条经络在体表24个原穴电能量值,量化评估人体健康状况.结果与结论:该系统可以作为中医望、闻、问、切的有效补充,对多种疾病的病情观察和疗效提供参考依据.%Objective:To discuss the mechanism and function of TDS TCM meridian detector. Methods:Health state of the human body was evaluated quantitatively through the detector to determine the energy value of 24 source points distributed on the surface by the twelve meridians. Results and Conclusion:This system could be an effective complement of TCM's diagnostic methods such as inspection, auscultation and olfaction,inquiry and pulse - feeling and palpation, which could provide reference to the observation of the patient 's condition and therapeutic efficacy of many diseases in clinic.

  12. The consequences of using advanced physical assessment skills in medical and surgical nursing: A hermeneutic pragmatic study (United States)

    Zambas, Shelaine I.; Smythe, Elizabeth A.; Koziol-Mclain, Jane


    Aims and objectives The aim of this study was to explore the consequences of the nurse's use of advanced assessment skills on medical and surgical wards. Background Appropriate, accurate, and timely assessment by nurses is the cornerstone of maintaining patient safety in hospitals. The inclusion of “advanced” physical assessment skills such as auscultation, palpation, and percussion is thought to better prepare nurses for complex patient presentations within a wide range of clinical situations. Design This qualitative study used a hermeneutic pragmatic approach. Method Unstructured interviews were conducted with five experienced medical and surgical nurses to obtain 13 detailed narratives of assessment practice. Narratives were analyzed using Van Manen's six-step approach to identify the consequences of the nurse's use of advanced assessment skills. Results The consequences of using advanced assessment skills include looking for more, challenging interpretations, and perseverance. The use of advanced assessment skills directs what the nurse looks for, what she sees, interpretation of the findings, and her response. It is the interpretation of what is seen, heard, or felt within the full context of the patient situation, which is the advanced skill. Conclusion Advanced assessment skill is the means to an accurate interpretation of the clinical situation and contributes to appropriate diagnosis and medical management in complex patient situations. Relevance to clinical practice The nurse's use of advanced assessment skills enables her to contribute to diagnostic reasoning within the acute medical and surgical setting. PMID:27607193

  13. Temporomandibular joint examination reviewed

    Directory of Open Access Journals (Sweden)

    L. Guarda Nardini


    Full Text Available The temporo-mandibular joint (TMJ it’s a joint closely related to the skull base, the spine, and the jaws; all these anatomical structures must be taken in consideration when evaluating pain involving the tmj. In order to detect patients affected by pathology or dysfunctions of the tmj, physical examination is of great value in orienting the diagnosis. Inspection must consider the symmetry of the body, the dental status and the type of occlusion. Palpation is a way to assess contractiont involving the muscles of the masticatory system and of the neck. Auscultation, based on articular noise provides means to determine whether we are dealing with degeneration of the joint or a dislocation of the intrarticular disc. In order to confirm the diagnosis obtained with the clinical evaluation, it’s useful to perform imaging techniques as opt, tomography and TC of the tmj and electromyokineosiography – index of the mandibular functionality and of the muscles status. MRI and dynamic MRI are among the non invasive exams which give the greatest amount of information, regarding the disc position and the joint degeneration. Arthroscopy is an invasive technique that allows early diagnosis of degeneration and is helpful to reveal early inflammatory processes of the joint.

  14. Ebstein’s Anomaly – A Rare Cause of Shortness of Breath in Pregnancy

    Directory of Open Access Journals (Sweden)

    Mark Belham


    Full Text Available In October 2009, a 28-year-old woman, G1P0A0, presented at 24 weeks gestation, with a two week history of progressive shortness of breath. Prior to this admission, she had attended for routine antenatal care. She did not have any significant past medical history. On examination, she was not cyanosed. Her blood pressure was 80/40 mmHg, pulse was 100-120, irregularly, irregular and respiratory rate was 35 per minute. Her jugular venous pressure was raised to the ear lobes and she had mild peripheral oedema. Her chest was clear to auscultation. She had audible third and fourth heart sounds along with a 3/6 pansystolic murmur maximally heard in the third and fourth left intercostal spaces parasternally.Her chest x-ray revealed severe cardiomegaly. Electrocardiogram showed atrial fibrillation incomplete right bundle branch block with right ventricular strain pattern. A CT pulmonary angiogram showed no evidence of pulmonary embolism. Her transthoracic echocardiogram revealed normal left ventricle, dilated right ventricle with preserved contractility and severe tricuspid incompetence with a severely dilated right atrium.The findings were suggestive of a congenital Ebstein’s anomaly. She was admitted under the joint care of cardiology and obstetric medicine. She was treated with intravenous diuretics, digoxin and therapeutically anticoagulated with subcutaneous Low-Molecular Weight (LMW heparin. An obstetric ultrasound showed normal foetal anatomy and normal foetal growth.

  15. A 15-year-old female with amenorrhea, abdominal distention, and elevated human chorionic gonadotropin: pregnancy, right? Not so fast…. (United States)

    Aggarwal, Arun; Ocon, Anthony J; Nibhanipudi, Kumara


    Nongestational choriocarcinoma, a rare ovarian tumor, may present in young women with amenorrhea, abdominal distention, and elevated urine human chorionic gonadotropin (hCG), all of which may be mistaken for pregnancy. A 15-year-old Hispanic female, who reported no sexual activity, presented with 6 months of amenorrhea, abdominal pain, and progressive abdominal distension. Initially, suspicion of pregnancy was considered. Physical examination was significant for abdominal distension, but no uterine fundus or fetal anatomy could be palpated, and auscultation did not reveal any fetal heart sounds or bruits. Laboratory values showed elevated urine hCG, cancer antigen 125, and cancer antigen 19.9 levels but normal serum hCG level and was inconsistent with pregnancy. Computed tomographic scans revealed a large abdominal heterogeneous mass and pleural effusions. Salpingo-oophorectomy with total omentectomy and inversion appendectomy removed a 21 × 20.5 × 16.5-cm tumor. Pathological testing determined it to be a nongestational choriocarcinoma. This rare tumor is more common in the pediatric adolescent population than in adults. Surgical resection and chemotherapy often result in a positive prognosis. In female adolescent patients presenting with elevated hCG level, amenorrhea, and abdominal distention, choriocarcinoma should be considered, especially in those with no history of sexual activity or before menarche.

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

    Directory of Open Access Journals (Sweden)

    Susana Corujeira


    Full Text Available 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 crackles and wheezes. Laboratory tests revealed elevated erythrocyte sedimentation rate, and elevated serum IgG and IgG4 with polyclonal hypergammaglobulinemia. Thoracic CT and MRI showed multiple mediastinal lymphadenopathies and a nodular posterior mediastinal mass in right paratracheal location with bronchial compression. Initial fine needle aspiration biopsy was compatible with reactive lymphadenopathy but after clinical worsening a thoracoscopic partial resection of the mass was performed and tissue biopsy revealed lymphoplasmacytic infiltrate and increased number of IgG4-positive plasma cells and a ratio of IgG4/IgG positive cells above 40%. Glucocorticoids therapy was started with symptomatic improvement, reduction in the size of the mass, and decrease of serum IgG4 levels after 6 weeks. There are very few reports of IgG4-RD in children. Long-term follow-up is necessary to monitor relapses and additional organ involvement.

  17. Hippocrates: the forefather of neurology. (United States)

    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.

  18. [Intraoperative monitoring in artificial respiration of premature and newborn infants. I. Monitoring of respiratory parameters and alveolar ventilation]. (United States)

    Lenz, G; Heipertz, W; Leidig, E; Madee, S


    Monitoring of ventilation serves to ensure adequate alveolar ventilation and arterial oxygenation, and to avoid pulmonary damage due to mechanical ventilation. Basic clinical monitoring, i.e., inspection, auscultation (including precordial or oesophageal stethoscope) and monitoring of heart rate and blood pressure, is mandatory. Mechanical ventilation is monitored by ventilation pressures (peak pressure, plateau pressure and endexpiratory pressure), ventilation volumes (measured at the in/expiratory valve of the respirator and by hot-wire anemometry at the tube connector), ventilation rate, and inspiratory oxygen concentration (FiO2). Alveolar ventilation should be continuously and indirectly recorded by capnometry (pECO2) and by measurement of transcutaneous pCO2 (tcpCO2), whereas oxygenation is determined via measurement of transcutaneous pO2 (tcpO2). Invasive monitoring of gas exchange is essential in prolonged or intrathoracic interventions as well as in neonates with cardiopulmonary problems. paCO2 may be estimated by capillary or venous blood gas analysis; arterial blood gas analysis is required for exact determination of paCO2 as well as arteriocutaneous pCO2 (atcDCO2) and arterio-end-expiratory (aEDCO2) gradients.

  19. Chronic resistance training does not affect post-exercise blood pressure in normotensive older women: a randomized controlled trial. (United States)

    Gerage, Aline Mendes; Ritti-Dias, Raphael Mendes; do Nascimento, Matheus Amarante; Pina, Fábio Luiz Cheche; Gonçalves, Cássio Gustavo Santana; Sardinha, Luís B; Cyrino, Edilson Serpeloni


    Resistance training has been recommended for maintenance or improvement of the functional health of older adults, but its effect on acute cardiovascular responses remains unclear. Thus, the purpose of this study was to analyze the effect of 12 weeks of resistance training on post-exercise blood pressure (BP) in normotensive older women. Twenty-eight normotensive and physically inactive women (≥ 60 years) were randomly assigned to a training group (TG) or a control group (CG). The TG underwent a resistance training program (12 weeks, 8 exercises, 2 sets, 10-15 repetitions, 3 days/week), while the CG performed stretching exercises (12 weeks, 2 sets, 20 s each, 2 days/week). At baseline and after the intervention, participants were randomly submitted to two experimental sessions: a resistance exercise session (7 exercises, 2 sets, 10-15 repetitions) and a control session. BP was obtained pre- and post-sessions (90 min), through auscultation. Post-exercise hypotension was observed for systolic, diastolic, and mean BP in the TG (-6.1, -3.4, and -4.3 mmHg, respectively; P post-exercise BP and 12 weeks of resistance training program do not change the occurrence or magnitude of this hypotension. ( NCT02346981).

  20. The reliability of lung crackle characteristics in cystic fibrosis and bronchiectasis patients in a clinical setting. (United States)

    Marques, Alda; Bruton, Anne; Barney, Anna


    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.

  1. [Life-support training to improve the clinical competence of pharmacy students]. (United States)

    Takamura, Norito; Tokunaga, Jin; Ogata, Kenji; Yoshida, Hiroki; Setoguchi, Nao


    Life-support (particularly, advanced life-support) training is not included in pharmacist education; however, the life-support should be mastered since a pharmacist is a medical professional. We consider it to be important to master other skills before the life-support practicing, because a pharmacist does not check a patient to assess their clinical condition and administer drugs (suppository, intravenous injection etc.) The pharmacist prepares medicines, but does not administer medicines to treat the patient. Furthermore, the pharmacist is not interested in the vital signs of the patient receiving the medicines (the pharmacist has not identified the patient has complaint from changes in vital signs), which is why pharmacists can not develop themselves as medical professionals. Based on this observation, life-support training should be considered. In other words, to foster pharmacists with high clinical competence, pharmacy students should receive life-support training after training in drug administration and vital sign checks in a bedside training room. Drug administration using a pharmacy system versatile-type training model and pharmacy training model, vital signs check and auscultation using a physical assessment model and a cardiac disease disorder simulator in our bedside practice are useful for advanced life-support using a high-performance care simulator (monitoring vital signs, adrenalin administration and oxygen inhalation for ventricular fibrillation (VF). These training skills can improve the clinical competence of pharmacy students.

  2. Time Effectiveness of Ultraviolet C Light (UVC Emitted by Light Emitting Diodes (LEDs in Reducing Stethoscope Contamination

    Directory of Open Access Journals (Sweden)

    Gabriele Messina


    Full Text Available Today it is well demonstrated that stethoscopes can be as contaminated as hands, which are a recognized source of Health-Care Associated Infections (HCAIs. Ultraviolet C (UVC light has proven disinfection capacity and the innovative UVC technology of Light Emitting Diode (LED shows several potential benefits. To verify whether the use of UVC LEDs is effective and reliable in stethoscope membrane disinfection after prolonged use, a pre-post intervention study was conducted. A total of 1668 five-minute cycles were performed on two UVC LEDs to simulate their use; thereafter, their disinfection capacity was tested on stethoscope membranes used on a previously auscultated volunteer. Then, a further 1249 cycles were run and finally the LEDs were tested to assess performance in reducing experimental contamination by Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli on the stethoscope membrane. Baseline volunteer contamination identified 104 Colony Forming Units (CFUs while treated Petri dishes had 12 and 15 CFUs (p < 0.001. Statistically significant differences (p < 0.001 were also found relating to the reduction of specific bacteria: in particular, after treatment no CFU were observed for S. aureus and E. coli. UVC LEDs demonstrated the capacity to maintain high levels of disinfection after more than 240 h of use and they were effective against common microorganisms that are causative agents of HCAIs.

  3. Diagnostic management of chronic obstructive pulmonary disease. (United States)

    Broekhuizen, B D L; Sachs, A P E; Hoes, A W; Verheij, T J M; Moons, K G M


    Detection of early chronic obstructive pulmonary disease (COPD) in patients presenting with respiratory symptoms is recommended; however, diagnosing COPD is difficult because a single gold standard is not available. The aim of this article is to review and interpret the existing evidence, theories and consensus on the individual parts of the diagnostic work-up for COPD. Relevant articles are discussed under the subheadings: history taking, physical examination, spirometry and additional lung function assessment. Wheezing, cough, phlegm and breathlessness on exertion are suggestive signs for COPD. The diagnostic value of the physical examination is limited, except for auscultated pulmonary wheezing or reduced breath sounds, increasing the probability of COPD. Spirometric airflow obstruction after bronchodilation, defined as a lowered ratio of the forced volume in one second to the forced vital capacity (FEV1/FVC ratio), is a prerequisite, but can only confirm COPD in combination with suggestive symptoms. Different thresholds are being recommended to define low FEV1/FVC, including a fixed threshold, and one varying with gender and age; however, the way physicians interpret these thresholds in their assessment is not well known. Body plethysmography allows a more complete assessment of pulmonary function, providing results on the total lung capacity and the residual volume and is indicated when conventional spirometry results are inconclusive. Chest radiography has no diagnostic value for COPD but is useful to exclude alternative diagnoses such as heart failure or lung cancer. Extensive history taking is of key importance in diagnosing COPD.

  4. [Case report: Löffler's syndrome due to Ascaris lumbricoides mimicking acute bacterial community--acquired pneumonia]. (United States)

    Acar, Ali; Oncül, Oral; Cavuşlu, Saban; Okutan, Oğuzhan; Kartaloğlu, Zafer


    In this study we present a patient with Loeffler's syndrome caused by Ascaris lumbricoides who presented with the clinical findings of community-acquired pneumonia (CAP). Our patient, who was twenty-five years old, and who had had symptoms such as coughing, expectorating, dyspnea and fever for approximately ten days, was hospitalized. We auscultated polyphonic rhonchuses at the both hemithoraxes. A chest X-ray revealed bilateral lower zone patch consolidation. Acute bacterial community acquired pneumonia (CAP) was diagnosed due to these findings and empirical antibiotic treatment was begun. Repeated sputum Gram stains were negative, and both sputum and blood cultures were sterile. A sputum smear was negative for acid-fast bacilli. The patient's fever and respiratory complaint did not respond to the empirical antibiotics therapy. During the course of advanced investigations, we measured peripheric eosinophilia, and high levels of total Eo and total IgE, and observed Ascaris lumbricoides eggs during stool examination. The patient was given a diagnosis of Loeffler's syndrome. Thereupon the patient was treated successfully with one dose of albendazol 400 mg. In conclusion, we suggest that Loeffler's syndrome must be considered early in the differential diagnosis for CAP when peripheric eosinophilia is seen in patients if they live in an endemic area for parasitic disease.

  5. Coronary Arteriovenous Fistula Causing Hydrops Fetalis

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    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.

  6. July 2014 critical care case of the month: there is still a role for physicial examination

    Directory of Open Access Journals (Sweden)

    Raschke RA


    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: A 90 yr old woman was the seatbelt-restrained driver in a low speed frontal motor vehicle collision with airbag deployment, after she accidentally hit the gas instead of the brake. In the emergency room, the patient’s main complaint was right shoulder pain. On ER physical exam, she had sternal ecchymosis consistent with “seatbelt sign”. Her right shoulder was said to be tender, but the mechanism of injury to the right shoulder was unclear since her drivers-side seatbelt would been in contact with her left rather than right shoulder. Her right upper extremity was said to be “weak secondary to pain”. Further neurological examination was noted to be difficult due to “patient crying out in pain and anxiety”, but it was noted that she could lift both legs off the bed. Her left knee was echymotic. Cardiac auscultation revealed irregularly irregular rhythm. PMH: Chronic atrial fibrillation; Coronary...

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

    Institute of Scientific and Technical Information of China (English)

    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.

  8. Elemental Study on Auscultaiting Diagnosis Support System of Hemodialysis Shunt Stenosis by ANN (United States)

    Suzuki, Yutaka; Fukasawa, Mizuya; Mori, Takahiro; Sakata, Osamu; Hattori, Asobu; Kato, Takaya

    It is desired to detect stenosis at an early stage to use hemodailysis shunt for longer time. Stethoscope auscultation of vascular murmurs is useful noninvasive diagnostic approach, but an experienced expert operator is necessary. Some experts often say that the high-pitch murmurs exist if the shunt becomes stenosed, and some studies report that there are some features detected at high frequency by time-frequency analysis. However, some of the murmurs are difficult to detect, and the final judgment is difficult. This study proposes a new diagnosis support system to screen stenosis by using vascular murmurs. The system is performed using artificial neural networks (ANN) with the analyzed frequency data by maximum entropy method (MEM). The author recorded vascular murmurs both before percutaneous transluminal angioplasty (PTA) and after. Examining the MEM spectral characteristics of the high-pitch stenosis murmurs, three features could be classified, which covered 85 percent of stenosis vascular murmurs. The features were learnt by the ANN, and judged. As a result, a percentage of judging the classified stenosis murmurs was 100%, and that of normal was 86%.

  9. Pulmonary hantavirus syndrome: case report and brief review

    Directory of Open Access Journals (Sweden)

    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 ...

  10. Design of Wearable Breathing Sound Monitoring System for Real-Time Wheeze Detection (United States)

    Li, Shih-Hong; Lin, Bor-Shing; Tsai, Chen-Han; Yang, Cheng-Ta; Lin, Bor-Shyh


    In the clinic, the wheezing sound is usually considered as an indicator symptom to reflect the degree of airway obstruction. The auscultation approach is the most common way to diagnose wheezing sounds, but it subjectively depends on the experience of the physician. Several previous studies attempted to extract the features of breathing sounds to detect wheezing sounds automatically. However, there is still a lack of suitable monitoring systems for real-time wheeze detection in daily life. In this study, a wearable and wireless breathing sound monitoring system for real-time wheeze detection was proposed. Moreover, a breathing sounds analysis algorithm was designed to continuously extract and analyze the features of breathing sounds to provide the objectively quantitative information of breathing sounds to professional physicians. Here, normalized spectral integration (NSI) was also designed and applied in wheeze detection. The proposed algorithm required only short-term data of breathing sounds and lower computational complexity to perform real-time wheeze detection, and is suitable to be implemented in a commercial portable device, which contains relatively low computing power and memory. From the experimental results, the proposed system could provide good performance on wheeze detection exactly and might be a useful assisting tool for analysis of breathing sounds in clinical diagnosis. PMID:28106747

  11. The history of veterinary cardiology. (United States)

    Buchanan, James W


    Throughout civilization, animals have played a pivotal role in the advancement of science and medicine. From as early as 400 BC when Hippocrates recognized that diseases had natural causes, the steadfast advances made by biologists, scientists, physicians and scholars were fueled by timely and important facts and information- much of it gained through animal observations that contributed importantly to understanding anatomy, physiology, and pathology. There have been many breakthroughs and historic developments. For example, William Harvey in the 16th and 17th centuries clarified the importance of the circulatory system, aided by observations in dogs and pigs, which helped to clarify and confirm his concepts. The nineteenth century witnessed advances in physical examination techniques including auscultation and percussion. These helped create the basis for enhanced proficiency in clinical cardiology. An explosion of technologic advances that followed in the 20th century have made possible sophisticated, accurate, and non-invasive diagnostics. This permitted rapid patient assessment, effective monitoring, the development of new cardiotonic drugs, clinical trials to assess efficacy, and multi-therapy strategies. The latter 20th century has marshaled a dizzying array of advances in medical genetics and molecular science, expanding the frontiers of etiologies and disease mechanisms in man, with important implications for animal health. Veterinary medicine has evolved during the last half century, from a trade designed to serve agrarian cultures, to a diverse profession supporting an array of career opportunities ranging from private, specialty practice, to highly organized, specialized medicine and subspecialty academic training programs in cardiology and allied disciplines.

  12. Time Effectiveness of Ultraviolet C Light (UVC) Emitted by Light Emitting Diodes (LEDs) in Reducing Stethoscope Contamination (United States)

    Messina, Gabriele; Fattorini, Mattia; Nante, Nicola; Rosadini, Daniele; Serafini, Andrea; Tani, Marco; Cevenini, Gabriele


    Today it is well demonstrated that stethoscopes can be as contaminated as hands, which are a recognized source of Health-Care Associated Infections (HCAIs). Ultraviolet C (UVC) light has proven disinfection capacity and the innovative UVC technology of Light Emitting Diode (LED) shows several potential benefits. To verify whether the use of UVC LEDs is effective and reliable in stethoscope membrane disinfection after prolonged use, a pre-post intervention study was conducted. A total of 1668 five-minute cycles were performed on two UVC LEDs to simulate their use; thereafter, their disinfection capacity was tested on stethoscope membranes used on a previously auscultated volunteer. Then, a further 1249 cycles were run and finally the LEDs were tested to assess performance in reducing experimental contamination by Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli on the stethoscope membrane. Baseline volunteer contamination identified 104 Colony Forming Units (CFUs) while treated Petri dishes had 12 and 15 CFUs (p < 0.001). Statistically significant differences (p < 0.001) were also found relating to the reduction of specific bacteria: in particular, after treatment no CFU were observed for S. aureus and E. coli. UVC LEDs demonstrated the capacity to maintain high levels of disinfection after more than 240 h of use and they were effective against common microorganisms that are causative agents of HCAIs. PMID:27669273


    Guerrero-Márquez, Gloria; Martínez-Serrano, Ana; Míguez-Navarro, Concepción


    Nasogastric tube (NGT) placement is a frequent procedure in the paediatric population. Nasogastric and orogastric tubes are commonly used in hospitalized children, in the paediatric emergency departments and in critical care departments. They have diagnostic, therapeutic, descompression or evacuation of gastric aspirates objectives. Making a blind placement of nasogastric tubes, involve that nasogastric tube could be misplaced in 4.7 % to 69 % of cases. An accurate method for confirmation of nasogastric tube positioning is therefore needed. Chest X-ray remains the only hundred per cent reliable method (gold standard), but it only confirms tube positioning at the exact time of the X-ray. Non-radiologic verification methods provide an accurate alternative and contribute to decrease radiation exposure for pediatric patients. Non-radiologic methods to verify appropiate placement of tubes are many and are supported by different degrees of evidence in the literature: measurement of tube length from point of entry; auscultation; placing the tube in water to assess bubbling; aspiration of stomach or intestinal contents for visual inspection; pH testing; use of CO2 monitoring devices, or combinations of these methods. In this article we thoroughly review the reliability and safety of these non radiologic methods for the verification of nasogastric tube placement.

  14. Lipossarcoma mixóide de mediastino: relato de caso e revisão da literatura Myxoid liposarcoma of the mediastinum: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Dante L. Escuissato


    Full Text Available As neoplasias mediastinais de origem mesenquimal são raras, representando menos de 6% dos casos. A maioria são lipossarcomas, apesar da aparência cística ser incomum. Os autores apresentam um caso de paciente feminina com 58 anos de idade, com queixa de dispnéia, com piora progressiva desde os 52 anos. Estridor laríngeo era auscultado durante o exame físico, e a tomografia computadorizada de tórax demonstrou uma lesão cística no mediastino posterior. O tumor foi ressecado e o estudo histológico definiu o diagnóstico de lipossarcoma mixóide.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 dyspnea 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.

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

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    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.

  16. Boerhaave syndrome - case report

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    Biljana Radovanovic Dinic

    Full Text Available ABSTRACT CONTEXT: Boerhaave syndrome consists of spontaneous longitudinal transmural rupture of the esophagus, usually in its distal part. It generally develops during or after persistent vomiting as a consequence of a sudden increase in intraluminal pressure in the esophagus. It is extremely rare in clinical practice. In 50% of the cases, it is manifested by Mackler's triad: vomiting, lower thoracic pain and subcutaneous emphysema. Hematemesis is an uncommon yet challenging presentation of Boerhaave's syndrome. Compared with ruptures of other parts of the digestive tract, spontaneous rupture is characterized by a higher mortality rate. CASE REPORT: This paper presents a 64-year-old female patient whose vomit was black four days before examination and became bloody on the day of the examination. Her symptoms included epigastric pain and suffocation. Physical examination showed hypotension, tachycardia, dyspnea and a swollen and painful abdomen. Auscultation showed lateral crackling sounds on inspiration. Ultrasound examination showed a distended stomach filled with fluid. Over 1000 ml of fresh blood was extracted by means of nasogastric suction. Esophagogastroduodenoscopy was discontinued immediately upon entering the proximal esophagus, where a large amount of fresh blood was observed. The patient was sent for emergency abdominal surgery, during which she died. An autopsy established a diagnosis of Boerhaave syndrome and ulceration in the duodenal bulb. CONCLUSION: Boerhaave syndrome should be considered in all cases with a combination of gastrointestinal symptoms (especially epigastric pain and vomiting and pulmonary signs and symptoms (especially suffocation.

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

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    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.

  18. Acute Purulent Tuberculosis Pericarditis with Cardiac Tamponade: a Case Report.

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    F. Z. Benaich


    Full Text Available Tuberculosis is a disease caused by Mycobacterium tuberculosis. Pulmonary localization is the most frequent. However, pericardial including extra- pulmonary disease, can cause fatal complications. A 37 years old man , without pathological history , who consults for emergency mid-thoracic pain associated with dyspnea, preceded by 10 days before a febrile syndrome with night sweats. Clinical examination showed patient in poor general condition, dyspneic and tachycardia. Cardiovascular examination showed spontaneous jugular veins and painful hepatomegaly, auscultation showed muted heart sounds without pericardial friction and breathless. Chest radiography showed cardiomegaly with symmetric edge straightness, electrocardiogram showed sinus tachycardia at 125bpm, microvoltage and electric alternating QRS complexes. A diffuse ST elevation ascending .Diagnosis of tamponade is suspected, transthoracic echocardiography showed abundance circumferential pericardial effusion measuring 40mm, with prolonged collapse of the right atrium and right ventricle , paradoxical septum , and significant changes in the flow inspiration. Pericardiocentesis ultrasound-guided has allowed a gradual evacuation of 2 liters of a cloudy yellow pericardial fluid, slightly viscous. Direct examination revealed the presence of 14 400 white cells, 99 % are neutrophils with gram-negative bacilli. Research bacillus by PCR and culture in the middle of LOWENSTEIN, later returned negative. Biologically, it is an important infectious syndrome. Taking into account the epidemiological profile of the country, diagnosis tuberculous primary infection tamponade was certain. quadruple anti- tuberculous treatment associated to corticosteroid therapy is instituted, The outcome was good, the patient was asymptomatic, with complete remission, echocardiography control finds no signs suggesting chronic constrictive pericarditis.

  19. Follicular bronchiolitis: a rare disease in children (United States)

    Kanık, Esra Toprak; Yılmaz, Özge; Türkeli, Ahmet; Şahin, Şebnem; Yüksel, Hasan


    Follicular bronchiolitis (FB) is a benign progressive lung disease. It is characterized with lymphoplasmocellular infiltration and hyperplastic follicles in the peribronchial areas in the small airways. Follicular bronchiolitis should be considered in cases where chronic cough, recurrent upper respiratory tract infections and progressive dyspnea are observed in children. The diagnosis should be supported by lung biopsy. A 8-year old female patient presented to our hospital with complaints including continuing cough and wheezing. Bilateral extensive rales and rhonchi in the lungs were heard on auscultation and lung graphy revealed reticuloglandular appearance. Bilateral extensive septal thickennings, reticulonodular appearance, patchy bronchiectasis, bronchiolectasis and peribronchial thickennings were found on high-resolution thoracal computarized tomography. A diagnosis of follicular bronchiolitis was made as a result of lung biopsy. Improvement was observed in the complaints and findings of our patient after methylprednisolone treatment. This patient was presented to emphasize rare interstitial lung diseases should also be considered in children who present with a clinical picture of chronic bronchial obstruction and do not respond to standard treatment. PMID:26078687

  20. Renovascular Hypertension: Clinical Features, Differential Diagnoses and Basic Principles of Treatment

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    Petrovic Dejan


    Full Text Available Renovascular hypertension is caused by renal artery stenosis. Its prevalence in populations of hypertensive patients is 1-8%, and in populations of patients with resistant hypertension, it is up to 20%. The two main causes of stenosis are atherosclerosis and fibromuscular dysplasia of the renal artery. The main clinical consequences of renal artery stenosis include renovascular hypertension, ischemic nephropathy and “flash” acute pulmonary oedema. Unilateral stenosis of the renal artery causes angiotensin II-dependent hypertension, and bilateral stenosis of the renal arteries produces volume-dependent hypertension. Renovascular aetiology of hypertension should be questioned in patients with resistant hypertension, hypertension with a murmur identified upon auscultation of the renal arteries, and a noticeable side-to-side difference in kidney size. Non-invasive diagnostic tests include the determination of concentrations of peripheral vein plasma renin activity, the captopril test, captopril scintigraphy, colour Doppler ultrasonography, computed tomography angiography, and nuclear resonance angiography. Renovasography represents the gold standard for the diagnosis of renovascular hypertension. The indications for revascularization of the renal artery include haemodynamically significant renal artery stenosis (with a systolic pressure gradient at the site of stenosis of - ΔP ≥ 20 mmHg, along with the ratio of the pressure in the distal part of the renal artery (Pd and aortic pressure (Pa less than 0.9 (Pd/Pa 0.8, chronic kidney disease (GFR <30 ml/min/1.73 m2 and negative captopril scintigraphy (lack of lateralization.

  1. A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder

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    Ronny Cohen


    Full Text Available We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patient with bipolar disorder being treated for depression. The case describes a 20-year-old man being treated in the psychiatry ward for worsening depression when he started complaining of chest pain and shortness of breath. His list of medications included clozapine, lithium, lorazepam, and haloperidol. The main findings on physical examination were tachycardia, low-grade fever, crackles in both lung bases on auscultation, and the absence of any notable edema. Abnormal labs included a troponin of 0.9, with a CK of 245 and CK-MB of 3.1. An ECG revealed sinus tachycardia and left anterior fascicular block (LAFB. An echocardiogram revealed global hypokinesis, severe left ventricular dysfunction with an ejection fraction estimated at 20%. The patient had an admitting diagnosis of acute left ventricular systolic dysfunction likely secondary to drug-induced myocarditis (suspect clozapine versus acute coronary syndrome. He was managed conservatively and transferred to another facility for endomyocardial biopsy confirming myocarditis. This case is an example of one of the most typical presentations of suspected drug-induced acute myocarditis and will hopefully prompt the reader to think of this underdiagnosed entity in the right clinical setting.

  2. Fresh frozen plasma as a successful antidotal supplement in acute organophosphate poisoning. (United States)

    Vučinić, Slavica; Zlatković, Milica; Antonijević, Biljana; Ćurčić, Marijana; Bošković, Bogdan


    Despite improvements to intensive care management and specific pharmacological treatments (atropine, oxime, diazepam), the mortality associated with organophosphate (OP) poisoning has not substantially decreased. The objective of this examination was to describe the role of fresh frozen plasma (FFP) in acute OP poisoning. After a deliberate ingestion of malathion, a 55-year-old male suffering from miosis, somnolence, bradycardia, muscular fasciculations, rales on auscultation, respiratory insufficiency, as well as from an inhibition of red blood cell acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BuChE), was admitted to hospital. Malathion was confirmed in a concentration of 18.01 mg L(-1). Apart from supportive measures (including mechanical ventilation for four days), antidotal treatment with atropine, oxime-pralidoxime methylsulphate (Contrathion(R)), and diazepam was administered, along with FFP. The potentially beneficial effects of FFP therapy included a prompt increase of BuChE activity (from 926 IU L(-1) to 3277 IU L(-1); reference range from 7000 IU L(-1) to 19000 IU L(-1)) and a reduction in the malathion concentration, followed by clinical recovery. Due to BuChE replacement, albumin content, and volume restitution, FFP treatment may be used as an alternative approach in patients with acute OP poisoning, especially when oximes are not available.

  3. Accuracy of Physical Examination in Distinguish Pathologic Murmur of non Pathologic

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    A Tanasan


    Full Text Available Abstract Background & aim: Cardiac auscultation is one of the most useful investigative tools that the physician may use at the bedside to detect alterations in cardiovascular anatomy and physiology. However, the sensitivity and specificity vary substantially with the expertise of the examiner. The aim of this study comparing the initial evaluations of heart murmurs in neonates between neonatologist and pediatric cardiologist. Methods: This cross-sectional study was conducted on 108 neonates admitted in Be’sat and Fatemieh Hospitals of Hamadan, Iran, in 2010. First, a neonatologist recorded their clinical evaluation (Pathologic, Likely pathologic, Innocent. Then, a Pediatric cardiologist recorded the infants’ clinical evaluation. Finally, echocardiography study was performed by the cardiologists for final diagnosis. The data were analyzed by SPSS version 16 and the using Chi-square. Results: In this study, 67 patients (62% had pathologic murmur. Clinical findings of pathological murmur by neonatologist and cardiologist are 98% sensitivity versus 87/2% 84/2% specificity vs. 100% 94/1% the positive predictive value vs. 100% and 94% negative predictive value vs. 85.4%, respectively. Conclusion: Evaluations of examination show no significant difference between neonatologists and cardiologists. Hence, echocardiography is the standard for establishing the cause of murmur. Key words: Murmur, Echocardiogram, Physical Examination

  4. Computed Tomography Following Body Stuffing Heroin

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    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.

  5. Hypersensitivity Reaction and Acute Respiratory Distress Syndrome in Pyrethroid Poisoning and Role of Steroid Therapy

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    Jisa George


    Full Text Available Background: Pyrethroids are generally of low toxicity to humans, but in suicidal poisonings which are usually associated with ingestion of high doses, they lead to severe systemic effects. Case Report: A 30-year old woman presented to emergency department with a history of intentional ingestion of about 15 mL of prallethrin around 3 days earlier. She complained of shortness of breath along with chest pain for the last 2 days. She reported no vomiting or stomach pain prior to presentation to hospital. On chest auscultation, breath sounds were mildly decreased in bilateral infrascapular areas with generalized crepitation. Arterial blood gas analysis revealed respiratory alkalosis. Chest X ray and computed tomography of thorax revealed widespread confluent areas of consolidation with interlobular septal thickening involving bilateral parahilar regions suggestive of acute respiratory distress syndrome (ARDS. The patient did not respond to broad spectrum antibiotic coverage, diuretics and oxygen inhalation. Intravenous methylprednisolone (2 mg/kg/day divided 6 hourly was started and slowly tapered off during the next days. The patient discharged after 3 weeks in good health. Discussion: As pyrethroids can affect sodium channels, the osmotic gradient of alveolar epithelium probably disrupts and therefore, alveolar infiltrations gradually spread over lungs. In addition, there is a possibility of hypersensitivity reactions to pyrethroids, which can cause progressive inflammation and involve respiratory tract in severe cases. Conclusion: Pyrethroid poisoning can lead to ARDS. Steroid therapy may help such patients tide over the pulmonary crisis.

  6. Tachycardia-Induced Cardiomyopathy in a 12-Year-Old Child With Long QT Syndrome

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    Full Text Available Introduction Tachycardia-induced cardiomyopathy (TIC is a ventricular dysfunction secondary to chronic and persistent tachycardia that can regress partially or completely following heart rate normalization. Paroxysmal atrial tachycardia and permanent junctional reciprocating tachycardia are two types of frequent arrhythmias that can cause cardiomyopathy in children. Case Presentation A 12-year-old child with obesity (body mass index > 26.8 was admitted with fatigue, pallor and tachypnea to the clinic. He had palpitation for the past 24 hours. On the cardiac auscultation, holosystolic 2/6 murmur was heard in the apex as well as gallop rhythm. Electrocardiogram revealed heart rate of 150 - 160 bpm and negative P waves in II, III and AVF leads. The echocardiography revealed dilated cardiomyopathy with an ejection fraction of 30%. Conclusions Diagnosis of tachycardia-induced cardiomyopathy in children is important, since appropriate treatment improves the prognosis. Every child with recurrent and persistent palpitation with the first episode of congestive heart failure should be evaluated for tachycardia- induced cardiomyopathy.

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

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    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.

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

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    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

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

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    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.

  10. Mistaken Endobronchial Placement of a Nasogastric Tube During Mandibular Fracture Surgery. (United States)

    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.

  11. Development of an Acoustic Signal Analysis Tool “Auto-F” Based on the Temperament Scale (United States)

    Modegi, Toshio

    The MIDI interface is originally designed for electronic musical instruments but we consider this music-note based coding concept can be extended for general acoustic signal description. We proposed applying the MIDI technology to coding of bio-medical auscultation sound signals such as heart sounds for retrieving medical records and performing telemedicine. Then we have tried to extend our encoding targets including vocal sounds, natural sounds and electronic bio-signals such as ECG, using Generalized Harmonic Analysis method. Currently, we are trying to separate vocal sounds included in popular songs and encode both vocal sounds and background instrumental sounds into separate MIDI channels. And also, we are trying to extract articulation parameters such as MIDI pitch-bend parameters in order to reproduce natural acoustic sounds using a GM-standard MIDI tone generator. In this paper, we present an overall algorithm of our developed acoustic signal analysis tool, based on those research works, which can analyze given time-based signals on the musical temperament scale. The prominent feature of this tool is producing high-precision MIDI codes, which reproduce the similar signals as the given source signal using a GM-standard MIDI tone generator, and also providing analyzed texts in the XML format.

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

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    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.

  13. Do continuous and intermittent exercises sets induce similar cardiovascular responses in the elderly women?

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    Úrsula Veloso


    Full Text Available There is a lack of information about elderly acute cardiovascular responses in the elderly during exercise involving different muscle groups and strategies of load/repetition interaction (LRI in continuous and intermittent sets. The purpose of this study was to compare heart rate (HR, systolic blood pressure (SBP, rate-pressure product (RPP and quality of exercise performance (QEx of upper and lower body exercises (arms abduction and hip flexion in different situations of LRI. Twelve healthy women aged 65 to 85 years old volunteered to this study. The subjects performed both exercises at 12 maximal repetitions workload, continuously (2 sets of 12 reps and alternately (4 sets of 6 reps. HR was measured with a cardiotachometer and SBP through auscultation technique at the end of the last repetition of each set. The exercises were recorded in video to evaluate QEx. At least for the selected exercises, LRI did not influence QEx. However, SBP and RPP values for the intermittent sets were significantly higher than for continuous situations (p < 0.05. The authors concluded that continuous sets seem to be associated to greater cardiovascular stress in elder subjects, mainly because of SBP responses during the exercise.

  14. Takayasu's arteritis following Crohn's disease in a young woman: Any evidence for a common pathogenesis?

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    Melissa AL Farrant; Justin C Mason; Newton ACS Wong; Robert J Longman


    Takayasu's arteritis and Crohn's disease are chronic inflammatory diseases of uncertain aetiology. They rarely occur together, with only twenty nine cases of co-existent Takayasu's arteritis and Crohn's disease reported in the literature. In 88% of these cases, Takayasu's arteritis was diagnosed simultaneously or following a diagnosis of Crohn's disease. We present a case of a young Caucasian medical student, incidentally found to have bilateral carotid bruits on auscultation by a colleague. Magnetic resonance angiography revealed stenoses of the common carotid arteries with established collaterals, and a diagnosis of Type 1 Takayasu's arteritis was made. An 18F-fluorodeoxyglucose positron emission tomography scan revealed no active disease. Nine months later, she presented with a short history of abdominal pain, vomiting and abdominal distension. Barium follow-through and computer tomography revealed a terminal ileal stricture and proximal small bowel dilation. An extended right hemicoloectomy was performed and histopathology supported a diagnosis of Crohn's disease. This case report is presented with a particular focus on the temporal relationship between these two disease processes and explores whether their concurrence is more than just co-incidence.

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

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    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

  16. Determinants of initiation, implementation, and discontinuation of amoxicillin by adults with acute cough in primary care (United States)

    Gillespie, David; Farewell, Daniel; Brookes-Howell, Lucy; Butler, Christopher C; Coenen, Samuel; Francis, Nick A; Little, Paul; Stuart, Beth; Verheij, Theo; Hood, Kerenza


    Aim To investigate the determinants of adherence to amoxicillin in patients with acute lower respiratory tract infection. Materials and methods Three European data sets were used. Adherence data were collected using self-reported diaries. Candidate determinants included factors relating to patient, condition, therapy, health care system/provider, and the study in which the patient participated. Logistic and Cox regression models were used to investigate the determinants of initiation, implementation, and discontinuation of amoxicillin. Results Although initiation differed across samples, implementation and discontinuation were similar. Determinants of initiation were days waited before consulting, duration of prescription, and being in a country where a doctor-issued sick certificate is required for being off work for <7 days. Implementation was higher for older participants or those with abnormal auscultation. Implementation was lower for those prescribed longer courses of amoxicillin (≥8 days). Time from initiation to discontinuation was longer for longer prescriptions and shorter for those from countries where single-handed practices were widespread. Conclusion Nonadherence to amoxicillin was largely driven by noninitiation. Differing sets of determinants were found for initiation, implementation, and discontinuation. There is a need to further understand the reasons for these determinants, the impact of poor adherence to antibiotics on outcomes, and to develop interventions to improve antibiotic use when prescribed. PMID:28352162

  17. Value of renal scintigraphy with captopril test in the exploration of renovascular hypertension: Case report; Apport de la scintigraphie renale avec test au captopril dans l'exploration de l'hypertension arterielle renovasculaire: a propos d'un cas

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    Ghfir, I.; Berehou, F.Z.; Ben Rais, N. [Centre Hospitalier Universitaire de Rabat, Hopital Ibn-Sina, Service de Medecine Nucleaire (Morocco)


    Introduction Dynamic renal scintigraphy with {sup 99m}Tc-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 {sup 99m}Tc-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)

  18. Variability in blood pressure in normotensive patients undergoing outpatient oral surgery

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    Heriberto Atanacio Núñez Mendieta


    Full Text Available Background: A dental appointment can be stressful for patients, especially if this involves a surgical procedure. Factors such as pain and catecholamines present in local anesthesia can cause a change of values of blood pressure (BP. The hypertensive peak is a sudden rise in BP and can occur even in a person usually normotensive by a stressful situation. Objective: To determine the variability of BP in normotensive patients attending the Department of Oral Surgery III Course of the Faculty of Dentistry at the National University of Asuncion. Methods: Descriptive observational study design. The PA was obtained by auscultation method by members of the Department of Physiology of the Faculty of Dentistry at the National University of Asuncion during different stages of the surgical procedure, in 109 patients aged 18 to 67 years who presented indicating teeth extraction. Results: 95.4% (104 of the patients showed variation in the values of BP during the surgical procedure. In 77% of the variation thereof within 5 minutes after local anesthesia, in 18% immediately after tooth extraction and 5% in the immediate postoperative period was observed. Conclusions: In most patients, BP variation was observed during the oral outpatient surgical procedure and surgical stage more often variation was within 5 minutes after administering local anesthesia.

  19. Anticipating pulmonary complications after thoracotomy: the FLAM Score

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    Anziani Marylene


    Full Text Available Abstract Objective Pulmonary complications after thoracotomy are the result of progressive changes in the respiratory status of the patient. A multifactorial score (FLAM score was developed to identify postoperatively patients at higher risk for pulmonary complications at least 24 hours before the clinical diagnosis. Methods The FLAM score, created in 2002, is based on 7 parameters (dyspnea, chest X-ray, delivered oxygen, auscultation, cough, quality and quantity of bronchial secretions. To validate the FLAM score, we prospectively calculated scores during the first postoperative week in 300 consecutive patients submitted to posterolateral thoracotomy. Results During the study, 60 patients (20% developed pulmonary complications during the postoperative period. The FLAM score progressively increased in complicated patients until the fourth postoperative day (mean 13.5 ± 11.9. FLAM scores in patients with complications were significantly higher (p Conclusion Changes in FLAM score were evident at least 24 hours before the clinical diagnosis of pulmonary complications. FLAM score can be used to categorize patients according to risk of respiratory morbidity and mortality and could be a useful tool in the postoperative management of patients undergoing thoracotomy.


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    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

  1. 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

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    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.

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

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    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.

  3. DSP implementation of a heart valve disorder detection system from a phonocardiogram signal. (United States)

    Ari, S; Sensharma, K; Saha, G


    Auscultation, the technique of listening to heart sounds, remains a primary detection tool for diagnosing heart valve disorders. Other techniques, e.g. electrocardiography, ultrasound, etc, are accurate as well as informative; but expensive. With major advancement in the speed of computers, heart sound signals can be processed with ease by memory efficient digital signal processing and pattern recognition algorithms. This paper presents a digital signal processor (DSP) implementation of such a technique by using new threshold criteria. The proposed work can detect whether a heart sound recording belongs to a person suffering from valvular heart disease or not by giving 'diseased' or 'not diseased' decisions. The algorithm is tested for nine commonly occurring pathological problems and normal heart sound. The robustness of the algorithm is also checked against synthetically injected additive white Gaussian noise (AWGN) with different SNR levels. It is found to give an accuracy of 96.67% up to SNR values of 15 dB and 93.33% up to SNR values of 5 dB.

  4. Spontaneous Pneumomediastinum with a Rare Presentation

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    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.

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

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    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.

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

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    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 ...

  7. Hybrid technique coil embolisation for intrahepatic arterioportal fistula in a cat: case report

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    Akiko Uemura


    Full Text Available Case summary A 13-month-old, female, mixed breed, 4.0 kg cat was referred with a 6 month history of decreased appetite, loss of vigour and intermittent vomiting. Physical examination revealed no cyanosis or wasting, and no audible heart murmur was auscultated. Blood profile revealed mild anaemia and mildly elevated postprandial serum ammonia (109 µg/dl. Abdominal ultrasonography revealed dilation of an intrahepatic portal vein branch and an intrahepatic aneurysm, with splenomegaly and ascites. Hepatic arteriovenous fistula/hepatic artery–portal vein fistula with multiple acquired portosystemic shunts was strongly suspected. Medical control was achieved using antibiotics, liver-protecting agents, a low-protein diet and blood transfusions. However, because medical treatment proved ineffective, coil embolisation was performed on day 11, using a hybrid approach via the mesenteric vein. Subsequent follow-up showed good appetite, with no signs of diarrhoea or ascites. Abdominal ultrasonography revealed that the mosaic pattern around the site of coil placement in the portal vein branch had improved and pulsatility had disappeared. Relevance and novel information Intrahepatic arterioportal fistula involves a circulatory shunt between the hepatic artery and the hepatic or portal vein within the liver, and may be congenital or acquired. Both forms have been reported in humans, but most cases in cats have been congenital. Few reports have described treatment methods or prognosis in cats. We report here that coil embolisation using a hybrid approach is a procedure offering easy, effective treatment by blocking hepatofugal blood flow.

  8. Exertional dyspnea as initial manifestation of Takayasu's arteritis – A case report and literature review

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    Bachmann Lucas M


    Full Text Available Abstract Background Takayasu's arteritis is a chronic systemic inflammatory disease that usually affects the aorta, its primary branches and occasionally the pulmonary and coronary arteries. Female gender in reproductive age and Asian origin are known factors associated with higher disease prevalence. The clinical manifestations vary considerably and are typically caused by limb or organ ischemia illness and fever. The estimated incidence rate in the western world is 2.6 cases per million persons per year. Occasionally, exertional dyspnea can be the sole primary clinical manifestation of Takayasu's arteritis. Case presentation We report the case of a 57-year-old woman who was referred to our institution with increasing exertional dyspnea caused by pulmonary artery involvement in Takayasu's arteritis. In a review of the literature we discuss demographic data, clinical and radiographic findings and available therapeutic options. Conclusions Dyspnea due to pulmonary artery involvement can be the initial symptom of Takayasu's arteritis. Simple clinical tests, including a complete pulse-status and blood pressure measuring at both arms can lead to the right diagnosis and should always be done beyond the auscultation of the heart and lungs in patients with dyspnea.

  9. Auditory display of knee-joint vibration signals (United States)

    Krishnan, Sridhar; Rangayyan, Rangaraj M.; Bell, G. Douglas; Frank, Cyril B.


    Sounds generated due to rubbing of knee-joint surfaces may lead to a potential tool for noninvasive assessment of articular cartilage degeneration. In the work reported in the present paper, an attempt is made to perform computer-assisted auscultation of knee joints by auditory display (AD) of vibration signals (also known as vibroarthrographic or VAG signals) emitted during active movement of the leg. Two types of AD methods are considered: audification and sonification. In audification, the VAG signals are scaled in time and frequency using a time-frequency distribution to facilitate aural analysis. In sonification, the instantaneous mean frequency and envelope of the VAG signals are derived and used to synthesize sounds that are expected to facilitate more accurate diagnosis than the original signals by improving their aural quality. Auditory classification experiments were performed by two orthopedic surgeons with 37 VAG signals including 19 normal and 18 abnormal cases. Sensitivity values (correct detection of abnormality) of 31%, 44%, and 83%, and overall classification accuracies of 53%, 40%, and 57% were obtained with the direct playback, audification, and sonification methods, respectively. The corresponding d' scores were estimated to be 1.10, -0.36, and 0.55. The high sensitivity of the sonification method indicates that the technique could lead to improved detection of knee-joint abnormalities; however, additional work is required to improve its specificity and achieve better overall performance.

  10. [Arterial reconstructive surgery of a coarctation of the abdominal aorta with involvement of renal and visceral arteries. Clinical and imagiologic evaluation 26 years after the operation]. (United States)

    Dinis da Gama, A


    The clinical case of a 13 years old female is reported, with the diagnosis of congenital coarctation of the abdominal aorta, with involvement of renal and visceral arteries, causing arterial hypertension and a systolic bruit in the auscultation of the epigastric and umbilical areas. Conventional angiography disclosed a stenotic process of the upper abdominal aorta, with concomitant ostial stenosis of the renal and digestive arteries, and post-stenotic dilatation of the celiac axis and superior mesenteric artery. The physical development of the patient, close to the adult pattern, allowed the performance of a complex revascularization procedure,accomplished in May 1984, consisting in the implantation of an aorto-aortic bypass graft, through the diaphragm, followed by visceral and renal revascularization, by means of independent prosthesis taken from the aortic bypass. The post-operative course was uneventful and blood pressure returned immediately to normal levels. Reviewed recently, the patient was found in good clinical condition,asymptomatic and with normal blood pressure, developing a normal family, social and Professional life. An Angio-CT evaluation, performed in February 2010, almost 26 years after the operation, revealed the complex revascularization procedure patent and working in excellent condition. To our knowledge, this seems to be the longest follow up of such a procedure employed successfully in a very rare clinical entity, thus justifying its presentation and divulgation.

  11. An Unusual Cause of Recurrent Respiratory Distress

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    Joshi Neha


    Full Text Available A one and a half years old boy presented with recurrent episodes of respiratory distress, accompanied by dry non spasmodic cough and characterized by appearance of a continuous stridor showing no positional variation. The child was symptomatic since early infancy. Parents also complained of inability to gain weight as compared to other siblings.  There was no history of foreign body ingestion or complaints of asthma or tuberculosis in the family. General physical examination revealed tachypnea and biphasic stridor in a malnourished and stunted child in the absence of any significant lymphadenopathy or oral thrush.On systemic examination, bilaterally, stridorous sounds were auscultated. Primary investigations on the child showed minimal reflux on gastro-esophageal reflux isotope scan, a normal chest roentgenogram, negative sweat chloride test and negative serology for HIV (Human immuno­deficiency virus. Echocardiography performed on the child revealed a structurally normal heart. On conducting further investigations, bronchoscopy detected a bulge in the anterior tracheal wall while barium swallow displayed indentation in the upper esophagus. The MRI (magnetic resonance imaging subsequently conducted clinched the underlying clinical condition. The MRI images are depicted below.

  12. MicroRNA Expression in Salivary Supernatant of Patients with Pancreatic Cancer and Its Relationship with ZHENG

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    Song Gao


    Full Text Available In traditional Chinese medicine (TCM, diagnosis and prescriptions are based on the signs and symptoms which are recognized as ZHENG. The cornerstone of TCM is to differentially treat one ZHENG from others, which is also known as syndrome differentiation, and this relies on the gathering of clinical information through inspection, auscultation and olfaction, inquiry, and palpation. However, the biomolecular basis of the ZHENG remains unclear. In this study, the expressions of 384 cancer-related miRNAs in salivary supernatant of patients with pancreatic cancer were assessed by miRNA polymerase chain reaction (PCR array, and the different expression patterns of miRNA in three different groups of ZHENG were studied with use of real-time quantitative PCR (qRT-PCR. Some miRNAs were found to be specifically expressed in some ZHENGs, for instance, miR-17, miR-21, and miR-181b in Shi-Re ZHENG and miR-196a in Pi-Xu ZHENG. This indicates that these miRNAs may play important roles in different ZHENG condition. Therefore, this study to some extent revealed the molecular basis of TCM ZHENG in pancreatic cancer.

  13. A decision tree – based method for the differential diagnosis of Aortic Stenosis from Mitral Regurgitation using heart sounds (United States)

    Pavlopoulos, Sotiris A; Stasis, Antonis CH; Loukis, Euripides N


    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 describe S1, S2 and the systolic

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

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    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

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

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    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

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

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    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.


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    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

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

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    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

  19. [Very rare and life-threatening complications of bocavirus bronchiolitis: pneumomediastinum and bilateral pneumothorax]. (United States)

    Yeşilbaş, Osman; Kıhtır, Hasan Serdar; Talip Petmezci, Mey; Balkaya, Seda; Hatipoğlu, Nevin; Meşe, Sevim; Şevketoğlu, Esra


    Human bocavirus (HBoV), that was first identified in 2005 and classified in Parvoviridae family, is a small, non-enveloped, single-stranded DNA virus, responsible for upper and lower respiratory tract infections, especially in young children. Although HBoV generally causes self-limited influenza-like illness, it may also lead to pneumonia, bronchiolitis, croup and asthma attacks. In this report, a case of acute bronchiolitis complicated with pneumomediastinum and bilateral pneumothorax caused by HBoV has been presented. A three-year-old boy was referred to our pediatric intensive care unit with a two day history of fever, tachypnea, hypoxia and respiratory failure. On auscultation, there were widespread expiratory wheezing and inspiratory crackles. The chest radiography yielded paracardiac infiltration and air trapping on the right lung and infiltration on the left lung. The patient had leukocytosis and elevated C-reactive protein level. On the second day of admission, respiratory distress worsened and chest radiography revealed right pneumothorax and subcutaneous emphysema in bilateral cervical region and left chest wall. He was intubated because of respiratory failure. In the thorax computed tomography, pneumomediastinum and bilateral pneumothorax were detected and right chest tube was inserted. Repetitive blood and tracheal aspirate cultures were negative. A nasopharyngeal swab sample was analyzed by multiplex real-time polymerase chain reaction method with the use of viral respiratory panel (FTD(®) Respiratory Pathogens 21 Kit, Fast-Track Diagnostics), and positive result was detected for only HBoV. On the ninth day of admission, pneumomediastinum and bilateral pneumothorax improved completely and he was discharged with cure. In conclusion, HBoV bronchiolitis may progress rare but severe complications, it should be kept in mind as an etiological agent of the respiratory tract infections especially children younger than five years old.

  20. Establishment of Stereo Multi-sensor Network for Giant Landslide Monitoring and its Deploy in Xishan landslide, Sichuan, China. (United States)

    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.


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    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.

  2. A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one-lung ventilation (United States)

    Amin, Nayana; Tarwade, Pritee; Shetmahajan, Madhavi; Pramesh, C. S.; Jiwnani, Sabita; Mahajan, Abhishek; Purandare, Nilendu


    Background: Confirmation of placement of Double lumen endobronchial tubes (DLETT) and bronchial blockers (BBs) with the pediatric fiberoptic bronchoscope (FOB) is the most preferred practice worldwide. Most centers possess standard adult FOBs, some, particularly in developing countries might not have access to the pediatric-sized devices. We have evaluated the role of preintubation airway assessment using the former, measuring the distance from the incisors to the carina and from carina to the left and right upper lobe bronchus in deciding the depth of insertion of the lung isolation device. Methods: The study was a randomized, controlled, double-blind trial consisting of 84 patients (all >18 years) undergoing thoracic surgery over a 12-month period. In the study group (n = 38), measurements obtained during FOB with the adult bronchoscope decided the depth of insertion of the lung isolation device. In the control group (n = 46), DLETTs and BBs were placed blindly followed by clinical confirmation by auscultation. Selection of the type and size of the lung isolation device was at the discretion of the anesthesiologist conducting the case. In all cases, pediatric FOB was used to confirm accurate placement of devices. Results: Of 84 patients (DLETT used in 76 patients; BB used in 8 patients), preintubation airway measurements significantly improved the success rate of optimal placement of lung isolation device from 25% (11/44) to 50% (18/36) (P = 0.04). Our incidence of failed device placement at initial insertion was 4.7% (4/84). Incidence of malposition was 10% (8/80) with 4 cases in each group. The incidence of suboptimal placement was lower in the study group at 38.9% (14/36) versus 65.9% (29/44). Conclusions: Preintubation airway measurements with the adult FOB reduces airway manipulations and improves the success rate of optimal placement of DLETT and BB. PMID:27052065

  3. A randomized trial to assess the utility of preintubation adult fiberoptic bronchoscope assessment in patients for thoracic surgery requiring one - lung ventilation

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    Nayana Amin


    Full Text Available Background: Confirmation of placement of Double lumen endobronchial tubes (DLETT and bronchial blockers (BBs with the pediatric fiberoptic bronchoscope (FOB is the most preferred practice worldwide. Most centers possess standard adult FOBs, some, particularly in developing countries might not have access to the pediatric-sized devices. We have evaluated the role of preintubation airway assessment using the former, measuring the distance from the incisors to the carina and from carina to the left and right upper lobe bronchus in deciding the depth of insertion of the lung isolation device. Methods: The study was a randomized, controlled, double-blind trial consisting of 84 patients (all >18 years undergoing thoracic surgery over a 12-month period. In the study group (n = 38, measurements obtained during FOB with the adult bronchoscope decided the depth of insertion of the lung isolation device. In the control group (n = 46, DLETTs and BBs were placed blindly followed by clinical confirmation by auscultation. Selection of the type and size of the lung isolation device was at the discretion of the anesthesiologist conducting the case. In all cases, pediatric FOB was used to confirm accurate placement of devices. Results: Of 84 patients (DLETT used in 76 patients; BB used in 8 patients, preintubation airway measurements significantly improved the success rate of optimal placement of lung isolation device from 25% (11/44 to 50% (18/36 (P = 0.04. Our incidence of failed device placement at initial insertion was 4.7% (4/84. Incidence of malposition was 10% (8/80 with 4 cases in each group. The incidence of suboptimal placement was lower in the study group at 38.9% (14/36 versus 65.9% (29/44. Conclusions: Preintubation airway measurements with the adult FOB reduces airway manipulations and improves the success rate of optimal placement of DLETT and BB.

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

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    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.

  5. 国际留学生脉诊教学初探%The exploration of pulse-taking teaching of international students

    Institute of Scientific and Technical Information of China (English)

    李明月; 徐一兰; 陈波; 郭义; 王卫


    脉诊作为“望闻问切”四诊中最能体现中医特色的诊法,是留学生中医教学的重点,然而因其深奥、抽象的描述方法以及脉学理论与临床实践之间的距离,也成为留学生学习中医的难点。因此在教学中应趣味教学,注重脉诊中的中医文化传授;形象教学,以脉象图、意象图、脉象动画等形式辅助记忆;实训教学,强化脉诊实践,实现脉诊理论向临床应用的过渡。%Pulse-taking, as one of the four diagnostic methods of inspection, auscultation and olfaction, inquiry and pulse-taking, can fully embodies the characteristics of traditional Chinese medicine. Pulse-taking is the teaching key point for the international students. However, because the pulsetheory and literature is quite profound and abstract and there is a long distance between the class teaching and clinical practice, the teaching of pulse-taking is also the difficult point for the international students. Therefore, the pulse-taking teaching should focus on the interesting teaching, the culture of traditional Chinese medicine of pulse, image teaching and practice training.

  6. A 16-Year-Old Girl with Acute Onset Respiratory Distress

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    Saeed Safari


    Full Text Available A 16-year-old girl with an intellectual disability (known case of Down syndrome arrived in the emergency eepartment with complaints of severe breathlessness, bloody salivation (bright red blood or clots, and difficulty in speaking and swallowing of liquids and solids. The patient gradually developed progressive bloody salivation and hoarseness, never had any history of trauma to the head and neck and respiratory problems, and was symptomatic from the previous 48 h. Furthermore, the patient had a positive history of peptic ulcer, chronic consumption of non-steroidal anti-inflammatory drugs, and traveled out of town and drank water from a well in the mentioned period. On admission, the patient had a respiratory rate of 17 per min, pulse rate of 89 per min, blood pressure of 120/80 mmHg, 90% O2 saturation in room air, and 38°C axillary temperature. The only positive finding on physical examination was inspiratory stridor. The auscultation of lung and heart sounds was normal. Digital rectal examination revealed brown feces. Throat examination was not possible owing to lack of patient cooperation. After initial assessment and essential consideration, electrocardiography (ECG and imaging was performed. The ECG showed normal sinus rhythm, and analysis of arterial blood gas revealed the following: pH = 7. 35, Pa-CO2 = 39 mmHg, HCO3 = 24 mEq/L, PaO2 = 89 mmHg, and O2 saturation = 92%. All other laboratory data, including complete blood counts (CBC, urine analysis, hepatic and renal function tests, and coagulation profile were in the normal range.  What is your diagnosis?

  7. Clinical evaluation of the 3M Littmann Electronic Stethoscope Model 3200 in 150 cats. (United States)

    Blass, Keith A; Schober, Karsten E; Bonagura, John D; Scansen, Brian A; Visser, Lance C; Lu, Jennifer; Smith, Danielle N; Ward, Jessica L


    Detection of murmurs and gallops may help to identify cats with heart disease. However, auscultatory findings may be subject to clinically relevant observer variation. The objective of this study was to evaluate an electronic stethoscope (ES) in cats. We hypothesized that the ES would perform at least as well as a conventional stethoscope (CS) in the detection of abnormal heart sounds. One hundred and fifty consecutive cats undergoing echocardiography were enrolled prospectively. Cats were ausculted with a CS (WA Tycos Harvey Elite) by two observers, and heart sounds were recorded digitally using an ES (3M Littmann Stethoscope Model 3200) for off-line analysis. Echocardiography was used as the clinical standard method for validation of auscultatory findings. Additionally, digital recordings (DRs) were assessed by eight independent observers with various levels of expertise, and compared using interclass correlation and Cohen's weighted kappa analyses. Using the CS, a heart murmur (n = 88 cats) or gallop sound (n = 17) was identified in 105 cats, whereas 45 cats lacked abnormal heart sounds. There was good total agreement (83-90%) between the two observers using the CS. In contrast, there was only moderate agreement (P <0.001) between results from the CS and the DRs for murmurs, and poor agreement for gallops. The CS was more sensitive compared with the DRs with regard to murmurs and gallops. Agreement among the eight observers was good-to-excellent for murmur detection (81%). In conclusion, DRs made with the ES are less sensitive but comparably specific to a CS at detecting abnormal heart sounds in cats.

  8. Clinical Analyses of Senile Retrogressive Cardiovalvulopathy-Report of 126 Cases

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    Chen Cibin; Lu Xiong; Huang Peilan


    Objectives To investigate the clinical characteristics and the diagnostic methods of senile retrogressive cardiovalvulopathy(SRC). Methods Total 126 cases had heart murmurs or complicated with congestive heart failure were selected into study. The diagnosis of SRC was detected by Echocardiography (UCG), chest X-ray, electrocardiography(ECG)and clinical data. The characteristics of clinical data included symptoms, signs, heart function and the prognosis, the features of UCG included quantify and positions of valvulae in pathosis, index of heart function, and the special findings of chest X-ray and ECG were analysed. Results The murmurs were found in total 126 cases complicated with different heart sounds and in different intensity in auscultate, 119patients were complicated with acute or chronic heart failure in different levels of heart function from Ⅱ -Ⅳ(NYHA). All the patients were received UCG examination, 126 cases had different calcifications with different extent and single or mixed valves were involved. The left ventricle heart function of systole and diastole were impaired. The mean LVEF was (35 ±0.7)%, In chest X-ray test: The ratio between heart and chest in larger than 50% were found in 122 cases.The ECG examination in total 84 patients shown that atrial premature beats were in 65 patients, atrial fibrillation or atrial flutter in 75 patients, ventricle premature beats 41 patients. Conclusions The results suggest that elder patients with heart murmurs,congestive heart failure or cardiac arrhythmias should be advised to received a UCG examination, SRC should be considerd, and other heart disease should be distinguished by UCG.

  9. [A complete ventilation-perfusion mismatch following one-sided lung transplantation and postoperative hemothorax]. (United States)

    Jellinek, H; Klepetko, W; Hiesmayr, M


    Eight days after single-lung transplantation for pulmonary hypertension, a patient presented with a hemothorax on the side of the transplanted lung that required acute thoracotomy. Pulmonary artery pressure had decreased from 78/32/58 mmHg prior to the transplant to 42/18/27 mmHg on the 2nd postoperative day. Therefore, a predominance of perfusion to the transplanted lung was expected. During induction of anesthesia, in spite of ventilation with pure oxygen the patient developed a hypoxic cardiac arrest (paO2 26 mmHg, 40% saturation measured by pulse oximetry) requiring external chest compression. Auscultation and chest movements suggested that the transplanted lung was not ventilated. Because blood flow went mainly to the transplanted lung, ventilation of the native lung was almost totally dead-space ventilation. To enable ventilation of the compressed transplanted lung, the patient was intubated using a single-lumen bronchial blocker tube to block the mainstem bronchus of the native lung. The transplanted lung could then be ventilated. Saturation increased and epinephrine re-established a stable circulation; 2500 ml blood were removed from the pleura without further complications. On the 7th postoperative day the patient was discharged from the intensive care unit without neurological deficits. A perfusion scan 28 days post-transplant revealed 89% of the perfusion going to the transplanted lung. Atelectasis of this lung resulted in a large intrapulmonary right-to-left shunt. Hypoxic pulmonary vasoconstriction could not ameliorate the shunt because of the high pulmonary vascular resistance of the native lung.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Obstetric performance, perinatal outcome and risk of infection to the newborn in spontaneous and artificial rupture of membranes during labour. (United States)

    Seneviratne, H R; de Silva, G D; de Silva, M V; Rudra, T


    Artificial rupture of the membranes during established labor is believed to augment labor progression, but this practice carries the risk of maternal and neonatal infection. A prospective study conducted at De Soysa Hospital for Women in Colombo, Ceylon, in 1995 compared the obstetric performance, perinatal outcome, and risk of neonatal infection in 151 women with spontaneous rupture of membranes (SROM) and 173 women with artificial rupture of membranes (AROM). The need for oxytocin was higher in both primi- and multigravidae in the AROM group (37.5% and 38.8%, respectively) than the SROM group (24.7% and 18.9%, respectively), but this association reached statistical significance only among multigravidae. Also higher in the AROM group than the SROM group, but not significantly, were the rates of instrumental delivery and emergency cesarean section. Compared with primigravid AROM women, a significantly larger number of primigravid AROM women had abnormal auscultated fetal heart rates and cardiotopographic patterns. The appearance of meconium in liquor and the occurrence of low Apgar scores were similar in both groups. There were no clinical maternal or neonatal infections, but the intrauterine sites showed evidence of inflammation soon after membrane rupture. 36.1% of women in the SROM group and 24.0% of those in the AROM group whose cord and membranes were evaluated had histologic evidence of inflammation. Choreoamnionitis and funisitis were slightly more common in the AROM group. The potential for infection at intrauterine sites had no linear relationship to the mean membrane rupture-delivery interval or the number of vaginal examinations.

  11. Is Carotid Ultrasound Necessary in the Clinical Evaluation of the Asymptomatic Hollenhorst Plaque? (An American Ophthalmological Society Thesis) (United States)

    Bakri, Sophie J.; Luqman, Ashraf; Pathik, Bhupesh; Chandrasekaran, Krishnaswamy


    Purpose: To evaluate the utility of carotid ultrasound in patients with asymptomatic Hollenhorst plaques. Methods: Retrospective chart review of 237 patients diagnosed with Hollenhorst plaques between 1996 and 2004. The baseline cardiovascular risk profile, medications, and carotid ultrasound findings were documented. Retinal ischemia, myocardial ischemia, and cerebrovascular events during follow-up were noted. Results: There was no statistically significant difference in the proportion of patients with carotid stenosis >40% between symptomatic (n=60) and asymptomatic (n=177) patients (32.7% vs 22.7%; P=.192, one-way ANOVA). However, symptomatic patients were statistically more likely to have stenosis >69% (25% compared with 9.2% in the asymptomatic group; P=.008, one-way ANOVA). Among asymptomatic patients, those with carotid bruit (27.1%) were more likely to have moderate carotid stenosis >40% (55.6% vs 18.6% in patients without bruit; P=.0008, one-way ANOVA) and significant stenosis >69% (37% vs 4.3% in patients without bruit; P=.0001, one-way ANOVA). Follow-up data was obtained from 32 symptomatic patients (39.6 ± 22.9 months) and 100 asymptomatic patients (41.3 ± 21.8 months). Vascular and neurologic event rates were similar between the two groups. Conclusions: Hollenhorst plaques are a marker of significant carotid disease irrespective of retinal symptoms. Carotid auscultation remains important in the examination of patients with Hollenhorst plaques and increases the yield of asymptomatic patients diagnosed with carotid stenosis. The presence of visual symptoms on presentation did not correlate with an increased risk of death or stroke compared to asymptomatic patients during follow-up. Therefore all patients with asymptomatic plaques should have a medical workup, including carotid ultrasonography. PMID:24072943

  12. [Otto Ulmgren--a distinguished pioneer in oral surgery]. (United States)

    Nordenram, Ake


    Otto Ulmgren (1844-1932) was graduated in 1874 as medical doctor. During sex months in 1875-76 he studied the diseases of teeth, mouth and neck at "Erste Wiener Zahntechnische Schule" in Wien. Then he auscultated at some prominent dental practitionars in Berlin. After that he practised further as dental surgeon in Stockholm. He was strongly engaged to improve dental education and contributed actively for starting the School of Dentistry in Stockholm in 1898. He appointed director of the school and chief of the Department of oral surgery. Otto Ulmgren's doctor's thesis was "Ofversigt af tandläkarekonstens historia" (Survey of the History of Dentistry) in 1877. He also published about 60 scientific articles especially dealing with dental education and oral surgery. Otto Ulmgren was one of the founders of Odontologiska Sällskapet i Stockholm (Dental Society in Stockholm) in 1901 and was its president during the period 1901-21. He was also one of the founders of Sveriges Tandläkareförbund (Dental Association of Sweden) in 1908. He was honorary member of many dental associations. Otto Ulmgren was regarded as a man of principle, an eminent teacher, a skilful clinician and scientist and a strong pioneer of dentistry, particularly in oral surgery. In leisure hours Otto Ulmgren devoted himself to singing and he was a member of the famous men's choir "Orphei drängar". He was also very interested in hunting and had a kennel with hunting dogs. He was appointed honorary member of the Swedish Kennel Club.

  13. Prevalence and predictors of hypoxemia in acute respiratory infections presenting to pediatric emergency department

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    Singhi S


    Full Text Available Rational & Objective: Early detection of hypoxemia and oxygen therapy improves the outcome of children with acute respiratory illnesses (ARI. However, facility to measure oxygen saturation (SpO2 is not available in many health facilities of resource poor countries. We have studied prevalence of hypoxemia in children with ARI and examined value of various clinical signs to predict hypoxemia. Subjects & Methods: Consecutive children, aged 2 months - 59 months, with respiratory symptom(s attending the pediatric emergency service between Oct 2001 to December 2002 were studied. Presence or absence of cough, nasal flaring, ability to feed/drink, cyanosis, chestwall indrawing, wheeze, tachypnoea (respiratory rate >50/min in children up to 11 months and >40/min up to 59 months, crepitations on auscultation and oxygen saturation (SpO2, by Nellcore™pulse oximeter and clinical diagnosis were recorded. Results: Of 2216 children studied 266 (11.9% had hypoxemia (SpO2 £90%. It was seen in 73.8% of 126 patients with WHO defined very severe pneumonia, 25.8% of 331 patients with severe pneumonia, 11% of 146 patients with bronochiolitis and 6.5% of 338 patients with acute asthma. Most sensitive indicators of hypoxemia were chestwall indrawing (sensitivity-90%, negative predictive value -98% and crepitations (sensitivity-75%, negative predictive value 95.7% while the best positive predictive value was seen with cyanosis (71.4% and inability to feed (47.6%. Nasal flaring had the good balance of sensitivity (64%, specificity (82% and positive predictive value (33% among the signs studied. Conclusion: None of the clinical signs of respiratory distress had all the attributes of a good predictors of hypoxemia. Chest wall indrawing was the most sensitive and 'inability to feed/ drink' was the most specific indicator.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  15. Clinical signs of pneumonia in children: association with and prediction of diagnosis by fuzzy sets theory

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    Pereira J.C.R.


    Full Text Available The present study compares the performance of stochastic and fuzzy models for the analysis of the relationship between clinical signs and diagnosis. Data obtained for 153 children concerning diagnosis (pneumonia, other non-pneumonia diseases, absence of disease and seven clinical signs were divided into two samples, one for analysis and other for validation. The former was used to derive relations by multi-discriminant analysis (MDA and by fuzzy max-min compositions (fuzzy, and the latter was used to assess the predictions drawn from each type of relation. MDA and fuzzy were closely similar in terms of prediction, with correct allocation of 75.7 to 78.3% of patients in the validation sample, and displaying only a single instance of disagreement: a patient with low level of toxemia was mistaken as not diseased by MDA and correctly taken as somehow ill by fuzzy. Concerning relations, each method provided different information, each revealing different aspects of the relations between clinical signs and diagnoses. Both methods agreed on pointing X-ray, dyspnea, and auscultation as better related with pneumonia, but only fuzzy was able to detect relations of heart rate, body temperature, toxemia and respiratory rate with pneumonia. Moreover, only fuzzy was able to detect a relationship between heart rate and absence of disease, which allowed the detection of six malnourished children whose diagnoses as healthy are, indeed, disputable. The conclusion is that even though fuzzy sets theory might not improve prediction, it certainly does enhance clinical knowledge since it detects relationships not visible to stochastic models.

  16. Signs and symptoms indicative of community-acquired pneumonia in infants under six months

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    Maria de Fátima Bazhuni Pombo March


    Full Text Available OBJECTIVE: Evaluation of the clinical signs and symptoms predicting bacterial and viral pneumonia, in accordance with the Brazilian National Control Program for Acute Respiratory (ARI. METHODS: Observational prospective study. Seventy-six children from birth to six months of age who had pneumonia were studied in the emergency room. The patients were subdivided into two groups, based on radiological findings (gold-standard: 47 had bacterial pneumonia, and 29 had viral pneumonia. The frequencies, sensitivities, and specificities of the signs and symptoms were evaluated. RESULTS: The sensibilities and sensitivities of general findings in bacterial pneumonia were, respectively: fever 53.2%/40.0%; hypoactivity 68.4%/55.6% and prostration detected by the doctor 72.7%/55.0%. The same findings in viral pneumonias showed, respectively: 37.9%/40.0%, 66.7%/55.6% and 66.7%/55.6%. The sensibilities and sensitivities of respiratory findings in bacterial pneumonia were, respectively: coughing 66.0/38.1%, Respiratory rate = 50 ripm 76.6%/38.1%, altered respiratory auscultation 91.3%/10.5%, and chest indrawing 46.7%/80.0%. The same findings in viral pneumonias were, respectively: 69.0%/38.1%, 86.2%/38.1%, 85.7%/10.5% and 44.8%/80.0%. CONCLUSION: Analysis of signs and symptoms in each group did not distinguish bacterial from viral pneumonia. Our findings reinforce the adequacy of the ARI program in Brazil, which gives an early diagnosis of pneumonia, independent of its etiology.

  17. TRALI in the perioperative period

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    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

  18. Clinical and biochemical changes in 53 Swedish dogs bitten by the European adder - Vipera berus

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    Frendin Jan HM


    Full Text Available Abstract Background Every year many dogs in Sweden are bitten by Vipera berus, the only venomous viper in Sweden. This prospective study investigated clinical signs, some biochemical parameters, treatment, and progress of disease after snakebite in 53 dogs. Effects of treatment with and without glucocorticoids were evaluated. Methods All fifty-three dogs bitten by Vipera berus were examined the same day the dog was bitten and the next day. Two more examinations during 23 days post snake bite were included. Creatinine, creatine kinase (CK, alanine aminotransferase (ALT, glutamate dehydrogenase (GLDH, alkaline phosphatase (ALP and bile acid results were followed through 3 to 4 samplings from 34 of the dogs. Results All dogs had variable severity of local swelling in the bite area and 73 per cent had affected mental status. Initial cardiac auscultation examination was normal in all dogs, but six dogs had cardiac abnormalities at their second examination, including cardiac arrhythmias and cardiac murmurs. All dogs received fluid therapy, 36 dogs were given analgesics, 22 dogs were treated with glucocorticoids, and ten dogs were treated with antibiotics. Evidence of transient muscle damage (increased CK was seen one day after the snake bite in 15 (54% of 28 sampled dogs. Moderate changes in hepatic test results occurred in 1 dog and several dogs (22 of 34 had transient, minor increases in one or more hepatic test result. No dog died during the observation period as a consequence of the snake bite. Conclusions Snake bite caused local swelling in all dogs and mental depression of short duration in most dogs. Some dogs had transient clinical signs that could be indicative of cardiac injury and some other had transient biochemical signs of liver injury. Treatment with glucocorticoids did not have any clear positive or negative effect on clinical signs and mortality.

  19. Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway

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    Sunde Geir A


    Full Text Available Abstract Background Although there are numerous supraglottic airway alternatives to endotracheal intubation, it remains unclear which airway technique is optimal for use in prehospital cardiac arrests. We evaluated the use of the laryngeal tube (LT as an airway management tool among adult out-of-hospital cardiac arrest (OHCA patients treated by our ambulance services in the Haukeland and Innlandet hospital districts. Methods Post-resuscitation forms and data concerning airway management in 347 adult OHCA victims were retrospectively assessed with regard to LT insertion success rates, ease and speed of insertion and insertion-related problems. Results A total of 402 insertions were performed on 347 OHCA patients. Overall, LT insertion was successful in 85.3% of the patients, with a 74.4% first-attempt success rate. In the minority of patients (n = 46, 13.3%, the LT insertion time exceeded 30 seconds. Insertion-related problems were recorded in 52.7% of the patients. Lack of respiratory sounds on auscultation (n = 100, 28.8%, problematic initial tube positioning (n = 85, 24.5%, air leakage (n = 61, 17.6%, vomitus/aspiration (n = 44, 12.7%, and tube dislocation (n = 17, 4.9% were the most common problems reported. Insertion difficulty was graded and documented for 95.4% of the patients, with the majority of insertions assessed as being “Easy” (62.5% or “Intermediate” (24.8%. Only 8.1% of the insertions were considered to be “Difficult”. Conclusions We found a high number of insertion related problems, indicating that supraglottic airway devices offering promising results in manikin studies may be less reliable in real-life resuscitations. Still, we consider the laryngeal tube to be an important alternative for airway management in prehospital cardiac arrest victims.

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

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    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.

  1. Sensory nerves and nitric oxide contribute to reflex cutaneous vasodilation in humans. (United States)

    Wong, Brett J


    We tested the hypothesis that inhibition of cutaneous sensory nerves would attenuate reflex cutaneous vasodilation in response to an increase in core temperature. Nine subjects were equipped with four microdialysis fibers on the forearm. Two sites were treated with topical anesthetic EMLA cream for 120 min. Sensory nerve inhibition was verified by lack of sensation to a pinprick. Microdialysis fibers were randomly assigned as 1) lactated Ringer (control); 2) 10 mM nitro-L-arginine methyl ester (L-NAME) to inhibit nitric oxide synthase; 3) EMLA + lactated Ringer; and 4) EMLA + L-NAME. Laser-Doppler flowmetry was used as an index of skin blood flow, and blood pressure was measured via brachial auscultation. Subjects wore a water-perfused suit, and oral temperature was monitored as an index of core temperature. The suit was perfused with 50°C water to initiate whole body heat stress to raise oral temperature 0.8°C above baseline. Cutaneous vascular conductance (CVC) was calculated and normalized to maximal vasodilation (%CVC(max)). There was no difference in CVC between control and EMLA sites (67 ± 5 vs. 69 ± 6% CVC(max)), but the onset of vasodilation was delayed at EMLA compared with control sites. The L-NAME site was significantly attenuated compared with control and EMLA sites (45 ± 5% CVC(max); P vasodilation during the early, but not latter, stages of heat stress, and full expression of reflex cutaneous vasodilation requires functional sensory nerves and NOS.

  2. [Lung ultrasound in acute and critical care medicine]. (United States)

    Zechner, P M; Seibel, A; Aichinger, G; Steigerwald, M; Dorr, K; Scheiermann, P; Schellhaas, S; Cuca, C; Breitkreutz, R


    The development of modern critical care lung ultrasound is based on the classical representation of anatomical structures and the need for the assessment of specific sonography artefacts and phenomena. The air and fluid content of the lungs is interpreted using few typical artefacts and phenomena, with which the most important differential diagnoses can be made. According to a recent international consensus conference these include lung sliding, lung pulse, B-lines, lung point, reverberation artefacts, subpleural consolidations and intrapleural fluid collections. An increased number of B-lines is an unspecific sign for an increased quantity of fluid in the lungs resembling interstitial syndromes, for example in the case of cardiogenic pulmonary edema or lung contusion. In the diagnosis of interstitial syndromes lung ultrasound provides higher diagnostic accuracy (95%) than auscultation (55%) and chest radiography (72%). Diagnosis of pneumonia and pulmonary embolism can be achieved at the bedside by evaluating subpleural lung consolidations. Detection of lung sliding can help to detect asymmetrical ventilation and allows the exclusion of a pneumothorax. Ultrasound-based diagnosis of pneumothorax is superior to supine anterior chest radiography: for ultrasound the sensitivity is 92-100% and the specificity 91-100%. For the diagnosis of pneumothorax a simple algorithm was therefore designed: in the presence of lung sliding, lung pulse or B-lines, pneumothorax can be ruled out, in contrast a positive lung point is a highly specific sign of the presence of pneumothorax. Furthermore, lung ultrasound allows not only diagnosis of pleural effusion with significantly higher sensitivity than chest x-ray but also visual control in ultrasound-guided thoracocentesis.

  3. Diagnosis and management of cardiogenic pulmonary edema. (United States)

    Alwi, Idrus


    Acute cardiogenic pulmonary edema (ACPE) is a common cardiogenic emergency with a quite high in-hospital mortality rate. ACPE is defined as pulmonary edema with increased secondary hydrostatic capillary pressure due to elevated pulmonary venous pressure. Increased hydrostatic pressure may result from various causes including excessive administration of intravascular volume, obstruction of pulmonary venous outflow or secondary left ventricular failure due to left ventricular systolic or diastolic dysfunction. ACPE must be distinguished from pulmonary edema associated with injury of alveolar capillary membrane caused by various etiologies, i.e. direct pulmonary injury such as pneumonia and indirect pulmonary injury such as sepsis. Numerous clinical manifestations may differentiate ACPE and Non-ACPE. ACPE usually presents with a history of acute cardiac catastrophe. Physical examination reveals a low-flow state, S3 gallop, jugular venous distention and fine crepitant rales with auscultation. The diagnosis of pulmonary edema is made based on symptoms and clinical signs are found through history taking, physical examination, ECG, chest X-ray, echocardiography and laboratory tests including blood gas analysis and specific biomarkers. Medical treatment of ACPE has 3 main objectives, i.e.: (1) reduced venous return (preload reduction); (2) reduced resistance of systemic vascular (afterload reduction); and (3) inotropic support in some cases. Treatment that can be administered includes: vasodilator when there is normal or high BP, diuretics when there is volume overload or fluid retention, and inotropic drugs when there is hypotension or signs of organ hypoperfusion. Intubation and mechanical ventilation may be necessary to achieve adequate oxygenation.

  4. Embedded Stethoscope for Heart Sounds

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    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.

  5. A comparison of the indirect estimate of mean arterial pressure calculated by the conventional equation and calculated to compensate for a change in heart rate. (United States)

    Rogers, G; Oosthuyse, T


    The standard equation used to calculate mean arterial pressure (MAP) assumes that diastole persists for 2/3 and systole for 1/3 of each cardiac cycle. This ratio is altered when heart rate increases, and therefore we investigated the efficacy of predicting MAP during exercise using non-invasive indirect methods. Eight subjects exercised on a cycle ergometer for 3 minute intervals to elicit heart rates between 100-110, 120-130, 140-150, 160-170, and 180-190 beats/min. In the last minute of each 3 min interval an ECG recording was taken and systolic (SP) and diastolic (DP) blood pressure was measured by manual auscultation. MAP was calculated for each heart rate interval by: MAP=DP+1/3(SP-DP) (method A), and MAP= DP + Fs(SP- DP) (method B), where Fs is the fraction of the cardiac cycle comprising systole, measured from the ECG. Fs increased from 0.35+/-0.049 at rest to 0.47+/-0.039 at a heart rate of 180-190 beats/min. MAP measured by method B was consistently greater than MAP calculated by method A at all heart rates greater than resting heart rate (pequation (method A) to derive MAP during exercise (measured as the percentage difference between method A and B) increased linearly with heart rate (r=0.98). The standard MAP equation should not be applied during exercise, as it does not account for the change in the systolic: diastolic period ratio as heart rate increases.

  6. Family Practitioners’ Advice about Taking Time Off Work for Lower Respiratory Tract Infections: A Prospective Study in Twelve European Primary Care Networks (United States)

    Godycki-Cwirko, Maciek; Nocun, Marek; Butler, Christopher C.; Little, Paul; Verheij, Theo; Hood, Kerenza; Fleten, Nils; Kowalczyk, Anna; Melbye, Hasse


    Background Acute cough and lower respiratory tract infections (LRTIs) are one of the most important causes of lost working hours. Aim to explore variation and predictors in family practitioners (FPs) advice to patients with LRTIs about taking time off work in different European countries. Methods Prospective observational study in primary care networks in 12 countries, with multilevel mixed-effects binomial logistic regression. Results 324 FPs recruited 1616 employed adults who presented to primary care with LRTIs. The proportion of patients advised to take time off work varied from 7.6% in the Netherlands to 89.2% in Slovakia, and of these, 88.2% overall were advised to stay off work for seven days or less. None of Finnish or Dutch patients were advised to take more than 7 days off, in contrast to 35.5% of Polish and 27.0% of Slovak patients. The strongest predictors of FPs’ advice about time off work were: patient symptoms interfering with normal activities (OR 4.43; P<0.001), fever (2.49; P<0.001), patients feeling generally unwell (2.21; P<0.001), antibiotic prescribing (1.51; P = 0.025) and auscultation abnormality (1.50; P = 0.029). Advice to take time off was not associated with patient reported recovery. Conclusions There is large variation in FPs’ advice given to patients with LRTIs in Europe about taking time off work, which is not explained by differences in patients’ reported illness duration, but might be explained by differences in regulations around certification and sick pay. Evidence based guidance for advising patients about taking time off work for this common condition is needed. PMID:27760225

  7. A Complication following the Transcatheter Closure of a Muscular Ventricular Septal Defect

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    Mustafa Karaçelik


    Full Text Available Today, congenital heart diseases may be treated without surgery through advances in interventional cardiology. However, complications such as infection and thrombus formation may develop due to foreign materials used during these procedures. Surgical intervention may be required for the removal of the device utilized for the procedure. In this case report, we present the surgical treatment of a residual ventricular septal defect (VSD that had developed in a 6-year-old patient with an apical muscular VSD closed with the Amplatzer muscular VSD device. The patient was admitted to the emergency room with complaints of abdominal pain and high fever 5 days after discharge without any cardiac symptoms. When she arrived at our clinic, she had a heart rate of 95 bpm, blood pressure of 110/70 mmHg, and temperature of 38.5ºC. Examinations of the other systems were normal, except for a 3/6 pan-systolic murmur at the mesocardiac focus on cardiac auscultation. Echocardiography showed a residual VSD, and the total pulmonary blood flow to the total systemic blood flow ratio (Qp/Qs of the residual VSD was 1.8. In the operating room, the Amplatzer device was removed easily with a blunt dissection. The VSD was closed with an autologous fresh pericardial patch. Following the pulmonary artery debanding procedure, the postoperative period was uneventful. The condition of the patient at the time of discharge and in the first postoperative month’s follow-up was good. There was no residual VSD or infection. 

  8. Opciones para la prevención: el caso del Volcán Arenal

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    Esquivel Valverde, Lidier


    Full Text Available El presente artículo analiza una serie de aspectos relacionados con la actividad del volcán Arenal y su repercusión la zona. Como tema principal, explica ampliamente la propuesta Uso de suelos en los alrededores del volcán, creada por el Comité Asesor Técnico en Vulcanología, integrada por el Observatorio Vulcanológico y Sismológico de Costa Rica de la Universidad Nacional (OVSICORI, la Red Sismológica Nacional de la Universidad de Costa Rica (RSN y el Área de Amenaza y Auscultación Sísmica y Volcánica del Instituto Costarricense de Electricidad (ICE, la cual estipula las zonas de restricción para el uso de suelo, dividida en dos niveles de restricción y cuatro sub áreas. El artículo incluye un Mapa de restricciones de uso del suelo, tránsito de personas y ubicación de los proyectos de desarrollo más importantes en los alrededores del volcán Arenal. Las conclusiones exponen los motivos que propiciaron la creación de la propuesta y su aplicación, así como algunos puntos deficitarios con respecto a la participación de otros actores This article analyses a series of aspects related to the activity of the Arenal Volcano and its repercussion in the zone. The main topic broadly explains the proposal about soil use around the Volcano, created by the Technical Advisor Committee in Volcanology, composed by the Volcanological and Seismological Observatory of the Costa Rica, National University (Observatorio Vulcanológico y Sismológico de Costa Rica de la Universidad Nacional - OVSICORI, the National Seismic Network of the University of Costa Rica (Red Sismológica Nacional de la Universidad de Costa Rica - RSN and the Threat Area and Seismic Auscultation of the Costa Rican Electricity Institute (Área de Amenaza y Auscultación Sísmica y Volcánica del Instituto Costarricense de Electricidad - ICE that includes the restricted zones for soil use, divided in two levels of restriction and four sub areas. The article includes a

  9. Idiopathic pulmonary fibrosis. (United States)

    Meltzer, Eric B; Noble, Paul W


    Idiopathic pulmonary fibrosis (IPF) is a non-neoplastic pulmonary disease that is characterized by the formation of scar tissue within the lungs in the absence of any known provocation. IPF is a rare disease which affects approximately 5 million persons worldwide. The prevalence is estimated to be slightly greater in men (20.2/100,000) than in women (13.2/100,000). The mean age at presentation is 66 years. IPF initially manifests with symptoms of exercise-induced breathless and dry coughing. Auscultation of the lungs reveals early inspiratory crackles, predominantly located in the lower posterior lung zones upon physical exam. Clubbing is found in approximately 50% of IPF patients. Cor pulmonale develops in association with end-stage disease. In that case, classic signs of right heart failure may be present. Etiology remains incompletely understood. Some environmental factors may be associated with IPF (cigarette smoking, exposure to silica and livestock). IPF is recognized on high-resolution computed tomography by peripheral, subpleural lower lobe reticular opacities in association with subpleural honeycomb changes. IPF is associated with a pathological lesion known as usual interstitial pneumonia (UIP). The UIP pattern consists of normal lung alternating with patches of dense fibrosis, taking the form of collagen sheets. The diagnosis of IPF requires correlation of the clinical setting with radiographic images and a lung biopsy. In the absence of lung biopsy, the diagnosis of IPF can be made by defined clinical criteria that were published in guidelines endorsed by several professional societies. Differential diagnosis includes other idiopathic interstitial pneumonia, connective tissue diseases (systemic sclerosis, polymyositis, rheumatoid arthritis), forme fruste of autoimmune disorders, chronic hypersensitivity pneumonitis and other environmental (sometimes occupational) exposures. IPF is typically progressive and leads to significant disability. The median

  10. Safety And Efficacy Of Proseal Laryngeal Mask Airway Versus Classic Laryngeal Mask Airway And Endo Tracheal Tube During Elective surgery

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    Soad A. Mansour , Wafaa G.Ahmed , Kawthar A. Azzam ,Tarek M. EL said


    Full Text Available The present study was performed to compare safety , efficacy of Proseal Laryngeal Mask Airway (PLMA, classic Laryngeal mask airway (LMA and cuffed Endo Tracheal Tube (ETT as a ventilatory device during controlled positive pressure ventilation and airway management , Haemodynamic response to insertion and removal, gastric tube insertion through either device, air leak detection and assessment of position by fiberoptic bronchoscope . Forty five ASA I or II patients aged between 18-55 years old , were divided equally into three groups of fifteen patients each , and airway management either through PLMA(groupI,classic LMA (groupIIand ETT (group III . All patients were premedicated by zantac hydrochloride 150 mg orally at mid night and two hours before the operation ­ Anaesthesia was induced with fentanyl 2 ug/kg and propofol 2.5 mg /kg and maintenance was with a mixture of 50% N2O , 50% O2 and isoflurane 1 - 1.5 % and rocuronium 0.5 mg /kg followed by continous infusion of rocuronium 0.3-0.6 mg/kg/hr A proper size PLMA , classic LMA or ETT was selected oxygenation and ventilation were optimal in 100% in group I and III while in group II 80% optimal and suboptimal in 13.3% and failed in 6.7 % . Haemodynamic parameters showed that significantly increase in HR and MAP in the three studied groups especially at insertion and removal of the airway device with statisticaly significant difference between group I,II in comparison to group III, comparison of gastric tube insertion showed that positive insertion was 86.7% in group I and in 46.7% in group II, while in group III positive insertion was 100% air leak was detected by epigastric auscultation which signified lower leakage in PLMA group than LMA group . Position assessment by fiberoptic bronchoscope in PLMA group was grade 4 in 5 patients , grade 3 in 5 patients , grade2 in 4 patients and grade 1 in 1 patient while in LMA group it was grade 4 in 7 patients , grade 3 in 6 patients , grade 2 in 2

  11. Idiopathic pulmonary fibrosis

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    Noble Paul W


    Full Text Available Abstract Idiopathic pulmonary fibrosis (IPF is a non-neoplastic pulmonary disease that is characterized by the formation of scar tissue within the lungs in the absence of any known provocation. IPF is a rare disease which affects approximately 5 million persons worldwide. The prevalence is estimated to be slightly greater in men (20.2/100,000 than in women (13.2/100,000. The mean age at presentation is 66 years. IPF initially manifests with symptoms of exercise-induced breathless and dry coughing. Auscultation of the lungs reveals early inspiratory crackles, predominantly located in the lower posterior lung zones upon physical exam. Clubbing is found in approximately 50% of IPF patients. Cor pulmonale develops in association with end-stage disease. In that case, classic signs of right heart failure may be present. Etiology remains incompletely understood. Some environmental factors may be associated with IPF (cigarette smoking, exposure to silica and livestock. IPF is recognized on high-resolution computed tomography by peripheral, subpleural lower lobe reticular opacities in association with subpleural honeycomb changes. IPF is associated with a pathological lesion known as usual interstitial pneumonia (UIP. The UIP pattern consists of normal lung alternating with patches of dense fibrosis, taking the form of collagen sheets. The diagnosis of IPF requires correlation of the clinical setting with radiographic images and a lung biopsy. In the absence of lung biopsy, the diagnosis of IPF can be made by defined clinical criteria that were published in guidelines endorsed by several professional societies. Differential diagnosis includes other idiopathic interstitial pneumonia, connective tissue diseases (systemic sclerosis, polymyositis, rheumatoid arthritis, forme fruste of autoimmune disorders, chronic hypersensitivity pneumonitis and other environmental (sometimes occupational exposures. IPF is typically progressive and leads to significant

  12. Clinical training in medical students during preclinical years in the skill lab (United States)

    Upadhayay, Namrata


    Background In Nepal, medical education is a high-stakes and stressful course. To enhance learning and minimize students’ stress, the conventional method has been replaced by integrated, student-centered learning. As an approach to train effectively, colleges have started establishing skill labs. Objectives To evaluate the effectiveness of clinical skill training on exam performance as compared with the conventional teaching practice. Further, to assess the perceptions of students of the importance of skill lab training in college. Method Twenty students were randomly selected to participate in this cross-sectional study. On the internal examination, students showed skills on manikins, and examiners evaluated them. A sample question in the exam was “To perform cardiopulmonary resuscitation (CPR) on half body human manikin.” On completion of the exam, opinions were collected from the students via a predesigned self-administered questionnaire. The questionnaire included questions regarding skill lab use and its benefits to them in developing their skills, with a few questions related to the exam pattern. The responses were expressed in frequencies. Results We found that all (20/20) students performed CPR with confidence and without hesitation on the manikin. The practical examination performance (marks) was categorized as excellent (7/20), good (8/20), average (3/20), and poor (2/20). The pass percentage after skill training was increased by 25% as compared with conventional teaching practice. The majority of the students (17/20) mentioned that skill is better learned by doing than by observing others’ performance or watching videos. A few students (6/20) said skills are better learned by observing the real disease state. They mentioned that skill lab is the better choice for learning major skills such as catheterization, opening vein, auscultation of heart sounds, and endotracheal intubation. Conclusion Students are confident and showed better exam

  13. Predicting the presence of bacterial pathogens in the airways of primary care patients with acute cough (United States)

    Teepe, Jolien; Broekhuizen, Berna D.L.; Loens, Katherine; Lammens, Christine; Ieven, Margareta; Goossens, Herman; Little, Paul; Butler, Chris C.; Coenen, Samuel; Godycki-Cwirko, Maciek; Verheij, Theo J.M.


    BACKGROUND: Bacterial testing of all patients who present with acute cough is not feasible in primary care. Furthermore, the extent to which easily obtainable clinical information predicts bacterial infection is unknown. We evaluated the diagnostic value of clinical examination and testing for C-reactive protein and procalcitonin for bacterial lower respiratory tract infection. METHODS: Through a European diagnostic study, we recruited 3104 adults with acute cough (≤ 28 days) in primary care settings. All of the patients underwent clinical examination, measurement of C-reactive protein and procalcitonin in blood, and chest radiography. Bacterial infection was determined by conventional culture, polymerase chain reaction and serology, and positive results were defined by the presence of Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Bordetella pertussis or Legionella pneumophila. Using multivariable regression analysis, we examined the association of diagnostic variables with the presence of bacterial infection. RESULTS: Overall, 539 patients (17%) had bacterial lower respiratory tract infection, and 38 (1%) had bacterial pneumonia. The only item with diagnostic value for lower respiratory tract infection was discoloured sputum (area under the receiver operating characteristic [ROC] curve 0.56, 95% confidence interval [CI] 0.54–0.59). Adding C-reactive protein above 30 mg/L increased the area under the ROC curve to 0.62 (95% CI 0.59–0.65). For bacterial pneumonia, comorbidity, fever and crackles on auscultation had diagnostic value (area under ROC curve 0.68, 95% CI 0.58–0.77). Adding C-reactive protein above 30 mg/L increased the area under the ROC curve to 0.79 (95% CI 0.71–0.87). Procalcitonin did not add diagnostic information for any bacterial lower respiratory tract infection, including bacterial pneumonia. INTERPRETATION: In adults presenting with acute lower respiratory tract infection, signs, symptoms and C

  14. The Apply of Univent-Endotracheal Tube with Movable Blocker for One-Lung Ventilation in Pediatrics%Univent单腔双囊气管导管在小儿单肺通气中的应用

    Institute of Scientific and Technical Information of China (English)

    张华; 张子莲


    目的:将Univent单腔双囊气管导管用于8~14岁小儿胸部外科手术以期实现小儿单肺通气。方法:择期行肺叶切除术患儿12例,在芬太尼、异丙酚、潘库溴铵静脉麻醉诱导下插入单腔双囊支气管堵塞导管,用听诊法判断目标侧肺是否完全堵塞。术中机械通气,常规进行循环、呼吸监测。结果:右侧开胸7例,6例放置满意,1例术中见右肺膨胀,放弃使用。左侧开胸5例,1例反复放置不能达目标侧,放弃使用。结论:Univent单腔双囊气管导管用于小儿肺叶切除术,患侧肺萎陷,手术暴露操作满意,患儿呼吸、循环稳定,是实现小儿单肺通气的方法之一。%Objective:To evaluate the use of Univent-endotracheal tube with movable blocker in children one-lung ventilation.Methods: Twelve patients who received selective lobectomy underwent Univent-endotracheal tube and movable blocker under anesthesia of fentanyl and propofol. Auscultation was used to monitor if the lung was completely blocked. The changes ofHR,EKG,SpO2, RR, Vt, MV, and PetCO2 were observed during the surgery. Results:In right thoracotomy, endotrachealtube was in proper position in 6 of 7 patients, and one patient happened pulmonary hypertroply and was operated by doublelung ventilation. In left thoracotomy,it was in proper position in 4 of 5 patients,and one patient failed during intubation.Conclusion:Univent tubes can be used in one-lung ventilation in lobectomy for the purpose of facilitating surgical exposureand stabilizing respiration and circulation. It is one of the one-lung ventilations in pediatrics.

  15. Aneurisma da Artéria Renal: caso clínico Renal Artery Aneurysm

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    Joana Moreira


    Full Text Available Apresenta-se o caso clínico de um doente com volumoso aneurisma da artéria renal esquerda. Do sexo masculino, de 22 anos de idade, com lombalgia à esquerda com algumas semanas de evolução. Recorreu ao médico assistente que solicitou estudo imagiológico por ecografia abdominal. Detectada imagem sugestiva de aneurisma da aorta abdominal. Este achado motivou a transferência para o nosso Hospital onde foi admitido consciente e orientado, hemodinamicamente estável, apresentando uma massa pulsátil epigástrica, com frémito e sopro sistólico à auscultação. Angio-TC revelou um aneurisma da artéria renal esquerda com 16 cm de diâmetro. Dada a estabilidade clínica e topografia lesional optou-se por tentar embolizar, sem sucesso, o tronco da artéria renal esquerda antes da abordagem cirúrgica. O doente foi então submetido a Nefrectomia total esquerda por via toraco-abdominal. Pós-operatório sem complicações, locais ou sistémicas. Alta ao 8ºdia, mantendo boa função renal e com níveis normais de hemoglobina. Diagnóstico de aneurisma da artéria renal confirmado por estudo anátomo-patológico da peça operatória.One case of a large left renal artery aneurysm in a young patient 22 years old is presented. He appealed to his assistant physician a few weeks after development of left back pain. Abdominal ultrasound imaging study has been requested. Suggestive abdominal aortic aneurysm was detected. This finding led to the transfer to our hospital where he was admitted conscious and hemodynamically stable. A pulsatile epigastric mass with a systolic murmur on auscultation and thrill were detected. Angio-CT scan revealed a left renal artery aneurysm, 16 cm in diameter. Given the clinical stability and lesional topography we decide a previous embolization of left renal artery, unsuccessfully. The patient underwent then left total nephrectomy, through thoraco-abdominal incision. No local or systemic complications in the postoperative

  16. Assessing the Extent of Adherence to the Recommended Antenatal Care Content in Malaysia: Room for Improvement.

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    Ping Ling Yeoh

    foetal heart auscultation were initiated earlier than recommended. Inadequate ANC content was associated with higher prevalence of preterm birth.Our findings indicate the presence of issues related to delivery of recommended ANC content. We advocate for all pregnant women to be ensured of adherence to the recommended ANC content. We also recommend monitoring the delivery of health advice. Conforming to recommended timing of initiation for ANC practices is essential due to resource implication and possible implication on maternal wellbeing. The association of inadequate ANC content and preterm birth may be due to lesser opportunities to receive some of the care because of lower number of ANC visits among preterm birth; this may also indicate the importance of having adequate ANC content.

  17. Selective inhibition of butyrylcholinesterase in vivo in horses by the feed-through larvacide Equitrol. (United States)

    Karanth, Subramanya; Holbrook, Todd; MacAllister, Charles; Pope, Carey N


    The organophosphate insecticide tetrachlorvinphos (TCVP, Rabon) is the active ingredient in "feed-through" larvacides (e.g., Equitrol) for fly control around horse stables. As with other organophosphates, TCVP elicits toxicity by inhibiting acetylcholinesterase, leading to accumulation of the neurotransmitter acetylcholine and cholinergic signs. Relatively little is known, however, on the effects of TCVP-containing larvacides on acetylcholinesterase or other esterases in horses. Previous in vitro studies indicated that horse plasma cholinesterase activity was substantially (>10,000-fold) more sensitive than erythrocyte cholinesterase activity to inhibition by TCVP. In the current study, we examined the relative proportion of acetylcholinesterase and butyrylcholinesterase activities in horse plasma and muscle, and evaluated the in vivo effects of Equitrol on target and non-target esterases following oral feeding in horses. In vitro inhibition studies suggested that essentially all cholinesterase activity in horse plasma was butyrylcholinesterase, while muscle contained >90% acetylcholinesterase activity. For in vivo studies, adult, male horses (364-590kg; n=3/treatment group) were given either sweet feed alone or sweet feed supplemented with Equitrol daily for 21 consecutive days at the recommended rate. Clinical signs (vital signs, abdominal auscultation, ophthalmic exam, body temperature) were recorded on a daily basis. Heparinized blood samples were taken at days -1, 1, 3, 7, 21, 28, and 42 while muscle (semimembranosus) biopsies were taken under aseptic conditions on days -1 and 21. No signs of overt toxicity were noted at any time during the study. Plasma cholinesterase activity was significantly inhibited (33%) in larvacide-treated horses as early as one day after treatment and peak inhibition (69-71%) was noted at days 7 and 21. Following cessation of dosing, plasma cholinesterase activity recovered (46% and 83% of control on days 28 and 42, respectively

  18. Flexible LMA在鼻内镜手术中应用的气道安全性%Airway safety of application of flexible laryngeal mask airway in endoscopic sinus surgery

    Institute of Scientific and Technical Information of China (English)

    马佳佳; 李天佐


    Objective: To investigate the safety of application of flexible laryngeal mask airway (Flexible LMA) in endoscop -ic sinus surgery (ESS) compared with endotracheal intubation. Methods: 60 adult patients selected for EES were randomly divided into group F and group T, with 30 patients for each group. Observation items included the impermeability of the Flexible LMA, blood staining conditions of the laryngeal mask after extraction and ventilation effectiveness, respiratory ca -pacity of the pressure loopy and the difficulty level of insertion between the two groups. Results: Impermeability of the Flexible LMA after insertion and before extraction was reliable. Auscultation showed clear neck breath sounds. One case of ventral blood stain occurred after extraction of the laryngeal mask. There was no significant difference between the two groups as to the ventilation effectiveness (P>0.05). The airway peak pressure of the group F was lower than that of the group T (P0.05). The insertion time of the group F was shorter than that of the group T (P=0.017). Conclusion: Compared with endotracheal intubation, the application of Flexible LMA in endoscopic sinus surgery is safe and practicable.%目的:探讨与气管插管相比,Flexible LMA(flexible laryngeal mask airway)在全麻下鼻内镜手术(endoscope sinus surgery,ESS)中的应用的安全性.方法:选取择期行ESS手术的成年患者60例,将其随机分为F组和T组,每组各30例.观察Flexible LMA的密闭性,拔出喉罩后罩体血染情况,比较两组通气效果、呼吸容量环路及插入难易程度.结果:Flexible LMA漏气压力值在插入后和拔出前均较满意,颈部呼吸音听诊均清晰,拔出喉罩腹侧血染为1例;两组通气效果比较差异无统计学意义(P>0.05),F组各时点气道峰压均低于T组(均P<0.05);呼吸容量环路比较差异无统计学意义(P>0.05);F组置入时间低于T组(P=0.017).结论:Flexible LMA与气管插管相比在ESS术中的应用是安全可行的.

  19. Study on the curative effect of interventional therapy of congenital heart disease%先天性心脏病的介入治疗疗效研究

    Institute of Scientific and Technical Information of China (English)



    目的 研究先天性心脏病的介入治疗的疗效.方法 选择54例先天性心脏病患者,动脉导管未闭(PDA)21例,房间隔缺损(ASD)8例,室间隔缺损(VSD)25例,研究3类患者施行介入治疗的疗效.研究术后心脏杂音、术后溶血、术后房室分离及封堵的成功率.结果 54例先天性心脏病患者术后即刻听诊心脏杂音消失,未见残余分流,未见溶血.2例封堵失败.封堵成功率为96.3%.其中4例膜部VSD和1例ASD患者术后出现加速性交界性心动过速伴干扰性房室分离,治疗后好转.结论 先心病介入治疗有诸多优点,值得推广并发展.%Objective To study the curative effect of interventional therapy of congenital heart disease.Methods Fifty - four patients with congenital heart disease,21 cases of patent ductus arteriosus (PDA),8 cases of atrial septal defect(ASD),25 cases of ventricular septal defect (VSD),the curative effects of interventional therapy of congenital heart disease with three class of patients.The success rate of heart murmur,hemolysis,atrioventricular dissociation and plugging after operation were studied.Results Immediate auscultation heart murmur of 54 patients with congenital heart disease disappeared after operation,the residual tap and the hemolysis were not seen,2 cases plugging failure,so the plugging success rate was 96.3%.Four cases of membranous septum VSD and 1 case of ASD patient appeared acceleration of the border tachycardia with interfering atrioventricular dissociation after operation and were improved after treatment.Conclusions Interventional therapy of congenital heart disease have many advantages,worth popularization and development.

  20. 普米克令舒联合博利康尼氧气雾化吸入治疗毛细支气管炎120例%Pulmicort combined Bricanyl inhalation of oxygen in treatment of bronchiolitis 120 cases

    Institute of Scientific and Technical Information of China (English)



    目的 观察普米克联合博利康尼以氧气作动力雾化吸入治疗毛细支气管炎的疗效.方法 将240例毛细支气管炎患儿随机分为两组,观察组120例在常规治疗的基础上辅以普米克令舒联合博利康尼氧驱雾化吸入;对照组120例仅进行常规治疗.结果 观察组咳喘消失时间、肺部湿啰音消失时间和住院时间均优于对照组(P<0.05),观察组总有效率91.7%,对照组总有效率55%,两组疗效差异有统计学意义(P<0.05).结论 普米克令舒联合博利康尼治疗小儿毛细支气管炎的临床疗效确切,值得临床推广使用.%Objective To observe the effect of Pulmicort combined Bricanyl with oxygen inhalation therapy for bronchiolitis. Methods Totally 240 patients with bronchiolitis were randomly divided into two groups, 120 patients in the observation group on the basis of conventional therapy supplemented by joint Bricanyl Pulmicort inhalation of oxygen flooding; Control group, only routine treatment of 120 cases. Results The study group cough lost time, pulmonary auscultation and hospital stay were betler than that of the control group (P < 0. 05 ) , observation group the total effective rate was 91. 7% , that of the control group the total efficiency 55% , the difference between the two groups efficacy was statistically significant (P < 0. 05 ). Conclusions The combined Pulmicort and Bricanyl clinical treatment of children with bronchiolitis is effective, is worthy of clinical use.

  1. Severe Brochostenosis by Oral Propafenone Immediately After Commencing Treatment. (United States)

    Torres, Daniele; Parrinello, Gaspare; Paterna, Salvatore; Bellanca, Michele; Licata, Giuseppe


    Propafenone is a membrane-stabilizing agent belonging to a subgroup of the Vaughan Williams class I antidysrhythmic agents, structurally resembling propranolol and characterized by weaker beta-blocking activity. Despite respiratory complications having been reported as examples of side effects, very few reports have been published in the literature.We describe the case of an elderly woman with a history of hypertension and allergy to Parietaria, grass, olive, mites, and with periodic asthmatic manifestations, for whom the administration of oral propafenone for recurrent supraventricular dysrhythmia was associated with the sudden onset of severe bronchostenosis.A 78-year-old woman was frequently admitted to the Emergency Department for a recurrent supraventricular tachycardia, which was treated initially with veramapil and thereafter with ivabradin. During her last visit to the cardiologist, she was prescribed propafenone (150 mg, 3 times a day) in place of ivabradin. After the administration of the second dose on the first day of the therapy, the patient began to complain of the onset of progressively severe dyspnea at rest. In the Emergency Department, respiratory auscultation showed diffuse rhonchi, wheezing, and rales; and arterial pressure was 200/100 mm Hg. Hemogasanalysis revealed hypoxemia, respiratory acidosis with 83% of O2-saturation. Emergency treatment with O2 therapy, methylprednisolone intravenous, furosemide, and then salbutamol was also started; the electrocardiogram only showed sinusal tachycardia. Results of laboratory examinations, including a white cell count and cardiac enzymes, were within the normal range. The patient achieved good respiratory function, after a period of 3 days.This report describes that even a relatively small dose of oral propafenone after commencing treatment can have a severe effect in exacerbating the obstruction of the airways in a susceptible subject. The likely mechanisms are an allergic reaction or a direct

  2. Occurrence and clinical significance of Aelurostrongylus abstrusus and other endoparasites in Danish cats. (United States)

    Hansen, Alice P; Skarbye, Line K; Vinther, Lene M; Willesen, Jakob L; Pipper, Christian B; Olsen, Caroline S; Mejer, Helena


    associated with the infection were increased sound on auscultation of the lungs (p=0.002), increased respiratory rate (p=0.02), coughing (p=0.007) and enlarged mandibular lymph nodes (p=0.002). None of these symptoms were associated with T. cati or C. aerophila which may also affect the lungs. This supports that the symptoms may be related to A. abstrusus and that aelurostrongylosis should be considered an important differential diagnosis in any feline respiratory patient.

  3. A radial basis classifier for the automatic detection of aspiration in children with dysphagia

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    Blain Stefanie


    Full Text Available Abstract Background Silent aspiration or the inhalation of foodstuffs without overt physiological signs presents a serious health issue for children with dysphagia. To date, there are no reliable means of detecting aspiration in the home or community. An assistive technology that performs in these environments could inform caregivers of adverse events and potentially reduce the morbidity and anxiety of the feeding experience for the child and caregiver, respectively. This paper proposes a classifier for automatic classification of aspiration and swallow vibration signals non-invasively recorded on the neck of children with dysphagia. Methods Vibration signals associated with safe swallows and aspirations, both identified via videofluoroscopy, were collected from over 100 children with neurologically-based dysphagia using a single-axis accelerometer. Five potentially discriminatory mathematical features were extracted from the accelerometry signals. All possible combinations of the five features were investigated in the design of radial basis function classifiers. Performance of different classifiers was compared and the best feature sets were identified. Results Optimal feature combinations for two, three and four features resulted in statistically comparable adjusted accuracies with a radial basis classifier. In particular, the feature pairing of dispersion ratio and normality achieved an adjusted accuracy of 79.8 ± 7.3%, a sensitivity of 79.4 ± 11.7% and specificity of 80.3 ± 12.8% for aspiration detection. Addition of a third feature, namely energy, increased adjusted accuracy to 81.3 ± 8.5% but the change was not statistically significant. A closer look at normality and dispersion ratio features suggest leptokurticity and the frequency and magnitude of atypical values as distinguishing characteristics between swallows and aspirations. The achieved accuracies are 30% higher than those reported for bedside cervical auscultation. Conclusion

  4. 分析新生儿感染性肺炎的诊断与治疗%Diagnosis and treatment of neonatal infectious pneumonia

    Institute of Scientific and Technical Information of China (English)



    Objective: To analyze the characteristics of neonatal infectious pneumonia and the significance of the diagnosis and treatment.Methods:32 cases of infectious pneumonia in our hospital were selected, and the clinical symptoms, diagnosis and treatment were analyzed. Results: neonatal infection pneumonia clinical symptoms are: children with fever, elevated body tem-perature; cough, even breathing difficulties, poor children's mental state, somnolence, crying, decreased appetite; in auscultation of the lung rale. The diagnosis and treatment of the.Results: 32 cases were treated, 21 cases were cured, 7 cases were improved, 4 cases were ineffective.Conclusion:This study provides a theoretical basis for the diagnosis and treatment of neonatal infectious pneumonia.%目的:通过临床研究分析新生儿感染性肺炎的的特点以及诊断、治疗方法的显著性。方法选取我院感染性肺炎的新生儿32例,分析这些新生儿的临床症状以及诊断、治疗方法的显著性。结果新生儿感染性肺炎的临床症状主要有:患儿发热,体温升高;出现咳嗽,甚至会呼吸困难的现象;患儿的精神状态欠佳,嗜睡、哭闹;食欲明显下降;在听诊的时候肺部会有水泡音。其诊断治疗后的结果:被治疗患儿32例,治愈患儿21例,好转患儿7例,无效患儿4例。结论本次研究为以后医师对新生儿感染性肺炎的诊断治疗提供了一定的理论基础。

  5. Puente sobre el embalse de Barrios de Luna /León/España

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    López Sáiz, José Manuel


    Full Text Available The bridge Carlos Fernández Casado covers the principal arm of the reservoir of Barrios de Luna, at the height of the former bridge of San Pedro de Luna, today covered by high waters. It is a suspension bridge with 440 m of space between its towers, with lateral bays each of 65 m. In carrying out the work the following phases were contemplated: — Counterweights. — Towers. — Braces. — Lintel. — Suspension. — Construction of the board. — Auscultation and control. The bridge is articulated in the center and with free longitudinal movement in order to permit the movements produced by retraction, flow and dilatation. This situation demands the carrying out, in the center of the bay, of a cap which permits vertical gyrations and horizontal displacements along the axle of the bridge and which prevents the rest of the movements. Both the project and the construction have been directed not only toward a viable construction from the point of view of resistance but also to obtain a balanced and esthetic work for the users of the highway.El puente Carlos Fernández Casado salva el brazo principal del embalse de Barrios de Luna, a la altura del antiguo pueblo de San Pedro de Luna, hoy inundado en aguas altas. Se trata de un puente atirantado de 440 m de luz entre sus torres, con vanos laterales de 65 m cada uno. En su ejecución se han contemplado las siguientes fases: — Contrapesos. — Torres. — Riostras. — Dintel. — Tirantes. — Construcción del tablero. — Auscultación y control. El puente está articulado en el centro y con libre movimiento longitudinal para permitir los movimientos producidos por retracción, fluencia y dilatación. Esta situación exige la ejecución, en el centro del vano, de una rótula que permita giros verticales y desplazamientos horizontales a lo largo del eje del puente y que impida el resto de los movimientos. Tanto el proyecto como la construcción se han

  6. Pre-anaesthetic screening of geriatric dogs

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    K.E. Joubert


    Full Text Available Pre-anaesthetic screening has been advocated as a valuable tool for improving anaesthetic safety and determining anaesthetic risk. This study was done determine whether pre-anaesthetic screening result in cancellation of anaesthesia and the diagnosis of new clinical conditions in geriatric dogs. One hundred and one dogs older than 7 years of age provided informed owner consent were included in the study. Each dog was weighed, and its temperature, pulse and respiration recorded. An abdominal palpation, examination of the mouth, including capillary refill time and mucous membranes, auscultation, body condition and habitus was performed and assessed. A cephalic catheter was placed and blood drawn for pre-anaesthetic testing. A micro-haematocrit tube was filled and the packed cell volume determined. The blood placed was in a test tube, centrifuged and then analysed on an in-house blood analyser. Alkaline phosphatase, alanine transferase, urea, creatinine, glucose and total protein were determined. A urine sample was then obtained by cystocentesis, catheterisation or free-flow for analysis. The urine specific gravity was determined with a refractometer. A small quantity of urine was then placed on a dip stick. Any new diagnoses made during the pre-anaesthetic screening were recorded. The average age of the dogs was 10.99+2.44 years and the weight was 19.64+15.78 kg. There were 13 dogs with pre-existing medical conditions. A total of 30 new diagnoses were made on the basis of the pre-anaesthetic screening. The most common conditions were neoplasia, chronic kidney disease and Cushing's disease. Of the 30 patients with a new diagnosis, 13 did not undergo anaesthesia as result of the new diagnosis. From this study it can be concluded that screening of geriatric patients is important and that sub-clinical disease could be present in nearly 30 % of these patients. The value of screening before anaesthesia is perhaps more questionable in terms of

  7. Clinical and pathological features and imaging manifestations of extrinsic allergic alveolitis%外源性变应性肺泡炎的临床病理特征和影像学表现

    Institute of Scientific and Technical Information of China (English)

    韩锋锋; 郭雪君; 郏琴; 张悦; 王妍敏; 李惠民; 管雯斌


    Objective To study the clinical and pathological features and imaging manifestations of extrinsic allergic alveolitis (EAA). Methods 5 patients with EAA were selected in this study, and their clinical features, imaging manifestations, and pathological features were analyzed. Results The most common clinical manifestations of EAA were cough, progressive dyspnea, sputum, fever, and slight cyanosis. The main positive signs were slight cyanosis, bilateral crackles or velcro rales on chest auscultation. The primary abnormalities of pulmonary function were restriction and reduction in diffusing capacity. The most common findings on high-resolution computed tomography ( 11RCT ) were ground-glass opacities, interlobular septum thickening, centrilobular nodules and reticular or honeycombing lesions. Bronchoalveolar lavage fluid ( BALE ) showed lymphocytosis. Pathologic examination of lung biopsy specimens showed lymphocytic interstitial pneumonitis, small uncharacteristic granuloma and multinucleated giant cells surrounding the bronchioles. Corticosteroids was effective to the patients. Conclusion Clinical diagnosis of EAA can be suggested by the clinical characteristics and typical imaging features. Video-assisted thoracoscopic lung biopsy is an effective method in the diagnosis of patients with EAA.%目的 探讨外源性变应性肺泡炎(EAA)的临床病理特征和影像学表现.方法分析5例外源性变应性肺泡炎病例的临床特点、影像学表现、肺活检的病理特征.结果 EAA常见的临床表现为咳嗽、呼吸困难、咳痰、发热;主要阳性体征为轻度紫绀、肺部听诊湿啰音或Velcro啰音;肺功能检查显示限制性通气功能障碍和弥散功能障碍.HRCT表现为磨玻璃影、小叶间隔增厚、小叶中心性结节、网格影和蜂窝肺等.支气管肺泡灌洗液显示淋巴细胞增多.肺活检组织病理学示淋巴细胞性间质性肺炎,细支气管周围可见小的不典型肉芽肿和多核巨细胞.

  8. Is scar tenderness a reliable sign of scar complications in labor?

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    Isha Gutgutia


    Full Text Available Background: Cesarean section has come a long way from being a risky & restrictive surgery to one that is safe and quick. Due to a rise in the rates of primary caesarean section globally, repeat cesarean section has also become very common. The chief concern during labor with scarred uteri is that of scar rupture which can have devastating fetal and maternal consequences, including mortality. Several studies monitoring for the features of scar rupture like abnormal cardiotocography (CTG, severe abdominal pain persisting between contractions, acute onset scar tenderness, hematuria or abnormal vaginal bleeding, maternal tachycardia or shock, cessation of uterine activity and loss of station of the presenting part exist with the exception of scar tenderness which has not been evaluated separately in any study. The present prospective observational study was undertaken in a tertiary care hospital to evaluate the sensitivity and specificity of scar tenderness as a sign of scar complications in labor. Methods: 78 women with one previous cesarean delivery in spontaneous labor at term undergoing trial of scar were monitored for progress of labor and observed for vaginal bleeding, scar tenderness, maternal pulse and blood pressure every 30 minutes. Scar tenderness was elicited by pressing below and behind the pubic symphysis in between uterine contractions while engaging the woman in conversation and noting for a visible wince. Fetal heart rate auscultation was done as per protocol. Trial of scar was terminated for scar tenderness, unexplained maternal tachycardia, fresh vaginal bleeding, fetal heart rate abnormalities and non-progress of labor. Results: The sensitivity and specificity of scar tenderness as a predictor of scar complications was 92.3% and 3.8%, while accuracy was 33.3%. The likelihood ratio of a positive sign of scar tenderness being associated with scar complications in labour is 1.48. Maternal tachycardia was not a significant predictor

  9. Protective effect of a bacterial extract against acute exacerbation in patients with chronic bronchitis accompanied by chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    李靖; 郑劲平; 袁锦屏; 曾广翘; 钟南山; 林材元


    Background Immunostimulating agents made from bacterial extracts represent a class of medications that contains antigens derived from several bacterial strains and their potential ability to prevent bacterial infections results from the stimulation of the nonspecific component of the immune system. The present study investigated the effect of the oral immunostimulant Broncho-Vaxom, which includes material from eight different species of bacteria that are frequently present in the lower respiratory tract, on the frequency and severity of acute exacerbation in patients with chronic bronchitis accompanied by chronic obstructive pulmonary disease (COPD). Methods Ninety patients with chronic bronchitis complicated with COPD were randomly divided into groups A and B. Forty-nine subjects in group A received oral capsules containing 7mg Broncho-Vaxom, while 41 patients in group B received similar placebo capsules. Both groups took one capsule daily for the first 10 days of each month for 3 consecutive months. The frequency of acute exacerbation, symptom scores, and lung function were recorded for the following one year period.Results There was a significant decrease in the incidence, duration, and severity of acute exacerbation, as well as a reduction in the course of antibiotics administered and in the dosage of bronchodilator and mucolytic agent in group A, as compared to group B (P<0.05, respectively). Symptom scores for cough, sputum, dyspnea, as well as symptoms observed upon auscultation of the chest also improved significantly in group A as compared to group B (P<0.05, respectively). The bacterial clearance rate in sputum cultures from patients who received no antibiotics for the first 3 months was also significantly higher in group A compared to group B (P<0.01).Conclusions Orally administered Broncho-Vaxom is associated with a decrease in the incidence of acute exacerbation and a decrease in the need for antibiotics and symptomatic relief medications in patients

  10. Uso de mascarilla laríngea para fibrobroncoscopía en lactantes durante ventilación mecánica USE OF LARYNGEAL MASK WHILE FLEXIBLE BRONCHOSCOPY IS PERFORMED IN INFANTS UNDER MECHANICAL VENTILATION

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    Full Text Available La mascarilla laríngea (ML se utiliza para el manejo de la vía aérea en adultos y niños bajo anestesia general con el objetivo de evitar la intubación traqueal y su uso se ha extendido para fibrobroncoscopía bajo anestesia general. Durante ventilación mecánica (VM la fibrobroncoscopía (FB se limita a tubos endotraqueales (TET > 4,5 mm de diámetro ya que el fibrobroncoscopio con canal de succión más pequeño es de 3,5 mm. Nuestro objetivo fue evaluar la utilidad de la ML para FB en niños sometidos a VM con TET Laryngeal mask (LM has been used to manage airways during general anesthesia, in both children and adults, to avoid tracheal intubation. Lately its use has been extended to perform flexible bronchoscopy (FB. In an infant under mechanical ventilation (MV, most of FB require an endotracheal tube # 4.5 because the smallest instrument with a suction channel has a 3.5 mm diameter. Our objective was to evaluate the use of LM while performing FB in patients on MV. Patients were sedated (atropine- midazolam and vecuronium, and monitored with transcutaneous oxygen saturation and cardiorespiratory monitor in an Intensive Care Unit setup. LM was introduced, and its position was verified by clinical auscultation. FB Olympus BF C-30, with 3.5 mm diameter was used. From December 1997 to October 1998 eleven procedures were done in 6 patients. Their mean age was 6.2 months (range: 0.5-33, weight 4.9 kg (2.7-10.5. MV parameters were FiO2 0.45 (0.4-1, MIP 28.4 cm H2O (20-60 and PEEP 5,18 cm H2O (3-8. In all patients we used LM # 1.0, with an internal diameter 5.25 mm. Indications for FB were: atelectasis (6, tracheobronchomalacia (2, hemoptisis (2 and subglotic stenosis (1. LM was introduced during the first attempt in 9 procedures, without complications. We maintained positive pressure ventilation without displacements of LM. After the FB, the patients were reintubated, with similar parameters compared to prior procedure. To sum up, we found

  11. Poor consistency in evaluating South African adults with neurogenic dysphagia

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    Mckinley Andrews


    Full Text Available Background: Speech-language therapists are specifically trained in clinically evaluating swallowing in adults with acute stroke. Incidence of dysphagia following acute stroke is high in South Africa, and health implications can be fatal, making optimal management of this patient population crucial. However, despite training and guidelines for best practice in clinically evaluating swallowing in adults with acute stroke, there are low levels of consistency in these practice patterns.Objective: The aim was to explore the clinical practice activities of speech-language therapists in the clinical evaluation of swallowing in adults with acute stroke. Practice activities reviewed included the use and consistency of clinical components and resources utilised. Clinical components were the individual elements evaluated in the clinical evaluation of swallowing (e.g. lip seal, vocal quality, etc.Methods: The questionnaire used in the study was replicated and adapted from a study increasing content- and criterion-related validity. A narrative literature review determined what practice patterns existed in the clinical evaluation of swallowing in adults. A pilot study was conducted to increase validity and reliability. Purposive sampling was used by sending a self-administered, electronic questionnaire to members of the South African Speech-Language-Hearing Association. Thirty-eight participants took part in the study. Descriptive statistics were used to analyse the data and the small qualitative component was subjected to textual analysis.Results: There was high frequency of use of 41% of the clinical components in more than 90% of participants (n = 38. Less than 50% of participants frequently assessed sensory function and gag reflex and used pulse oximetry, cervical auscultation and indirect laryngoscopy. Approximately a third of participants showed high (30.8%, moderate (35.9% and poor (33.3% consistency of practice each. Nurses, food and liquids and

  12. Transient receptor potential vanilloid type-1 (TRPV-1) channels contribute to cutaneous thermal hyperaemia in humans. (United States)

    Wong, Brett J; Fieger, Sarah M


    The initial, rapid increase in skin blood flow in response to direct application of heat is thought to be mediated by an axon reflex, which is dependent on intact cutaneous sensory nerves. We tested the hypothesis that inhibition of transient receptor potential vanilloid type 1 (TRPV-1) channels, which are putative channels located on sensory nerves, would attenuate the skin blood flow response to local heating in humans. Ten subjects were equipped with four microdialysis fibres which were randomly assigned one of four treatments: (1) vehicle control (90% propylene glycol + 10% lactated Ringer solution); (2) 20 mm capsazepine to inhibit TRPV-1 channels; (3) 10 mm l-NAME to inhibit NO synthase; and (4) combined 20 mm capsazepine + 10 mm l-NAME. Following baseline measurements, the temperature of skin heaters was increased from 33°C to 42°C at a rate of 1.0°C every 10 s and local temperature was held at 42°C for 20-30 min until a stable plateau in skin blood flow was achieved. An index of skin blood flow was measured directly over each microdialysis site via laser-Doppler flowmetry (LDF). Beat-by-beat blood pressure was measured via photoplethysmography and verified via automated brachial auscultation. At the end of the local heating protocol, temperature of the heaters was increased to 43°C and 28 mm nitroprusside was infused to achieve maximal vasodilatation. Cutaneous vascular conductance (CVC) was calculated as LDF/mean arterial pressure and normalized to maximal values (%CVCmax). Initial peak in capsazepine (44 ± 4%CVCmax), l-NAME (56 ± 4%CVCmax) and capsazepine + l-NAME (32 ± 6%CVCmax) sites was significantly attenuated compared to control (87 ± 5%CVCmax; P thermal hyperaemia was significantly attenuated in capsazepine (73 ± 6%CVCmax), l-NAME (47 ± 5%CVCmax) and capsazepine + l-NAME (31 ± 7%CVCmax) sites compared to control (92 ± 5%CVCmax; P thermal hyperaemia. These data further suggest a portion of the NO component of thermal hyperaemia may be

  13. High Intensity Interval- vs Moderate Intensity- Training for Improving Cardiometabolic Health in Overweight or Obese Males: A Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Gordon Fisher

    Full Text Available To compare the effects of six weeks of high intensity interval training (HIIT vs continuous moderate intensity training (MIT for improving body composition, insulin sensitivity (SI, blood pressure, blood lipids, and cardiovascular fitness in a cohort of sedentary overweight or obese young men. We hypothesized that HIIT would result in similar improvements in body composition, cardiovascular fitness, blood lipids, and SI as compared to the MIT group, despite requiring only one hour of activity per week compared to five hours per week for the MIT group.28 sedentary overweight or obese men (age, 20 ± 1.5 years, body mass index 29.5 ± 3.3 kg/m2 participated in a six week exercise treatment. Participants were randomly assigned to HIIT or MIT and evaluated at baseline and post-training. DXA was used to assess body composition, graded treadmill exercise test to measure cardiovascular fitness, oral glucose tolerance to measure SI, nuclear magnetic resonance spectroscopy to assess lipoprotein particles, and automatic auscultation to measure blood pressure.A greater improvement in VO2peak was observed in MIT compared to HIIT (11.1% vs 2.83%, P = 0.0185 in the complete-case analysis. No differences were seen in the intention to treat analysis, and no other group differences were observed. Both exercise conditions were associated with temporal improvements in % body fat, total cholesterol, medium VLDL, medium HDL, triglycerides, SI, and VO2peak (P < 0.05.Participation in HIIT or MIT exercise training displayed: 1 improved SI, 2 reduced blood lipids, 3 decreased % body fat, and 4 improved cardiovascular fitness. While both exercise groups led to similar improvements for most cardiometabolic risk factors assessed, MIT led to a greater improvement in overall cardiovascular fitness. Overall, these observations suggest that a relatively short duration of either HIIT or MIT training may improve cardiometabolic risk factors in previously sedentary overweight or

  14. Integrating wireless sensor network for monitoring subsidence phenomena (United States)

    Marturià, Jordi; Lopez, Ferran; Gigli, Giovanni; Intrieri, Emanuele; Mucchi, Lorenzo; Fornaciai, Alessandro


    An innovative wireless sensor network (WSN) for the 3D superficial monitoring of deformations (such as landslides and subsidence) is being developed in the frame of the Wi-GIM project (Wireless sensor network for Ground Instability Monitoring - LIFE12 ENV/IT/001033). The surface movement is detected acquiring the position (x, y and z) by integrating large bandwidth technology able to detect the 3D coordinates of the sensor with a sub-meter error, with continuous wave radar, which allows decreasing the error down to sub-cm. The Estació neighborhood in Sallent is located over the old potassium mine Enrique. This zone has been affected by a subsidence process over more than twenty years. The implementation of a wide network for ground auscultation has allowed monitoring the process of subsidence since 1997. This network consists of: i) a high-precision topographic leveling network to control the subsidence in surface; ii) a rod extensometers network to monitor subsurface deformation; iii) an automatic Leica TCA Total Station to monitor building movements; iv) an inclinometers network to measure the horizontal displacements on subsurface and v) a piezometer to measure the water level. Those networks were implemented within an alert system for an organized an efficient response of the civil protection authorities in case of an emergency. On 23rd December 2008, an acceleration of subsoil movements (of approx. 12-18 cm/year) provoked the activation of the emergency plan by the Catalan Civil Protection. This implied the preventive and scheduled evacuation of the neighbours (January 2009) located in the area with a higher risk of collapse: around 120 residents of 43 homes. As a consequence, the administration implemented a compensation plan for the evacuation of the whole neighbourhood residents and the demolition of 405 properties. In this work, the adaptation and integration process of Wi-GIM system with those conventional monitoring network are presented for its testing

  15. 人造机械瓣心音的分析研究%Analysis of Heart Sounds with Artificial Mechanical Prosthetic Heart Valves

    Institute of Scientific and Technical Information of China (English)

    张地; 姚尖平; 杜明辉; 杨嵩


    在一些致命性心脏病的诊断中,心音听诊是最有效也是应用得最成功的手段之一.鉴于目前机械瓣的使用非常普遍,研究简单有效的机械瓣病变判别方法对于临床诊断来讲具有重要意义.运用希尔波特-黄变换(HHT),针对不同的机械瓣心音进行分析,并设计一种基于Hilbert边界谱特征的提取方法,结合线性判别分析(LDA),对不同的机械瓣心音进行分类.同时,与基于局部最优基特征的分类器分类结果进行比较.分析结果表明,机械瓣心音的各阶Hilbert边界谱具有非常明显不同的分布,基于HHT的分类器识别率达到了97.3%,较基于局部最优基特征分类器的识别率(91.3%)更高.对于人造机械瓣心音而言,HHT是一种有效的分析处理手段.%Auscultation is a widely used efficient technique by cardiologists for detecting some deadly heart diseases. Since the mechanical prosthetic heart valves are widely used today, it is important to develop a simple and efficient method to detect abnormal mechanical valves. In this paper, Hilbert-Huang transform ( HHT) was applied to analyze the heart sounds with different kinds of mechanical prosthetic valves. A Hilbert marginal spectral based feature extraction procedure was also developed. Combined with linear discriminant analysis ( LDA) , the extracted features were used to classify different kinds of heart sounds for mechanical prosthetic heart valves. Experimental results showed that the spectrum of different heart sounds were significantly different. The proposed classifier achieved a recognition rate of 97. 3% , higher than the one based on local discriminant bases (91. 3% ). It is demonstrated that HHT is an efficient analyzing technique for artificial heart valve sounds.

  16. Clinical training in medical students during preclinical years in the skill lab

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    Upadhayay N


    vein, auscultation of heart sounds, and endotracheal intubation.Conclusion: Students are confident and showed better exam performance after basic clinical skills training in the lab. They perceived skill lab training as a better teaching method for the preclinical students. Keywords: skill lab, preclinical years, practical examination, innovative learning  

  17. [Wood chip alveolitis]. (United States)

    Müller-Wening, D; Renck, T; Neuhauss, M


    A 52 year old farmer was referred to us for investigation of suspected farmer's lung. For many years the farmer had been exposed to hay, straw, pigeons, and fuel chip dust. Under exertion he suffered from shortness of breath. In the farmer's own fuel chips we could identify Aspergillus fumigatus, Paecilomyces species and Mucor species. In the farmer's blood we found IgG-antibodies against his own fuel chips, thermophilic actinomycetes, Penicillium species, Mucor species and Aspergillus fumigatus. We did not detect any IgG-antibodies against pigeon serum or pigeon faeces. In order to determine the responsible allergen we performed two challenge tests. In the first test the farmer had to inhale his own hay and straw dust for one hour. This provocation was negative. A second one-hour inhalative challenge was carried out 16 days later using his own fuel chips. This time he experienced significant pulmonary and systemic reactions: body temperature rose by 3.3 degrees C, leucocytes by 12,200/mm3; PO2 fell by 39.4 mmHg, vital capacity by 52%, DLCO by 36%. After the challenge the farmer complained of coughing and dyspnoea. Rales could be heard on auscultation, and an interstitial infiltrate was seen to develop on chest x-rays. After the challenge the patient had to be treated with oxygen and systemic corticosteroids. We diagnosed a fuel chip-induced exogenous allergic alveolitis (EAA). Eight days later the parameters were back to normal and the farmer was discharged from our hospital with further corticosteroid medication. This method of inhalative provocation is very important in diagnosing an EAA. Problems arise when the mode and duration of exposure to substances has to be chosen. Because of the risk of severe reactions, inhalative provocations relating to EAAs should only be performed in special centres with an intensive care unit. In this paper we present a diagnosis of fuel chip lung, which is rarely seen in Germany. However, with the rising use of fuel chips as

  18. 膈肌起搏下体位引流在颈髓损伤气管切开患者中的应用%Application of external diaphragm pacemaker with postural drainage treatment for cervical spinal cord injury patients with tracheotomy

    Institute of Scientific and Technical Information of China (English)

    付金英; 章微微; 李学军; 王元姣


    the regular treatment , were given external diaphragm pacemaker with postural drainage treatment .All the patients were treated for four weeks .The pulmonary ventilation function , lung auscultation, ability of expectoration and self-sensation were analyzed before and after treatment within each group.Results The pulmonary ventilation function of SpO2, respiratory rate, PaO2, and PaCO2 were (96.72 ± 1.89)%, (16.48 ±0.62) per min, (85.15 ±0.43)mmHg and (39.65 ±0.41)mmHg, respectively, in the research group, and (93.83 ±2.11)%, (22.05 ±0.59) per min, (74.80 ±0.29) mmHg and (33.11 ± 0.45)mmHg, respectively, in the control group, and the differences were statistically significant ( t =6.57, 3.45, 9.69, 4.67, respectively;P<0.05).The grades of lung auscultation and ability of expectoration in the research group were (2.74 ±0.27) and (2.67 ±0.32), which were significantly higher than those of control group [(2.22 ±0.33) and (2.15 ±0.41)], with significant differences (t=8.78,13.56,respectively; P<0.01).The improvement of the self-sensation in the research group was better than that in the control group (χ2 =8.86, P<0.05).Conclusions The external diaphragm pacemaker with postural drainage treatment has obvious better effect for the cervical spinal cord injury patients with tracheotomy , and it is worthy of generalizing .

  19. Análise dos sintomas, sinais clínicos e suporte de oxigênio em pacientes com bronquiolite antes e após fisioterapia respiratória durante a internação hospitalar Análisis de los síntomas, señales clínicas y soporte de oxígeno en pacientes con bronquiolitis antes y después de fisioterapia respiratoria durante la internación hospitalar Analysis of symptoms, clinical signs and oxygen support in patients with bronchiolitis before and after chest physiotherapy during hospitalization

    Directory of Open Access Journals (Sweden)

    Giselle de Castro


    , clapping, vibración, aceleración de flujo espiratorio y aspiración nasotraqueal. La evaluación fue realizada diariamente mediante examen físico antes de la atención fisioterapéutica y 15 a 45 minutos después, siguiendo una ficha específica. Los desenlaces analizados fueron: modificaciones del soporte de oxígeno, señales clínicas (ausculta pulmonar, presencia de tirajes, oxigenación y clasificación de la gravedad por el Escore de Downes y síntomas (inapetencia, hipoactividad, dificultad en dormir, obstrucción nasal y tos constante. RESULTADOS: De los 29 pacientes evaluados, hubo mejora significativa en los signos y síntomas a continuación: ausculta pulmonar con ruidos adventicios (pOBJECTIVE: To evaluate the effects of chest physiotherapy in hospitalized patients with bronchiolitis. METHODS: The study included 29 patients younger than one year, diagnosed with acute bronchiolitis, without uncorrected congenital heart disease, neuropathy, lung pathology or need of mechanical ventilation, from March to July 2009. The opinion of the parents or guardians was evaluated using a questionnaire about the clinical condition of the patient before and after the first session of chest physiotherapy. Airway clearance techniques, such as postural drainage, manual percussion, vibration, acceleration of expiratory flow and tracheal suction were applied. The evaluation was performed daily by physical examination prior to physiotherapy and 15 to 45 minutes later, following a specific form. The outcomes observed were: changes of oxygen support, clinical signs (pulmonary auscultation, presence of retractions, oxygenation and severity classification by Downes score and symptoms (difficulty in sleeping and in feeding, decreased activities, nasal obstruction and constant cough. RESULTS: Among the 29 patients evaluated, a significant improvement was noticed in the following signs and symptoms: pulmonary auscultation with adventitious sounds - general (p<0.001, rales (p=0.017 and

  20. Avaliação da função respiratória do recém-nascido no período neonatal imediato Evaluación de la función respiratória del recien-nacido en el periodo neonatal inmediato Assessment of the newborn respiratory function in the immediate neonatal period

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    Amélia Fumiko Kimura


    predictive factors and the signals of transient tachypnea of the newborn valued by the nurses who work at neonatal ward and rooming-in when they assess the newborn respiratory function during the immediate neonatal period in the first six hours after birth. A cross sectional study carried out at two public hospitals of São Paulo city. The sample consisted of 28 nurses who replied a structured questionnaire about the newborn respiratory function assessment practices. Data showed they valuated to know the evaluation of labor, delivery and Apgar score when they evaluate the newborn respiratory function. About the signals of respiratory distress they valued to evaluate the respiratory rate and auscultation, evaluation of the respiratory distress using the Silverman-Andersen Index besides, the neonatal nurses valued to evaluate de oxygen saturation.

  1. 细支气管肺泡细胞癌文献复习%Document review of bronchioalveolar carcinoma

    Institute of Scientific and Technical Information of China (English)

    李建东; 郝淑玲


    Objective To promote the recognition of manifestation and imaging variety of bronchioalveolar carcinoma. Methods The clinical date of 1 patient with bronchioalveolar carcinoma in July 2012 were retrospective-ly analyzed and reviewed. Results A patient hospitalized on July 26, 2012, because of fever, cough and sputum for 1 month, and dyspnea for 1 week. Velcro rale was auscultated in both lungs. Chest CT showed small nodules, diffuse opacity, consolidation shadows and air bronchogram in both lungs. Blood gas analysis showed typeⅠrespiratory fail-ure. The patient was given methylprednisolone sodium succinate for injection and BiPAP noninvasive ventilation. The patient's dyspnea alleviated, and type Ⅰ respiratory failure was corrected. Latterly, pulmonary lesion was diagnosed as bronchioalveolar carcinoma by CT-guide percutaneous lung biopsy. Exon 21 mutation of EGFR was detected in bi-opsy specimen. The patient was treated with chemotherapy, but the curative effect was not satisfying. The patient took gefitinib (250mg) every day, and her breath shortness and lung velcro rale disappeared and pulmonary lesion turned better. Conclusion Because of no specific clinical manifestation and verity of chest CT scanning, bronchio-alveolar carcinoma can be misdiagnosed easily, the recognition for bronchioalveolar carcinoma should be promoted. Percutaneous lung biopsy and sputum cell pathological examination are more valuable in the diagnosis of bronchioalve-olar carcinoma.%目的:提高对细支气管肺泡癌临床表现及影像学多样性的认识。方法分析2012年7月收治的1例细支气管肺泡癌患者的临床资料及诊治经过,文献复习。结果因发热、咳嗽、咳痰1月,呼吸困难1周于2012-7-26住院。肺部可闻及velcro啰音,胸部CT为双肺散在分布的小结节,斑片模糊影,可见充气支气管征,血气分析为Ⅰ型呼吸衰竭,经甲强龙及无创呼吸机治疗,患者呼吸困难明显减轻,呼衰减

  2. 催眠镇痛肌松下选择性患侧肺控压吹张治疗术后顽固性肺不张的疗效%Effect of bronchial intubation for constant-pressure expanding ipsilateral lung on postoperatively intractable atelectasis in hypo-analgesia and muscle relaxation

    Institute of Scientific and Technical Information of China (English)

    陆雅萍; 方向明; 胡奕; 黄冰; 孙建良; 施谷平


    Objective To investigate the effect of bronchial intubation for constant-pressure expanding ipsilateral lung on postoperative intractable atelectasis. Methods For this prospective study, we recruited 18 patients with pulmonary atelectasis who could not been relieved by bronchoscopic suctioning,closed thoracic drainage, backslap, blowing hall and other routine treatments for over a week. After bronchial intubation, ipsilateral lung was expanded with a constant pressure. And the therapeutic effect was evaluated by chest radiographic examination and auscultation at the following day. Results Collapsed lung tissue were examined in 15 patients (83.3%) after the first treatment and in 2 patients ( 11. 1% ) after twice inflation. And another case failed even after three times treatment. During the procedure, the vital signs of all patients were stable and no complication occurred. Conclusion Constant-pressure expanding of ipsilateral lung during bronchial intubation is a safe and effective treatment for postoperative intractable atelectasis.%目的 探讨选择性患侧肺支气管插管控压吹张治疗术后顽固性肺不张的临床效果.方法 将嘉兴市第一医院2005年1月至2010年5月18例接受纤维支气管镜吸痰、胸腔闭式负压引流、拍背、吹气球等常规综合治疗7 d仍不能使患肺复张者在催眠镇痛术下行支气管插管选择性患侧肺控压吹张治疗,由胸部听诊及次日胸部X线片评判疗效.结果 术后第2天复查X线胸片,15例患者(83.3%)萎陷肺已全部复张,3例患者萎陷侧肺复张不完全,经第2次控压膨肺治疗后2例复张成功(11.1%,总有效率94.4%),另1例患者经3次膨肺治疗仍无效(5.6%).期间患者生命体征稳定,无插管损伤及其他并发症发生.结论 在催眠镇痛肌松下由纤维支气管镜引导选择性支气管插管控压吹张治疗术后顽固性肺不张是切实可行的.

  3. Measurement and treatment of elevated blood pressure in the pediatric patient with chronic kidney disease. (United States)

    Swinford, Rita D; Portman, Ronald J


    measurement, self-measured BP, and ambulatory BP monitoring. The recommendation for BP measurement in children is, when permitted, by auscultative method with a well-calibrated mercury manometer. Most casual BP measurements are performed with an automated oscillometric device whose validation has not been confirmed in children with CKD. The ambulatory BP monitor (ABPM) has 2 advantages: it significantly correlates with the presence of end-organ damage, and it identifies abnormal BP patterns that are frequently present in CKD patients, such as hypertension during the sleep period. An abnormal ABPM pattern can also be predictive of the development of end-organ damage. Treatment of hypertension in children, with and without CKD, is based on 3 factors: degree of BP elevation, the presence of cardiovascular risk factors, and the presence of end-organ damage. Additionally, the initial antihypertensive agent may be selected on available and age-appropriate formulations (eg, suspension and dosage selection). A physician treating a hypertensive child with CKD faces multiple challenges. They include selecting the convenience of available automated devices and the ABPM versus traditional auscultatory techniques upon which all normative standards have been based. Current research initiatives propose to develop pharmacokinetic and pharmacodynamics properties of antihypertensive medications and to study the effect of early intervention on end-organ damage.

  4. 急性脑损伤继发神经源性肺水肿%Neurogenic pulmonary edema secondary to acute central nervous system injury

    Institute of Scientific and Technical Information of China (English)

    梁锦泉; 冯子泽


    Objective To explore the pathogenesis and summarize the clinical characteristic and treatment experience of neurogenic pulmonary edema (NPE) secondary to acute central nervous system injury. Methods The data of 18 cases of NPE were retrospectively analyzed by reviewing medical literature. Results The age ranged from 19 to 69. The patients became acutely dyspneic, tachypneic and hypoxic following neurologic injury. Pink, frothy sputum was seen and bilateral crackles and rales were appreciated on auscultation. Chest X-ray or CT revealed diffuse bilateral pulmonary infiltrates. Eventually, they were cured by mechanical ventilation and other combined treatment. According to glasgow prognosis score, 13 cases of them got good recovery, 3 cases got moderate disability, 2 cases got severe disability. Conclusion NPE is characterized by the development of respiratory failure soon after neurologic injury. The primary therapy is to control the development of the damage to central nervous system, break the vicious circle, and apply mechanical ventilation, vascular active drugs and sedatives. After weaning, sputum suction via fiberoptic bronchoscopy shall be administered until the symptoms are relieved.%目的探讨脑损伤继发神经源性肺水肿的发病机制,总结其临床特点和救治经验。方法整理近年来18例急性脑损伤继发神经源性肺水肿病例的临床资料,并结合文献分析。结果患者19~69岁,均在急性脑损伤后出现呼吸困难,咳粉红色泡沫痰,血氧饱和度下降,双肺满布湿啰音,胸部CT/DR提示双肺弥漫性渗出性病变,最终经机械通气等综合处理后治愈。根据格拉斯哥预后评分(glasgow prognosis score,GOS),恢复良好(5分)13例,轻残(4分)3例,重残(3分)2例。结论急性脑损伤继发神经源性肺水肿的临床特点是均有急性脑损害的基础,短期内出现呼吸衰竭,基本救治方法是控制脑损伤的进展,打断

  5. Percepção de sabores em pacientes com acidente vascular encefálico Taste perception in stroke patients

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    Leda Maria Tavares Alves


    Full Text Available OBJETIVO: avaliar a percepção dos sabores amargo, azedo, doce e neutro. MÉTODO: foram estudados 36 pacientes com Acidente Vascular Encefálico (AVE (5 hemorrágicos e 31 isquêmicos e 30 sujeitos controles. Foi realizada avaliação fonoaudiológica estrutural e funcional incluindo postura, vedamento labial, presença de resíduos, tosse, engasgo, e ausculta cervical. Cada sujeito deglutiu em sequência aleatória 5 mL de líquido com os 4 sabores [chá de boldo (amargo, suco de limão diluído (azedo, sacarose diluída (doce e água (neutro] na temperatura ambiente. Entre as deglutições os participantes eram questionados sobre a dificuldade em deglutir e qual o sabor do líquido daquela deglutição. RESULTADOS: entre os pacientes houve maior freqüência de erros na identificação dos sabores amargo (controles: 16,7%, AVE: 47,3%, p=0,01 e azedo (controles: 6,7%, AVE: 27,8%, p=0,05, sem diferenças para o sabores neutro (controles: 10,0%, AVE: 16,7%, p=0,50 e doce (controles: 13,3%, AVE: 16,7%, p=0,80. Os pacientes com AVE tiveram maior dificuldade para deglutir os líquidos do que os controles (pPURPOSE: to assess the perception of bitter, sour, sweet and neutral flavors in stroke patients. METHOD: we studied 36 patients with stroke (5 hemorrhagic and 31 ischemic and had a 30 subjects' control group. W performed a structural and functional oral and pharyngeal evaluation including posture, lip sealing, presence of residues, cough, choking, and cervical auscultation. Five ml of fluids with the 4 flavors ["boldus" tea (bitter, diluted lemon juice (sour, diluted sucrose (sweet, and water (neutral] were offered in random sequence under room temperature. Participants were questioned, between swallows, on the difficulty in swallowing and which flavor they had just swallowed. RESULTS: patients with stroke had greater difficulty in swallowing the fluids than control group (p<0.04. Patients made more mistakes in identifying bitter (control: 16

  6. Postoperative diaphragmatic paralysis after cardiac surgery in children: incidence, diagnosis and surgical management

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yan-bo; WANG Xu; LI Shou-jun; YANG Ke-ming; SHENG Xiang-dong; YAN Jun


    Background Cardiac surgery for congenital heart disease covers a wide spectrum from simple to complex cardiac and extracardiac malformations.Innovations in pediatric cardiac surgery and perioperative care over the past decades have allowed surgical correction or at least palliation in almost all complex congenital heart defects in the first years of life.Diaphragmatic paralysis (DP) due to phrenic nerve injury after congenital cardiac surgery is an important respiratory complication resulting with respiratory insufficiency,lung infections,prolonged hospital stay time and even death.Methods Between April 2001 and December 2010,among patients undergoing cardiac surgery for congenital heart disease,postoperative DP was diagnosed in 47/10 200 (0.46%) patients.Diaphragmatic placation was performed in 37/47 patients.DP was suspected in children who failed to wean from mechanical ventilation or in those with persistent respiratory distress when there is no cardiac cause.Decreased respiratory sounds in auscultation,paradoxical breathing during spontaneous ventilation and elevated hemidiaphragm on chest X-ray led us to use fluoroscopy,ultrasound and/or electromyogram (EMG).When chest X-rays did not have a diagnostic value in patients with persistent respiratory distress,bilateral DP was suspected and immediate fluoroscopy of EMG was performed for diagnosis.In all patients,diaphragmatic placation was performed using a thoracic approach,through the sixth or seventh intercostals space with lateral thoracotomy.Results A total of 47 patients (21 females and 26 males) with a median age of 7.21 months (range 0.27-71 months) were diagnosed DP after cardiac surgery.The incidence of DP was 0.46% after cardiac surgery.The paralysed hemidiaphragm was left side in 26/47 (55.3%),right side in 17/47 (36.2%) and bilateral in 4/47 (8.5%) cases.The assisted ventilation time after cardiac surgery was (450±216) (116-856) hours.The median time from cardiac surgery to surgical

  7. Influência do tratamento ortodôntico-cirúrgico nos sinais e sintomas de disfunção temporomandibular em indivíduos com deformidades dentofaciais Influence of orthodontic-surgical treatment on signs and symptoms of temporomandibular dysfunction in subjects with dentofacial deformities

    Directory of Open Access Journals (Sweden)

    Marcela Maria Alves da Silva


    patients presented at least one sign or symptom of temporomandibular dysfunction, verified through interview and clinical evaluation carried out before and after 30 to 60 days of the orthognathic surgery. The final evaluation investigated the presence of pain on palpation of masticatory and cervical muscles, and temporomandibular joint pain; auscultation of the temporomandibular joints was performed, and jaw movements were measured. RESULTS: All symptoms investigated in the interview decreased after the orthognathic surgery. Regarding mandibular movements, there was a significant decrease in postoperative mandibular opening, and little variation was observed in measures of lateral excursions. It was also noticed a decrease of pain in cervical muscles. CONCLUSION: The orthodontic-surgical treatment resulted in short term decrease of the investigated symptoms and clinical signs of pain in cervical muscles, and reduction of mandibular opening in patients with dentofacial deformities.Clinical trials register: 083578.

  8. Elaboração e aplicação de um instrumento de avaliação no pós-operatório imediato com base no protocolo do Advanced Trauma Life Suport Elaboración y aplicación de un instrumento de evaluación en el post operatorio inmediato con base en el protocolo del Advanced Trauma Life Suport Elaboration and application of an evaluation instrument in the immediate postoperative period, based on the Advanced Trauma Life Support protocol

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    Marisa Dias Von Atzingen


    Trauma permitió identificar las principales alteraciones fisiológicas en el POI contribuyendo, por tanto, a la asistencia de enfermería.OBJECTIVE: Elaborating and applying a patient evaluation instrument in the immediate postoperative period (IPOP after general anesthesia, based on the Advanced Trauma Life Support protocol. METHODS: An instrument was created, based on the Trauma ABCDE and applied in the post-anesthetic recovery room in all adult patients submitted to surgeries under the effect of general anesthesia, from September to November, 2007. RESULTS: 93.5% of the patients were observed to have pervious airways; however, 92.2% of them needed oxygen supplementation. There were alterations in pulmonary auscultation in 15.6% of the patients, hypotension in 16.9% and hypothermia in 23.4%. A statistically significant difference was also observed, suggesting that women have better recovery conditions than men. CONCLUSION: The physical exam in the sequence proposed by the Trauma ABCDE allowed for the identification of the main physiological alterations in the IPOP, contributing for nursing care.

  9. Influence of Nursing Intervention and Pain on the Childbirth Process%分娩过程中心理干预及疼痛护理对产程进展的影响

    Institute of Scientific and Technical Information of China (English)

    张秀欣; 王红霞


    目的:探析分娩过程中心理干预及疼痛护理对产程进展的影响。方法:选取本院2013年1月-2014年1月收治的84例临产妇,均为产道正常、头位、单胎、足月初产妇。按照随机数字表法分为观察组、对照组,每组42例。观察组进行个体化心理护理及疼痛护理,对照组进行定期听诊胎心、产前会阴备皮、生命体征的监测、产程监护、无菌操作等常规护理,比较两组的产时疼痛、分娩方式、新生儿窒息、产程时间等情况。结果:观察组的产时疼痛程度显著低于对照组,差异有统计学意义(P<0.05);观察组的潜伏期,活跃期,第一、二、三产程时间显著低于对照组,差异有统计学意义(P<0.05);观察组剖宫产、产钳助产、新生儿窒息情况显著低于对照组,差异有统计学意义(P<0.05)。结论:对临产妇进行心理干预及疼痛护理,可有效缩短产程,降低新生儿窒息率及剖宫产率,临床效果确切,值得临床推广。%Objective:To explore the impact of the process of delivery center nursing intervention and pain on the birth process. Method:84 cases of parturient were selected in our hospital from January 2013 to January 2014,whose the birth canal were normal,head position,singleton,term primiparae.They were randomly divided into observation group, control group,42 cases in each group.The observation group of individualized psychological nursing and nursing of pain, the control group were regularly auscultation of fetal heart,prenatal perineal skin preparation,vital sign monitoring, process monitoring,sterile operation routine nursing care,pain,mode of delivery,neonatal asphyxia,labor and time between two groups at birth.Result:The group of intrapartum pain was significantly lower than the control group,the difference was statistically significant(P<0.05).Observation group incubation period,active period,the first and the two or three

  10. Clinical features and prognostic factors of peripartum cardiomyopathy%围生期心肌病临床特征及预后因素研究

    Institute of Scientific and Technical Information of China (English)

    肖宁; 王园; 徐明付


    Objective To investigate clinical features and prognostic factors of peripartum cardiomyopathy. Methods Clinical data of 50 cases of peripartum cardiomyopathy in our hospital from June 2010 to November 2012 were reviewed .Its clinical features and prognostic factors were analysed. Results 50 cases of peripartum cardiomyopathy in the presence of two or more clinical symptoms , the main symptoms include palpitations , fatigue, orthopnea , cough, heart rate, heart community to expand , weakened heart sounds , lung auscultation and so on. Second pregnancy , twins pregnancy incidence and within 2 months postpartum signiifcantly higher incidence of perinatal other time periods ( P <0.05 ).After treatment, 43 cases cured , 5 cases left with symptoms of heart failure , 2 patients died of heart failure. Conclusion Peripartum cardiomyopathy occurs with the patient's own gestational age, parity and inferior products is closely related to its long-term prognostic factors , including left ventricular size and the recovery of left ventricular ejection fraction , left ventricular ejection prognosis factors include score and left ventricular end-diastolic diameter ..%目的:总结和分析围生期心肌病的临床特征以及影响预后的相关因素。方法选择2010年6月至2012年11月期间我院收治的50例围生期合并心肌病患者为研究对象,回顾分析其临床资料,总结分析其临床特征及相关影响预后因素。结果50例围生期心肌病患者中多数存在两种或两种以上临床症状,主要症状包括心悸、乏力、端坐呼吸、咳嗽、心率加快、心界扩大、心音减弱、肺部湿啰音等。第二胎妊娠、双胎妊娠者发病率高于其他人群,产后2个月内发病率明显高于围生期其他时间段,且差异具有统计学意义(P<0.05);经治疗后43例痊愈出院,5例遗留有心衰症状,2例心衰死亡。结论围生期心肌病的发生与患者自身妊娠年龄、胎次

  11. Assessing the teaching of nursing physical examination in the context of pediatric semiology Evaluando el aprendizaje del examen físico de enfermería en el contexto de la semiología pediátrica Avaliando a aprendizagem do exame físico de enfermegem no contexto da semiologia pediátrica

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    Marisa Rufino Ferreira Luizari


    Full Text Available OBJECTIVES: To assess how nursing students perform the physical examination of children regarding the use of instruments, the sequence of the procedures and the interaction with patients, and identify the phases of motivation and performance in the learning of this exam. METHODS: This is a descriptive study, using forms and observing students attending the course 'Semiology and sign and symptom interpretation' in a nursing undergraduate program in Campo Grande, Mato Grosso do Sul State, Brazil. RESULTS: Most students felt motivated to perform the exam and interacted with the child under examination. By assessing student performance, it was possible to identify the difficulties they face using techniques to collecting data on anthropometric measurements, vital signs, auscultation, palpation, percussion, and inspection. CONCLUSION: The evaluation instrument was considered effective in allowing students to identify the features distinguishing normal from abnormal patterns in children.OBJETIVOS: Verificar cómo realizan los alumnos de enfermería el examen físico en cuanto a la utilización del material, la secuencia y la interacción con el niño, y analizar las fases de la motivación y del desempeño en el aprendizaje de ese examen. MÉTODOS: Se trata de um estudio descriptivo realizado por medio de la observación y de la aplicación de formularios a los alumnos de la disciplina 'Semiología y semiotécnica' en una institución de Campo Grande, MS. RESULTADOS: La mayoría de los alumnos se mostró motivado y mantuvo interacción con el niño. La evaluación del desempeño permitió identificar las dificultades encontradas por los alumnos en la realización de las técnicas de recolección de datos antropométricos, signos vitales, auscultación, palpación, percusión e inspección. CONCLUSIÓN: El instrumento de evaluación física se mostró eficaz para que el alumno identifique las características de los patrones normal y anormal en el ni

  12. The Clinical Observation of Air Current Signs in Endotracheal Intubation through Mouth%经口明视气管内插管气流征象临床观察

    Institute of Scientific and Technical Information of China (English)

    胡彬; 吴仲烨; 任斐; 薛鹏; 高慧; 陈彬; 刘磊; 张兆伟


    Objective:To observe the practicability and dependability of air current signs in check the result of endotracheal intubation. Method:100 cases of ASA I-II who underwent endotracheal anesthesia were chosen,and the patients with too tall,too small,too fat,acromegaly and hard to intubation were excluded.Rapid sequence induction, endotracheal intubation by common bending laryngoscope. Looking steadily at the tuba,continue enter 1-2 cm and stop when the airbag posterior border get into glottis,gasing,quickly press the sternum,check the signs of air current in tube by our ears,connect to anesthetic machine,check the tidal volume by anaeshetic machine,manual control,observe etCO2,auscultation with stethoscope two lungs and stomach to make sure the tube was get into the trachea.Result:91 cases(91%)were positive,73 cases(73%)were strong positive and the tidal volume was 61-64 mL;18 cases(18%) were weak positive and the tidal volume was about 19-22 mL,some cases only hear the signs of air current and no tidal volume;9(9%)cases were negative.Conclusion:The signs of air current in tube can be one of standard to make sure the success endotracheal intubation,shortcut,easy to do,no tissue damage on cavum oropharyngeum and respiratory tract, can operate repeatedly,has certainly practicability and dependability.%目的:观察气流征象检测气管内插管成功与否的实用性和可靠性。方法:选择较为标准的国人,剔除特别高大、矮小、肥胖、肢端肥大症、困难插管患者,100例ASA Ⅰ~Ⅱ级气管内麻醉患者,选择合适的导管,静脉快速诱导,普通弯喉镜片明视气管内插管。插管时看到导管插入声门,导管气囊后缘进入声门再进约1~2 cm停止进管,导管气囊充气,快速按压胸骨,耳听导管内是否有气流声及强弱,接麻醉机,检测潮气量大小,手控呼吸,观察呼末二氧化碳,听诊器听诊双肺和剑突下,确定导管在气管内。结果:100例插

  13. 241例儿童支原体肺炎临床诊断和治疗%Analysis of clinical diagnosis and treatment of 241 cases of child mycoplasma pneumonia

    Institute of Scientific and Technical Information of China (English)

    杨膺黄; 倪馨莉; 宋善路


    Objective:The analysis of the clinical characteristics of people with mycoplasma pneumonia, imaging findings and treatment.Methods:A retrospective analysis of 241 cases diagnosed as Mycoplasma pneumoniae pneumonia in children in our hospital's clinical medical records.Results:Mycoplasma pneumoniae pneumonia clinical symptoms such as cough and fever;nfants and young children are usual y accompanied by shortness of breath, wheezing, auscultation could be heard and sputum.Showing the diversity of imaging features,Patchy shadow, common in infants and young children.Segmental, large patchy shadows, more common in school-age children.Erythromycin or azithromycin in the treatment available to the clinical efficacy;Part of the refractory Mycoplasma pneumoniae,Given the combination of glucocorticoids in the drug treatment at the same time,can stil get a good clinical efficacy.Conclusion:Mycoplasma pneumoniae has the characteristics of clinical presentation and imaging findings do not match,the imaging findings of a lack of specificity.Early specification of application macrolides timely treatment, which can effectively al eviate the clinical manifestations, and prevent the recurrence of a very important clinical significance.%目的:分析患有肺炎支原体肺炎患儿的临床特点、影像学表现与治疗手段。方法:回顾性分析241例确诊为肺炎支原体肺炎在我院住院的患儿的临床病历资料。结果:肺炎支原体肺炎主要的临床症状为咳嗽及发热等;婴幼儿通常还伴有气短喘憋、听诊可闻及痰鸣音。影像学特征呈现多样性,主要为斑片状阴影时,以婴幼儿常见,主要为节段性、大片状阴影时,以学龄儿童多见。应用红霉素或者阿奇霉素治疗可获得很好的临床疗效;部分难治性支原体肺炎,在药物治疗同时联合应用糖皮质激素,仍可得到不错的临床疗效。结论:支原体肺炎具有临床表现和影像学表现不相符

  14. Pneumonia enzoótica em javalis (Sus scrofa Enzootic pneumonia in wild boars (Sus scrofa

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    Roselene Ecco


    presented reduced growth rate, anorexia, lethargy, cough and dyspnea, especially after they were moved. High body temperature (40ºC in average was verified in some animals. Auscultation revealed moderate pulmonary crepitation and stertors. Pulmonary gross lesions were typical of lobular bronchopneumonia. Lung lesions were characterized by ventral-cranial consolidation in the majority of the cases. The color of affected pulmonary areas varied from diffuse dark red to mosaic pattern (dark red lobule intercalate by grayish lobule or diffusely grayish. The majority of the lungs had mucopurulent exsudate in the bronchial lumen that also drained from the parenchyma cut surface. Upon microscopy, the changes were characterized by purulent and histiocytic bronchopneumonia with necrotic foci. In some animals, there was BALT hyperplasia associated with perivascular and peribronchial plasma cells and lymphocytes infiltration in most of these cases. Bordetella bronchiseptica and Streptococcus spp. were the most frequently isolated bacteria. Immunohistochemistry evaluation demonstrated Mycoplasma hyopneumoniae on the luminal surface of bronchial and bronchiolar epithelial cells, and the DNA of bacteria was detected by PCR. This is the first report of bronchopneumonia in wild boars associated with M. hyopneumoniae infection.

  15. Diagnóstico clínico diferencial entre oclusão da artéria carótida interna e da artéria cerebral média A comparative symptomatological study of internal carotid artery occlusion and middle cerebral artery occlusion

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    Roberto Melaragno


    compared the patients' age and sex, onset of the disease, ocurrence of convulsions and/or headache, onset during sleep or waking, the pre-existence of strokes, blood pressure levels, degree of consciousness, muscular strength, electroencephalography tracings, palpation and auscultation of the cervical carotid arteries. The results of the study did show that there is no statistical significative difference in these data except for 3 of them: greatest incidence of convulsions in middle cerebral artery occlusion, ophtalmodynamometry and cervical carotid symptomatology. Ophtalmodynamometry reveals significantly lower values for retinal central artery pressures on the same side as the carotid thrombosis in 70.0% of the cases, while normal and symmetrical measurements appear in all cases of middle cerebral artery occlusion. With reference to arterial signs in the neck, there were palpatory and auscultatory abnormalities in 52.4% of the patients with carotid thrombosis and in 8.6% of the cases of middle cerebral artery occlusion.

  16. La técnica DInSAR: bases y aplicación a la medición de subsidencias del terreno en la construcción

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    Marchamalo, M.


    Full Text Available Subsidences are defined as slow and gradual movements of the terrain or built surface. These may affect all types of terrains, and are caused by tension-induced changes for many reasons, such as lowering water tables (groundwater extraction, underground mining (minerals, coal, salt, excavation of tunnels, extraction of oil or gas, slow processes of dissolution and lixiviation of materials, consolidation of soft soils, organic soils,... The measurement and monitoring of land subsidences are the major components of infrastructures’ auscultation in the construction and monitoring phases. In many cases, subsidences occur gradually and may be recognized before they cause damage in the works. The most common procedure for subsidence’s control in engineering until now, is based on the use of instrumentation and methodologies for surveying such as precision levelling, inclinometers, photogrammetry, laser scanning and DGPS (Differential Global Positioning System. In the last decade a new technique is emerging, DInSAR (Differential Interferometry Synthetic Aperture Radar, which is based on the detection of small variations in altitude from the phase difference calculation between pairs of radar images (satellite’s data acquired from active sensors in the microwave region covering the same area of study. This article presents the evolution of this technique for measuring surface land subsidence and its application to various fields with satisfactory precision results. It presents a review on the use of DInSAR for monitoring and measuring subsidence of land and earth structures in Construction and in the fields of Geotechnics, Hydrology and Volcanology.

    Las subsidencias se definen como movimientos lentos y paulatinos de la superficie del terreno natural o construido y que pueden afectar a todo tipo de terrenos. Son debidos a cambios tensionales inducidos en éstos, por: descenso del nivel freático (extracción en acuíferos, minería subterr

  17. Infecção natural pelo Vírus Sincicial Respiratório Bovino (BRSV no Estado de Alagoas Spontaneous BRSV infection in cattle of the state of Alagoas, Brazil

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    Paulo V. Peixoto


    Full Text Available Descreve-se a ocorrência de infecção pelo vírus sincicial respiratório bovino (BRSV em bezerros descendentes de animais das raças pardo-suíça e holandesa importados da Alemanha, Áustria, Suíça e Uruguai, na qual morreram em Alagoas, Brasil, pelo menos 220 cabeças, de 1995 até a presente data. O quadro clínico caracterizou-se por hipertermia, tosse seca, mais tarde dispnéia acentuada e por vezes lacrimejamento; à auscultação havia estertores secos, depois úmidos, com sibilos, muitas vezes audíveis à distância. O exame histológico revelou pneumonia intersticial com formação de células sinciciais, infiltração predominantemente linfocitária com presença de eosinófilos e de corpúsculos de Russel, proliferação de pneumócitos tipo II e leve metaplasia escamosa. Células epiteliais de bronquíolos e células sinciciais marcaram-se positivamente com o anticorpo anti-BRSV. A ocorrência da enfermidade no Sul e agora no Nordeste do Brasil indica a necessidade de se promover um amplo levantamento epidemiológico para se avaliar o grau de perdas e a proporção de animais infectados no país. Lembramos que parte dos animais importados, ao que tudo indica, já estavam infectados nos países de origem, quando desembarcaram em Belém, Pará.Cases of bovine respiratory syncytial virus (BRSV infection affecting calves in the State of Alagoas, Brazil, are described. At least 220 calves, which were the progeny of Brown Swiss and Holstein Friesian cattle imported from Germany, Austria, and Uruguay, have died from the disease since 1995. Clinical signs included fever, dry cough, serous ocular discharge and, towards the final stages, marked dyspnea. On auscultation there were loud and harsh breathing sounds, and a strong wheezing could be heard from a distance. Histopathology of the lung revealed interstitial pneumonia associated with syncytial cells and infiltration by lymphocytes and eosinophils. A few plasma cells containing

  18. Prevalência de pressão arterial elevada em crianças e adolescentes: revisão sistemática The prevalence of high arterial blood pressure in children and adolescents: a systematic review

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    Diego Giulliano Destro Christofaro


    were those developed by the Task Force and National High Blood Pressure Education Program. In all, 52.4% of studies used auscultation to determine blood pressure and 47.6% used oscillometry. CONCLUSIONS: despite the great discrepancy between the values for prevalence found in the studies, it is clear that there has been a growth in the prevalence of high blood pressure in children and adolescents all over the world.

  19. Influência do estado de treinamento sobre o comportamento da pressão arterial após uma sessão de exercícios com pesos em idosas hipertensas Influence of the training status on the blood pressure behavior after a resistance training session in hypertensive older females

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    João Bruno Yoshinaga Costa


    Full Text Available INTRODUÇÃO: São escassas as investigações envolvendo o efeito hipotensivo pós-esforço dos exercícios com pesos em idosos e hipertensos. OBJETIVO: Verificar o comportamento da pressão arterial sistólica (PAS, diastólica (PAD e média (PAM após uma sessão de exercícios com pesos em idosas hipertensas treinadas e não treinadas. MÉTODOS: Participaram do estudo 15 mulheres (66 ± 4 anos; 63,9 ± 9,1kg; 1,6 ± 0,1m divididas em grupo treinadas (GT; n = 6 e grupo não treinadas (GNT; n = 9. A amostra foi submetida aleatoriamente a uma sessão controle (SC, na qual permaneceram sentadas em repouso por 40 min e a uma sessão experimental (SE, realizando sete exercícios com pesos executados em duas séries de 10-15 repetições máximas. A pressão arterial foi verificada pelo método auscultatório após 10 min de repouso no período pré-exercício e em ciclos de 15 min durante 1h após o término da sessão. RESULTADOS: Não foram encontradas diferenças entre os grupos para as variáveis analisadas no período pré-exercício. A análise de variância para medidas repetidas identificou, no GT, PAS significativamente menor no 30º min após o exercício comparado com o repouso (P = 0,03 durante a SE e nenhuma diferença na SC. O GNT apresentou reduções na PAS (P BACKGROUND: There are few studies on post-resistance exercise hypotension in hypertensive older females. PURPOSE: To verify the acute systolic (SBP, diastolic (DBP, and mean arterial pressure (MAP response after a resistance exercise session performed by hypertensive elderly subjects with and without experience in resistance training. METHODS: Fifteen elderly women (66 ± 4 yrs; 63.9 ± 9.1 kg; 1.6 ± 0.1 m were divided in trained group (TG; n = 6 and non-trained group (NTG; n = 9. The sample performed a control session (CS - seated during 40 min and experimental session (ES - seven resistance exercises; two sets; 10-15 RM. Blood pressure was assessed by auscultation after 10

  20. Repercussão da monitorização fetal intraparto sobre os índices de operação cesariana Impact of intrapartum fetal monitoring on cesarean section rates

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    Edson N. Morais


    Full Text Available A monitorização fetal eletrônica (MFE tem sido o método mais amplamente utilizado para a vigilância fetal direta, especialmente durante o trabalho de parto. Na tentativa de elucidar o efeito da MFE sobre os índices de cesárea (IC, um estudo retrospectivo foi realizado no Hospital Universitário de Santa Maria (HUSM. Estudamos dois grupos de pacientes perfazendo um total de 2.114 gestantes: um grupo (n=517 com MFE e outro (n=1.597 com ausculta intermitente (AI. No grupo MFE observamos um IC de 38,0%, contra 27,2% do grupo AI. Para todas as pacientes, o IC foi de 29,9%. O sofrimento fetal agudo foi a indicação mais comum de cesárea no grupo MFE (40,6%, ao passo que a cesárea prévia foi a terceira causa (10,1%. No grupo AI, o sofrimento fetal foi a terceira causa de cesárea (14,3%, ao passo que a cesárea prévia foi a indicação mais comum (32,4%. Baseados no presente estudo, acreditamos que a MFE não tem efeito, por si só, sobre as taxas de cesárea, se considerados todos os nascimentos no HUSM. Com uma educação adequada dos obstetras e uma correta interpretação dos traçados, a MFE não aumenta os índices de cesárea, ao contrário permite mais acuracidade na descrição das condições fetais intraparto.Electronic fetal heart rate monitoring (EFM is the most widely used method of direct fetal surveillance especially during labor. In an attempt to elucidate the effect of EFM on cesarean section (CS rates, a retrospective study was performed at the University Hospital of Santa Maria (HUSM. We studied two groups of patients, consisting of 2114 pregnant women: EFM group (n=517 and intermittent auscultation (IA group (n=1597. In the EFM group we observed 38.0% of CS vs. 27.2% in the IA group. For all patients, the CS rate was 29.9%. Fetal distress was the most common indication for CS in the EFM group (40.6%, while previous CS was the third cause (10.1%. On the IA group, fetal distress was the third cause in CS (14.3%, while

  1. Health and sanitary status in 1970 of Tubu nomads dwelling in Northeastern Niger

    Institute of Scientific and Technical Information of China (English)

    Jean-Franois Magnaval; Christian Oosterbosch; Michel Mandl; MABN group


    Background: The Tubu are nomadic people who live in remote parts of the central Sahara, primarily in the Tibesti massif (Chad), and in both Northeastern Niger and Southern Libya. All of these areas are close to become conflict zones. However, no data about the Tubu’s health and sanitary status are currently available, which would be of major concern if humanitarian interventions would become required. Methods: In 1970, the “Mission Anthropologique Belge au Niger” (MABN) investigated a Tubu tribe named Broaya that lived at Seguedine and Djado on the northeastern rim of the Tenere desert. One hundred fifty-one adult volunteers answered an oral questionnaire and underwent a medical examination, followed by the collection of blood thin films and samples of urine and stool. The environmental fauna of medical importance was also studied. Results: Albeit 43 year-old, these results have not been previously published. The estimated age of death for fathers was approximately 56 years, and that for mothers was 60 years. On average, each married woman had had 4.7 children. The overall perinatal mortality rate was 232 ‰, the overall infant mortality rate was 153 ‰, and the overall child mortality rate was 99 ‰. The mean height was 164.1 cm and 157.4 cm, the mean weight was 50.1 kg and 47.9kg, and the mean blood pressure was 131/78 mmHg and 127/75 mmHg for males and females, respectively. The physical examination found 6 cases of blindness (4.0%). Five subjects presented with an elevated blood pressure (3.3%), and 5 (3.3%) displayed an abnormal thoracic auscultation evocative of tuberculosis or of an acute lung infection. The abdominal examination and renal palpation found 5 large masses (3.3%), and 2 subjects had a palpable enlarged spleen (1.3%). The blood thin films were fixed in methanol and subsequently examined in Toulouse. The search for blood parasites was negative. The urine samples were centrifuged and then microscopically examined in the field. No blood

  2. Applying the seismic interferometry method to vertical seismic profile data using tunnel excavation noise as source (United States)

    Jurado, Maria Jose; Teixido, Teresa; Martin, Elena; Segarra, Miguel; Segura, Carlos


    response and the reflection response for a 1D multilayer structure, and next 3D approach (Wapenaar 2004). As a result of this seismic interferometry experiment the 3D reflectivity model (frequencies and resolution ranges) was obtained. We proved also that the seismic interferometry approach can be applied in asynchronous seismic auscultation. The reflections detected in the virtual seismic sections are in agreement with the geological features encountered during the excavation of the tunnel and also with the petrophysical properties and parameters measured in previous geophysical borehole logging. References Claerbout J.F., 1968. Synthesis of a layered medium from its acoustic transmision response. Geophysics, 33, 264-269 Flavio Poletto, Piero Corubolo and Paolo Comeli.2010. Drill-bit seismic interferometry whith and whitout pilot signals. Geophysical Prospecting, 2010, 58, 257-265. Wapenaar, K., J. Thorbecke, and D. Draganov, 2004, Relations between reflection and transmission responses of three-dimensional inhomogeneous media: Geophysical Journal International, 156, 179-194.

  3. Efectividad de las placas oclusales estabilizadoras en el manejo de la sintomatología temporomandibular

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    Rosalía Bustillo Verbel


    evaluated by the analogous visual scale of pain, the articular noise was auscultated by means of the fonendoscopy, the evaluation of the diversion and ranges of pertaining to the mandibular movement was realized by means of a milimetric rule. Results: Than muscular pain as articulate diminished significantly in 89% and 97% respectively, in the behaviour of the articulate noise type pop there was decrease of 45.63%, whereas in the crepitation type there was no variation. The ranges of the mandibular movements were increased 8.08% while the diversion in the pertaining to the mandibular movement does not present changes. Conclusion: The occlusive’s stabilizing plates were effective solving the tempolamandibular symptomatology.Key words: occlusive’s stabilizing plates; tempolamandibular symptomatology; analogous visual scale of pain.

  4. The Reconsideration of Animal Experimental Study of Traditional Chinese Medicine%中医药动物实验研究的再思考

    Institute of Scientific and Technical Information of China (English)

    王灿; 苗艳艳; 苗明三


    theory of TCM syndrome differentiation and treatment,by the etiol-ogy and pathogenesis of TCM,use a variety of methods copy"malady" of animal model,then use drug reduction to absurdity inspection"malady" model.③To strengthen the clinical research of traditional Chinese medicine,pay attention to human body science:establish-ment of the TCM syndrome depends on inspection,auscultation and olfaction,inquiry,and pulse-taking and palpation,evidence of tradi-tional Chinese medicine is difficult to reflect on animals,the nature qualitative difference of human and animals. The clinical patients must be as the carrier,and should be in the human body on the basis of syndrome standardization study the basis of TCM syndrome.④To establish Chinese medicine syndrome animal evaluation standard:Optimization of animal building factors,the establishment of animal model evaluation method,select has the characteristic of evaluation index.⑤Animal experimental study of TCM to return to the tradi-tional Chinese medicine clinical reality:in animal studies,to link up the standardization of experimental and the authenticity of clinical, experimental study is not only for the purpose of the mechanism,in order to paper,for the sake of so-called science,more research re-sults to be practical,can have an effect in the real open environment,make research of traditional Chinese medicine return to nature,re- turn to the real world,let the theory research is consistent with the real world.

  5. Intervenções de enfermagem para o diagnóstico de enfermagem Desobstrução ineficaz de vias aéreas El cuidado de enfermeria para el diagnóstico de enfermería desobstrucción de las vias aéreas Nursing interventions for the nursing diagnosis ineffective airway clearence

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    Ivete Martins


    Comité de Ética en Pesquisa del IDPC. Las acciones/cuidados de enfermería prescritas/os por las enfermeras fueron: hacer inhalación, estimular el paciente a caminar, sentarlo en la poltrona, estimular la tos y la ingestión de líquidos, aspirar el tubo endotraqueal, observar el patrón respiratorio, la saturación de oxígeno, la presencia de cianosis en las extremidades y, proceder la ausculta pulmonar. Las convergencias identificadas con la NIC fueron las siguientes: facilitar la remoción de la secreción por medio de la hidratación, mover al paciente, estimular la tos, aspirar la secreción y controlar la condición respiratoria. Se considera que las acciones prescritas por las enfermeras son pertinentes, no obstante les falte mayor especificación.The purpose of this study is to identify the nursing actions prescribed by the nurses at Instituto Dante Pazzanese de Cardiologia (IDPC towards patients under the nursing diagnosis of ineffective airway clearence and compare them with the ones found in the Nursing Intervention Classification (NIC, whose aim is the improvement of nursing prescription for this diagnosis. This is a retrospective study, whose data source has included 435 patients' cards hospitalized from July to December 2000, analysed after the Ethics Committee on Research at IDPC. The prescribed nursing actions are following: to perform inhalation, stimulate de ambulation, to seat the patient on an armchair, stimulate cough, stimulate hydrical intake, aspirate endotracheal cannule, observe the respiratory pattern and oxygen saturation, as well as the cyanosis of the limbs, and perform pulmonary auscultation. Some convergences along with NIC have been found, such as: to facilitate the secretion remotion by means of hydratation, the patient mobilization, stimulation to the cough, secretion aspiration and control/monitorization of the respiratory condition. The actions prescribed by the nurses are regarded to be of concern, however, detailing is in lack

  6. 1个Alagille综合征家系中JAG1基因新突变的识别%Identiifcation of a novel JAG1 mutation in a family affected by Alagille syndrome

    Institute of Scientific and Technical Information of China (English)

    程映; 赵书涛; 郭丽; 邓梅; 周清; 宋元宗


    Alagille 综合征(ALGS)是一种主要由JAG1基因突变导致的常染色体显性遗传病,可累及肝脏、心脏、骨骼、眼和面部等多器官。本文报道1例ALGS患儿的临床和遗传学特征。患儿,男,2岁9个月,因发现肝功能异常及心脏杂音2年余就诊。查体:发育营养稍差,皮肤巩膜无黄染。前额突起,左眼内斜视,鼻梁低平,小下颌。双肺呼吸音清,胸骨左缘2~3肋间可闻及2/6级收缩期杂音,肝脾不大。血生化发现胆汁酸、胆红素、转氨酶等均升高。心脏彩超提示房间隔缺损(静脉窦型)和左肺动脉狭窄;脊柱正位片发现第6、8胸椎蝴蝶椎畸形。患儿明显左眼内斜,眼科诊断眼球后退综合征。因此,该患儿符合ALGS在肝脏、心脏、脊柱和面部的特殊表现,且DNA直接测序发现JAG1基因存在一个新突变c.2419delG(p.Glu807AsnfsX819),ALGS诊断明确。确诊后予以对症支持治疗。目前已随访至4岁2个月,病情平稳,但面部畸形、左眼内斜视、心脏杂音和肝功能异常持续存在,其远期预后有待观察。%Alagille syndrome (ALGS) is an autosomal dominant disorder which is mainly caused by JAG1 gene mutation and can affect multiple systems including the liver, heart, eyes, skeleton and face. This paper reports the clinical and genetic features of an ALGS patient. A 2-year-and-9-month-old boy was referred to the hospital with the complaint of abnormal liver function and heart murmur discovered over two years. Jaundice of the skin and sclera was not observed. The child had a prominent forehead, left esotropia, depressed nasal bridge and micromandible. The two lungs were clear on auscultation, but a systolic cardiac murmur of grade 2/6 could be heard between the 2nd and 3rd intercostal space at the left sternal border. Neither abdominal distension nor enlarged liver or spleen was discovered. X-ray radiography uncovered butterlfy malformation

  7. Avaliação do perfil clínico e laboratorial de gatos hipertireoideos com ou sem lobo tireoidiano aumentado a palpação cervical Clinical and laboratorial evaluation of hyperthyroid domestic cats with or without palpable thyroid gland

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    Vanessa P. de Faria


    és da palpação tireoidiana e avaliação sérica de tiroxina total, pois muitos gatos sem sinais clínicos apresentam hipertireoidismo e o diagnóstico precoce permite diminuir os efeitos sistêmicos da doença em órgãos como fígado, rins e coração.Hyperthyroidism is the most common endocrine disorder of older cats. Due to the progressive nature of the disease, the identification of a subclinical stage is essential in order to have a better control of the disease. The present study was a survey of the frequency of feline hyperthyroidism in Rio de Janeiro, from March, 2007 to April, 2008. The purpose of this study was to perform an evaluation of the clinical, laboratorial and echocardiographic aspects in a feline population of naturally acquired hyperthyroidism, with or without palpable thyroid gland. The selection of the cats was done by the documentation of an elevation of total thyroxine (TT4 levels by radioimmunoassay. The animals were divided in two groups according to the thyroid palpation: group I (non-palpable thyroid lobe and group II (palpable thyroid lobe. Laboratorial and complete clinical evaluations were performed in all cats. The clinical evaluation included behavioral evaluation, body weight, body condition, dermatologic, cardiopulmonary auscultation, thyroid palpation and systolic blood pressure reading. Besides the TT4, the following exams were performed: urea, creatinine, alanine aminotransferase (ALT, alkaline phosphatase (ALP and glucose. Thirty one cats had an echocardiogram performed. On the basis of TT4 concentrations, 51 of the 178 cats were classified as hyperthyroid. One or more enlarged thyroid glands were palpated in 25 of the 51 hyperthyroid cats and were included at Group II. Twenty six cats didn't palpable thyroid gland and were included at Group I. Clinical, laboratorial and echocardiographic parameters were similar between the two groups. However, the TT4 levels were significantly lower in the non-palpable thyroid group. All

  8. Disfagia orofaríngea em crianças com síndrome Cornélia de Lange Oropharyngeal dysphagia in children with Cornelia de Lange syndrome

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    Priscila Martins Foroni


    : This is a retrospective case report. We performed a descriptive analysis of four protocols for speech evaluation of swallowing, routinely used in the Speech Therapy Service and applied to children with Cornelia de Lange syndrome of both genders, with age going from 1:2 to 9:6 years, referred for clinical and videofluoroscopic evaluation of swallowing to a public university hospital. Aspects of the oral and pharyngeal of swallowing were analyzed using clinical functional and videofluoroscopic evaluation. RESULTS: the changes in the orofacial sensorimotor system that were most detected are hypersensitivity and muscle hypertonia of the orofacial region. Among the changes observed in the oral phase of swallowing, was the presence of labial closure inefficient, previous oral escape of the food, inadequate bolus formation/organization and deficient oral ejection. In the pharyngeal phase there was a change in cervical auscultation, nasal reflux, reduced hyolaryngeal excursion, pharyngeal residue after deglutition, laryngeal penetration, and laryngotracheal aspiration. Oropharyngeal dysphagia was detected in all children. CONCLUSION: these findings indicate changes in the orofacial sensoriomotor aspects and impaired swallowing biomechanics. The important alterations in swallowing detected in these cases may correspond to typical manifestations of Cornelia de Lange syndrome.

  9. Risk factors of postoperative pulmonary complications in patients with hepatocellular carcinoma undergoing hepatic resection%肝癌术后肺部并发症危险因素分析

    Institute of Scientific and Technical Information of China (English)

    王东; 曹利平


    hypertension, respiratory system and diabetes, respiratory tract infection in 2 weeks before surgery, auscultation of lung), preoperative examination results (tumor location, tumor size, portal vein invasion, invasion of hepatic vein, portal vein thrombosis, portal vein width, bilirubin levels, albumin levels, prothrombin time, ascites, Child score, Child classification, ALT, AST, GPT, AFP, hemoglobin levels, platelets, blood oxygen saturation and ASA classification) and surgical information (incision, operation time, anesthesia time, and intraoperative blood transfusion). Non- conditional binary Lo-gistic regression was used to analyze the correlation of those factors with pulmonary complications fol owing operation of hepato-cel ar carcinoma. Results Univariate analysis showed that hypoproteinemia, operation time,anesthesia time and intraoperative blood transfusion were the risk factors of postoperative pulmonary complications (pleural effusion, pneumonia)(P<0.05 or 0.01). The multivariate logistic regression analysis identified preoperative albumin level as an independent risk factor for postoperative pulmonary complications (P<0.05). Conclusion Preoperative albumin level is an independent risk factor for postoperative pul-monary complications after hepatocel ular carcinoma radical surgery.

  10. 以提高临床实践能力为导向的出科OSCE实施探索%Preliminary exploration of OSCE-test on completion of a course to improve students' clinical competence

    Institute of Scientific and Technical Information of China (English)

    周金懿; 丁美琴; 徐文; 丁晓林; 孙书方; 陈卫昌


    sample t test and independent sample t test were employed. Measurement data is expressed as x±s and P<0.05 signifies statistically significant differences. Results Clinical practice ability of students in experiment group was enhanced to various degrees after internship com-pared with that before internship. ECG interpretation, heart and lung auscultation, interrogation tech-nique, medical and surgical operation performances of students in experiment group were promoted significantly (P<0.05). Students' overall competence in the final graduation skill test was better in ex-periment group than in control group (P<0.05). Conclusions OSCE-test on completion of a course not only make intern management more effective, but also make students' aim more definite, therefore it is conducive to enhancing clinical competence.

  11. MONITORING OF LARGE INSTABLE AREAS: system reliability and new tools. (United States)

    Leandro, G.; Mucciarelli, M.; Pellicani, R.; Spilotro, G.


    emission (AE) measurement has constituted for decades a monitoring system able to define precisely, in presence of a favourable geometry, the micro-cracks pattern, describing both propagation of cracks and formation of failure surfaces. In stiff materials the deformations are associated to micro distortions or micro failures, with release of vibrational energy in the acoustic range of the frequencies. Therefore, the survey of such precursors can result extremely profitable to the goals of an early recognition of the evolution of stress states towards the failure. For this reason, the survey of AE in geological materials, besides monitoring and forecast of landslide movements, has revealed very useful in other fields, as the safety auscultation of the mines, the stability of underground deposits of liquid and gaseous hydrocarbons and radioactive cinders, and the forecast of avalanches. The studies in literature, especially in the mining field, have underlined that the typical emission is in the low frequencies range, where waves suffer a limited attenuation in the propagation through the rocks. The generation of micro-fractures is, on the other hand, accompanied by acoustic emission at higher frequencies. The Authors in the last years have experienced the possibility of acoustic emission measurement, finally coming to the design and construction of a simple mono-channel device. This device is unable to determine the location of the spreading point of new failures, which is possible only with more than three channels devices. A mono-channel device can realize: a - recognition of the phenomenon (definition of AE frequency range of rock mass under examination, characteristic ampleness), b - recognition of the physiological activity (number of issues in time), c - enucleation of the remarkable noises from those physiological or occasional produced outside. The third point is realized through the transformation of sampled noise in FFT, for which is easier to define a threshold

  12. Clinical Observation of Single lumen endotracheal tube used for children with single lung ventilation%单腔气管导管用于儿童单肺通气的临床应用观察

    Institute of Scientific and Technical Information of China (English)

    汪俊; 汪幸; 韩芬; 夏迎静


    目的:通过观察单腔气管导管用于儿童单肺通气(OLV)的应用,探讨其在临床应用的安全性。方法:随机选取14例行胸科手术患儿,全麻诱导气管插管后,将单腔气管导管在纤维支气管镜(φ:2.8mm)引导下置入健侧主支气管,并经听诊后确定封堵效果。观察单肺通气前(T1),单肺通气5mim后(T2),单肺通气结束前(T3),单肺通气结束后(T4)的心率HR、血压BP、SpO2、动脉血气分析、气道压力(PAW)变化。结果:左侧单肺通气5例,右侧单肺通气9例,单肺通气时间40~210mim。全组病例PaO2:T2较T1明显下降(204±102.2),T3持续小幅下降(202.9±112.3);T4基本恢复至单肺通气前水平(393.6±88.3)。 PaCO2:T2上升(36±4.8),T3持续升高(39.6±5.2),T4降至术前水平(36±5.1);PAW:T2升高(22±2.9),T3维持较高水平(21.4±2.3),T4恢复术前水平(17.9±1.9)。全组病例pH值各时间点数据无明显变化。结论:单腔气管导管能够安全的用于儿童的单肺通气。%Objective:by observing the single lumen endotracheal tube application of one-lung ventilation (OLV) in children and its safety in clinical application. Methods:randomly selected 14 children with routine thoracic surgery, after endotracheal intubation of general anesthesia induction, the single lumen endotracheal tube in fiber broncho-scope (φ:2.8 mm) guided into the contralateral primary bronchus, and determine the effect after auscultation. One-lung ventilation (T1), before the observation after 5 mim one-lung ventilation (T2), before the end of single lung ventilation (T3), single lung ventilation (T4), heart rate after HR, blood pressure (BP), SpO2, arterial blood gas analysis, and airway pressure changes (PAW). One-lung ventilation in 5 cases,Results:the left the right side of the 9 cases of single lung ventilation, 40-210 mim one-lung ventilation time. Incidence

  13. Prevalência de pressão arterial elevada em crianças e adolescentes do ensino fundamental Prevalencia de presión arterial elevada en niños y adolescentes de la enseñanza fundamental Prevalence of elevated blood pressure in children and adolescents attending highschool

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    Ana Elisa M. Rinaldi


    hipertensión arterial (HAS para los valores entre los percentiles 90 y 95 y superior al percentil 95, respectivamente. Los datos antropométricos fueron comparados, conforme al sexo, por la prueba t de Student. La correlación de Pearson fue utilizada para verificar la variación de las PA sistólica (PAS y diastólica (PAD según datos antropométricos. La variación del escore Z de la PA según percentil de IMC fue evaluada por el análisis de variancia seguida por la prueba de Tukey. RESULTADOS: Se evaluaron 903 niños (51,7% niños, con edad de 9,3±2,5 años para ambos sexos. La prevalencia de PH fue de 9,1% y de HAS fue de 2,9%. Hubo correlación positiva significativa entre los niveles presóricos elevados (PAS/PAD > percentil 90 y las variables antropométricas, con valores mayores para peso (r=0,53 y r=0,45, pOBJECTIVE: To assess the prevalence of elevated blood pressure in schoolchildren and adolescents and the association of blood pressure with anthropometric measures. METHODS: This cross-sectional study, conducted in three schools in Botucatu, Brazil, collected blood pressure (BP measurements taken at three different time points and anthropometric data: weight, height, body mass index (BMI, arm circumference, waist circumference, triceps and subscapular skinfolds. Blood pressure was measured using the auscultation method, and children were classified into two groups: pre-hypertension or hypertension for values between the 90th and 95th percentiles or above the 95th percentile. Data were compared according to sex using the Student's t test. The Pearson correlation coefficient was used to evaluate the association between blood pressure and anthropometric data. To evaluate blood pressure, the Z score according to BMI percentile categories, one-factor analysis of variance (ANOVA and the Tukey post hoc test were used. RESULTS: This study evaluated 903 children and adolescents (51.7% boys whose mean age was 9.3±2.5 years. The prevalence of pre-hypertension and

  14. 1 ∶ 2 matched case-control study on the risk factors related to congenital heart disease during the peri-conceptional period%围孕期先天性心脏病危险因素的1∶2配比病例对照研究

    Institute of Scientific and Technical Information of China (English)

    李侠; 谢胜男; 王寅; 王建敏; 凌子羽; 纪昌文; 张清凯; 杨森焙; 张静


    目的 探讨围孕期环境暴露因素与先天性心脏病(CHD)发生风险之间的关系.方法 采用1∶2配比的病例对照研究方法,于2012年1月至2014年1月对武汉市某区妇幼机构儿童进行“CHD免费筛查”,通过常规听诊、超声心动图初筛,并经市级以上医院确诊.以CHD患儿为病例组,按照年龄、性别、社区配对选择健康的儿童为对照组.用EpiData 3.1软件录入数据,用SPSS 11.5软件进行单因素和多因素的条件logistic回归分析.结果 采集138名患儿和276名对照儿童的父母信息.对27个主要研究因素进行单因素条件logistic回归分析.结果显示,孕早期补钙、孕早期精神刺激、母亲孕期营养、不良孕产史、经产妇、围孕期患病及居住地附近有污染企业与子代CHD发生有一定关联;多因素条件logistic回归分析显示,孕早期精神刺激(HR=3.35,95%CI:1.28 ~ 8.79)、母亲孕期营养不良(HR=1.50,95%CI:1.10 ~ 2.03)及不良孕产史(HR=1.62,95%CI:1.03 ~ 2.57)是子代发生CHD的危险因素,而孕早期适当补钙(HR=0.40,95%CI:0.25~0.65)则可降低CHD发生的风险.结论 CHD的发生可能与孕早期精神刺激、围孕期营养、孕早期补钙及既往不良生育史有一定关系,应加强围孕期保健,降低CHD的发病率.%Objective To explore the possible risk factors during the periconceptional period relevant on the occurrence of congenital heart diseases (CHD) in the offspring.Methods A 1 ∶ 2matched case-control study was designed.From January 2012 to January 2014 in a district from Wuhan city,HuBei province,children were proved by MCH institutions through the "free screening for congenital heart disease" program.Cases with CHD were screened out by conventional auscultation,echocardiography figure and confirmed by physicians from the high-level hospitals.According to age,gender,community paired healthy children were chosen as controls.EpiData 3.1 software was used to input data

  15. Caso 1/2013: homem de 69 anos com dor súbita em dorso e membro inferior direito e choque Case 1/2013: 69-year-old male patient with sudden back and lower right limb pain and shock

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    Carlos Vinícius Abreu do Espirito Santo


    lost consciousness and went into shock. Subcutaneous emphysema was observed in the left hemithorax, as well as abolition of breath sounds at auscultation. Tracheal intubation was performed with draining of blood-tinged fluid from the left hemithorax. Echocardiography showed left ventricle with 44/29 mm; septum, 12 mm; posterior wall, 13 mm; mild aortic root dilation, dissection of the lamina and periaortic hematoma. The valves and pericardium were normal. The patient was transferred to Instituto do Coraçao - InCor. Physical examination (21 Oct 2004: 10:45 showed that the patient was sedated with tracheal intubation, pale, heart rate at 90 bpm, blood pressure 130 x 80 mmHg, bloody drainage in the chest tube. Electrocardiogram - frequency 90 bpm, sinus rhythm, low voltage in the frontal plane and decreased voltage in left leads (Fig. 1. Computed tomography showed bilateral subcutaneous emphysema, thoracic aorta with inaccurate borders in its descending portion (from the subclavian artery to the middle portion, collapsed left lung and extensive collection of hematic characteristics in same hemithorax and middle and posterior mediastinum. Small right pneumothorax; small right pleural effusion with underlying parenchymal alterations. The analysis of the heart was impaired by the presence of hemothorax. While undergoing computed tomography, the patient showed no pulse, mydriasis, with asystole unresponsive to resuscitation and died (21 Oct 2011; 15:00 h.

  16. 振动反应成像系统在间质性肺疾病患者肺功能评价中的应用%A new lung imaging: vibration response imaging applied to evaluate pulmonary function of interstitial lung disease

    Institute of Scientific and Technical Information of China (English)

    张钰旋; 张苑; 徐金富; 李霞; 周瑛; 卫平; 金晓凤; 蒋幸; 李惠萍


    Objective To discuss the value of vibration response imagine (VRI) on evaluating the pulmonary function of interstitial lung disease (ILD).Methods 80 patients who were diagnosed as ILD from June 2010 to September 2011 enrolled in this study.Then,all the patients took the VRIxp pulmonary function test so as to make a comparison with the traditional pulmonary function test.This paper analyzed the advantage and disadvantage of VRIxp and the traditional pulmonary function teat in evaluating the pulmonary function of ILD by observing the changes of patients' condition after the test respectively.Results The changes and significance of the main VRIxp parameters:①By observing airflow distribution map and maximum vibration energy diagram,a variety of abnormities were discovered such as the out-sync of the images and the size difference in all patients.②It is found that 69 patients had abnormal energy distribution.According to grouping of the various disease types and CT scan,the energy values were compared which indicated that the abnormities had no statistical significance.③ The energy curve had some abnormities such as the platform and curve separation.④The study showed that VRIxp could qualitatively,quantificationally detect the abnormal breath sounds and VRIxp was more sensitive than that of traditional auscultation (the positive rate were 90.00% vs 82.50%,respectively).⑤VRIxp could locate the lesion directly by combining air distribution figure with regional energy distribution.The accuracy rate was as high as 91.25% compared with CT scan.Comparing with traditional pulmonary function technology,there were some advantages of VRI.①For some patients,their ventilatory functions were detected as normal by traditional pulmonary function technology,while through VRI test,the results were abnormal.And the lesions were consistent with HRCT.② By evaluating conditions of patients before and after pulmonary function test,VRIxp was less secondary effects than

  17. 床边幽门后喂养管置管法用于重症患者的初步研究%A pilot study of a novel method for bedside placement of postpyloric feeding tubes in critically ill patients

    Institute of Scientific and Technical Information of China (English)

    高友山; 邝耀均; 刘宇; 徐君; 黄世芳; 刘晖


    Objective To investigate a novel method of bedside placement of postpyloric feeding tubes in critically ill patients,and to evaluate its success rate,time used,and safety of this bedside method.Methods Data of consecutive patients requiring postpyloric feeding from February 2009 to July 2009 were collected.In this new method,a nonweighted 130-cm-long nasoenteric feeding tube with a guide wire was used under 10 mg of intravenous metoclopramide.The tube was gradually advanced,and the position of the tube was confirmed by auscultation to detect bubbling sound and respiration of inflated air (the vacuum test),as well as pH measurement of aspirated fluid.An abdominal radiograph was made finally for confirmation of the position of the tube before the feeding was initiated.The time taken to insert the tube,the success rate,the time between the decision to feed and commencement of feeding,and the complications of the procedure were recorded.Results In 28 patients the postpyloric feeding tube was placed.The main indication was 18 cases with high risk of aspiration,3 with gastroparesis,and 7 with acute pancreatitis.Of the 28 tube placements performed,26 (92.9%) were successful,and in 21 (75.0% of 28) the tube was in the jejunum.The average time for successful placement was (20.36±6.41) minutes.The time between the decision for feeding and commencement of feeding was (4.15±1.68) hours.No complications occurred.Conclusion Using a conventional nasoenteric feeding tube with a guide wire,and only one medical staff needed for the placement of the tube,this method is an efficient and cost-effective method of bedside postpyloric feeding tube placement.%目的 观察床边徒手幽门后喂养管置管法对重症患者治疗的效果,并对置管成功率、操作时间及安全性进行评价.方法 2009年2月至7月对需幽门后喂养者实施幽门后喂养管置管.使用130 cm长、带导丝的普通鼻胃肠管,操作前静脉给予10 mg甲氧氯普胺.置管过程中依

  18. 实验猕猴肺部CT影像断层初步观察%Observation of Lung CT Tomography of the Laboratorial Rhesus Monkey

    Institute of Scientific and Technical Information of China (English)

    范春梅; 李志雄; 周建华


    Objective To research the clinical diagnosis of lung disease in rhesus monkey with the observation of lung CT tomography of the adult laboratorial rhesus monkey, to establish the maps of CT tomography of the healthy adult rhesus monkey, to provide the basic image data of CT technology in the applications of anatomy, clinical diagnosis and scientific experiments of rhesus monkey. Methods 5 male and 5 female health adult monkeys aged 5 ~ 10 yean were selected for this study of lung CT tomography after being checked by palpation, percussion, auscultation and by examination of body temperature, respiratory rate, heart rate, breathing motion and blood parameters. After general anesthesia, the monkeys were placed on the table-board of CT in supine position and were scanned to get the image of lung CT tomography. The main structure of every level in scanned images were labeled, tuch as lobe, trachea, arteries and veins,etc, Results (I) 13 anatomical images of lung CT tomography are obtained. (2) In the image of CT tomography, lung, trachea, large blood vessels arc all in focus. Lungs ore composed of the right put and (he left part, the left lung is divided into upper lobe, middle lube and luwer lobe. Right lung is divided into upper lobe, middle lobe, lower lobe and aiygos lobe. Left main bronchus. Right main bronchus, bronchial and vascular are very obvious in different scanned images- (3) Interfaces of small blood vessels, small nerves and muscle tissues ore no! Clearly defined on the CT Manned images. Conclusions (1) The images of lung CT tomogrphy of the healthy adult rhesus monkey show that all the lung lohes are absolutely clear, lung transmitancc is flood, and there are no any shadow,. (2)Obtained the anatomy CT tomography image datu of healthy aduft rhesus monkey. It can provide a new M&, convenient and accuralf hasis for diagnosia of monkey lung disease. It also established the background Information data of CT tomography anatomy of the healthy adult rhesus

  19. COMPARACIÓN DEL USO DE ESTEROIDES CON EL MANEJO CONVENCIONAL DE LA EXACERBACIÓN DE LA ENFERMEDAD PULMONAR OBSTRUCTIVA CRÓNICA Comparison of steroids use in conventional management of exacerbations of chronic obstructive pulmonary disease

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    Ariel Pérez-Monroy¹


    octogenarios y aquellos con enfermedad avanzada de baseBackground. Chronic obstructive pulmonary disease is a common condition characterized by limited chronic, progressive and irreversible airflow that affects 52 million people worldwide. Objective. To compare two different steroid schemes with current conventional treatment of non-acidotic acute exacerbations of chronic obstructive pulmonary disease. Materials and methods. The study was conducted in the Clínica Carlos Lleras Restrepo in Bogotá. A total of 106 patients diagnosed with exacerbated COPD were assigned to 3 treatment groups: a conventional treatment, b hydrocortisone and conventional treatment and c prednisone and conventional treatment. After 72 hrs, the percentage of change in peak flow values, the variation in lung auscultation and the clinical perception of improvement were evaluated. The length of hospital stay, the need for additional treatments and mechanical ventilation, and the presence of side effects were recorded. Results. We did not find any significant differences in treatment outcomes between the three schemes, except for a greater perception of symptom improvement with hydrocortisone. In the subgroup analysis, oral prednisone shortened the length of hospital stay and improved the peak expiratory flow and the subjective perception of symptoms in patients over 80 years old, with a FEV1 < 50% of predicted, and a severe exacerbation. Sex, functional class, cause and type of exacerbation, number of exacerbations per year, and cumulative smoking history did not affect the treatment outcome. The most frequently reported side effect of steroid therapy was hyperglycemia. Conclusions. Systemic steroids were not superior to conventional therapy for COPD exacerbations. However, oral prednisone caused objective and subjective improvement in patients over 80 years old with severe exacerbations and in those with severe underlying disease.

  20. Considerações sobre a medida da pressão arterial em exercícios contra-resistência Considerations on blood pressure assessment during resistive exercise

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    Marcos Doederlein Polito


    situações de prescrição de ECR.Cardiovascular demands during exercise are related to arterial blood pressure (BP. However, BP assessment during resistive exercises (RE can be biased by limitations of measurement techniques. The purpose of this paper was to review the methods of BP assessment during RE, and to suggest ways to minimize differences between indirect and direct methods. Intra-arterial catheterism (IC is considered the gold-standard for BP assessment. However, its application is unusual and not recommended for healthy individuals, due to enhanced risk of pain, arterial spasm and occlusion, syncope, or blending. The most common indirect methods are the photoplethysmographic (Finapres and auscultation (AU techniques. There are few studies comparing these methods during RE. Only one paper was found comparing IC to Finapres, and three comparing IC to AU. In conclusion, despite its precision, IC utilization to assess BP during RE in healthy subjects seems not to be feasible nor ethical. Finapres is considered the best indirect procedure, but it relies on an expensive device which is no longer available, since its production was discontinued. On the other hand, AU can lead to important underestimation of the actual BP values, depending on the exercise characteristics. Some recommendations can be adopted to reduce these differences, such as making the measurement the latest possible before the end of the exercise. The absolute differences between AU and the other methods notwithstanding, it seems that it is adequate to identify trends of BP profile associated to different RE situations.

  1. 人感染 H7N9禽流感与甲型 H1N1流感重症肺炎的临床及CT影像比较%Comparative study of CT findings and clinical course of patients with severe pneumonia due to avian influenza H7N9 and swine influenza H1N1 infection

    Institute of Scientific and Technical Information of China (English)

    许少华; 米海峰; 张琦; 柳娇娇; 李宏军; 李宁; 胡春红; 李润涛; 齐石; 李云芳; 丁金立; 张岩岩


    Objective:To compare the CT characteristics and clinical course in patients with severe pneumonia due to avian influenza H7N9 and swine influenza H1N1 infection.Methods:The materials of epidemiology,serology,clinical mani-festations,complications,treatment outcome and CT findings of severe pneumonia in 21 patients with influenza A (H1N1) and 12 patients with influenza H7N9 were retrospectively analyzed.Results:The age of H7N9 patients were older and they had more basic diseases (χ2= 3.111,P<0.05).In addition,the proportion of ICU treatment in H7N9 patients was higher than that in H1N1 patients (χ2= 3.599,P<0.05).The onset symptoms of the 2 groups were fever and cough,and might be accompanied by running nose,expectoration,fatigue,nausea,vomiting,diarrhea and abdominal pain.Moist rales and wheezing sound could be assessed on auscultation.Bloody or rusty sputum in H7N9 infections was more observed than that in H1N1 (P<0.05).Dyspnea and shortness of breath in H7N9 infections were more (P<0.001),as well as the incidence of complicated acute ARDS was higher (χ2= 3.111,P<0.05).Treatment with invasive mechanical ventilation as well as mortality were higher in H7N9 group compared with that of H1N1 group (χ2= 7.219,P<0.01;P<0.05).In both two groups,the major pathology was invasion of pulmonary parenchyma and interstitial tissue.The fundamental pulmonary CT findings were pulmonary ground-glass opacities (GGOs)and consolidations,often associated with air bronchogram;inter-lobular septum thickening,bronchiectasis,lymph node enlargement or pleural effusion could also be revealed.Pleural effu-sion and reticular appearance of lung in H7N9 group were more observed than that in H1N1 group (P<0.05).Conclusion:Compared with influenza A (H1N1)patients,H7N9 patients were older in age,with more basic diseases,serious complica-tions and more rapid progression of disease,mortality was higher as well.CT not only could display objectively the imaging characteristics of the two disease

  2. Endocardite infecciosa por Haemophilus aphrophilus: relato de caso Infective endocarditis due to Haemophilus aphrophilus: a case report

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    Ricardo M. Pereira


    adequação do tratamento.OBJECTIVE: To report the case of a child with infective endocarditis caused by Haemophilus aphrophilus. DESCRIPTION: Boy with 20 days of fever and chills. On admission, he was febrile, pale and with no signs of hemodynamic instability; on cardiac auscultation, a mitral-related holosystolic murmur was observed. Laboratory examination identified anemia (hemoglobin = 9.14 g/dL, total leukocytes of 11,920 mm³, platelets of 250,000 mm³, elevated sedimentation velocity of red cells and elevated C-reactive protein. The echocardiogram revealed image on mitral valve, resembling vegetation. Considering endocarditis, antibiotic therapy was started with crystalline penicillin (200,000 UI/kg/day in association with gentamicin (4 mg/kg/day. On the third day of treatment, Haemophilus aphrophilus was identified in the blood cultures and the antibiotic scheme was replaced with ceftriaxone (100 mg/kg/day. On the 20th day of evolution, the patient was pale but with no fever or other complaints. Examinations showed hemoglobin = 7.0 g/dL, leukocytes = 2,190 mm³, platelets = 98,000 mm³, international normalized ratio = 1.95 and R = 1.89. Considering the hypothesis of adverse reaction to ceftriaxone, a 6-week replacement treatment with ciprofloxacin (20 mg/kg/day was started. Examination results normalized after 72 hours of the replacement therapy. During ambulatory follow-up, patient presented with severe mitral regurgitation, undergoing a valve replacement with a metallic prosthetic valve 9 months after acute event. Patient has done well throughout the 3-year ambulatory follow-up. COMMENTS: Identification of agents of the HACEK group (Haemophilus ssp, Actinobacillus actinomycetemcomitans,Cardiobacterium hominis, Eikenella corrodens and Kingella kingae in children with infective endocarditis is rare. This case report, with no HACEK agent-related risk factors, reinforces the need for identification of the etiological agent of endocarditis to ensure adequate

  3. Clinical features and therapy of persistent bacterial bronchitis in 31 children%持续性细菌性支气管炎31例诊治分析

    Institute of Scientific and Technical Information of China (English)

    史军然; 刘金荣; 李惠民; 王维; 赵顺英


    目的 探讨持续性细菌性支气管炎的临床诊治要点.方法 对2010年10月至2014年5月在首都医科大学附属北京儿童医院呼吸二科住院的31例持续性细菌性支气管炎患儿性别、发病年龄、症状、肺部听诊、胸部影像学、支气管镜下表现及呼吸道分泌物细菌培养、对抗生素的应用反应等进行回顾性分析.结果 31例患儿男17例,女14例,发病年龄均在3岁以下,主要临床表现:有痰咳嗽,持续4~11周,病程中曾有发热13例,伴有喘息25例.所有患儿肺部听诊闻及痰鸣音.胸部X线片提示均有两肺纹理粗多、模糊,6例有散在小斑片影.肺部高分辨CT发现25例有支气管壁增厚,其中18例伴有支气管周围小斑片影,7例伴有陈旧性肺炎(5例合并条状肺不张).6例仅表现为模糊的小叶中心性小结节和透光度不均匀或磨玻璃影.支气管镜下发现支气管腔内有白色分泌物.16例为肺炎链球菌感染.28例应用阿莫西林克拉维酸钾或第二、三代头孢菌素和加酶抑制剂2周以上痊愈.最终应用碳青霉烯类、替考拉宁、利奈唑胺各1例.结论 持续性细菌性支气管炎常发生于3岁以下,主要临床表现为有痰咳嗽持续4周以上,可伴有发热、喘息,肺部高分辨CT常表现为支气管壁增厚,呼吸道分泌物细菌培养常为肺炎链球菌,大部分病例应用阿莫西林克拉维酸钾或第二、三代头孢菌素和加酶抑制剂治疗2周以上痊愈.%Objective To investigate the clinical features and therapy of persistent bacterial bronchitis (PBB).Method A retrospective review of 31 patients with PBB from Octorber 2010 to May 2014 in Department 2 of Respiratory Diseases in Beijing Children's Hospital was undertaken.Result (1) The patients (17 boys and 14 girls) were 6 months to 3 years old.The main complaint was chronic wet cough (>4 weeks);13 cases had fever and 25 cases had wheezing.Rattle was heard on auscultation in all patients.(2

  4. Intubação nasotraqueal às cegas em paciente acordada candidata à hemimandibulectomia: relato de caso Intubación nasotraqueal a ciegas en paciente despierta candidata a la hemimandibulectomía: relato de caso Blind nasotracheal intubation in awaken patient scheduled for hemimandibulectomy: case report

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    Daniel de Carli


    old patient, weighing 56 kg, was scheduled for hemimandibulectomy; she presented cervical immobility secondary to arthrodesis, mouth opening of 2.2 cm, moderate retrognatism, voluntary protrusion of the mandible was absent, mentosternal distance of 11 cm and mento-thyroid distance of 6 cm, therefore receiving a score of 5 on the Wilson scale. The patient signed an informed consent after being informed about the procedure. After monitoring and oxygenation, continuous infusion of dexmedetomidine was initiated. Superior and inferior laryngeal nerve block was performed with 2.0% lidocaine without vasoconstrictor and the hypopharinx was anesthetized with a lidocaine spray. Before NTI, ondansetron, midazolam, fentanyl, and droperidol were administered and the patient remained awake and cooperative. Nasal insertion of the tracheal tube was oriented by its opacification and respiratory sounds and the placement was confirmed by pulmonary auscultation and capnography. Continuous infusion of propofol and remifentanil was instituted, vecuronium was administered and controlled ventilation was initiated. The surgery lasted 60 minutes without intercurrences. At the end, the patient was breathing spontaneously, so she was extubated and transferred to the recovery room from where she was discharged without any complaints. CONCLUSION: Nasotracheal intubation is an alternative to fiberoptic endoscopy when safety and control of the airways is uncertain. Informing the patient about the procedure was essential. Safety was assured and respiratory depression and hemodynamic instability was not observed.

  5. Instabilidade hemodinâmica grave durante o uso de isoflurano em paciente portador de escoliose idiopática: relato de caso Severe hemodynamic instability during the use of isoflurane in a patient with idiopathic scoliosis: case report

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    Adriano Bechara de Souza Hobaika


    ámica grave causada por isoflurano en pacientes previamente saludables. Anafilaxia, taquicardia supraventricular con repercusión hemodinámica y sensibilidad cardiaca aumentada al isoflurano son discutidas como posibles causas de la inestabilidad hemodinámica. Actualmente, existen evidencias de que el isoflurano pude interferir en el sistema de acoplamiento y desacoplamiento de la contratilidad miocárdica a través de la reducción del Ca2+ citosólico y/o deprimiendo la función de las proteínas contráctiles. Los mecanismos moleculares fundamentales de este proceso deben ser elucidados todavía. El relato sugiere que la administración del isoflurano fue la causa de las alteraciones hemodinámicas presentadas por el paciente y que este, probablemente, presentó una sensibilidad cardiovascular no común al fármaco.BACKGROUND AND OBJECTIVES: Isoflurane is considered a safe inhalational anesthetic. It has a low level of biotransformation, and low hepatic and renal toxicity. In clinical concentrations, it has minimal negative inotropic effect, causes a small reduction in systemic vascular resistance, and, rarely, can cause cardiac arrhythmias. The objective of this report was to present a case of severe hemodynamic instability in a patient with idiopathic scoliosis. CASE REPORT: Male patient, 13 years old, ASA physical status I, with no prior history of allergy to medications, scheduled for surgical repair of idiopathic scoliosis. After anesthetic induction with fentanyl, midazolam, propofol, and atracurium, 1% isoflurane with 100% oxygen was initiated for anesthesia maintenance. After five minutes, the patient presented severe hypotension (MAP = 26 mmHg associated with sinus tachycardia (HR = 166 bpm that did not respond to the administration of vasopressors and fluids. Lung and heart auscultation, pulse oxymetry, capnography, nasopharyngeal temperature, and arterial blood gases did not change. The patient was treated for anaphylaxis and the surgery was cancelled. The

  6. Edema pulmonar após absorção sistêmica de fenilefrina tópica durante cirurgia oftalmológica em criança: relato de caso Edema pulmonar después de absorción de fenilefrina tópica durante cirugía oftalmológica en niño: relato de caso Pulmonary edema after topic phenylephrine absorption during pediatric eye surgery: case report

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    Maria de Fátima Savioli Fischer


    % phenylephrine were applied. Five minutes after beginning of surgery, patient has developed hypertension and tachycardia, refractory to increased remifentanil and propofol dose, as well as to droperidol. Blood pressure and heart rate could be controlled after sevoflurane administration, but there has been oxygen saturation decrease with diffuse pulmonary rales by possible development of acute pulmonary edema. Furosemide was administered and anesthetic solutions were withdrawn. Patient presented progressive pulmonary improvement while blood pressure remained within normal values. Patient was discharged from PACU six hours after surgery with spontaneous ventilation in room air, and normal O2 saturation, pulmonary auscultation and blood pressure. CONCLUSIONS: Topic phenylephrine should be cautiously administered before surgery and the anesthesiologist should be informed so that measures may be taken to prevent systemic absorption of large amounts. If there is absorption, preconized management should be followed, that is, decrease blood pressure without inducing myocardial depression, as it is the case with beta-blockers or calcium channel blockers. Direct action vasodilators, or alpha-blockers, are the options for severe hypertension induced by systemic phenylephrine absorption.

  7. Hipoxemia por fístulas artério-venosas pulmonares em criança: relato de caso Hipoxemia por fístulas artério-venosas pulmonares en niño: relato de caso Hypoxemia by pulmonary arteriovenous fistulae in childhood: case report

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    Aleksandra Paula Lima


    ístulas pulmonares o en otros órganos podrán surgir, caracterizando la síndrome de Rendu-Osler-Weber.BACKGROUND AND OBJECTIVES: Pulmonary arteriovenous fistulae (PAVF should be investigated in patients with cyanosis of unknown cause. This is a case of cyanosis in a child submitted to pulmonary lobectomy with PAVF. CASE REPORT: Male patient, 3 years old, with history of cyanosis without dyspnea since 8 months of age. He presented significant cyanosis, finger clubbing and normal heart auscultation. Chest X-ray showed condensation in the upper half of the left lung. Normal echocardiography and ECG. PaO2 = 28 mmHg in room air and PaO2 = 31.5 mmHg with nasal O2 catheter. Pulmonary arteriovenous fistula was diagnosed through magnetic resonance imaging, with no possibility of embolization. Patient was submitted to upper left lobectomy under general anesthesia associated to spinal anesthesia with morphine and bupivacaine. Selective tracheal tube for the right lung was inserted for monopulmonary ventilation. SaO2 was 59% in room air; at operating room admission 69% (FiO2 = 1.0; after general anesthesia induction 65% (FiO2 = 1.0; during monopulmonary ventilation 58% (FiO2 = 1.0, after lobectomy 98% (FiO2 = 1.0 and 98% at the end of the surgery (FiO2 = 0.6. Extubation was performed one hour after surgery completion. As from the fifth postoperative day patient started presenting progressive SpO2 decrease down to 83% due to increase of another PAVF, which was embolized under general anesthesia. Patient was discharged on the 15th PO day. CONCLUSIONS: In this case, there was poor preoperative response to oxygen therapy, and patient has immediately improved after surgical treatment. However, after surgical resection of the largest PAVF, another fistula increased, thus leading to decrease in postoperative SpO2, reverted by embolization. As the child grows, other pulmonary fistula or fistulae in other organs may be diagnosed, indicating Rendu-Osler-Weber Syndrome.

  8. Guidelines for the Management of a Pregnant Trauma Patient. (United States)

    Jain, Venu; Chari, Radha; Maslovitz, Sharon; Farine, Dan; Bujold, Emmanuel; Gagnon, Robert; Basso, Melanie; Bos, Hayley; Brown, Richard; Cooper, Stephanie; Gouin, Katy; McLeod, N Lynne; Menticoglou, Savas; Mundle, William; Pylypjuk, Christy; Roggensack, Anne; Sanderson, Frank


    traumatisme 12. En présence d’un traumatisme majeur, la priorité doit être accordée à l’évaluation, à la stabilisation et à la prise en charge de la femme enceinte; par la suite, lorsque le fœtus est viable (≥ 23 semaines), l’auscultation de la fréquence cardiaque fœtale et un monitorage fœtal peuvent être mis en œuvre. De plus, une consultation en obstétrique devrait être obtenue dès que possible. (II-3B) 13. La tenue d’une consultation d’urgence en obstétrique est recommandée en ce qui concerne les femmes enceintes dont le fœtus est viable (≥ 23 semaines) et chez qui l’on soupçonne la présence de contractions utérines, d’un décollement placentaire ou d’une rupture utérine traumatique. (II-3B) 14. En présence de saignements vaginaux à 23 semaines ou par la suite, la tenue d’un examen vaginal au moyen d’un spéculum ou des doigts devrait être reportée jusqu’à ce que la présence d’un placenta praevia ait été écartée par échographie (préalable ou actuelle). (III-C) Tests d’appoint dans le cadre de l’évaluation maternelle 15. Les études de radiographie nécessaires aux fins de l’évaluation maternelle (dont la tomodensitométrie abdominale) ne devraient pas être retardées ni reportées en raison de préoccupations à l’égard de l’exposition du fœtus à des rayonnements. (II-2B) 16. L’utilisation de produits de contraste à base de gadolinium peut être envisagée lorsque les avantages maternels l’emportent sur les risques fœtaux potentiels. (III-C) 17. En plus des tests sanguins qui sont régulièrement menés dans le cadre de l’évaluation des patientes enceintes ayant subi un traumatisme, un profil de coagulation (comprenant la mesure du taux de fibrinogène) devrait être obtenu. (III-C) 18. Chez les patientes enceintes ayant subi un traumatisme, la tenue d’une échographie abdominale ciblée pour l’identification de traumatismes devrait être envisagée aux fins de la d